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COVID-19 Weekly Update, August 25, 2020

Aug 26, 2020
 

Click here for Spanish translation recording.

Transcript of Dr. Good's COVID-19 Weekly Update, August 25, 2020 

Hello, I'm Michael Good, CEO of University of Utah Health, and I present the COVID update for August 25th, 2020. Trends we've been following at the national level continue with declining numbers of new coronaviruses cases reported each day in our nation and with a leveling off of the number of new deaths from coronavirus reported each day. So both of these favorable trends at the national level. Similarly, here in the state of Utah, our decline has continued in the number of new cases reported each day and we're currently kind of leveling off around 350 or so new cases each day. Some days dipping into the 200s, some days remaining up around 400 or a little bit higher. Similarly, a stable number of new deaths reported from coronavirus maybe with a slight decrease here in the last couple of days, but again, favorable trends, both in new cases and in deaths from coronavirus.

With these positive trends, particularly at the state level, a continued decline in the number of active coronavirus cases. Remember that after three weeks, most patients have recovered from their coronavirus illness, more than 99 per cent have recovered and are no longer considered infectious. So the current active cases of around 7,800 keeps us in that two and a half or so of every thousand Utahns with a current active case. That's much lower than the four per thousand we were seeing earlier this year. Testing is interesting this week. We've been following this continuing decline in the number of positive tests per hundred. We do a seven-day average to take out some of the day-to-day variation. And over the last few weeks, we've had this shift downward to where we were seeing, for most the last week or so, somewhere around eight and a half percent positive test rates. In other words, eight and a half positive tests for every hundred.

We're trying to sort out the last few days on the chart. It looks worrisome with higher and higher positivity reported each day. But today we received a note from the Department of Health noting that they're trying to make sure that the data is being accurately recorded and we may be having the total number of tests reported as... I'm sorry, the positives may be grouped and reported in one day and the total number of tests reported is low. So we have more work to do, before next week, to figure out if this is really a trend in our positive rate for what had been a continuing decline in this measurement. The seven-day rolling average of new cases by county, we show you here, the chart we'd shown before, where we separate Salt Lake County from the rest of the state. Somewhere around here, the 27th of June is when a requirement for face coverings went into place in Salt Lake County, but not in the rest of the state.

We saw an immediate leveling off of cases in Salt Lake County, and then this long and continuing decline for a while. A continuing upstroke, but we believe with more widespread use of masks throughout the state, we've also seen a decline throughout the rest of the state, and this is responsible for a lot of those declining cases, and leveling off and hopefully declining deaths from coronavirus. Last two points on the curve, though, click up. So as with all coronavirus statistics, we'll continue to watch this and have an updated report next week. Our transmission, our real-time reproductive number, which is a measure of the transmission of the virus in our community continues to hover at, or fortunately below, one because such small changes in R-T below one make a huge difference in the number of cases. We've created an inset, again, thanks to Dr. Zhang in our biostatistics department.

And we've blown this up, so this line right here is 0.75. So that you can see this period in early August where R-T, the real-time reproductive number dropped below one, probably to around 0.85 - 0.88, but was sustained there. It really caused the momentum that allowed the new case counts to decrease. We had a slight blip up here for a couple of days, but now, again, a very favorable trend upward. And remember, the last six days or so on this chart will continue to be influenced by what happens tomorrow and the next day, and the next day. R-T continues to be influenced for about a week. And so if you've noticed from week to week, the tail end of the curve gets reshaped from one week to the next, as those subsequent days are added in. But small decreases even to 0.9 or 0.85, put another way, if the R-T was 0.9, it means for every 10 people who are infected with coronavirus, they only transmit to nine others.

And those nine transmit to approximately eight others. And you can see how we get that declining case rate. Remember when R-T was up really early in the pandemic, when the reproductive number or transmission was two, that meant two people with an infection infected four, those four infected two others, you were at eight, eight became 16, 16 became 32. So small changes in reproductive number have a huge influence. And right now, fortunately, we're seeing a reproductive number below one and that's helping us with slowing the spread and the declining case counts. Declining case counts mean fewer people need hospitalization. In both, at the state level and here in Salt Lake County, we're seeing declining hospitalization for coronavirus. The curves are pretty self-evident. The gray bars at the bottom of the curve or the bottom of the chart show the number of daily admissions.

Now, most days, at or below 10, and the blue line shows the 14-day summation of the number of people admitted to the hospital with coronavirus. And so you can see that that number now is below 150. So over the last 14 days, less than 150 people have been admitted to the hospital. So making progress on hospitalizations. The same is true here at the University of Utah Hospital, where our hospitalizations now are running anywhere from, say, about one to four on any given day. Whereas they had been up higher several weeks ago, and the result is the cumulative sum of hospitals now is under 54 for our hospital here at the university. That means our census, the number of patients at any one time with coronavirus in the hospital, which had been running up between 40 and 45 has now come down.

And today we're in the mid-twenties for the number of patients in the hospital with coronavirus and we're very pleased to see this decline in the number of patients that are in our intensive care unit. For a week or so there, we had about equal number of patients in the ICU and on the hospital ward, and now we're back to a more normal, about one out of three, in the ICU and two out of three on the hospital ward. So fewer patients in hospitals across the state, fewer COVID patients at University Hospital. So the school year has begun and we'll be adding some statistics that we’ll follow with you and for you related to activities here at the University of Utah campus. Classes began yesterday on August 24th. And as you can see here, are compliments of senior vice president for academic affairs, Dan Reed, who's worked very hard with colleagues and our deans to have a variety of educational modalities, including in-person, interactive video conferencing, a large component of what we're doing, online instruction, hybrids between these modalities and hybrids with the interactive video conferencing.

