Daily Status, August 25

 Daily Status, August 25:

Summary/Situational Awareness

Today, across the commonwealth, there were 1005 reported new cases.  This right near average number of cases in the last three week.  Regionally, Northern VA's slow increase continues, but the rate of change is decreasing.  With the exception of NOVA and NW Virginia, the rest of of the state is trending down -- with the leader in the decrease being Hampton Roads/Eastern VA.  It is worth noting that the areas seen growth have a much lower prevalence of the virus, and and much better testing statistics.    The testing numbers across the state remain ok, but not great.

One specific area of concern is JMU.  The area around Harrisonburg has seen a surge in the number of cases:  they were averaging 10 cases per two days; that number increased to 32 cases per two days.  This suggests that approximately 22 cases were identified among returning and new students, or about o case per 1000 students.  The JMU students have not been present long enough to see community spread.  My concern is other schools (e.g., VA Tech) are seeing positive rates through surveillance of  about 0.25%, suggesting there are undiagnosed students at JMU in the greater community that do not know they need to quarantine/isolate.  It would not surprise me to see an explosion in cases around JMU.  

While the areas of I64 are typically doing better, there are now multiple concerning hotspots north of I64.  For example, Warrenton VA reported a 25% growth in cases over the weekend, mostly attributed to a single outbreak in a long-term care facility.  In general, the smaller cities are not doing as well as the more urban parts of the state.   It is worth noting, though, most of the state is doing okay.  There are a few communities experiencing outbreaks, but most are improving..  The previously hard-hit areas around VA Beach and Norfolk are doing much better; at its peak about 1 month ago, Virginia Beach had about 200 cases per day whereas it is now about 50.  











Regions:

First of all, and this is important, eastern VA/Hampton Roads has decreased it case count such that is is now in line with the rest of the state.  


The statewide numbers are decreasing decreasing slowly, and the five identified regions of the state are doing about equally well.  The improvement in the Hampton Roads region is most noteworthy.  In a week or two, if the trends continue, it will have the lowest number of active cases per capita.  While Eastern, Central and SW VA are improving, NW and Northern VA are about flat -- possibly slow growth, but less than 1$. Overall, the regions are doing ok.  We need to be cautious throughout the state. Yesterday, the sky was not falling and today, we are not doing great.  But, as locations go, much of Virginia is improving, no overall region is particularly concerning.  The current 7 day average is between 60 and 80 per 100,000, or about 10 per day per 100,000, which puts us around average for all states.





The three week growth rates are (in fraction per day)


NOVA: 1.004

Central VA: 0.991

Hampton Roads/Eastern VA:  0.996

SW VA: 0.993

NW VA:  0.991

 

The state as a whole down 1.0% per day, being driven by Hampton Roads (down 4.7% per day). 


The following charts are for the 5 regions/trends.  To me, what is most fascinating is each part, even though we are mostly part of the same guidelines.  Note that the total number of new cases in East/Hampton Roads is now about the same as Northern VA (though NoVA has a significantly more people).


One interesting aspect of the virus currently is the trend lines have been constant for 6 weeks:  nothing has changed in any region requiring a new trend line (the last change was when Hampton Roads/Eastern VA started behaving better).




Local/Northern VA:

The overall trend in Northern Virginia indicates, that after correcting, are case load has dropped by more than a factor of 10x since our early may peak, though significantly higher than the early July minimum.  However, over the last several weeks, Northern VA has been essentially flat, at about 240 new confirmed cases a day.  That is twice the rate from early July (120 / day), but down from about 3000 cases per day at the peak (because of the availability of testing, 40% of the tests were positive in northern VA, indicating that only 1 in 8 cases were confirmed).  Hospitalizations and deaths are also down from the peak, but up in the last month.






Still, now, Northern VA as a region is showing the highest growth rate in the commonwealth.  Most of the growth is in Fairfax; the rest of the region is essentially flat.  By county, it is:  

Fairfax Co.: 1.012
Arlington Co.: 1.000
City of Alexandria: 1.023
Prince William Co.: 1.003
Loudoun Co.: 0.991

The growth rate is defined as Rt, or the growth time constant.  Simply, todays number are approximately the growth rate times yesterday's numbers.  This is the exponential time constant.  Fortunately, while the numbers are increasing locally, they are low enough that drastic steps are not really required to stop the increase.

Again, though, while we have positive growth, the absolute numbers are low. 



If we look at the current status by zip code, we see that most areas are doing ok, though along the I95 corridor and US1 is doing worse.  The one exception is the area around Warrenton, but that is caused by a single outbreak at a long-term care facility.  Also, in general, for Fairfax and Arlington County, North of US50/I66 are doing marginally better than south of I66/US50.  No area with significant population is doing really well (<0.1%), but all are less than 1%.

