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COVID-19 Weekly Update, October 13, 2020

Oct 14, 2020
 

Click here for Spanish translation recording.

Transcript of Dr. Good's COVID-19 Weekly Update, October 13, 2020 

Hello. I'm Michael Good, CEO of University of Utah Health, and I'm here to present the COVID-19 update for October 13, 2020. We'll review trends, data, and statistics related to the coronavirus pandemic in our nation, state, and here at University of Utah. At the national level, we've seen now a couple of weeks of rising cases, positive coronavirus tests at the national level. So far, the death rate, the number of deaths, remains fairly constant, around 800 with a stable curve. Remember, in fact, we'll see this here in the Utah traces, that there is a time lag between when cases increase and when we see deaths from coronavirus increase often two weeks or occasionally a little bit more. As you can see from this chart, the fairly substantial increase in the number of coronavirus infections in our state continues to increase with a little bit of flattening here, and over the last couple of days, a slight decrease from some of these higher levels. But overall, cases of coronavirus continue to increase in the state of Utah in, quite frankly, a worrisome manner.

As I mentioned, the death rate now, which had been on a slow decline for many, many weeks, has similarly, after this time delay, also begun an upward trajectory. We're seeing on an average basis increased numbers of deaths from coronavirus in our state. If we break the new cases down by age group, we'd see the same patterns that we've reviewed before. We have this big spike that started in the 15 to 24 year-olds climbing all the way to 65 per 100,000 individuals has come down and now leveled off. And in the meantime, you can see the infection as it moved from these younger groups to virtually every age group now, and we particularly follow and worry about the 25 to 44 and 45 to 64 age group. And notice that these, now, are at levels higher than the peaks that we saw during the month of July, our previous high point in this pandemic.

We also very much worry about those older than 65. This is where many of the deaths from coronavirus occur, and we similarly have had this substantial increase to a point now quite a bit higher than where we were in July. And indeed, in fact, all ages are increasing at this point, with the exception of the 15 to 24 year-olds. So putting all this together, we now have over 22,000 active infections in the state of Utah. And what this means is that out of every 1,000 Utahns, seven have an active coronavirus case, and they're in the period of time when they could be spreading the virus to others. Remember we spent much of this pandemic virtually about half or less than the level that we're at now. So, currently seven out of 1,000 Utahns are experiencing the active phase of a coronavirus infection.

A little bit of good news in our positivity rate. The bad news is it remains high. So, here we are at 14 percent of tests for coronavirus now are positive, but clearly with the leveling off after this really substantial increase we saw in the early part of September. So, a couple of weeks now of positive test rates hovering around 14 percent.

If we look at this test positivity rate by the whole state, by Salt Lake County, and by Utah County, as we've reported before, this trend into September started in Utah County, and a week or so later, then, started similarly in Salt Lake County. Utah County has gone up quite high, plateaued, and in a recent week or a recent couple of weeks has actually begun now to decline. Unfortunately, Salt Lake County continues its increase, as you can see by the red line. Obviously, much of the population in the state, these two, and surrounding counties after this steep upswing in the number of positive tests well over 1,000 that steep slope has leveled somewhat, still climbing, but at a slower rate. So again, in a couple of days, the past weekend, with quite high case counts. So you see this peak the top, but we have had a couple of days back down closer a little bit to 1,000.

So hopefully we'll see continue rounding, leveling, and hopefully eventually decline. But again, the virus is spreading at a fairly rapid rate in our community at this time. More infections translate to hospitalization, and the continuing increase of hospitalized COVID patients in the state continues. You can see that both in the day to day admissions, the orange bars, and also in the 14 day summation of admissions. This is in all of Utah except Salt Lake County. Again, some leveling off in the last week or so in Salt Lake County. But you can see, there are days when we have large numbers of COVID patients admitted to hospitals here in Salt Lake County. Again, if you put all this together at the state level, we now have 250 COVID patients admitted to hospitals across the state of Utah. And of course, this correlates with the peaks that we saw back in the summer, really this sustained period, we're back there after a fall with many, particularly in August, where we saw a lot of decline.

Similarly, the number of patients in ICU. It’s not quite back to the July peak, but certainly closing in on it, and with an upward trend in the number of patients admitted to ICUs. So we're seeing the increased numbers of positive tests, if you will, the number of positive cases, translating to increased hospitalizations and increased numbers of patients in our ICU. Remember, we keep track of our symptomatic patients here at University of Utah Health testing centers, and after this period where each week we saw higher and higher daily average of positive tests got back up to 178. We saw a decline in our report last week. Unfortunately, that increased again this past week. Now 181 on average positive tests among symptomatic individuals at our University of Utah Health testing sites. This 181 puts us clearly back to where we were in the early part of July when the pandemic and the virus were really moving quickly through our community. So, not good news at the symptomatic testing sites.

We previously reported challenges at our Sugar House testing center related to the windstorm, structural issues in the parking lot, and so on. I'm pleased to report that this past Monday, we were able to open a new drive-through testing site at Rice-Eccles stadium here on the University of Utah campus. You see a picture of the testing facility. Again, we try to keep symptomatic patients coming to our outside testing centers so they can be tested in their automobile and decrease their exposure and they decrease the risk of them sharing the virus with others. Again, the outside environment is less friendly to the inside environments. Testing hours are shown, and I remind you that our testing sites are by appointment only. We got to the point where we had three and four hour wait times and large parking queues at our centers, so we're now testing via appointment.

