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COVID-19 Weekly Update, September 22, 2020

Sep 23, 2020

Click here for Spanish translation recording.

Transcript of Dr. Good's COVID-19 Weekly Update, Septemer 22, 2020 

Hello, this is Michael Good, CEO of University of Utah Health sharing this week's COVID-19 update today, September 22, 2020. At the national level, we generally see the continuing trends that we've watched over the past few weeks. The number of new coronavirus cases reported nationally has continued to go down for almost two months now. A little bit leveling off here in the last couple of weeks, in this down, up, down dip here. But, overall, generally continuing to decline, and the same is true with the deaths from coronavirus. Although, still many days around 1,000 deaths in our country from coronavirus, a decreasing trend with this measure that we follow as well. Unfortunately, a different story here in the state of Utah. After a period of first declining and then fairly level for the latter part of August. Since the first week or so of September, we've seen this dramatic increase in the number of positive coronavirus tests reported each day, reaching over 1,000 on a couple of days, and clearly higher than the peaks we saw back in July.

So this is quite worrisome from our community. The trend is still going up. We did see 650 new cases the last couple of days, but increase in coronavirus cases in the state of Utah is higher than we've seen in the entire pandemic. Fortunately, the death rate continues to decline, a trend we've seen now for almost two months. But as we've shown before, the new cases then are followed by the hospitalizations and the hospitalizations are followed by the mortality. Fortunately in very few individuals but still we're pleased to see the declining deaths from coronavirus in our state. So with that spike in the number of new cases, we had gotten down to where two to three Utahns per 1,000 had an active case of coronavirus. We're now back up around four per 1,000 with this surge of new cases over the past few weeks.

There's more virus in our communities and it has spread faster over the last couple of weeks. Reflected another way, we've been following closely the changing positive test rate per 100 tests. Again, this is approximately a positive testing rate of about 10 percent, 12 percent, and so on. And since September 10, we've had this run from right around 10 percent, a couple of days now over 14 percent. Remember, the last few days, the data set is incomplete, so the last few points may wander around. But nonetheless, the percentage of positive tests per 100 tests conducted has increased dramatically over the last two weeks. We've shared the breakout between Salt Lake County, Utah County, and the entire state. So black is the entire state, with the seven-day average, these are all seven day averages, for the state now up over 700. 400 of those positive cases per day are in Utah County and 300 of those cases are in Salt Lake County.

So virtually almost all of the positive cases in the state are occurring in Salt Lake County and Utah County. We did see the takeoff in Utah County precede that both in Salt Lake County and also the state. But clearly now, the trend line is up on all three, and with a rather sharp slope.  Notice that this current 700 cases a day is back here similar to the rates we were seeing back in the middle of July at what was, we believe, the first peak in the waves of this pandemic. Hospitalizations following the same thing here in Salt Lake County. After a period of decline, now here with a couple of sustained weeks of ever increasing hospitalization. The blue line showing the cumulative 14-day admissions and the orange lines on the bottom showing the daily admissions. Again, you get this notion that we're seeing levels back similar to what we saw in July.

The trend is a little less pronounced at the state level with a lot of sawtooth, if you will, up-down, up-down. Still a decreasing trend with a tail on the end. But, again, a lot of the population and a lot of the hospital beds here in Salt Lake County. After several weeks of declining positive tests in symptomatic patients at our University of Utah Health testing centers, remember we had multiple weeks of 70, mid-70s, positive coronavirus tests in our symptomatic patients, we don't know exactly what to do. This was the week that was disrupted by the windstorm, but in our first full normal week after the windstorms, we jumped from this run of 70 or so a day to a 150, on average, a day last week in our testing centers. So there are clearly more symptomatic patients and, of those symptomatic patients, a much higher percentage are showing positive for coronavirus infection.

So far, we have not seen increased admissions or census at our University of Utah Hospital. We saw the same declining trend that we've talked about before. We've been stable with anywhere from about one to four patients a day being admitted to University Hospital with coronavirus. So our census has come down and stabilized, but we have seen an increase in the severity of patients admitted to the hospital with COVID and we now have more in our ICUs than we have on our hospital wards. We've seen that pattern at other parts of the pandemic, and then eventually the patients get well, move to the ward, and eventually go home. But right now, it's another one of those periods where there are more patients in our ICU than in our hospital wards.