The in-person, we're really trying to emphasize experiential learning, where being present with the professor and the instructor really adds value to the instruction. That's certainly true in the health science center where so much of clinical skills require experiential learning. But in those activities where the interactive video conferencing achieves the same objectives, we're doing that to help reduce a density. Also, an emphasis on our in-person modality for freshmen who are arriving to our campus for the first time. We have now over 3,000 students who have checked into our dormitories on the University of Utah campus. And we tested all of those students for coronavirus before they received the keys to their dormitory. This happened over the first three weeks of August, although the vast majority of those students were tested over the last four or five days.

We're pleased to report that of those more than 32-hundred tests, just 16 returned positive. Initially, that's under a 0.5 percent positive rate. So these are asymptomatic students showing up to check into the dorm and begin their classes. Actually, of those 16, six of the students knew they had had coronavirus prior. And one of the interesting things about coronavirus testing is that those who have had a coronavirus infection and fully recovered from it still continue to show positive on the coronavirus test, even though they are no longer infected. And so we have six of those students who knew they had had coronavirus. Four of them have already been assessed medically and cleared for return to the dorm and to their classrooms. And as of this morning, two of the students were still waiting on their medical clearance. If you actually remove those six who have already had coronavirus and are just still having a positive test, but are not infected, that actually brings our positivity rate, if you will, our adjusted positivity rate down to 0.31 percent.

So a very low level of positive coronavirus tests in our students who are returning to campus. Really a shout out to vice president for students, Dr. Lori McDonald and her team who have made sure we have 400 isolation beds available on campus for students who need to be isolated either because they have tested positive, or because they have had contact with individuals who are positive. Right now with the students who have tested positive, in context who have been identified through contact tracing, we have 27 of those 400 beds currently in use. So a lot of capacity developed by Dr. McDonald and her team. And so far so good as we bring students back to campus and begin the fall semester. Going forward, our ongoing testing practices, we will focus in three areas. First and foremost, and in my mind, the most important is the testing of individuals who have flu-like symptoms; cough, shortness of breath, sore throat, symptoms like that, typical flu symptoms.

It's important for those individuals to get a coronavirus test. I'll give you more information about that in just a minute. Then, in those individuals who do have a positive coronavirus test, we do contact tracing. And here, we have a shout out for Dr. Steven Lacey, who's the chief of public health, our division of public health in our Department of Family and Preventive Medicine. He and his team are conducting contact tracing. And individuals identified as having significant contact with somebody who is now known to have a positive coronavirus test, they also then get tested. And so that's what we call our testing of asymptomatic contacts. And then in the next week or so, we will implement kind of a randomized asymptomatic monitoring, where we'll monitor randomly selected students, staff and faculty, so we can keep an eye on the overall status and movement of the virus in our campus community.

So more to coming future weeks about our asymptomatic monitoring program. And what's made all of this much easier and possible to extend further is compliments to ARUP Laboratories at University of Utah Health. They've now completed studies that show, as noted on the slide, that self-collected saliva samples are equally effective to those deep nasal swabs that perhaps many of you have had, they're extremely uncomfortable. So we really are pleased and proud and thank ARUP Laboratories for bringing the science to make us competent in saliva-based testing. We expect to have our testing tents located throughout the community converted over to saliva-based testing probably the 1st of the month, 1st, 2nd or 3rd of September. And then in each of those areas, asymptomatic testing, asymptomatic contacts and asymptomatic monitoring will be transitioning to this method of sample collection.

So real advances that will help our community monitor the virus and stay healthy. So here are those two phone numbers that I mentioned. We do break the decision tree down to those of our students, faculty, and staff who are involved in patient care. So if you are part of the campus community that performs clinical work, here is what you do should you be concerned particularly about if you have flu-like symptoms, or if you're worried that you've had a coronavirus exposure. If you have clinical work, here are the steps you should take and the resources you can check to help navigate. Again, here's the phone number for those that are doing clinical work. And for those members of our community that do not perform clinical work, linkage is to the main campus guidelines. And if you have any questions at all, 801-587-0712, and if you do have a coronavirus test, we ask you to register with the university so we can keep track of this virus on our campus and in our community.

So again, a lot of signs that masking matters. It's particularly helpful if both those that are healthy and those that are infected with coronavirus wear masks. And since it's often difficult to know whether at any moment you have a coronavirus infection, many of us are just wearing masks whenever we're in public spaces, whenever we're around other people. Taking the mask off really only when we're alone. Again, a sign that you'll see up over campus that emphasizes in addition to masking, frequent hand washing, maintaining distance wherever possible, and not coming to work or school when we're not feeling well. This will become even more important. Both the masks and staying home when we're sick will become even more important as the fall moves forward and we deal with not only coronavirus, but the seasonal flus that typically come on during the fall months.

So overall, perhaps one of the most favorable reports we've had in several months related to coronavirus in our community. We're very pleased and excited to welcome students and faculty back to the fall semester. We'll continue with these weekly updates, bringing you a review of the data, statistics and trends describing the coronavirus pandemic in our nation, state, community, and now here at the University of Utah. Thank you.

 
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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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