You can call our coronavirus hotline or access through your health provider to get an appointment at one of our testing centers. Inside University Hospital, we see the same trends that we've seen at the state level previously back in July. Our high census was at 40. We're now well into the upper 40s, and in fact, today, as we record, we went over 50 with our inpatient census here at University of Utah Hospital. You see that in the total number of hospitalized patients and the breakouts with around 30 patients on the hospital ward and in the high teens in the ICU. Again, the chart on the left shows the daily admissions on the gray bars and the 14-day summation of admissions over the previous 14 days; clearly much higher than where we were in July. We did see a little bit of decline over the weekend, but I can tell you from the last two days here, which are not yet in this database, we're continuing to head back up.

The one bit of good news in our report is that by multiple measures, the coronavirus on our campus is stable. We've continued to see this seven-day rolling average of about 20 coronavirus cases from multiple sources, our students who are in isolation or quarantine, the number of self-reported cases of coronavirus infection. We track multiple metrics, and this is stable, if not ever so slightly declining. We are in the first week following our two-week break period-- a break from in-person classes and a shift to entirely online.

This week, October 12, we started our resumed in-person classes, but those are all proceeding with social distancing, small groups, most at 20 or less, and with masks on everyone, including faculty and students. So a stable and low situation of coronavirus here at University of Utah. I would really like to thank our students and our faculty. They're doing a phenomenal job adhering to the public health guidelines. As I run through campus, students outside, or even when we go into the buildings, they're wearing their masks. They're practicing physical distancing. They're using the hand sanitation dispensers that are located all over campus. And I commend them because their efforts are showing that this positive environment is keeping our campus safe.

As I finish today, as we come on the air, the Governor has just announced new coronavirus strategies and guidelines, including a two-week circuit breaker similar to what we, as I just mentioned, implemented here at the University of Utah in the prior two weeks. Some of the specifics: this is all out just in the last few hours, but we are moving to mask requirements in all indoor settings and gatherings less than 10 people if an area is designated as high-transmission. These new guidelines shift this from the color-coding system that we'd been using to a system that speaks to areas of high transmission, moderate transmission, or low transmission. In this two-week circuit breaker, we are looking for masks to be worn. But as this system is rolled out, and each area is designated as low or moderate transmission, a mask will still be encouraged strongly in the moderate and low transmission areas with slightly different criteria related to gatherings.

And again, the gatherings and the masks are interrelated. Existing mass mandates, and Salt Lake's, Summit’s, and Grand County's remain in effect. Schools remain open, and the governor encourages cooperation and an individual responsibility. We all really need to come together and break this current increase in coronavirus transmission and infection that our state is currently experiencing. Some of the criteria are spelled out on this slide. There are a number of states in the high-transmission category, and especially here in Salt Lake County, which is the home of the University of Utah. This is all relatively new. Our teams are all still working on all of the specific implications for our campus environment and our health system. And I, again, refer you to www.coronavirus.utah.gov, a website where these new directives from the governor have just been published.

So as we conclude today's COVID update, as we do each week, we've reviewed a lot of numbers and statistics and trends. But I want to end today by reminding us that coronavirus is a very human experience, both for those who become infected, and particularly those who develop more severe forms of COVID, their families, but also our health care workers. And I want to commend our nurses, our respiratory therapists, our aids, our environmental service workers, and of course our physicians, everyone who comes together to help provide care for coronavirus, patients. This is a very challenging time, and I want to share some of their stories with you as we finish this week's coronavirus update.

Health Care Worker 1:

He reaches up, and he comes forward, and he's got his ECMO in his hand. He's got both cannulas, and he's coming forward. And his arm's extending, and there was no more standing at the door talking him down. He was pulling his ECMO out. It was coming out. It was going to happen. So I ran in there, and just grabbed his wrist, and eyes to eyes, "You are going to kill yourself right now. Stop, stop."

Health Care Worker 2:

The viruses cause intense inflammation, so the bronchial tubes, when you look at them with a scope, it looks like raw meat.

Health Care Worker 3:

They cough a lot. It's agonizing to watch these patients cough, especially when they're on the ventilator. And then the breathing tube. They're gagging. They're coughing. It's miserable.

Health Care Worker 4:

Sometimes it feels like, in the MICU lately, these waves are coming and are literally just crashing into us over and over and over.

Health Care Worker 5:

I’ve got 20 minutes to pull it together, and come home, and be a wife, and be a mom, and talk to them. How do you do that?

Health Care Worker 6:

Seeing these people that are so sick and likely won't live, and then seeing people completely disregard all of that. And I'm like, "Do you realize that this person's here dying?"

Health Care Worker 7:

I don't think that they understand the impact or how bad and serious this disease is, and they don't see it here in Utah. But I think we need to learn from those experiences and realize that, yes, we need to continue social distancing and the business closures because the mortalities are astounding.

Health Care Worker 8:

We've been working in this environment for several months now, and we're accustomed to it. However, there's not really an end in sight that we know of. It's just a constant feeling of being tired but knowing that you have to keep going.

 
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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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