Weekly COVID-19 Round-up - 11/13/20
River City Data No. 6
In this week’s edition of River City Data, I provide some updates on the latest numbers in Missouri, share a few updates to the tracking site, discuss some of the first election polling postmortems, and share my interview with Emma Crocker, DNP, RN. The overall message from our data, and in Emma’s interview, is that these numbers of new cases threaten to crush our health care system.
Early next week, I’ll also be publishing a special issue with my pal Tim Wiemken, PhD about the changes to school policies announced in Missouri on Thursday.
- Chris
COVID-19 by the Numbers
Total cases in MO: 235,156 (+25,194 from last Friday)
7-day average of new cases per day in MO: 4,315 (+1,149.57 from last Friday)
Counties with the highest per capita rates of new cases per day this past week:
Dade (306.79 per 100,000), Reynolds (253.37), Ste. Genevieve (162.27), Moniteau (148.6), Cole (147.44), and Perry (143.26)
Total deaths in MO: 3,441 (+224 from last Friday)
7-day average of new deaths per day in MO: 34.86 (+5.86 from last Friday)
These numbers are current as of Thursday, November 12th. Additional statistics, maps, and plots are available on my COVID-19 tracking site.
New on the COVID-19 Tracking Site
Together with my colleague Tim Wiemken, Ph.D., we’ve added a new mortality page to the COVID-19 tracking site. It includes a comparison of reported deaths and actual deaths by date and a pair of interactive plots that show an estimate of excess mortality in Missouri and the United States. The St. Louis ZIP code maps now include Franklin County, and as of tonight Warren County and all of Metro East appear on the 14-day average map.
As a reminder, my plans for the remainder of the year include:
Next few weeks - age breakdowns for both morbidity and mortality statewide and in a few key counties
In early December - a similar ZIP code map for the Kansas City area (covering Kansas City as well as Jackson, Platte, Clay, Johnson, and Wyandotte counties)
Summary for the Week Ending November 13th
The alarms in Missouri are blaring red this week. One thing to understand off the bat is that our testing environment has been through several evolutions that you can see on the State’s dashboard. However, from early July through mid-September, we had a pretty stable number of PCR tests administered at around 100,000 per week. We’ve been averaging (back of the napkin) around 130,000 PCR tests per week from mid-September on. This stability since mid-September is critical for understanding how the number of cases and the percent positive metrics have changed.
The first alarm bell is in the current seven-day average percent positive measure - 23.9% of tests are currently coming back positive. Take into account where we’ve been since the testing environment last shifted in mid-September. From mid-September through mid-October, when the overall numbers of PCR tests were stable, the percent positive number hovered between 8% and 10%. All of the sudden, beginning in mid-October, our percent positive numbers started to rise steadily to where we are right now. Recall that the WHO’s guidance was to have a percent positive number below 5% for two weeks before reopening.
The second alarm bell is the degree to which new cases have jumped over the same period. Remember - the testing environment has been stable, so we can’t say that this jump is due to surveillance bias (if we test more, we may find more cases). In mid-October, our seven-day averages of new cases statewide hovered between 1,500 and 1,900. As late as October 28th, we were averaging 2,062 new cases per day. As of November 12th, our seven-day average of new cases has climbed steadily to 4,315, more than double where we were two weeks ago.
The above plot also shows the third alarm bell - roughly half of the new cases right now are occurring “outstate.” However, this meso region includes only about a third of Missouri’s population. This speaks to just how geographically widespread transmission is right now. There have been points - early in the pandemic and in August - when cases were concentrated mainly in St. Louis and, to a lesser extent, in Kansas City. Transmission is everywhere now.
This gets us to the fourth alarm bell. Until recently, the “outstate” region had made up about sixty percent of new cases. This has dropped to about half over the past couple of weeks or so. In particular, St. Louis has seen case numbers begin to grow steadily to new all-time highs in every single county in the metro. Things may seem comforting in St. Louis City, which has rates of new cases well below surrounding counties. Still, rates of new cases in the City have more than doubled, and the trajectory of new cases is steepening.
The fifth and final alarm bell follows this fourth one - hospitalizations have spiked to unsustainable levels in Missouri. In St. Louis, where we have reliable data from the Metro’s Pandemic Task Force, trends have outstripped our numbers in the Spring. We’re adding new patients at a faster rate, and the total number of patients is now higher than at any point so far in the pandemic.
Even more concerning, our ICU numbers are starting to climb as well.
By early December, Dr. Garza and the Pandemic Task Force warned today, our hospitals will reach capacity if these trends do not abate. I said last week that we were heading towards hospitalization numbers that we could not sustain. Today’s press conference confirms that we are rapidly approaching that place.
Into the Weeds
As we get further out from the election, we’re starting to get experts digging into the election polling miss we experienced this presidential cycle. Both The Upshot blog at the New York Times and FiveThirtyEight have now published some initial thoughts on what happened. The polls “missed,” depending on where you look, by at least or even a little more than in 2016. It will take a long time to fully sort out some of the sources of these errors, so patience is needed. However, both of these are great starting points for understanding polling.
