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COVID-19 Weekly Update, October 6, 2020

Oct 07, 2020
 

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Transcript of Dr. Good's COVID-19 Weekly Update, October 6, 2020 

Hello, I’m Michael Good, CEO of University of Utah Health. Today is October 6, 2020, as we present our weekly COVID-19 Update. At the national level, a pretty much continuation of fairly stable trends with several weeks now where the number of new cases of coronavirus reported in the country, relatively stable. Earlier in the month, a little bit of a decrease, perhaps a little bit of an increase, very slight over the last few days, but overall stable. Same on the number of deaths reported nationwide from coronavirus, relatively stable around 800. A little bit up a little bit down, but stable patterns, similar to what we've seen in the last few weeks. Not the same here in Utah. We began in early September seeing this dramatic increase in the number of new coronavirus cases reported each day.

Perhaps a little bit of leveling off, here, the last few days, and we did have just 700 new cases reported today. So, hopefully this is beginning to level off. We'll see some other signs that suggest that, although, as we said before, the hospitalizations and those that die of coronavirus follow many weeks later. Indeed after this long period of slow, but declining deaths from coronavirus in our state, we now see that trend also reversing the cases, starting back here in early September. If this is an inflection point in the deaths, it occurs much later in the month. We did have a day where 15 deaths were reported during the past week.

But as noted in the media reports, these are the days the death is reported by the medical examiner or certified, the death certificate is certified. So, these days do not always correlate with the actual expiration of the individual. So, that has to be noted when you see a day like that, that sticks out from all the others. That's why we do tend, on all these charts, to wherever possible, use seven day averages to take some of the day-to-day variation out. So, with that growth in cases, we now have over 20,000 active cases of coronavirus in our state. This is the first time we've been up over a 20,000, and it means on average there's about 6.3 current cases or active cases of coronavirus per thousand Utahns.

Again, the highest level that we've seen in the pandemic. That trend also is still continuing to increase. Our positive testing rate appears to have leveled out over the past week, although it remains high, up here at around 14 percent positive rate. That's up, again, the highest we've seen in the pandemic. Though, hopefully leveling off from this dramatic rise that we've seen during the month of September. This is the chart that shows the seven-day average of positive tests. The black line is the State of Utah, the red line, Salt Lake County, and the blue line Utah County.

Recall that Utah County is where our inflection point began. Then, followed by Salt Lake County. Fortunately, it does appear that Utah County has now leveled off and is maybe declining slightly. Utah County, or I'm sorry, Salt Lake County continues to increase. Although, the slope of that line is slowing down, not this dramatic period that we saw here in the middle two weeks of September. So, hopefully, again, some suggestion, and you put all that together at the State level, hopefully, we're beginning to see a leveling off of this most recent increase, this most recent spike in positive cases.

All of those cases have resulted in hospitalization, although this spike in cases has seen a larger percentage of young people. The total number of those age 25 and older is still significant. Those are the individuals who are being hospitalized. So, both across the state we've seen this dramatic increase in hospitalizations. Again, the orange line, the day-to-day admissions, the blue line showing the 14-day summation of admissions. Notice now we're up at a level that exceeds the peak that we saw back in July. Same as true here in Salt Lake County, with a peak that exceeds that what we saw in July.

So, there's dramatic run up, but in the last few days, hopefully here, a little bit of decline over the last few days that have been reported. This is another graph of hospitalizations. The green line on top shows the number of individuals in the state admitted to hospitals with coronavirus. Unlike the previous chart, which was the number of admissions, this shows the census, both in the hospital in total and also in the ICUs. You can see that, again I emphasize, this lagging between. We just saw a couple of charts suggestive that the new cases hopefully are leveling off, but the hospitalizations continue to increase.

The increase in the number of deaths is just now starting to turn up. So, there's these two to three week lag between cases, hospitalizations, and another two to three week lag when we see the deaths. So, unfortunately, the hospitalization, as measured by the number of people in the hospital, continues to increase. Fortunately, we've seen a little bit of a leveling off in those that are in the ICU. So, there still is this general trend upward, but with a suggestion of some leveling off in the ICU. We've certainly seen that here at University of Utah Hospital, which I'll show in a moment.

But we are heading in a direction and the hospitals in our state are certainly feeling the stress from the increased number of patients, in the hospital, with coronavirus. We show the charts of symptomatic patients tested at University of Utah Health community clinics. On the top bar, we show some of the peak months during the summer, particularly here in early July, which was previously, prior to the last few weeks, was the peak of the pandemic in our area. We saw that in August we got down to where we were only seeing around 70 positive patients each day, symptomatic patients, in our University of Utah Health community clinics.

That then peaked two weeks ago. We got back up to a 178 here with more tests, meaning, more symptomatic individuals and a greater number of individuals testing positive, getting close to what we were looking at back here in July. Fortunately, the past week, last week, we saw that start to ease a little bit with fewer symptomatic individuals and fewer of those individuals having positive coronavirus. So, hopefully, this is a trend that will continue. This is just University of Utah Health, in our community clinic testing sites, and specifically, looking at the symptomatic patients with flu like illness.

