COVID-19 Weekly Update, July 28, 2020
By: Michael Good, MD | Jul 29, 2020 8:00 AM
Transcript of Dr. Good's COVID-19 Weekly Update, July 28, 2020
Hello, this is Michael Good, CEO of University of Utah Heath with our COVID-19 update for July 28, 2020. In our update today, we see some encouraging trends over the last week or so occurring both at the national and at the state level. At the national level, after many weeks of increasing numbers of new positive coronavirus cases each day for the last week or so, looking at a seven-day average, we have seen a leveling off and a decline in the last couple of days. The trend in increasing deaths continues, although on a slight upslope with much day-to-day variation. Remember, we've talked before about the lag time between changes in new cases, hospitalizations, and deaths from coronavirus. So the flattening of the new cases is encouraging and we'll continue to watch daily deaths.
Similar patterns hold here in the state of Utah. A very encouraging leveling off of new cases reported over the last week or so, and in recent days here, some numbers down around 400—even one day below 400. So again, we'll hope that this positive trend in the number of new cases continues. We'll talk more about that in a minute. Like the national trend, the number of new deaths now reported each day is around four or five, where previously we had been around two. So hopefully, as the new cases decline, we'll continue to see the number of deaths from coronavirus similarly decline.
The seven-day average of positive coronavirus tests shows the same leveling off over the last week—and even with those low numbers, the last few days of lower numbers are potentially really the first downward trend that we've seen in this curve over the last couple of months. With those declining cases, the number of active cases has also leveled off. Remember, active cases are the number of active infections—not the number of cases that we've seen from the beginning of March, but the number of active infections. At that 12,000 number, that means that's around 4 out of every 1,000 Utahns currently having a coronavirus infection. Again, it’s encouraging to see the number of active cases level off after several months of continually increasing.
The number of positive tests per hundred tests run similarly now, hovering more in the 10, some days nine range. The averages are around 9.7 for recent days, and as we pointed out before during this period of yellow restrictions, the slope of the trend line continues to move favorably to fewer positive tests each day. Clearly a lot of day-to-day variation, but overall moving in the correct direction.
Also an encouraging sign consistent with the decreasing cases is the real-time reproductive number, a measure of how the virus is moving through the community. For the first time, we see it below one. When coronavirus cases are fewer each day than prior days, that means the reproductive number is below one, and in our calculations, we actually see that, particularly over the last three or four days. Remember last week saw this sloping up? We’ll have to look at this again next week as the case count from successive days can influence the reproductive number. As I said last week, the number was heading up, but as cases came down, the reproductive number also came back towards one, so encouraging news there.
With declining cases we are seeing fewer hospitalizations. First, a leveling off here at the state level, and then some decreases over the last few days. Remember, the blue line is the 14-day sum of all hospitalizations, and on most days, that’s now running somewhere between about 25 and 30 Utahns hospitalized with COVID-19 each day. Here in Salt Lake County, it’s running about 10 to 20 individuals. Not quite as much flattening over the last couple of weeks, but in recent days, decreasing numbers of residents of Salt Lake County are being admitted to hospitals with coronavirus.
In contrast, here at the University of Utah, our COVID-19 census remains at its highest all-time level. The gray bars on the left panel show the number of patients admitted each day, and you can see many days where we've had five, seven or as high as 10 patients admitted. The blue line is the cumulative 14-day admission, and clearly that is increasing. We have currently approximately 20 patients in our ICU and 20 patients on our medical surgical ward for around just under 40 patients in our hospital. We mentioned last week the patients that were seen at University Hospital have a higher severity of illness from their COVID-19, with approximately half of them in the ICU and half of them on the hospital ward. So in contrast to what's happening in the state at the moment, University Hospital has a higher number of coronavirus patients.
We're watching closely the number of patients in ICU beds with COVID-19 across the state. This is a new chart this week, so this is the number of patients with coronavirus infections, with COVID-19, in ICUs across the state. You can see after several weeks of a growing trend the blue line is the day-to-day totals and the yellow line is the seven-day average. That had been growing. It got up to around 115, and then over the weekend and the first part of this week I've really seen a number of patients discharged from the ICUs, and that number has come back down all the way into the mid 80s. So again, we track this carefully because this is often the limiting resource in a community or in a state when coronavirus cases increase rapidly or dramatically.
Finally, we continue to build on the relative severity of illness, if you will, from COVID-19 relative to other things such as traffic accidents, stroke, suicide, traditional flus and pneumonias, as well as cancer and heart disease. You can see that, although we've had these nice last few days, prior to that, COVID-19 had continued to increase to where the three-day average deaths due to coronavirus was similar to that from traffic accidents. We'll continue to watch that, and hopefully we can see that also decline as we see declining case numbers.
This is a really important slide. The purple line shows the seven-day average of positive tests—we've seen that before. We don't have the last few days on this chart when it was created, but you can see it traces back to May. And then the green line, the lower green line, is the number of positive tests—the seven-day average of positive tests—in Salt Lake County. So green is Salt Lake County and the blue line is the rest of the state of Utah. You can see that, for much of the pandemic, about half the cases were occurring in Salt Lake County and half the cases outside of Salt Lake County. This was a period where we had the number of cases spike at the meat-packing plant, but other than that period up until around mid to late June, the two curves are tracking pretty closely.
On June 27, Salt Lake County implemented a face mask mandate for face masks to be worn, and it's interesting that you then see really within a week or two, the new cases in Salt Lake County kind of leveled out right around 300. You see down a bit, up a bit, but in contrast to the two curves moving together, Salt Lake County kind of leveling out here around 300 new cases a day, while the rest of Utah continues to increase with now about a 150 difference between the number of new cases in Salt Lake County and the number of new cases in the rest of the state. So some evidence that face masks are potentially having a pretty significant impact here in Salt Lake County.
We have had a universal masking policy here within the health system and within the university, and we do believe this is a way we can really reverse the trends—this constantly increasing number of new cases we've seen for so many months—by really emphasizing face masks. Not only those who are feeling ill and may have coronavirus themselves, or are a so-called coronavirus carrier, but increasingly there's belief that masks also help healthy individuals who do not have coronavirus. If they do come in contact with droplets from an infected individual, the mask reduces the amount of virus that is able to get into the healthy person—and perhaps with a less severe dose of the virus or form of the illness. So the basic principles remain the same: wear face masks, wash hands, keep physical distance wherever possible, and really stay away from others. Stay at home and stay away from work when one’s not feeling well.
So in summary, after several months of increasing trends in most of the data items and statistics that we follow, we have seen several days now of declining new cases, and with that a leveling off of some of the trends. We'll continue to follow these trends and we'll be back next week with our next COVID-19 update.
Michael Good, MD
Michael Good is CEO of University of Utah Health Sciences, 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.