Weekly COVID-19 Round-up - 10/9/20
River City Data, No. 1
Welcome to the inaugural edition of “River City Data,” a newsletter dedicated to sharing insights about Missouri and St. Louis from an empirical data perspective. For now, this is going to be focused on COVID-19. Eventually, as the pandemic recedes (and it will recede eventually!), I’m hoping to take on other topics as well. In the meantime, thanks for joining me on this new adventure. This is one big experiment, so the format might change a bit from week to week. Feel free to drop me a line on Twitter and let me know what you think! - Chris
COVID-19 by the Numbers
Total cases in MO: 142,732 (+9,007 from last Friday)
7-day average of new cases in MO: 1,564.857 (+110.429 from last Friday)
Counties with the highest per capita rates of new cases this past week:
Barton (81.98 per 100,000 residents), Livingston (66.33), Wright (60.13), Buchanan (59.34), Shannon (58.9), and Osage (58.74)
Total deaths in MO: 2,360 (+153 from last Friday)
7-day average of new deaths in MO: 25.143 (+6.286 from last Friday)
Additional statistics, maps, and plots are available on my COVID-19 tracking site.
Summary for the Week Ending October 9th
This was a rough week data-wise. Last Tuesday (September 29th), several counties had large additions or subtractions entered into the State’s dashboard. This meant that the 7-day averages for both our statewide and regional numbers, and specific counties, were all over the place this week. We had significant spikes in places like Audrain County and considerable dips in areas like Kansas City. The KC dip can’t wholly be blamed on the State - the City is now only posting updates to its dashboard once per week.
When the dust settled yesterday (because the anomalous numbers from the 29th were no longer factored into the 7-day averages I track), we got the first clear picture we’ve had since the 28th. It is not great. What appeared in my regional plots to be a big drop was just artifact. We’re still averaging around 1,550-1,600 new cases per day right now. We’re still seeing 58%-63% of new cases falling in the “outstate” region - outside of the St. Louis and Kansas City Metro counties.
New cases are spread out widely over Missouri. We’re seeing elevated per capita 7-day averages of new cases in the Ozark Mountains, around Springfield, up through Lake of the Ozarks and Mid-Missouri, and into the northwest corner of the state.
A couple other trends to note:
Our 7-day average of deaths statewide is near all-time highs right now. But I’ll go back to my concerns about data - a lot of these deaths are due to delays in reporting. They’re sometimes months old. According to the state, is because there are delays in counties reporting death certificate data to DHSS.
Greene County, where Springfield is located, surpassed St. Louis City’s cumulative number of cases this week. The CEO of CoxHealth, Steve Edwards, also noted that they had hit a “high water mark” for hospitalizations in their system in Springfield this week.
A growing number of counties in southeast Missouri, Mid-Missouri, and around Lake of the Ozarks have passed the cumulative per capita rate of cases in St. Louis City and County and Kansas City recently. This is indicative of another “outstate swing” in cases away from the two large metros. Early in the pandemic, St. Louis in particular was really setting the pace in terms of cases and deaths. That is no longer the case now.
Hospitalizations in St. Louis, where we have the most reliable hospitalization data, are slowly, slowly creeping downward. It is taking a much longer time for these rates to recede relative to April and May.
Weekly Interview
Timothy Wiemken, Ph.D., is a colleague of mine from SLU. He’s an epidemiologist with a focus on infectious disease. You can follow him on Twitter.
Chris: Where do you think we are at in Missouri right now with the pandemic?
Tim: I think Missouri is pretty similar to most states right now. There are up’s and down’s with every state which changes daily, weekly, monthly or whatever timeframe, but everyone seems to end up in the same spot. Although this past week Missouri was one of the three states with down-trending data I don’t really put much stock in that as historically this all seems to be normal variation (common cause variation). Without any major outbreaks I don’t really see this changing too much in the short term without a new intervention.
The lack of transparency in data reporting, the lack of timeliness of reporting from various groups, and the difficulty in amassing the data for public consumption further muddies the waters with respect to what the data actually mean. One of the better metrics locally is hospitalizations as those are easier to quickly document. Other than some anomalies I think we are in ok shape with respect to hospitalizations – as you have mentioned many times, surge capacity is something to keep a keen eye on.
Luckily we haven’t really had too many issues with surge here. In 2017/2018 infleunza season there were patients in the hallways of many hospitals in town due to surge issues. We don’t want a repeat of that.
Chris: There is a lot of focus right now on vaccines for COVID-19. What do folks need to know about our prospects and expectations for vaccines?