In Fairfax County, the different communities had been following similar overall trends, with higher numbers in May, much lower numbers in late June-Early July, then slow growth to the present, except the absolute rate per capita differs as much as 3x (this is a log plot).   In the last week, most of Fairfax County has continued the slow growth, with the exception of Vienna and  McLean decreasing g about 20% week over week.   My suspicious in the variation is the result of household income:  the wealthier parts of the county can afford to be more careful.





In the last week, we have seen growth in all parts of Arlington and Alexandria.  



Age Distribution:

The age distribution of cases shows growth (RT>1) among all age groups, but the working age people (young adults & middle age) are higher than younger and older groups.  And once again, the Teens and Tweens are showing the slowest growth rate (practically flat).  Once again, the teen bubble's social isolation from anyone not a teen is working for them.  It proves if one only associate with non-infected individuals, then the risk is low.  However, based on observed behaviors among that age group, if the disease expands at all, then there will be a problem.  

One interesting aspect of the case numbers is a comparison of the rate of cases for teens (about 0.02%of all teens in the commonwealth) are reporting to be positive, but the numbers for returning students at colleges are more like 0.25%, suggesting that most of the teens are not being diagnosed, and probably means that only 10% of that age group are sick enough to justify testing.






Colleges:

There are two questions I am addressing with colleges:  what is the rate of the disease in the regions around the colleges (is it safe there), and are the students causing local surges (e,g., UNC).   Right now, the colleges in VA are in reasonably good shape, though the numbers at Va Tech have jumped measurably. It is not clear if that is a result of the testing of incoming students or community spread.  I did hear that 7 students have been suspended from Tech for violating protocols off campus.  VA Tech Suspends 7 students.  If you are sending offspring to college campuses, make sure they are aware to take things seriously.  Also, the dean of students at William and Mary sent out a strongly worded letter to students outlining the consequences of violating the COVID restrictions.

In terms of the local communities around the colleges, I think we can feel confident sending our kids to college (assuming they are not stupid).  So far, the numbers for incoming students at Tech have been low – which is good. Looking at the community number, the apparent growth around Tech is 100% the result of the student return, and the fact that Tech is testing on campus.  This means that the reported cases are showing up on campus rather than elsewhere.  With 11,000 tests, they have identified about 30 infected.  The concern here, though, is the infected students could cause the virus to spread to the regional community, which is not taking proper precautions.   In terms of the surrounding communities, ODU is now in line with UMW and VCU.  ODU is trending in the right direction whereas VCU and UMW are flat over two weeks.  W & M/ CNU are doing the best.  W & M is welcomed freshmen last week, as are some of the other schools.  The regional trends, which is good for W & M, CNU and ODU, but concerning for VT and GMU.  




As colleges start to reopen, there will be an interesting data experiment:  with large cohorts smaller communities, the impact of the colleges on the numbers should be apparent.  My plan for this is to track the colleges by zipcodes, particularly those where I can isolate the students or the students make up a majority of the population.  For example Blacksburg and Virginia Tech.  Right now, I am showing 6 colleges.


Because I am tracking ZIPCodes, I will pick up events unrelated to the campus.  For example on 8/22, there was a 4 standard deviation event near Williamsburg, but it was unrelated to William and Mary; the surge was probably caused by a documented outbreak at the Peninsula, VA jail, which (while outside of the city) shares a ZIPCode with Williamsburg.  


Today, the only school that is showing significant growth is JMU.  JMU just brought the students back to campus, and it seems unlikely that community infection could happen in the limited time they have been on campus. JMU did not test the students prior to arrival on campus, and are trying to capture any positives as they happen.  Unfortunately, since the majority of cases in the college age group are minor to asymptomatic, there will be many people that are infections that are not identified.  Assuming the students returning to JMU (roughly 22,000) have the same prevalence of the virus as VA Tech, they should have 55 students bringing the virus to campus.  So far, JMU has identified perhaps 22 of them (press reports say 10 as of yesterday's numbers (10 cases at JMU).  That means there are many kids running around infecting other people, not knowing they are infected.    In order to have an outbreak, you need irresponsible behavior and the virus.  Most schools are trying to deal with both issues:  testing prior to arrival on campus and threats of suspension/expulsion for inappropriate COVID behavior.  JMU did not test.  Any irresponsible behavior will result in an outbreak on campus.  


With the aformentioned JMU issues excluded , I am seeing no evidence of an outbreak at any other campus in Virginia.


