Daily Status, August 27

Bookkeeping:

I am still working on how handle old text.  Enough complaints about the grayed background caused me to nix it.  I am trying a different approach today:  Different font and greying out the words.  

Daily Status, August 27:

Summary/Situational Awareness

Today's concern are with the universities.  First of all, Radford is now at 185 reported cases  in the last week or so.  And, they have only tested 345 people in that period (based on the ZIPCode 24141).  So, they are running a 53% positive rate.  That means that they are unable to test all of the people that are sick.  My estimate is they are probably undercounting by a factor of 10x1.  If so, that means at least 20% of the student body have been infected. I It seems that Radford has testing capacity of about 60 per day; This is the scenario that I have been worried about. Fortunately, at this time, none of the (likely) students have been hospitalized.  It has been very difficult  to get information beyond the state numbers, but anecdotal reports are that kids who are sick are being told not to test, just assume they have the disease (this is from comments on facebook).  If this is true, the state health department needs to get involved.

JMU continues to be watched; the number of new cases has increased by 64 in the week since the students returned; prior to the students returned, the case count has increased from about 3 per day to 8 per day.  And in the last 4 days, it is averaging 12 per day.  Part of that is expected, as the population increased by 20K with the students. Testing is showing a 15% positive which suggest they are undercounting by a bit.

Across the commonwealth, there were about 1121 reported new cases (including Radford).  This below average number of cases in the last three week.  Regionally, Northern VA is now flat to slightly negative.  In fact all of the regions within the state arestrending 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.

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:

The statewide numbers are decreasing slowly, and the five identified regions of the state are doing about equally well:  all are decreasing (for the first time since June), but the absolute numbers remain just above the threshold of many states for entry without quarantine (we are at 11.5/100K, the threshold is 10/100K). 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.  We are around the median for all states.






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


NOVA: 0.998

Central VA: 0.991

Hampton Roads/Eastern VA:  0.974

SW VA: 0.996 -- 0.986 without Radford

NW VA:  0.988

 

The state as a whole down 1.0% per day, being driven by Hampton Roads (down 2.6% 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 for testing, the 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.



None of the counties is showing significant growth; all are essentially flat (or statistically, they are indistinguishable from flat).  This is an improvement over the last several weeks.


Fairfax Co.: 1.001
Arlington Co.: 1.007
City of Alexandria: 0.996
Prince William Co.: 1.001
Loudoun Co.: 0.985

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, the time constants are about 1, and our rate of cases is about 7/100,000 per day.  Ideally, we would be 0, but 7 is much better than our peak in which was around 30/100000K



If we look at the current status by zip code, we see that most areas are doing ok -- The previous hot spots are doing better, and the "blue regions" are not green  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.




Arlington and Alexandria seem to have leveled off, which is positive.



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:

VA Tech
UVA
JMU
CNU
UMW
Radford
VCU
William and Mary

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. Note that Va Tech is in the New River Health District, and the community numbers look bad because of the outbreak in Radford.  If Radford was excluded, the growth rate in New River is 2%, not 12%. (Radford is growing in at 30+%/day). Some colleges are taking COVID VERY SERIOUSLY,  some are not.

In terms of the local communities around the colleges, I think we can feel confident sending our kids to college -- except for Radford.  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 7 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.  


With that said, Radford is experience large scale uncontrolled community spread.  Fortunately, this will not continue for long, as within a week, they will achieve herd immunity the hard way.  Radford is running 50%+ of the tests positive, they have 185 cases since the school reopened.  Except, based on the percent positives, they are severely under testing.  The optimal testing to catch all cases will have less than 5% positive; this suggests that the actual case number could be significantly higher.  Reading press reports, it is clear the university is taking a laize faire approach.  https://www.wdbj7.com/2020/08/26/radford-sees-a-spike-in-cases-radford-university-amends-gathering-size-to-10-people/.  Unfortunately, bringing offspring home from Radford will probably mean the family will be sick.  At this point, it is safe to assume that nearly every student at Radford has been exposed since school began.  I would advise any Hokie parents to make sure there offspring understand the risks of socializing with Radford students at this time.   


JMU is starting to increase again.  The initial surge in cases was probably  the result of "sick/presymptomatic" JMU coming to campus as a result of JMU's decision not to test the student body prior to entry into the campus community.  Today, we are at the point where community spread would start showing up, And we see a small increase in cases. JMU's approach of assuming any incoming case would be symptomatic may be to blame,  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 107 self reported and another 15 from the health service (JMU DASHBOARD). 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.    Parents of JMU students, talk to your kids about what is happening at Radford. 

VCU is also trending up.  At this time, being the first indication, it just moved to a watch list.

With the aforementioned JMU & Radford issues excluded , I am seeing no evidence of an outbreak at any other campus in Virginia.   And only Radford has confirmed community spread.



Commentary:

Today I am angry.  It seems that some schools just do not care if the students get sick.  Radford is exploding.  Colleges across the country are closing.   The only schools that are doing okay had pre-screening and testing plans.   In VA, most colleges went with prescreening.  JMU and Radford did not.  Radford frankly should be quarantined at this time.  JMU may still be ok.    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

Comments

  1. The way the text showed up today was great for me. A big improvement. Thanks!

    ReplyDelete
  2. Thanks David! My husband is a Radford graduate and he said he wasn't surprised by outbreak there. Sigh. Keep up the good work!! - Chrissy

    ReplyDelete
    Replies
    1. I can only hope I am overestimating the magnitude of it.

      Delete

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