Tim: There are several vaccines in phase 3 trials in the US right now (and coming soon). Phase 3 means that the dosing and most of the basic safety metrics have already been documented as reasonable to give the vaccine to a large group of people. Of course, safety is a continuum. Nothing is without potential side effects for at least one person, so like every medication or intervention, we rely on the risks and benefits calculations. Just like taking aspirin or any over the counter medication has potential catastrophic side effects in some people, a vaccine could cause a side effect in someone. Luckily we have many decades of experience with vaccines and they are probably the most rigorously tested medical interventions we have. A lot of people have compared this to the potential issues with the 1970s influneza vaccine and Guillain-Barre syndrome. Keep in mind that was 50 years ago. Science has come a long way. Further, no vaccine is perfect so it could not be ruled out that infection with the actual virus caused these issues and not the vaccine. Very messy.
With the COVID-19 (SARS-CoV-2) vaccines, there is concern of potential early ‘emergency use authorization’ to get them available to the population at large sooner than we would normally allow. There are several considerations for this. First, all of the vaccines in phase 3 have gone through two other phases of testing already and will be given to about 15,000 volunteers for the phase 3 studies (the total study populations are 30k, but ½ get placebo randomly). Thus far, for all of the vaccines enrolling in the thousands of subjects, there has really only been one potential ‘serious adverse event’ (bad side effect) reported (AstraZeneca/Oxford trial). Although any adverse event is terrible, for the population as a whole, this is a very good sign. We generally don’t even report or collect data on side effects for medications that many folks take (think about how many peole take NSAIDs and how often – we have zero data on side effects as this is not part of national surveillance) so I would consider this a non-issue for these vaccines at the moment (everything can change – it’s science!).
One concern for two of the current phase 3 vaccines is that they are new platforms (messenger RNA vaccines) as we have never had these before. Given the mechanisms of how they work, they should likely have even fewer side effects than some of the others, particularly the adenoviral vector vaccines. Again, I’m not at all concerned about these.
Overall, I would expect early authorization for at least two vaccines pretty soon (Moderna and Pfizer). How soon is more of a political game – and I’m not going there. After authorization they will not be readily available to everyone though. Most likely they will be available for high risk folks (healthcare workers, first responders, nursing home residents, etc). Given most of these vaccines right now require two doses a month apart and many have extremely difficult transportation issues, it’s going to be even more tightly monitored. This means continued diligence with masking, hand hygiene, and surface disinfection for quite a while. I wouldn’t expect vaccine available on-demand until late next spring or early next summer.
Chris: What is one thing that you see missing from discussions about COVID-19?
Tim: The critical importance of hand hygiene and surface disinfection. This was a political mess in the beginning of the outbreak, and everyone decided to just focus on one intervention – masking. Masking is very important for prevention of infection of others, but it is not foolproof by any means and ignores personal protection (face shileds are better than cloth or surgical masks for personal protection). All other respiratory viruses (there are many!) transmit the same ways and SARS-CoV-2 is no different. Respiratory droplets are expelled from people and can be directly breathed in by others, infecting them. However, these droplets also settle on surfaces and the virus remains infectious for some time. People touch these surfaces then touch their eyes, nose, mouth without washing their hands. This is also a primary mode of infection (self-inoculation).
Like every bundle of interventions, we have to have many stacked on top of each other. The old adage that each intervention is like a piece of swiss cheese is quite fitting. Each slice is an intervention with some holes (since they aren’t perfect) and you want to block something from getting from one side to the other. If you stack up enough slices, each with their own separate issues, we can do much better than with just one intervention. This is why we have masking, social distancing, restaurant and bar closures, etc.
One of the keys is that none of these are fool-proof. No intervention is perfect. Also, you can’t always do everything. If you have to relax one intervention, try to increase another to make up for the loss. For example, if you cannot wear a mask, try physical distancing. If you cannot have physical distancing, try to increase hand hygiene and environmental disinfection.
Chris: What is something you’re feeling positive about right now in terms of COVID-19?
Tim: I think the therapies are coming along quickly which should reduce severity and mortality. Vaccines are on the horizon which should help as well. This is all we can hope for. After all, we live with a lot of different infectious diseases that can cause substantial morbidity and mortality. We have lived with them from the beginning of humanity. These will never stop so we just learn to manage. Once we are confident the hospitals aren’t going to be over-run and people are not dying, interventions can be relaxed. I see the light at the end of the 2020 tunnel.