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COVID-19 Weekly Update, November 3, 2020


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Transcript of Dr. Good's COVID-19 Weekly Update, November 3, 2020 

Hello, I'm Michael Good. CEO of University of Utah Health. Today is Election Day, November 3, 2020. And we present the COVID-19 update. Again, November 3, 2020. As you can see by the color coded map, which shows number of positive coronavirus tests per 100,000 over the last seven days, the darker colors are higher levels on a population adjusted basis. And you see that at one time, coronavirus affected principally the coasts of the United States of America, but the highest rates and the highest increases, right now, are happening across particularly the Rocky Mountain West and also the Midwest, as you can see on this color-coded map. Utah continues to be one of the leading states in the nation, as far as cases per 100,000. And this has crept up even a little bit since last week. So again, Rocky Mountain West, Midwest, Central Plains are the areas where the coronavirus seems to be being transmitted with the greatest degree of spread.

At the national level, we've all been following the news. The increase in the number of cases on a daily basis continues to go up. A couple a days there, as you can see, surpassing a 100,000 new cases per day. If you will, kind of starting to see perhaps, if you will, the third wave of a coronavirus now confronting our community at the national level. The death rate has increased a little bit, but not certainly as much as the cases after a fairly long period of stability here. So we'll have to see if these increased cases, which turn into increased hospitalizations, we are seeing that across the country, what that impact will have on the mortality rate. A more worrisome trend here in the state of Utah, again, with this very sharp rise in the number of new cases, again, having our first day over 2,000, actually 2,200 cases during the past week.

So the cases are increasing. We'll talk about different aspects of that as we continue today. The death rate, similar to the national trend, more or less stable with four to five or so deaths per day now in Utah from coronavirus. Same thing, we'll have to see if these increased cases, I will show you is leading to more hospitalizations, but at this point the death rate has not shown that uptick. But we need to be vigilant for that.

We've shown on this chart before. This is the number of active cases of coronavirus infection. It's calculated by looking at the three week total of infections. That's how long on average an individual is expected to have a case of coronavirus. And you can see that as we cross 30,000 now, that means we're getting there close to ten cases of coronavirus per 1,000 Utahns, or approximately one percent. So approximately one percent of Utahns now having an active case of coronavirus. And this is what is creating a large part of the challenge is that many of those individuals with active coronavirus infections are either asymptomatic or minimally symptomatic. And so they are sharing the virus, they are transmitting the virus to those around them. Often family, often friends in casual social settings is where it appears this virus is spreading most rapidly, right now. Much less so in structured, organized events where physical distance is maintained and masks are warm by all participants.

So recall that at the beginning of the pandemic in Utah, we typically had only one or two or three individuals per 1,000. We're now approaching 10, or approximately in 100. So the community spread of the virus, particularly among family and friends, is evident. Needless to say with cases continuing to increase, our reproductive number remains above one. And although you may say this is just a small amount above one, all of this area under the curve between the brown and the one, the axis if you will, that means each individual shares the virus, transmits the virus to more than one individual, and then goes to spread it to more than two, and so on and so forth. So this was the period when we got the virus under control during the month of July, we pulled that transmission rate down. And as you'll recall for much of August we had a very stable number of individuals with coronavirus. So we've got to get the transmission of this virus under control in our state.

Again, we've combined a lot of things on a single graph here, so we can show the relationships. The first thing is the rolling seven-day average of new coronavirus cases. And that's shown over here in the vertical bars, the gray bars are the PCR tests run in the laboratory, and the yellow bars are the newer antigen tests. Many of them, not all of them, but many of them point of care. So you can see that we're adding testing capacity in our state with these new testing modalities, but these are the positive tests. These aren't the total tests. These are the positive, and as you know, we're closing in now on seven day rolling averages. 1,700-1,800 new positive cases a day.

