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COVID-19 Weekly Update, September 15, 2020

Sep 16, 2020

Click here for Spanish translation recording.

Transcript of Dr. Good's COVID-19 Weekly Update, Septemer 15, 2020 

Hello. I'm Michael Good, CEO of University of Utah Health. Today is September 15, 2020, and we present our COVID-19 weekly update.

As we look at the national level, the national statistics, trends similar to what we've seen over past weeks continue with a slight continued decrease in the number of new coronavirus cases reported each day in the United States and a gradual decrease in the number of new deaths reported each day with a little bit of leveling off here, over the last several days. So continued slow decline at the national level, but still with many tens of thousands of new coronavirus cases each day and some days still having a thousand deaths from this virus in our country.

Here in Utah, after a period of declining and then leveling off cases, we now see a slow continued increase at the state level with quite a step-off here in the last four days after a pretty sustained period of time with new coronavirus cases running 500 or less per day, often in the 300s. We've had, now, four days over 500 cases each day, and that's caused our trend line to turn back up. We'll talk more about that in a minute.

Our tracking of daily reported deaths from coronavirus continues to decrease. We've spoken before about the lag time between what's happening with the case count and when we see the death rate increase, so decreasing death rate, increasing new cases over the past week. Of course, that increasing number of new cases means our reproductive number, the transmission of the virus, is back above one. As we see here at the inset, it's actually at one-point-five. That  transmission rate, the last time we saw that, was way back in late May, mid to late May. So after a period of time with a transmission rate below one and the decreasing number of new cases and all of the positive trends we saw here during July, a stable August, we see the transmission rate reproductive number kicked back up to a fairly high level. That means the virus is being transmitted.

Remember, a reproductive number of one-point-five means that each individual who is infected with coronavirus on average infects one-point-five other individuals. Or stated another way, two individuals infect three, those three infect about four and a half, and you start to get this multiplier effect, which is how the virus can spread through our community and through our state.

Interestingly, as we've done before, we separate on the red line, new cases reported in Salt Lake County, and we do a seven-day average  to smooth out some of the day-to-day variation, and we compare that on the blue line to all other counties in the state of Utah. Interestingly, the Salt Lake County new cases per day is either stable or actually slightly declining. Actually, there's a little uptake here at the end, but the general trend is stable or ever so slightly declining. While the growth, all those previous charts that I showed you in today's report of increasing new cases and so on, all of that is happening predominantly in counties outside of Salt Lake County. So again, here at the University of Utah, which is in Salt Lake County, we have one situation and then in the rest of the state, we have a fairly significant increase. In fact, if you look, we've gone from just a little bit more than 200 new cases a day in other parts of the state to now up over 300. So that's over a 50 percent increase here just in a matter of a couple of weeks. That's a look at the county or counties where increases are or are not occurring.

And then this chart breaks down the number of new cases reported by age group. You can see, obviously, it jumps right off the chart literally. It's in this 15 to 24-year age group where we've gone from around 20 new cases per 100,000 back here in the later parts of August and early September. And now, just in the first couple of weeks here of September, really off the charts, hitting over 40 new cases a day. So a doubling of the new cases reported in 15 to 24-year-olds.

We do see in the last couple of days a little bit of increase in the 25 to 44 and 45 to 64. Although for much of this, it has been relatively stable, got a little uptick here toward the last few days. Interestingly, school-aged children do not often exhibit symptoms and are less frequently tested, but we're not seeing any change in the number of new positive tests, in either the very young or in the very old. Again, a lot of day-to-day variation, but more or less both of these trends are stable. So clearly, it's the 15 to 24-year-old age group that is responsible for much of the new caseload that we're seeing here in Utah.

With an increase in the number of new cases each day, our active cases, which had leveled off here, plateaued and leveled off, is now back on an upswing. So we're, again, beginning to approach three active coronavirus infections per thousand Utahans. So we had been down in the low to mid-two, two and a half, now again heading back up to three coronavirus infections per thousand Utahans.

The testing positivity rate. We've tried to show the various trends and the various time periods when we were trending up, when we were trending down on positive test rate. The last few days, we've gone back up over 10 percent, so this means one in 10 individuals who are tested for coronavirus test positive. So even though we've shown the trend line from August 22 to present, the last few days have an even steeper incline. Clearly something we'll want to keep an eye on. I'll come back to testing in a minute, because obviously our testing centers were disrupted by the severe windstorm of last week. I'll show you a chart on that.

