Weekly COVID-19 Round-up - 12/30/21
River City Data No. 61
As we prepare to ring in 2022, I find myself feeling incredibly conflicted. A year ago, we had no timeline for when our family would be vaccinated. Now, both my wife and I have not only received our initial vaccines, but we have also received boosters. My daughter has received her initial series of vaccinations as well. In addition, we have access to much higher quality masks than we did a year ago. These advances are significant and worth remembering.
At the same time, our policy responses in Missouri have eroded. Mask mandates have been repealed, including in many school districts in Missouri in just the last few weeks. The intention before Christmas was that many, if not most, St. Louis County districts would go “mask optional” this coming week. These changes were a bad idea at the time, spurred on not by public health guidance but by a vocal minority of parents enabled by misguided state politicians.
When districts began debating changes, it was already clear that cases were rising. We now have a rapidly deteriorating situation in the St. Louis and Kansas City areas. I’ll break down the trends below, but the bottom line is that we are entering the most challenging pandemic period. We need a statewide mask mandate and limits on the highest risk settings. Instead, Gov. Parson will allow the state of emergency order to expire tomorrow night.
Do not let the “Omicron is not as severe” rhetoric lull you - the pressure on our hospitals may well be the worst it has been so far due to the sheer number of individuals who get sick. For unvaccinated individuals, including most children under 11 and all children under 5, Omicron may very well be just as severe as Delta. Therefore, our children’s hospitals face the highest rates of sick children we have seen so far in the pandemic.
In the absence of mitigation strategies, keeping kids in school will be very difficult. Therefore, schools absolutely must step up and lead on keeping their communities safe. Doing so means not only doing every single thing they can to keep your students, faculty, and staff safe but advocating for community sacrifices that prioritize kids. If we genuinely believe kids need to be in school, we must prioritize that outcome.
The honest districts will not wait even a few days into next week to make the right decision. Kirkwood’s superintendent, Dr. David Ulrich, emailed parents today to tell them that masks would be required when students return to school. Moreover, those un-boosted students will have to return to quarantining if they are a close contact of a sick community member. I applaud Dr. Ulrich’s honesty with parents and the steps Kirkwood is taking - other districts must follow his lead!
In light of this, if you have New Year’s plans, it is time to cancel them. Even if you had a successful Christmas gathering, things are significantly worse now, and what worked at Christmas may not work this time around. Please make the decision that is not just safest for you but for your community. We are all counting on it. - Chris
COVID-19 by the Numbers
Total cases in MO: 1,014,228 (+28,217 from last Thursday)
7-day average of new cases per day in MO: 4,031 (+914.86 from last Thursday)
Counties with the highest per capita rates (per 100,000) of new cases per day this past week:
St. Louis (100.36 per 100,000), Andrew (95.22), St. Charles (93.81), St. Louis City (93.44), Lafayette (92.06), Ray (88.25), Atchison (86.74), Jackson (80.94), and Kansas City (80.51)
Total deaths in MO: 16,205 (+195 from last Thursday)
7-day average of new deaths per day in MO: 27.86 (+4 from last Thursday)
Percent of all Missourians initiating vaccination: at least 56% (+1% from last week)
Percent of all Missourians completing vaccination: at least 50% (+1% from last week)
Case and mortality numbers are current as of Wednesday, December 29th. Vaccination numbers are current as of Thursday, December 30th. Additional statistics, maps, and plots are available on my COVID-19 tracking site.
Trends in the Past Week
Rates of new cases have exploded since my last newsletter. We have experienced new all-time highs in just a week in both the St. Louis and Kansas City regions of Missouri. However, the St. Louis region accounts for most of the growth we have seen in the past week.
Kansas City is not far behind but has experienced a much more significant post-Thanksgiving bump than St. Louis has. They were starting for an already high-transmission place. Therefore, St. Louis’s growth looks incredibly steep. Keep both trends in mind, though.
