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COVID-19 Weekly Update, August 11, 2020


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Transcript of Dr. Good's COVID-19 Weekly Update, August 11, 2020 

Hello, I'm Michael Good, CEO of University of Utah Health, and today, we present the COVID-19 update for August 11, 2020. At the national level, we continue to see trends that we followed in previous weeks after first hitting a plateau of around 22,000 new coronavirus cases a day in the United States at about 32,000. We saw this slowly come down into June to around 22,000 but during June and July, cases increased dramatically picking just under 70,000 new cases a day. Fortunately, the number of new cases has pulled back somewhat and currently we're seeing about 55,000 new cases of coronavirus diagnosed each day in the United States. The deaths that this has caused, deaths from coronavirus peaked at around 2,200 here toward the middle of April, then declined dramatically reaching a trough, a low point of around 500 deaths each day in July. And that has come up somewhat now around 1,100, maybe dropping to 1,000 in recent days and hopefully showing some signs of leveling off.

As we've talked about before, the time shifts between changes in new cases and changes in the deaths that are coming from coronavirus, we continue to watch and track, but declining cases nationally and also some stability in the number of deaths reported each day. This is a new chart that we found and borrowed from Johns Hopkins, and each little inset shows what's happening at the state level. And you can see states that are in red are still experiencing increases in the number of new coronavirus cases, states that are in green shades are showing declining cases and then states with a clear behind them are really in a very good place with coronavirus.

Look at New York here, which has had a very high number of cases then a dramatic decline and several weeks of stability. Of course, we've just talked about our Utah trends, which have gone up and then come back. And you can look at other states. Again, Arizona is having a sharp peak, but a pullback. Florida, a sharp peak and pullback, and so on. We talk about what's going on at the national level, but really, that is a collection of situations in individual states, which can be dramatically different from one another.

As I mentioned, at the state level, we saw a long period of a stable case trends here in around 150, then beginning in late May, sustained increases in cases plateauing off at around 670-680 new cases a day, and then fortunately, declining and continuing to decline to where now we're seeing a seven day average of around 400 new coronavirus cases each day in the State of Utah. Certainly a positive decline. A positive trend. Daily deaths in Utah, for a long period here, bounced around two on average, two deaths per day, and then have increased to four to five and occasionally, a six range. And we stay there hopefully, at a plateau or hopefully, with declines headed into our future.

We also add a county-by-county breakout for Utah. Again, we talk about what's happening in the state, but the state is really an accumulation of different activities happening in different counties. You can see Salt Lake County had been really driving a lot of that positive growth in new cases, now with a nice downtrend and continuing over the last few weeks. Davis County also with either a stable or perhaps a slightly decrease in their daily positive test rate. Utah County, another large population area with stable but high, they're at their highest level that they've seen since the pandemic began. And you can see the other trends county-by-county in this chart.

So what this means, the declining number of new cases each day over a sustained period, is that our number of active coronavirus infections in the state is finally declining and has done so for actually more than a week. Again, we peaked up here at around, as we're approaching 13,000. That means that about four out of every 1,000 Utahns had an active coronavirus infection. And as we come down and begin to approach 10,000, that means now we're getting close, I think the actual number right now is 3.3 individuals with a positive coronavirus infection out of 1,000. So this is a really important trend and we need to keep doing the things that we are doing because we're obviously decreasing the number of active infections in our community, in our state, and this is a very positive trend.

We're similarly seeing the number of positive tests. This chart is the seven-day rolling average of new positive tests. And as you can see for this period here throughout the latter parts of June and early July, we were looking at 10 percent positive testing rates. And now, particularly in the last two weeks, we've seen that come down and we have testing rates hovering around 9 percent the last few days. Again, a positive trend. Our reproductive number, a measure of whether the virus is accelerating or declining in our community: again, the rapid run-up of new cases was associated with this period in late May and early June when the reproductive number was at 1.1, 0.5, and a lot of points, 1.2, 1.3, and even just getting the reproductive number down below one, even 0.8, 0.9, has really shown or has resulted in the decrease in cases. So positive trends here. Again, always need to keep an eye on the tail of the reproductive number curve. The confidence intervals are wide, and we'll have to see what evolves in the next few days to see whether this trend of a reproductive number below one continues. Again, a positive development.