Last week, we showed you that the reproductive number, a measure of transmission of the virus, had gotten up to 1.5, one of the highest levels in the entire pandemic. And you see that it drifted even higher in the days since we last reported, but in the last few days has started to drift back down. This coincides with those 1,000 plus new cases a day for several days. Now, with a couple days of 600, still not the level we'd like to see. We're much more comfortable at a state level with no more than 400 coronavirus cases each day. But at least this trend line on the reproductive number is heading back down. Continued thanks to Dr. Zhang and Dr. Samore in our School of Medicine for helping us measure reproductive number of coronavirus in Utah over time.

The differentiation in different age groups continue. We reported last week on the 15 to 24 year old group, which back here in early September started this very steep increase in the number of positive coronavirus cases from around 20 per 100,000 and now up over 60, mid-60s, per 100,000. Not yet available in chart form, but we have further looked into to the 15 to 24 year old group and divided it into 15 to 18 year olds and then 19 to 24 year olds, if you will, trying to get some clarity on whether it's the high school group in general or the college group. And we find about one-third of this increase is from the high school group and about two-thirds of this increase is from the college-age students. So we're going to try to better define and better follow that. But this does seem to be where the step off in the infections occurred. You can see for the better part of the week, the other curves continued to go down or remain flat.

But then about a week later, we began to see increases in both the 25 to 44 year-old group as well as the 45 to 64 year-old group. And even now we see in the elderly groups and the very young groups increasing rates of positive tests, normalized by population, or per 100,000 of population. So not the direction we like to see these trends going, and we'll talk about ways as we conclude that we can hopefully get these trends to reverse. Things are pretty stable on the University of Utah campus. Our number of self-reported coronavirus cases per week has grown from around, it's marched up from about 80 to 90 to 110. So it is increasing, but not running away from us at some of the rates that we've seen in, for example, the charts that I just showed you. So, last week, 130 individuals identified as having coronavirus and that brings our total as we close here on the first five weeks of the semester to 324 individuals out of our 62,000 campus community who have had a coronavirus infection.

So, finally, we conclude by reemphasizing particularly the importance of masks. A perspective that appeared in the New England Journal of Medicine pointed out that when we wear a mask while if we have coronavirus, we prevent ourselves from transmitting the virus to somebody who doesn't have it. Wearing the mask when healthy, according to this perspective, decreases the amount of virus that enters our mouth or our nose, and with a lower inoculum, with a lower volume of virus, we're more likely to have lower symptoms or even an asymptomatic case of coronavirus. And remember with those asymptomatic cases, we do develop immunity. Our studies earlier in the spring showed that of the individuals who had coronavirus anti-bodies, only a third of the individuals actually recall or knew they had had coronavirus virus. The other two-thirds, either they thought they had had a mild flu or weren't even aware they were sick.

So emerging approaches to masking suggest that there are tremendous benefits for the healthy individual to wearing a mask as well. The other part I'd like to highlight this week is we do believe many of those transmissions in particularly that 19 to 24 year-old group were caused by large gatherings, many individuals in closed spaces and without masks. And that's just the perfect environment for the virus to spread from one individual to another. So the University of Utah has three more days of in-person classes and then we'll enter two weeks of return to online learning. This plan, which was developed back in July, put two weeks of online learning in the middle of the semester with in-person learning, and that two week interval is what we need to break the cycle of transmission.

We've had a really great start to the fall semester here at the University of Utah. We'll finish up this week with our in-person learning, and then we'll go to two weeks of online learning, and hoping during that period, we can slow down the spread of this virus and then be able to come back in a couple of weeks and the plan is to return to in-person learning to complete the remainder of the semester up until Thanksgiving. So please remember, wear masks, wash hands, keep distance, and stay alone when you're ill so we can get these curves turned back around the other way and headed down.


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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