For both St. Louis City and County, the rates we see now are all-time highs. St. Charles County appears to be on a similar trajectory, though because it experienced a higher peak in November 2020, it will take a little bit of extra time to reach record-setting territory.
One thing missing on these time series plots is a “true” representation of what the first wave looked like because testing was so scarce. Hospitalization data from the St. Louis Pandemic Task Force gives us a clue on how to think about that context. Unfortunately, as of today (the last update before January 3rd), our one-day number of in-patients was well above the worst of the first wave in St. Louis. We have also outstripped the seven-day averages seen during the summer 2021 surge and are nearing the seven-day average’s peak from the first wave.
Patients are also presenting at hospitals at a sharply growing rate. Our one-day number of new in-patients on the 28th far outstripped any previous single day of the pandemic, and the seven-day average is comparable to early January of 2021.
One change from the first wave of the pandemic to now is the impact on children. Over the past couple of days, we have seen pediatric hospitalizations rise. The seven-day averages are still relatively flat, but if this holds through the holiday weekend, we are potentially looking at the highest pediatric hospitalization rates of the pandemic next week. I am especially concerned about the rising numbers of young children in hospitals and ICUs.
Keep in mind that a portion of the children below twelve years of age is not eligible for vaccination and, among those eligible, vaccination rates are pretty low. These low rates are despite continuing confirmation that the vaccines for children are both safe and very effective.
Both the city and Jackson County are now at all-time highs for new cases in the Kansas City area. Cass, Clinton, and Lafayette counties have recently surpassed their prior all-time highs, though rates have fallen just a tiny bit. Ray and Johnson (KS) counties are close to setting new all-time highs.
I am very skeptical that the trend for “Outstate” Missouri holds. First, several areas in western Missouri, from Iowa south to just above Joplin, are seeing significant rates of new cases. The same is true of counties outside of St. Louis south to the fringes of the Cape Girardeau area.
Moreover, as of yesterday, many rural counties were beginning to experience slight increases in their seven-day averages. Keep in mind that St. Louis City and County escalated remarkably quickly from relatively low rates of new cases to all-time highs. There is absolutely no reason to think that this will not play out in other parts of Missouri as well. For example, look at all the slight up-turns in counties around Springfield and the steeper turn in Hickory County in particular.
As we begin to see rates rise around Missouri, it is critical to remember three additional points. First, hospitals are already facing dramatic staffing shortages and burned-out providers. This situation is worse, I believe, than at any point in the pandemic. Second, the Delta variant is driving much of the rise in new cases (except perhaps the recent spike in St. Louis). So, we are not yet really seeing the full effect of Omicron.
Third, beyond the usual challenges with broken-up case reporting because of Christmas and New Year’s, we are also facing a new source of uncertainty in our data. Many of us, myself included, relied on at-home rapid tests to lower the risk associated with seeing family last weekend. Unfortunately, people rarely report these test results to local health departments, so they never appear in my charts above. Of course, you can call your local health department, but this is not widely known. Moreover, some departments have stopped all COVID-19 related work in response to the disastrous ruling in Cole County, and many people may not see a reason to share their test results with others.
What does this mean? Despite the pressing need to understand what community transmission looks like, local health departments are increasingly unsure how many individuals are positive. The New York Time’s reporting suggests that this may be the final straw that breaks the back of daily case counts, especially as we look to the other side of our Omicron wave later this spring.
In the meantime, remember that the data in my plots and maps show artificially low case rates. This situation has always been the case, though the underlying reasons have shifted over time. Instead, think of them as indicators of trajectory. The actual number of cases is less significant than the relative magnitude and the slope of the trend line.
I’ll end my last message of 2021 with some hope. South Africa announced today that they are not experiencing the mortality of prior waves. Of course, there are fundamental differences between South Africa and Missouri. Still, I hope we follow this pattern and add as few new neighbors as possible to the list of more than 16,000 Missourians who have died in the last twenty-one months. This outcome is not inevitable, though, and the policy decisions Missouri makes in the following weeks will inform just how tragic the Omicron wave will be.