Commentary:

Today I am angry.  I do not have a child at James Madison University.  But the idea of placing 22,000 kids in an incubator with no prescreening testing is irresponsible at best.  Since the majority of teens are asymptomatic (or minimally symptomatic), the majority of infected teens will not know they are sick.  For them, it is not an issue.  Unfortunately, not all cases in teens are minor, and the teens will infect the broader community.  


There is an article suggesting that, while children are less likely to show severe symptoms of COVID-19, they have, on average higher viral loads, which suggests (but is not proven) that then may shed more viruses, and be likely to get the people around them sick.  This includes teachers, parents, and grandparents. It also points out the true tragedy of the situation:  we all know the children need the socialization, but the socialization can become a vector in spreading the disease to more vulnerable populations. Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Responses


I want to get back to Vienna, locally.  Most of my readers are from Vienna.  I believe most of us are following protocols.  In, we are nearly 100% masked, and none of the nose exposed masks.  This is good.  Outside, while it is overall not crowded, people are generally not wearing masks.  The guidelines say 6-10 feet.  However, the virus follows physics not guidelines.  Two feet behind a person is safer (for me) than 10 feet in front.  Two people can probably stand safely back to back, at 1 foot, but not face to face at 6 feet.  The virus is carried with the breath.  The harder the breathing, the farther the breath will go (higher the velocity out of the mouth).  So, yelling at a sporting event is significantly riskier than sitting on a bench sipping coffee.  The mask mitigates the risk by capturing the larger particles, which is much more likely to contain the virus.    

 

Unfortunately, the state has not empowered the town to enforce the mask ordinance.  In commercial sites, the site manager can trespass a person and the police will enforce that.  However, particularly with the current social justice issues, I do not think the police enforcing mask wearing is optimal (Thank you Del. Keam for that perspective).  If you see a problem with a place that sells alcohol, The ABC office can enforce it.  Otherwise, the health department is in charge of mask enforcement, and that is a county organization, and they do not seem to follow up with calls.  Moreover, the problems observed at Waters field is not enforceable by the town, as the county owns the land and issues the permits.  I spoke with the person in charge of permitting and fields for the county, and there is no desire to enforce the governors mask ordinance; he was sympathetic to my concern and will send out reminders, but there is no desire to go beyond that.   If we want to change things, we need to look to the political leaders and not the county employees.  With that said, the town can only enforce the rules at, for example, Southside or Glyndon park.  But the offences that I have observed are at Waters field.  The funny thing is the leagues had to come up with a safe reopening plan (at least VGSL did), but that is not being followed.  

 

The best we can to is to focus on ourselves.  Wear the mask and be safe. This disease does not really discriminate. There is no shame in getting sick, but we all have an obligation to our community to stay healthy. Dr. Fauci says we may have a Vaccine by the end of the year, but it will probably not be until the second half of the year where the majority can be inoculated. Until that time, we are living with COVID. There are numerous studies that show there are potentially long-term effects for COVID (I say potentially because we are 8 months in to COVID-19 globally, and that is not long-term). Including neurological, cardiac, and respiratory issues. And that is with a mild case. Based on numbers from NYC, 1/34-1/40 people with antibodies end up hospitalized – which is presumably a life-threatening case. Some people say, but it only kills 0.5%, which does appear to be true. But 2.5-3.3% have life threatening cases. These are the numbers. If you do not believe me, look them up yourself: Total hospitalizations compared with total probable exposure based on Antibodies. 

 

THERE IS INCREASING EVIDENCE THAT MASKS ACTUALLY DO PROTECT THE WEARER. 

While the mask your mask may not prevent your exposure, it will limit the viral load, which gives your immune system a better chance, and statistically may lead to less severe cases. 

https://link.springer.com/article/10.1007/s11606-020-06067-8.

 

This has been a difficult 5 months so far, and we probably have at least another 5 months to go before a vaccine is available. But anyone reading this is still alive. 170000 Americans are not.  Some say wearing a mask is a sign of weakness – of being a sheep.  I would rather be free to roam while wearing a mask than cooped up inside.

Attribution:

1) You can repost / share in the entirety by forwarding the link, 2) If you want share partial content, you must receive my permission – I need to make sure you understand what I am saying. If anyone sees this work being used without attribution, please let me know as soon as possible. I am willing to have an informed discussion / debate on my approach, but I want to make sure the proper context is captured.

Links: 

Source data is from the Virginia Dept of Health COVID Site

Why I did this:  About the blog

State Actions: Impact on Growth:  TBD

Figure Descriptions:  TBD

Other Sites:  John's Hopkins


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