COVID-19 Weekly Update, August 4, 2020
By: Robert Pendleton, MD, BSC, FACP | Aug 5, 2020 8:00 AM
Transcript of COVID-19 Weekly Update, August 4, 2020
Hello, I'm Bob Pendleton. I'm the Chief Medical Quality Officer for University of Utah Health. Dr. Michael Good is having a well-deserved vacation and so I am here today to give our Weekly COVID-19 Update about the status of the pandemic nationally, as well as here at home in Utah, and within University of Utah Health. So let's jump right into this week's update.
Nationally, we have, both in terms of daily new cases across the country, as well as daily new deaths, we have seen favorable trends. Dr. Good, last week, talked about this early positive direction across the country, and that positive trend across the United States has continued to hold. We are still at a range where we have over 60,000 new cases a day, so the pandemic is very active still, but nonetheless, the trends are favorable.
As we talk about weekly deaths due to COVID-19 they are a lagging indicator. Usually when we see an increase in new daily cases, we then see deaths reflected as that over the next several weeks. So deaths are still on a slight upward trend, but appear to perhaps be flattening as we start to see this lower case count across the country.
Within Utah, those trends are even more favorable. We have now seen several weeks of gradual continued decline in the new daily case counts. After getting daily case counts of new patients with COVID-19 as high as 750 new cases a day and above, we're now seeing a new daily case counts of 500 or below. Again, a very favorable sign across the state of Utah.
As we see those cases in Utah decline over the last couple of weeks, as we would expect, we have seen a plateauing of new daily patients dying of COVID-19 across our state. The hope is that this plateau will start to lead to a downward trend in the weeks ahead. Looked at a little bit differently, is a rolling seven-day average of daily COVID-19 positive cases. At the top of this graph are the different statewide levels of restriction we've had since the pandemic started back in March, moving from Red to Orange, to where we've settled in as a state in Yellow. After seeing a fairly steep increase in new cases that started towards the end of May, again, we've now had several weeks of consecutive decline in these new cases. Again, a very favorable and optimistic signal.
As Dr. Good has talked about in the prior weeks, when we can turn these new cases into the total number of active coronavirus cases across the state, these are patients that we'd anticipate still being infectious with coronavirus, and with the cases now coming down for several weeks in a row, the number of active coronavirus cases has followed as well. With the most recent estimates being around 11,000 cases. Stated differently, this means that for every 300 Utahns, 299 do not have active coronavirus, but one of every 300 does. And again, as we, as a community, continue to do the things to further slow the spread of the virus, we hope and anticipate that the number of active cases will continue to decline as well.
Well, one of the other statistics that we look at is for every 100 COVID tests that are performed across the state, how many of those are positive? Said another way, what percent of coronavirus tests come back as a positive result? Again, we saw a steady increase in the percent positive rate up over 10 percent for much of June. July, we've seen a decline in that where the positive case rate has been less than 10 percent for nearly a month or so now. Again, another favorable trend. But I would point out that as long as our case positive rate is above 10 percent, this still means that we have fairly widespread community activity and we need to not let our guard down. In fact, if anything, double down on our efforts to keep ourselves, our family members, and our community safe.
One of the areas that we look very closely at is something that Dr. Good has talked to you about called real-time reproductive number. This real-time reproductive number is a marker that if it is over one, it means that we are keeping the virus best case at bay, but largely we anticipate the virus will continue to spread in an incremental way. If this real-time reproductive number is below this dash line or below one, it means that we are on the path to curbing and starting to stop the spread of coronavirus. It was very encouraging that for the last couple of weeks now we've seen this real-time reproductive number be pushed below one. Again, another marker for us to double down on our efforts in keeping each other safe and continuing to curb the spread of the coronavirus.
Well, cases in the community as you, by now, are well aware, translate then to patients sick enough to require hospitalization. As we have seen cases decline over the last few weeks, as we would hope and anticipate, we have started to see a similar decline in cumulative 14-day hospitalizations across the state of Utah and in an even more pronounced way, within Salt Lake County. So again, very encouraging that our healthcare providers who are busy taking care of all of our healthcare needs are starting to have a little bit of reprieve after a very busy month in taking care of coronavirus patients in addition to our normal care.