The lines represent either total hospitalizations, ICU beds, or the number of new admissions into the hospital. So again, this trend is going up. We're seeing nearly 50 people a day being admitted to Utah hospitals. That means we now have over 350 individuals in Utah hospitals across the state, and nearly 140 of those individuals are in ICUs. This ICU trend and increase in hospitalization trend, really a steep increase. Our hospitals are very, very full across the state of Utah and in particular, our ICU beds. So increasing cases lead to increasing hospitalizations. And then although the mortality rate from coronavirus in the state of Utah is very low, 0.5 percent, or in other words, 99.5 percent of individuals who contract coronavirus will recover. With these large numbers, we do worry about increasing deaths from coronavirus in our state.

The highest rate, this is seven-day rolling average new coronavirus cases per 100,000, the group with the highest rate are the 15 to 24 year olds. I'll speak more to that in a minute. Many of these individuals are asymptomatic and they then share it particularly at home and in work settings, can share it with those in the 25 to 64 year old categories shown in the green and blue lines. And then it's the transmission to the 65 to 85 and older, where we worry about the most severe cases. Coronavirus, in most cases, is gentler, milder in the 15 to 24 age group, but the severe, the hospitalizations and the deaths more commonly are occurring in the older groups, older age groups. As you can see, all of the age breakouts are increasing, also including the one to 14. And even some upward trending now in the newborns and infants, although again, at a much, much lower rate.

So again, we need to focus on reducing transmission. This is symptomatic. The individuals with flu-like symptoms at our University of Utah community clinics. As you can see our testing capability, more or less stable, with approximately over 800 tests being run each day. But as you can see, a greater and greater portion of those tests right now are coming back positive. Nearly 100 ... over 180, beginning to approach 20 percent of symptomatic individuals testing positive for coronavirus.

What this means, is if you have flu-like symptoms, fever, cough, sore throat, shortness of breath, upper nasal congestion, if you have any muscle aches and so on, if you have any of these flu like symptoms, you have a one in five chance of having a coronavirus infection and you need to isolate and stay away from others and get tested so that you can know whether you're the one in five that does have coronavirus. So just another marker of both in symptomatic and in asymptomatic individuals, the increasing spread of this virus in our community.

The similar trends continue at University of Utah hospital. We continue to see increasing admissions, both on the gray bars, the daily admission, or the blue line, the 14-day summation. Our healthcare teams have been doing a phenomenal job, and although there's been a little up, a little down, we've been hovering in the high 40s to low 50s. Again, a few days up a few days down, a few days up for the past a week or so. You see it in the upper chart here, in the lower chart, the total hospital census, those on the medical ward and then the red line are the ICUs. So again, up, down, up, down, but overall stable at the moment. Although the increasing admissions are worrisome that our census in the hospital will increase, and we are working to mobilize additional teams to be ready to care for coronavirus patients in our hospital.

So far this week we've been able to complete our entire surgical schedule. That's one of the things that we can do if we need additional beds for coronavirus patients is to ever so slightly reduce the surgery schedule, particularly for those patients that need hospitalization after their surgery. But right now, a stable coronavirus census and all surgeries being performed.

Continue to be very proud of the very low rate of coronavirus on the University of Utah campus. As in past weeks, the number of individuals on a daily basis in our community of over 60,000 individuals, faculty, students, staff, healthcare workers, the 60,000 community of the University of Utah, about 20 individuals identified each day as having coronavirus. A very manageable level. And in fact, recall that our number of students in isolation from coronavirus, either from having a positive test or having an exposure to somebody who is positive, had been as high as 70 and last week, I reported that was down in the forties. And this week it's even down further into the 30s. The wastewater monitoring continues to only show coronavirus in the two locations where we know we have students with coronavirus in isolation rooms. So other than that, we don't see coronavirus on the campus. And again, I just commend our students and our faculty, the meticulous use of masks on campus, physical separation during in-person classes. And so on and so forth. We've had a very successful semester so far, and we hope everyone will keep doing the things they need to do to keep our campus transmission very, very low.

