Daily Status, August 29

Daily Status, August 29:

Today's report was late because the data are late.  Typically, I report 1-2 hours after the data are published.  Note:  Today, I focused on the colleges.  Much of the text in other sections could be reused.  The figures are 100% from today, though.

Summary/Situational Awareness

Like yesterday, today's concern are with the universities.  Only two (W & M aare showing no increase since the students arrived.  Va Tech and UVA are showing increases, but probably consistent with the increased populations -- they have moved to monitor closely.  Meanwhile, there is large scale community spread at JMU, Radford and possibly VCU. More on this in the section title "Colleges".  The discussion of colleges will take up most of the new discussion

Across the commonwealth, there were about 1217 reported new cases (including Radford).  This with is slightly above the average number of cases in the last three week, but within 1 standard deviation.  Regionally, Northern VA is now flat to slightly negative.  In fact only SW VA is trending up -- and that is the result of the outbreak at Radford.  All of the other regions within the state are strending 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 no longer decreasing.  The increases are being driven by Radford. Three of the five identified regions of the state are doing ok:  flat to creasing, 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). The only region performing poorly is SW VA.  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: 1.007

Central VA: 1.004

Hampton Roads/Eastern VA:  0.979

SW VA: 1.014

NW VA:  1.002

 

The state as a whole is flat. 


The following charts are for the 5 regions/trends.  Looking at the trends, there may be a need to create a new event for SW and NW Virginia. This is mostly due to the of case surges at Radford & JMU. 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 NW, SW VA are showing deviance from the trend line. I may define new events: college students return.  Those will go in tomorrow.





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.

Unfortunately, both Arlington and Fairfax counties are starting to show growth again, at a little over 1% per day.  The other counties are statistically flat.

Fairfax Co.: 1.013
Arlington Co.: 1.013
City of Alexandria: 0.985
Prince William Co.: 1.007
Loudoun Co.: 1.002

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 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:

Before I get into details, I can not find evidence of any hospitalized college student at this time in Virginia. Note: I have added a top level table.  


School

% Pos

VDH # Case

Est # Case*

Dashboard

Case

% sick

Va Tech

0.007

   51

   51

21

0.1

UVA

0.059

    0

    0

40

0.0

 JMU

0.161

   118

  379

190

1.8

CNU

0.048

    0

    0

 3

0.0

 UMW

0.090

    0

    0

 

0.0

Radford

0.560

  234

 2616

98

33.0

VCU

0.075

   49

   74

108

0.3

William and Mary

0.021

    0

  0

 1

0.0

*estimated number of cases is an attempt to normalize for testing limitations. Specifically, I assume at 5% positive, 100% of the cases would be caught. so I normalize it to that value.



Large Scale Community Spread:

RADFORD (linked to the university Dashboard)

First of all, Radford is now at 234 reported cases  in the last week or so.  And, they have only tested 417 people in that period (based on the ZIPCode 24141).  So, they are running a 56% 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 33% of the student body have been infected. 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). Note the dashboard has not been updated in several days, and is using data nearly a week old. There is very little information, and Radford has not been open with the situation.  To give the university the benefit of the doubt, it is possible they have been overwhelmed.  They have limited the size of gatherings.

JMU

JMU is open about what is going on, and had a plan to contain the virus.  Unfortunately, in the last two days, there has been 118 newly identified cases in Harrisonburg.  Looking at JMU's dashboard, there are 16 new cases on campus (health service), and 31 since the school reopened.  In addition, another 159 students self-reported.  Note that the self-reported may not be laboratory confirmed cases.  Also of concern is the percent positive:  it is 16% in the community as a whole, and 27% on campus.  JMU is still in good for on-campus quarantine beds, with a total of 124 beds available.  Unfortunately, with the community spread, it is possible that JMU can no longer recover.

Watch List:

Virginia Tech:

With the return of the students, the population of Blacksburg increases by 2-3x.  As such we would expect a 2-3x increase in case load.  The initial surge was from testing all on-campus students prior to arrival.  That was expected and is now complete.  After that, it dropped back 20 about 2x the pre-student value, which is not surprising with the increase in people.  The concern -- why it is yellow, is the sudden increase, which may be the first step in community spread.  It is being watched closely.  It is not clear if the campus new cases were the result of surveillance or symptoms.    The school has a plan, and seems to be following up with it.  

VCU

VCU is showing signs of community spread. But, so far, it appears to be isolated to athletes.   VCU's problem, though is the space for isolation is and quarantine is near capacity.  Being in an urban setting the zip-code and regional surveillance that works well at some of the other schools is not particularly helpful here.  So, I have to rely on the dashboard.  

Other schools:

William and Mary -- so far so good -- No evidence of community spread(1 case in the last week with 4000 students on campus now).  Williamsburg did report 5 cases yesterday, which is above there average, but they had been below average for the week prior to today.

CNU -- Just reopening; looks ok but the student have not been present long enough to see community spread.

UVA -- Just reopening.  There appears to be increased reported in the dashboard that will show up in the state numbers in the next day or two.  If that happens, expect it to go on the watch list.

UMW -- Not open yet.

Communities:

In terms of the local communities around the colleges, I think we can feel confident sending our kids to college -- except for Radford.  The New River Health District, which includes Radford and VT is showing extreme case growth.  So far, the numbers for incoming students at Tech have been low – so, most of the growth has been from Radford.  The acceleration in cases in the health district is the result of Radford's outbreak.  


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 no longer a problem 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. VCU seems to be much of the problem around VCU.




Commentary:

I have heard repeatedly people complaining that the scientists changed their minds.  The implication is often the scientists don't know anymore than anyone else.  But, the reality is the scientific approach is to continually test the hypotheses to improve the understanding of the situation.  As more data is available, some ideas are shown to be incorrect, while others are shown to be consistent with the data.   Until it was clear that asymptomatic spread (not that common) was happening, the thought was, with aggressive contact tracing and testing. 

Because of the asymptomatic spread, the person that infected you may not know they were sick, which makes it much tougher.  At that point, the only way to stop the spread distance between people.  That accounts for Fauci changing the view that we don't need to shut down to we do need to lock down.

Similar knowledge grew out of questions about death rates -- it is not as high as we initially feared, but it is not non-zero.  On the other side, we are learning there are more long-term consequences than were initially assumed.  Also, initially, it was thought to be primarily a lung disease.  Now, it is clear that more of the body is involved.

So, when scientists change their recommendations, it is not because we no nothing, but rather, we base our recommendations on what the data show.

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

Masks Work -- but the following link does not:  https://link.springer.com/article/10.1007/s11606-020-06067-8.

Kids can pass covid to parents: Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Responses






Comments

  1. Great data. The "masks work" link seems to be broken (as of 8/29/2020, 1 pm, returns "article not found."

    ReplyDelete
    Replies
    1. I can't take credit for the data, only the presentation and analysis. Sorry about the broken link. For today, I noted it. I will try to find the article from another source.

      Delete
  2. Do I understand that Dr. Fauci said we should have a lockdown or that the schools should? Rhetorical, but still: why hasn't Radford shut down?

    ReplyDelete
  3. Seems the students are speaking out. Redford has the information form VDH just like everyone. If they wanted, they could be better at reporting. Sigh.

    http://wset.com/news/local/radford-university-students-speak-out-on-recent-covid-19-outbreak

    ReplyDelete

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