Well, within University of Utah Health, we are hopefully starting to see these same favorable trends. Again, on the left is the 14-day cumulative hospitalizations, and you can see that blue line continues to March up until just the past few days where we have started to see a little bit of a reprieve. Over on the right-hand side shows our total daily census broken out by total numbers of patients with COVID in our hospital. And then the gray line, those patients in the acute care service, and the dark red line, those patients who are in an intensive care unit beds. And after peaking at nearly 50 patients with coronavirus in our hospital, we've had a few days where we've seen that number start to decline. Currently, we have about an equal mix of patients with COVID in our acute care setting, as we do in our intensive care unit setting.
I'd just like to pause and really acknowledge the incredible, heroic, and hard work that our entire team members within University of Utah Health have accomplished over the past few weeks as they have very successfully taken this additional number of patients, provided outstanding world-class care, while keeping themselves safe and taking similarly outstanding care of all of our patients in our health system that don't have COVID.
Well, we wanted to pull back up again to the state level. As we've learned more and more about the impact of COVID-19 on our community at large, the rate-limiting or most constraining resource we have to successfully manage this pandemic is staffed intensive care unit. This particular graph shows Utah ICU bed capacity with the number of COVID patients across the state of Utah that are in an ICU bed at any given day. You'll note that a week to two weeks ago, that COVID ICU census across our entire state got above 100. This is 100 patients needing intensive care unit care above and beyond those who need ICU care for traumas, heart attacks, strokes, and other common problems. Working in collaboration with Intermountain Healthcare, Steward Healthcare, and HCA, we know that once this additional population of ICU patients with COVID gets up above 100 and pushes towards 135, that our healthcare systems become under enormous duress in being able to manage that.
So the good thing is after getting above 100, we've now seen, for a week to nearing two weeks, a declining trend overall, and we're in a range where we can safely and effectively care for this additional patient population.
One of the other metrics that Dr. Good has been mentioning to you and following closely is the impact of our own personal behaviors on our ability to control this pandemic. This is a slide going back to positive COVID-19 tests by day, broken out by, in the gray line, the entire state of Utah, and again, mentioning that we've seen a decline over the last couple of weeks. The blue line is all counties with the exception of Salt Lake County and the yellow line is Salt Lake County. Last week, Dr. Good mentioned that for most of this pandemic, half of the new daily cases have been identified in Salt Lake County and half of the new daily cases have been in counties outside of Salt Lake County. Salt Lake County wound up issuing a mask mandate. Again, all of us living within Salt Lake County became much more compliant and vigilant about wearing masks and social distancing, and what we saw is that since that time we have had a continued decline in cases across Salt Lake County.
Well, fortunately, after a upward rise in all the other counties across the state, we've now, for the last week to week and a half, started to see a similar decline in new COVID-19 cases in all other counties. Again, I think as we all continue to recognize what our own personal behaviors are that are needed to slow this pandemic, our hope is that these favorable trends will continue.
So again, I do think it's important to remind ourselves that this virus is one that has dramatic negative consequences for many of our neighbors and community members. As mentioned over the last few weeks when we saw a rise in case counts, so did we see a rise in COVID-19 deaths where, for the month of July, COVID-19 deaths across the state of Utah represented the third most common cause of death, only distant to heart disease and cancer. As we've started to get control over the last few weeks of the pandemic, the COVID-19 death rate has fallen, and now it is below accidents and nearing the number of patients who die on any given week of strokes. So again, positive trends, but sobering, nonetheless, that so many of our neighbors and family members have passed away from this infectious illness.
I’ll end with this. As we have now been dealing with this pandemic for four to five months, I know I have gained and continue to have a very healthy respect for this virus, but I would remind us all that although I have a healthy respect for this virus, this virus is not particularly complicated. We do hold the keys to continuing to control the virus until we are at a point in time where we have effective vaccinations. And these effective interventions have not changed: this is masking, this is hand sanitizing, this is physical distancing, this is staying home when ill.
As a community, I'm really proud that we've all really embraced these, continue to adjust our lives so that we can adhere to these, and we're starting to see the positive impact of those efforts over the last few weeks. So I'd encourage you all to continue to be leaders in your families, in your neighborhoods, in your community, and together, we will continue to whether this pandemic. In the meantime, I wish you to be well and safe. Thank you on behalf of University of Utah Health.
Robert Pendleton, MD, BSC, FACP
Robert Pendleton is Chief Medical Quality Officer (CMQO) of University of Utah Health Hospitals and Clinics and professor of medicine. Pendleton develops a physician-directed quality improvement and patient safety program that builds on his experiences in clinical care, program development, and patient safety. In addition to his role as CMQO, he co-directs the Hospitalist group.