On Saturday, we were fortunate to welcome Dr. Deborah Birx and Dr. Robert Redfield from the CDC, and from the White House Coronavirus Task Force. These are two of the leading experts in the country when it comes to coronavirus, and we appreciate that they took time to visit us here at the University of Utah and University of Utah Health. And we shared our experiences and both the things that we've been successful about, particularly on campus, but also that we're in a county and an area that has one of the highest spreads of coronavirus at this moment in time. Their message was twofold. Number one: masks work. When everyone wears masks, it drastically slows the movement of this virus. I think we've demonstrated that here.

Certainly at University of Utah Health, we've been wearing masks everywhere all the time since June, and we've had essentially no transmission of the disease in the hospital or clinic setting. We have had ... Many of our members have developed coronavirus. Most of those that were infected either at home or in the community. We have had a few in the workplace, but we traced them back to, for example, a break rooms or areas where people let their guard down and perhaps took their mask off to share a meal. Again, these informal social gatherings are proving to be one of the ways that the virus starts to move around among us. So being very vigilant and keeping our masks on, as you can see the over hour long meeting with Dr. Birx and Dr. Redfield, as you can see, we all obviously wore masks and kept distance from one another.

Their second message was that the spread of this virus among asymptomatic individuals appears to be responsible for the current spikes across the nation. And what they believe is at cause here in the state of Utah. Remember, our testing strategies included symptomatic. I just shared the most recent weeks of our testing of symptomatic individuals at our health centers. We've been working on testing asymptomatic individuals who been exposed to those with coronavirus. In approximate numbers, about one in 20 who are exposed to someone else with coronavirus will become infected themselves.

But we've not done much in the area of asymptomatic. Asymptomatic without exposure. As I shared, we do have an asymptomatic random testing protocol active. Last week at the University of Utah, 150 randomly selected individuals were tested for coronavirus and only six tested positive. 0.8 percent. Another sign of the low level of virus on our campus community. But Dr. Birx and Dr. Redfield challenged us that the way we're going to get ahead of this virus is to aggressively test asymptomatic individuals so we can identify them and get them isolated. And they pointed out particularly 15 to 24 year olds are often either entirely asymptomatic or very minimally symptomatic. So they themselves don't develop the disease COVID-19, they don't develop very severe symptoms, or they don't develop symptoms at all. But they then transmit it to the adults in their lives, in their communications, especially when masks are not worn, for example, as I said before, in the home setting or in the informal social gathering.

So what you're going to hear in the coming weeks, we're going to do our best to test all of our students, not just the ones that live in dorms, but all of our students at the University of Utah, at least once before they head home for Thanksgiving, we think it's important that people know before they return to their homes, whether they may be one of these asymptomatic individuals who has a coronavirus infection. So in the coming weeks, we're going to try to test all of our students and then develop a regular testing program for students with regular testing of all students, certainly by the winter and spring semester. But again, early parts of that program rolling out here in the next few weeks before Thanksgiving.

We'll also then work to regularly test our healthcare professionals and our faculty and staff at the University of Utah. This will require additional testing capabilities, especially the point of care tests that return a result in about 15 minutes. Dr. Birx and Dr. Redfield said they would help us receive the testing kits that we need so that we can test our students, test our faculty and staff, test our healthcare workers as they recommended in a regular and routine way.

So again, we thank them for their visit, and we thank all of you for all you are doing to help us at this very important moment in the coronavirus pandemic in Salt Lake City and in the state of Utah. We're going to really need to focus on testing of asymptomatic individuals so we can figure out that 10 in 1,000 ... I'm sorry. Yeah, 10 in 1,000 that I referred to. The one in 100 individuals with an active coronavirus infection, so we can get them in isolation, get them away from family members, get them away from friends and others for the 10 days that they need to be isolated, and hopefully that will slow down the really significant spread of the virus that we're seeing right now.

Thank you for all you're doing to help us in this endeavor, and stay tuned for additional weekly updates as we describe the rollout of asymptomatic testing. Thank you.


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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