Weekly COVID-19 Round-up - 12/23/21
River City Data No. 60
As we approach the end of 2021, we have crossed another milestone with at least 16,000 deaths in Missouri. This milestone comes amid reports that confirm some of my worst fears. First, we could have saved an estimated 1,900 of these folks’ lives if we had enacted a statewide mask mandate. It is a staggering loss that shows just how dangerous our state leadership’s anti-science, anti-public health rhetoric is for our neighbors.
Second, we don’t know the full scope of mortality because reporters have caught coroners in Missouri (elected politicians, not medical professionals) playing games with death certificates yet again. Earlier reporting in the Kansas City Star had already established that families could request to have COVID-19 left off the death certificate in at least one rural county. Now, a team including the Missouri Independent has found that Cape Girardeau’s corner is not declaring anyone to have died of COVID-19.
Taking stock of this human tragedy is essential. We need a full accounting of deaths in Missouri, even if it is belated. We need immediate action to head off more of these preventable deaths in the next few months. We absolutely can have a better 2022, but it requires a dramatic reversal in how we approach public health in Missouri. - Chris
COVID-19 by the Numbers
Total cases in MO: 986,011 (+21,813 from last Thursday)
7-day average of new cases per day in MO: 3,116.14 (+400.71 from last Thursday)
Counties with the highest per capita rates (per 100,000) of new cases per day this past week:
Knox (141.01 per 100,000), Buchanan (117.24), Carroll (114.7), Monroe (100.7), Lafayette (99.95), Scotland (90.42), Marion (89.68), Mercer (85.78), Holt (83.35), and Clark (81.93)
Total deaths in MO: 16,010 (+167 from last Thursday)
7-day average of new deaths per day in MO: 23.86 (-1.29 from last Thursday)
Percent of all Missourians initiating vaccination: at least 55% (no change from last week)
Percent of all Missourians completing vaccination: at least 49% (no change from last week)
Case and mortality numbers are current as of Wednesday, December 22nd. Vaccination numbers are current as of Thursday, December 23rd. Additional statistics, maps, and plots are available on my COVID-19 tracking site.
Trends in the Past Week
Our latest wave of new cases continues unabated, with Kansas City averaging per capita rates of just over 60 new cases per 100,000 residents per day. This is just a bit below its peak in mid-November of last year. St. Louis and “Outstate” Missouri are each clocking around 45 to 50 new cases per 100,000 residents per day on average. As recently as early November, we had rates below 20 per 100,000 in all three regions.
When we consider our statewide totals, the full scale of the surge is readily apparent. When our rates were at that low point in early November, they equated to about 1,000 new cases per day on average. Those were more than twice what we saw in mid-May. Now, however, we are averaging more than 3,100 new cases per day - three times our early November rates and six times what we saw before our initial Delta wave.
It is also notable that cases are climbing quickly in St. Louis, especially in the last couple of days. At the end of the plot, the slope of the line is quickly becoming more vertical, which is deeply concerning. We’re seeing that steepening growth in the City and County, as well as St. Charles and Warren counties. The other three Missouri counties saw cases fall, but those declines have abruptly stopped.
For St. Charles County as well as the City and the County, we are now seeing rates higher than at any point since last January.
Outside of the St. Louis area, areas of both Northeastern Missouri and counties just east of the Kansas City metropolitan area have some of the most concerning rates in the state right now.
One theme we repeatedly see in this pandemic is the denial of individuals who are steadfastly opposed to new rounds of non-pharmaceutical interventions. Claims about hospitalizations and deaths as the metrics of choice are chief among these denials. Yet, as of December 10th (HHS’s hospitalization data are lagged), we can see increasing hospitalization rates in every metropolitan area. In St. Joseph, these rates had already eclipsed those seen during the summer surge.
In St. Louis, where we have more up-to-date hospitalization data, our seven-day average was just a few patients below our peak during the last wave. There are also signs this pace is beginning to accelerate as well. However, I cautioned folks in my Twitter thread last night that the eye-popping number of admissions - 118 - several days ago corresponded with a considerable number of discharges. Still, the slope of the in-patient line was steepening before they paused data releases until next Monday due to the Christmas holiday.
So, hospitalizations are absolutely climbing. This shift is terrible news not just for patients (including non-COVID patients, who will experience longer wait times and more uncertainty) but for hospital staff, who are exhausted.
We do not yet see signs of a surge in deaths corresponding to rising cases and hospitalizations with mortality. However, this null finding does not mean that our current wave is categorically different from prior waves. Instead, I want to remind folks that mortality is the last indicator to move. Moreover, it takes time to process death certificates in Missouri. All of this means that we will only see rising deaths after a significant amount of community transmission has occurred. Notice the gap between the red line (actual date of death) and the blue line (reported date) - weeks to over a month’s worth of a delay is apparent depending on the period of the pandemic you look at closely.
My conclusion so far is that we have no evidence to suggest this wave will be any different from prior waves. However, what will be different will be the degree that data delays disrupt our understanding of what is happening around us. We already experienced a significant disruption before and after Thanksgiving. We should anticipate more disruptions over the next two weeks, though it is not clear yet how substantial they will be. It may be possible for me to continue reporting. However, it may not. I will keep my Twitter account updated earlier next week with details on the effect of holiday reporting slowdowns.
The other difference this time around is that when students in parts of Missouri return to school in the first days of 2022, they may not have a mask mandate in place anymore in their district. This change results from a misguided lawsuit and the Attorney General’s and parents’ erroneous claims that the lawsuit’s result applies to schools (it does not). However, districts are bowing to pressure and de-prioritizing the health and well-being of their students, staff, and faculty. At the same time, they may be walking back into classrooms when community transmission is higher than at any point than it was in 2021.
There is still time for districts to buckle down and do the right thing. Like I said last week, it is deplorable that districts find themselves abandoned by legislators, the state, and the communities they serve. However, re-instating mask mandates is essential to reducing mortality and keeping students in the classroom over the next few months.