Daily Status, Sept 1

 

Daily Status, Sept 1:

Reminder:  any sections that are unchanged since yesterday are grayed out.

Summary/Situational Awareness

Again, today's concern are with the universities.   Only two schools are  doing well (W&M & GMU), with no increase since the students arrived.  UVA is showing increases, but probably consistent with the increased populations -- they have moved to monitor closely.  Meanwhile, there is community spread is present at Virginia Tech, JMU, Radford, and VCU.  It is worth noting that Tech and VCU seem to be managing it at this time.  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 1021 reported new cases .  This win lines average number of cases in the last three week Overall, cases are increasing at about 1% per day. It is worth noting that 20% (208) of the cases are directly related to colleges.  Regionally, all parts of VA are increasing except eastern VA. SW VA is leading the pack, largely the result of the outbreak at Radford and to a leser extend, VT.   The testing numbers across the state remain ok, but not great.  I would like to see the overall positive rate under 5%

Previously, we saw a strong North-south divide, with locals south of I64 trending worse than those north.  That trend continues, but is less dramatic, rather there are a few pockets in the state where things are trending bad, much of which are the smaller cities with colleges, such as Radford, Harrisonburg, etc.  Outside of those isolated hotspots, the state is doing well. In fact, 20% of the cases are affiliated with a combination of Radford, JMU, VT, UVA, and VCU; those schools account for 1.5% of the population.


Regions:

The statewide numbers are no longer decreasing; they are increasing slowly (less than 1% per day; the growth is solely the result of the outbreaks at some colleges. We need to be cautious throughout the state.  Outside of college environments, we are doing ok.  The best way to describe the situation is: 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 (SW is explained by college outbreaks).  We are around the median for all states.


What is most noticeable is the worst part of the state per capita is SW VA.  This is a dramatic change from the situation earlier.  SW is high mostly from the outbreak at Radford.  It is also with noting that Eastern VA's rate of improvement seems to have curtailed, and they actually show their first week over week increase in a month.



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


NOVA: 1.003

Central VA: 1.002

Hampton Roads/Eastern VA:  0.980

SW VA: 1.019

NW VA:  1.013

 

The state as a whole is is increasing at 1.003.


The following charts are for the 5 regions/trends.  It is worth noting that for NW and SW VA, the recent uptick are 100% the result of the case surges at Radford & JMU. Note that the total number of new cases SW VA is similar to East/Hampton Roads and Northern VA (though NoVA & Hampton Roads have a significantly more people than SW VA).


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, but over the last week, has started to increase again.  The current rate is  more than 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, most jurisdictions are showing slight increases


Fairfax Co.: 1.009
Arlington Co.: 0.989
City of Alexandria: 0.974
Prince William Co.: 1.005
Loudoun Co.: 1.001

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. 

The weekly case numbers are nearly uniform in all jusridictions, with the exception of Prince William. 





What is most noteworthy of the NOVA Zip code map is the the overall lack of contrast:  the bad areas are doing better, and the good areas are doing worse, with the exception of two areas near the fringe of "Northern VA".  (The state would call those NW VA).  

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: 

NOTE:  THIS CHART WAS NOT UPDATED.  I have a data processing error at the moment.

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. 

The concern with college students are long-term impacts (unknown), and spreading to more vulnerable members of the community (like me).   

My advice for colleges in trouble are not to send the students home -- at least not without tests.  Most students will be fine; the home communities could be problematic.


College

% Positive

VDH Cases*

Estimates Cases**

Dashboard Cases***

% of population infected ****

Va Tech

2.2

115

115

178 

0.3

 GMU

5.6

 34

 39

 7*****

0.1

 UVA

11.0

 31

 69

 89

0.3

 JMU

26.7

 285

1521

 513

7.2

 CNU

6.7

    0

    0

7

0.0

 UMW

9.7

    0

    0

 NA

0.0

 Radford

79.0

  357

 5633

 98*****

71.1

VCU

9.2

   73

 133

 97

0.4

 W&M

1.9

    0

    0

0.0

* VDH cases are based on the cases either in the zipcodes containing the student population or the community.  In addition, I remove the rate of cases prior to students arriving on campus
** 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.  If the % positive is very high (>40%) I am likely overestimating the numbers.
*** Dashboard cases are only counted if I can find the dashboard.  In some cases, it is difficult to distinguish positive tests from cases (1 case may have multiple positive tests; that is mostly at VT).  I include active cases if reported, otherwise, I use total cases.
****% population uses the total reported number of students rather than just those on campus; it may be off when the percent positive is above >40%.
***** Old data, not updated for today.