But, again, another early indicator, if you will, that this week is trending in the correct direction. Like hospitals in the state, we are now, with certainly our admissions, again, blue line is the 14-day sum of admissions that basically summarizes the last 14 days of the gray bars. You can see, we're at an all-time high, exceeding the number of admissions we were seeing in the summer, at the peak in July. This is also seen in our census. So, left charts are the admissions, right charts are the census. You can see we're not quite back up to where we were in July, but we appear to be heading there fast.

With the number of patients we're treating for other conditions here at university hospital, we are feeling the stress of a very full hospital and having to actually defer and delay some episodes of care to make sure we can take care of all the patients presenting with coronavirus. As I mentioned, after a period here where we had more ICU patients than we had on the hospital ward, most of this recent increase, most of the recent admissions are being admitted to the hospital ward and the ICU census has leveled off. So that means we have the proportion of patients in the hospital.

We now have more back on the hospital ward. Getting pretty close to our one third, two third distribution that we've seen for much of the pandemic. But, again, hospital trends across the state, and here at University Hospital, showing increasing hospitalization for coronavirus. As you can imagine, the increasing cases that we've seen, all the data that we've shared so far in a report would suggest, and indeed, Dr. Zhang and Dr. Samore do show us with a reproductive number greater than one. It had started to ease a bit, but now, here he even showed them better in the inset, is rising again, approaching 1.5.

That means for every two individuals that have coronavirus, they infect three individuals. Four individuals with coronavirus infects six other individuals. The pandemic, the spread of the virus does not diminish until we get the reproductive number back down below one. So, this period here throughout the latter parts of July and almost all of August, where we had a very low reproductive number is when we saw all of those cases coming down and so on. So, again, a worrisome trend with our reproductive number and consistent with the increased number of cases that we've been seeing over the last few weeks. This chart breaks down those new cases.

Again, a seven-day rolling average of new coronavirus cases. We've talked about before the large increase from around 20 per 100,000 to up over 65 per 100,000 in this 15 to 24-year old age group. We're pleased to see that now declining and declining at a pretty rapid rate, but we're not happy about, or now we're seeing that what started in that age group now being transmitted through interactions at home, through interactions at work to other age groups. Other age groups, well, the 15 to 24 group does not see a high hospitalization rate as the virus is transmitted to other groups such as the 25 to 44.

Particularly, this 45 to 64, this is the group that accounts for most of our admissions here at university hospital. Then, of course, very worrisome as well, the 65 to 84. Note in this 45 to 64 age group, the current rates exceed what we saw back at the peak here in mid-July. So, we're hoping what we're now seeing in the 15 to 24-year age group, this declining number of new cases will soon similarly round off and hope to begin to see declines, particularly in the 45 to 64. Also, in this 65 to 84-year old. We know this is a group that particularly sees hospitalizations.

This is a group where we see a lot of the deaths resulting from coronavirus. So, a good trend on top, some very worrisome trends in some of the other age groups continuing. We are in the circuit breaker, the two-week break, or I'm sorry, I should say the two-week transition to online classes at the University of Utah, as planned way back in July, in part to make sure our campus is in the best state. We are hosting the Vice Presidential Debate, tomorrow, on October 7th. We have been doing a significant amount of testing individuals who are coming here for the debate.

Kingsbury Hall will be at very low density. Those that are in the hall, predominantly students, will be socially distanced. Everyone in the hall will be wearing a mask. I'm very pleased to report that all the testing of all the individuals working the debate, the media, the students who are helping us, we're seeing that very low, less than one percent as we test everyone who's allowed inside the perimeter, the debate grounds, we're seeing less than one percent positive tests. These are the asymptomatic individuals without exposure. It's consistent with the very low rates we see in our randomized testing of asymptomatic students, and in our randomized asymptomatic testing of individuals coming for a surgical or other medical procedures in the health system.

So, another week in our circuit breaker, and next week then we will resume our testing and our reporting of coronavirus activity on our university campus, among our 62,000 students, faculty, staff, employees. Again, please follow the basics. We've seen in recent days and weeks, particularly what happens when large groups get together and do not socially distance and do not wear masks. In contrast, the first couple of months here at the University of Utah with our fall semester have gone very well. As I walk around campus, I observed all of the basics being followed. I'm very proud of our students and our faculty and staff, particularly the use of masks on our campus.

In my walks around campus, even outside, individuals are wearing masks. When they gather, they gather in small groups and they stay separated from one another. We continue to wash hands. We continue to update our guidelines, particularly for our health professionals, but also for all working in our academic communities about the importance of staying home, when to get tested if you're symptomatic, and so on. So, please keep following the basic four. I'm confident we'll continue to have a good experience here at the University of Utah in this fall 2020 semester, which has been so challenging because of coronavirus. Please stay well and stay safe. 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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