Hospitalizations have stabilized, here shown both for the whole state, peaking in this period. Remember, the blue line is the 14-day cumulative sum of hospital admissions. There's so much variation in the day-to-day chart. We tend to look at the 14-day cumulative sum as our trend. We did see some decline here toward the end of July and into early August with a little bit of bump, here, in the last few days. Similarly, in Salt Lake County, first kind of slowing. Slowing didn't really level off, but then turned and came down for a period. A little bump, here, in the last few days, but again, trends that we'll continue to watch. Certainly, not that continued almost straight-up growth or increase that we had seen in both charts earlier.

We track the number of COVID patients in ICU beds across the state with really good accuracy and resolution right now. In the middle of July, we got up to almost 115 Utahns in ICU beds across the state. Like most of our charts, we've seen a very encouraging decline, and today we have around 80 Utahns in ICU beds. And we do have a good capacity should these trends reverse. We hope they don't. But at this point, we have the ICU beds that we need in the state to take care of our Utah citizens.

Now we look at the hospitalization here at the University of Utah Hospital, and like the state charts after this several week period of sustained increases, first, the leveling off, and then in the last few days, the decline in the cumulative admission rate of individuals admitted to our hospital with COVID-19. Our census got up into the mid-40s as shown here, but has tracked back down below 40 in the recent days. Also note that on the lower right panel, for most of the pandemic, we've had about two patients on the hospital ward for every one patient that we've had in the ICU. We went through a couple of periods, one back here in May, and we've just completed another period here toward the end of July when the severity of the patients being admitted to the hospital increased dramatically. More of the patients were in the ICU.

And in fact, we had a couple of periods here, we had a couple of days, we had more patients in the ICU than we had on the ward. Those trends have reversed again and we're now back to having about two patients on the ward for every patient that we have in the ICU. So the University Hospital remains with a large number of COVID patients, although leveled off and to some degree, declining. Again, another positive trend.

Another positive trend is looking at our testing sites. Now, these are University of Utah testing sites in the clinic for symptomatic patients. These are just the patients who present with flu-like illnesses, and you can see both the total number of tests and the number of positive tests. And you can see two trends that are important. Fewer patients are presenting with flu-like symptoms for testing, fewer patients with flu-like symptoms are presenting for testing, and we're seeing a decreased number of those patients actually having a positive coronavirus test as I showed previously. So again, another approach or another angle that suggests our collective measures have slowed down the spread of this virus.

This is one of the reasons that we think we've had success both in Salt Lake County and in Utah, and that has been the mask mandate here on June 27. And shortly thereafter, we began to see the number of positive tests in Salt Lake County, which had been going up at a pretty dramatic rate. First, level off, and now in a very encouraging way, declining. The rest of Utah continued for several weeks to see a continuing increase in the number of new cases, but similarly, for the last few weeks has shown a decline. So, fewer new cases both in Salt Lake County with the mask mandate, but also with declining in the rest of the state, although we do note and we thank the Utah Department of Health and our state government and others for a number of public service messages and other communications with the state broadly about just how critical face masks are to slowing down the pandemic and the spread of virus in our state.

Again, similar trends. This is where we compare the seven-day average number of deaths per day in the red line for COVID-19, but also traffic accidents, stroke, suicide, pneumonia, cancer, heart disease, other causes of death that we see in our community. And after this worrisome run-up in the number of average deaths per day it has come down dramatically over the last couple of weeks. And again, we now show deaths from traffic accidents exceeding that from COVID-19 for the last week or so. Again, similar patterns, similar trend and encouraging.

So I end, again, as I have for the last few weeks, really encouraging you to wear a mask wherever possible and certainly, when you're in close proximity with others, when you cannot maintain a physical distance. This virus spreads from one person to another, particularly through respiratory secretions. Masks on both those who are not feeling well, but also on those who are feeling well, slow down the virus, reduce the number of cases, make it less likely for the virus to move from one person to another. Continue to wash hands, continue to isolate when you are not well and we will continue as we have done in the last few weeks as a community, coming together to really slow down the spread of coronavirus in the State of Utah. Thank you for joining us for today's coronavirus update, August 11, 2020. Please stay well and stay safe. Thank you.


Michael Good, MD

Michael Good is CEO of University of Utah Health, Dean of the University of Utah School of Medicine, and A. Lorris Betz Senior Vice President for Health Sciences. A professor of anesthesiology, Good joined U of U Health after more than three decades of teaching, innovation, and leadership at the University of Florida, where he served as dean of the College of Medicine for 10 years.

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