Large Scale Community Spread:

RADFORD (linked to the university Dashboard)

First of all, Radford is now at 357 reported cases in the last week or so.  And, on the last week, they are running 79% positive(based on the ZIPCode 24141). 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 more than 60% of the student body have been infected, though at this point, herd immunity should kick in soon. It seems that Radford has testing capacity of about 60 per day (based on the number of tests 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.  The students, though, are noticing, with classes being half empty.

JMU

JMU is open about what is going on, and had a plan to contain the virus. The dashboard reports 500+ cases, which is significantly higher than the community numbers.  Also of concern is the percent positive:  it is 26.7% in the community as a whole, and 27% on campus.  Unfortunately, with the community spread, JMU is at a tipping point: they may be able to stop the spread, but it is possible it is too late. Also of concern is, according to the dashboard, JMU is running out of isolation space.

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.  The concern -- why it is yellow, is the sudden increases, indicating community spread among the student population.  However, the numbers remain low relative to the size of the campus..  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.  The rate of infection so far is manageable, if they can limit the addition spread.  They continue to have significant space for quarantining on-campus students, but the off campus students are on their own.

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.  

UVA

The students are just returning to UVA.  With the students return, there has been a marked increase in cases.  It is not clear if the increase is from community spread or from the disease coming in with the students.  If it is the latter, UVA could drop off the watch list.  One thing to note, is my tracking approach is far more optimistic than the school's dashboard.  That suggests I am tracking too many ZIPCodes, and am not seeing the signal within the clutter.  Fortunately, UVA is forthcoming with the dashboard, allowing me to identify the issue. 

Other schools:

William & Mary -- so far so good -- No evidence of community spread (no cases with several thousand students on campus now.  Right now, W&M on campus is limited to Freshman, Transfers, RA's/OA's and on-campus grad students. (on campus for about 3 weeks).  In addition, there are some upperclassman who live off campus.  The rest will return in the next week or so.  

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


UMW -- Not open yet.

GMU -- Nothing noteworthy; once case is reported; dashboard has not been been updates in several days.

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.  JMU is also growing rapidly. 








Commentary:


FIRST:  DO NOT BRING COLLEGE STUDENTS HOME FROM THE IMPACTED UNIVERSITIES WITHOUT A COVID TEST UNLESS YOU ARE WILLING TO RISK EXPOSURE TO YOUR HOME FAMILY UNIT.  Statistics show the kids might feel sick, but will most likely need no significant medical intervention (99.5%). On the other had, about 10% of the parents will need significant medical intervention if sick.  
  
I want to talk a little bit about the difference between political decisions and science.  Ideally, politics is balancing the multiple facets of the problem to come up with an acceptable solution.  For example, balancing the risk of the pandemic to the cost of a shut down.  Science can advise, but I -- as a scientist -- am focused on what I know, which is the data and the models.  The actions based on that data and model analysis are political decisions.

I am writing this before I have seen Sunday morning's data (actually, writing this Saturday Afternoon).  However, my expectations are the outbreaks at Radford and JMU will appear to be worse (it is possible that Radford has peaked but because of the delays in reporting, it is not clear yet).  JMU could still stop the outbreak.  What they do in response to the outbreak is a different decision.  The political decision will need to look at information I do not have: the capacity of the health system, the impact to the broader community, etc.  There will be negative consequences on society if they just shut down:  sending the sick and contagious home will spread the virus to other locations.  The reality is, of the total number of students at JMU and Radford, the total death toll from the virus will probably be in the low single digits or so -- worst case if everyone gets sick.  And maybe 20-200 will be hospitalized -- and this could be high.  

The problem is, if you send the kids home, they will bring the virus with them.  The parents are in a more vulnerable population.  50 something have a 1-2 % mortality on average, and potentially much higher with comorbidities.  For example, if my offspring were to bring the virus home, I would have to isolate myself -- I have several comorbitities.  

Furthermore, at the universities, many of the staff -- either professors or support staff will similarly have comorbitities.  That is the political balancing act.  

The same decision the public schools had to make.  The kids are not the problem.  The parents, teachers, custodians, and society as a whole are what factor into the decision.
 
It is not just the science of one field.  It is the science of the disease balanced by the social science/implications balanced by the economics.


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

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



A fun video showing masks work, guy style:



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