Now, this is interesting, I showed you that Salt Lake County cases are stable while rest of Utah is increasing, seeing the opposite effect here in hospitalization. Although we report, or we show, the hospitalization on these charts are by the location of the hospital. So if the individual crosses county lines, if you will, to be hospitalized, and that happens quite often, that may be one factor affecting this. The state of Utah chart without Salt Lake County, again, has a lot of up and down. If you tried to smooth that to a downtrend, clearly the worrisome part of, again, even more marked downtrend was taking place in the Salt Lake chart. But now the last week, we've seen an increased number of hospitalizations in the hospitals here in Salt Lake County.

This is what I was mentioning about the testing trends for symptomatic individuals, so this is not all individuals who are tested but those who are symptomatic. You can see that in July, at our University of Utah Health testing centers, we had seen declining numbers of positive cases, 176, 126, 139, 102, and then continuing into August—83, 71, 74, 73, 74, and even down to 71, and as I mentioned before, with fewer and fewer symptomatic individuals presenting for testing.

Now, we're going to have to watch this chart because here are our two days last week where the testing centers were closed because of the severe windstorm and then the next day, the damage that had ensued. In fact, our Sugar House Health Center testing site has still been unable to resume activities. So the number of tests increased, as shown here, the number of positives did not, but we're going to have to watch this another week to see if perhaps these higher numbers were just patients who wanted to be tested but correctly chose not to come out in the windstorm for those tests. So we think the decreasing number of symptomatic patients is continuing, but we'll need to watch that another week to make sure.

Similar to the Salt Lake chart, after several weeks of declining admission and declining census in University of Utah Hospital, we have seen an uptick. Here's a day where we had six admissions for coronavirus, so we have a slight uptick in the number of admissions here at University Hospital. Interestingly, it's been in our patients admitted to the ICU, so some of the more severely impacted patients. You can see here even yesterday, which is our most recent reported day, we, once again, had more patients in the ICU than we had on the hospital ward, so an uptick. We'll have to see if that upward trend continues or if it's more of that up, down, up, down saw tooth pattern that we've seen in many of the data points that we track during the coronavirus.

Here at the University of Utah, we, again, have testing of symptomatic individuals, asymptomatic testing of those with exposure identified through contact tracing, and this week our asymptomatic randomized testing began. So we're increasingly randomly selecting individuals and testing them so that we can keep an eye on the level of virus on our campus. Remember, many individuals are asymptomatic or very minimally symptomatic, and so this addition of asymptomatic randomized testing is an important addition this week that we'll be reporting on in future weeks.

For now, we continue to share with you as on the coronavirus website, the number of self-reported cases of coronavirus in our most recent update now, that's 90. This is the third week we've been able to report this statistic. We've gone from the low 50s, I believe it was around 52, the second week was 86, and this week essentially similar, a 90. So those are the one-week rolling averages of new self-reported coronavirus cases in our campus community of over 60,000. So it appears to be stable and well within what we both expected and particularly, for our students, well within the capacity of the isolation rooms that we have available. Last report I heard, using around 70 of the 400 isolation spaces that we have available. So very clearly, there is virus present on the University of Utah campus, but so far at a very manageable level. And we continue with our planned instructional modalities for this week and next week, and then we head into the planned online two weeks that coincide with the Vice President Debate here at the University of Utah campus.

So I do want to close by making a comment. We have been unable to reopen the Sugar House testing site. This was an outdoor tent testing site first damaged in the windstorm, but then we're also having some issues related to the parking lot and water egress flooding parts of the facility. So unfortunately, this Sugar House Health Center testing site is not open at this time. We share with you, in this slide, the other sites operated by University of Utah Health and we also share with you sites of our community partners. We are working day and night to identify a site, hopefully, and perhaps closer to campus for symptomatic patients to be able to be tested. As soon as we're able to do that, we'll share that information. So for now, those of you needing testing, please consider one of our other University of Utah Health testing sites or alternative community sites.

So please keep doing the things that we've been doing, wearing face masks, sanitizing hands frequently, maintaining distance wherever possible, and staying home when ill. I think over the last couple of months we've all learned that there are many things that we can do while following these guidelines, and if we all continue to reliably practice these four approaches in all of our activities, we'll be able to continue to do many of the things we love to do while we continue to battle the coronavirus. Thank you. Stay well and stay safe. We'll be back next week.


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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