Weekly Interview
This week’s interview is with Emma Crocker, DNP, RN, a registered nurse with a Doctorate of Nursing Practice degree focused on population health. She has worked in various St. Louis City hospitals over the last six years. In July, Emma left the hospital setting to work as a community health nurse at CHIPS Health and Wellness Center, which serves St. Louis community members who are uninsured or underserved.
CP: What has it been like being a nurse during the COVID-19 pandemic?
EC: It is frustrating and scary to be a nurse during the COVID-19 pandemic.
It is scary because you know the virus is all around and that there is a shortage of equipment and resources that protect you. The N95 mask is supposed to be single use, but you are using it for the third day in a row. It is the only thing protecting you from a virus that could kill you or your family. It is scary because you see what the virus is doing to the public and there are so many who are not taking precautions necessary to decrease its spread. It is frightening because we are putting our lives on the line to save those that need our help the most in any setting hospitals, schools, community clinics. It is scary because we did not have enough equipment during the spring and summer. Now winter is here, and the number of daily cases is increasing rapidly. It is scary because the rest of the community is out and about while we sit in fear of infecting others at the grocery store because we are not tested regularly, if at all by our employers, to determine if we are carriers of the virus. My parents have been tested three times but my husband who is also a nurse has never been tested and I have been tested once.
Once the fear has subsided about an hour into the shift then the frustration takes over. Winter is here. We have not won against this virus. In fact, we are still losing to it, especially here in Missouri. We are frustrated when we are holding the hands of those who are dying of this virus while another five COVID patients wait in the Emergency Department (ED) to find a room. It is frustrating when you see Halloween parties, weddings, and sports teams gathering with no comprehension of how these events can spread the virus to the population. The virus will find its way around these types of gatherings and ultimately end up increasing the wait time for the ED or increase the wait time to see the primary care provider. You know more and more are dying at home, yet you still have leaders in the community telling you “you are being a Debbie Downer” and “stop living in fear”. To them, I say we are trying to protect you. We are trying to save your lives. We are trying to keep you home and keep you safe. So, when you do end up in the hospital due to COVID, your medical team is energized and ready to take care of you. We are trying not to be too fatigued to take care of you, so that you don’t end up dying from a medical error, which is one of the leading causes of death in the United States.
CP: Something I’m particularly concerned about are disparities in who is getting sick and dying from COVID-19 in our St. Louis community. What disparities are you seeing personally? What worries you?
EC: There are too many gaps within the healthcare system where one can fall through and end up in a lifetime of stress and suffering. COVID-19 exposed the gaps that registered nurses saw every single day before this pandemic. There is a rising mortality in those patients diagnosed with Type II Diabetes and whose blood sugars are not being managed.
Before the pandemic, managing Type II Diabetes was no easy feat. With the pandemic, more stress is placed on those who are trying to manage their disease. According to the St. Louis Partnership for a Health Community, the death rate from diabetes is almost three times higher for the Black community members living in St. Louis City. The rate is 34.4 deaths per 100,000 Black community members; compared to 12 deaths per 100,000 for white community members.
This brings me to the impact that this virus is having on our Black community members. Racism runs deep in this city and this state. We know this. When 60% of our patients admitted to our hospitals are Black, 50% of our total deaths are Black community members and they only make up around 18% of our region’s population we need to take a long look at ourselves and how we are addressing this pandemic. We need to work together to ensure the most vulnerable in our community are taken care of and then we can build upon a foundation where no one fall through the cracks.
CP: What is one thing that you see missing from discussions about COVID-19?
EC: The one thing I see missing from the discussion about COVID-19 is the navigation of the patient through the process of being hospitalized and then their transition home. This is where I believe it is necessary to have registered nurse, social workers, care managers, and home health workers at the table for these discussions. They are part of the process and have valuable information to contribute to the solution. Yes, public health is about informing the public and ensuring we do the right thing, but public health is also about transparency.
Nurses have been the number one trusted profession for the last 18 years. We are the ones holding your hand while you pass on without your family. We are the ones holding up the iPad because your loved one is too weak. We are your life savers. We are your advocates. We fight for you, the patient, the family, the community. We should have someone at the table that advocates for the patients. We need more nurses leading us through this pandemic. We need more nurse leaders because registered nurses have been battling this virus since day one. Why are nurses not being offered leadership positions to find solutions for this pandemic?
CP: What is something giving you hope right now in terms of COVID-19?
A few things give me hope right now:
My husband, who is a registered nurse and often works on the COVID-19 floors.
My best friends who are nurses and patient care techs at hospitals in the area.
The St. Louis community because we just elected Cori Bush, a Black woman and registered nurse, to Congress. Cori’s election gives me so much hope for our future because she knows what it takes to get the work done. Registered nurses show up every day to save lives in our community because they care. That gives me hope.