Daily Status, Sept 17.

 

Daily Status, Sept. 17

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

Situational Awareness


Across the commonwealth of Virginia, there were 1101 reported new cases of COVID-19.  The number higher than the recent trends;  Overall, cases are declining slowly (-0.5%) for the last three weeks. It is worth noting that, over over that time, 17% of the positives have been from colleges; today,  colleges account for 10% cases are.   Regionally, all districts showing are flat to negative case growth. The testing numbers across the state remain ok, but not great, at around 5% positive, which, if Virginia can maintain, will be significant.  

We continue to see enhanced cases across age groups in in the vicinity of Va Tech & Radford (New River Health District), and JMU (Central Shenandoah Health District)(JMU) suggesting the college outbreaks are spreading to the local populations.  This is concerning for two reasons:  1) the local population in these rural areas tend to not practice social distancing that well, and 2) more vulnerable populations are exposed.  At this time, we are also seeing a small uptick in hospitalizations, and possibly deaths among the seniors citizens.

With that said, it It looks like some colleges are either getting a handle on the virus or achieved herd immunity: Radford and VCU are stable now.  Unfortunately, the outbreak at JMU continues to spread, but at apparently a slower rate; only about half the students returned home, and those that did brought the disease home.  The VT outbreak continues to grow, as does the smaller UVA outbreak.  And there are some preliminary indication of an outbreak at ODU. 

Outside of college towns and a few smaller cities/towns, the state is doing well. In fact over the last three weeks, 17% of the probable active COVID cases are affiliated with a the colleges of JMU, VT, UVA, and VCU; those colleges account for 1.5% of the population.  







Regions:

We have completed the tradition from COVID-19 being an urban disease to being a rural disease.  The urban centers of NOVA and Hampton Roads are showing the lowest infection rates whereas the highest rates are in the Central, SW, and NW parts of the state.  





Regional growth rates are (in fraction per day) continue to to show improvement.


NOVA: .990 -- GMU

Central VA: 1.001 --  VCU

Hampton Roads/Eastern VA:  0.964-- W&M, CNU & ODU

SW VA:  0.964-- VT & Radford

NW VA:  0.982- JMU & UVA

 

The state as a whole is is decreasing with Rt at  0.995.


Daily case count per 100,000 is a often sited metric (below 10 (0.01%) statewide would take VA off the quarantine list .  The following table shows the number per region. Again, NOVA and Eastern VA are doing the best, and NW & SW are doing the worst, but in those regions 35% of the cases were from the colleges.


Daily Cases/100,000 
(corrected for testing)

Region

Last month

Last week

NOVA

 9.3

8.9

Eastern

10.6

9.9

Central

12.4

12.1

NW

10.9

16.6

SW

16.8

16.9


The following charts are for the 5 regions/trends.  For the last month or so, we note that NOVA have been flat at around 300 cases per day, but in the last several days that has dropped precipitously.  Hampton Roads (Eastern) droppeed from about 800 to under 200.  The dive in the last two days may be the result of the weekend low numbers in NW & Central Virginia.  Again, SW VA, even with the lower population, has roughly the same number of cases than any other region. 









Local/Northern VA:


In the trends of case, we can either describe it as slow growth since late June, or flat since early august.  Both equally describe the data. Except, for the last several days, the case load is down 30%.  The cause is unknown.  Note that hospitalizations and deaths remain much lower than the peak in May.









Currently, the all jurisdictions are improving.


Fairfax Co.: 0.989
Arlington Co.: 0.984
City of Alexandria: 0.991
Prince William Co.: 0.992
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. 


About three weeks ago Arlington began enforcing social distancing guidelines -- or at least threatened to.  Since then, there trend has gone from 1% per day to -5% per day Now, Arlington has the fewest cases per capita whereas Alexandria and PW have the most.  The enhanced enforcement (or threat of enforcement) worked, but on 9/16, the Arlington County Board of Supervisors voted to let the restrictions expire at the end of the month.  It will be an interesting experiment. 




What is most noteworthy of the NOVA Zip code map is the the overall lack of contrast.  With the exception of near zero population localities, every part is doing about the same.  One trend that is clear:  a month ago regions north of US50/I55 were had lower COVID-19 rates than those south of the highways.  That is no longer the case. For example, Vienna/Oakton has more cases than Fairfax. 







Every part of Northern Virginia is down last week compared with the last month, except for Vienna. The good news is, in the last week, all of Northern VA is showing less than 10/100,000 cases.    Vienna, while still below the 10 threshold, has increased its baseline rate from about 4 cases a day/100,000 one month ago to about 7 cases per day now. If you look at the Fairfax county chart, Vienna is no longer the part of the county with the least transmission.  The good news in Vienna, though, is for the last week (prior to yesterday), we were averaging 5.125±3.75.  Yesterday, we were at the low of the range, but within it.  I am concerned that, as a community, we are setting ourselves up for a tough autumn.


Region

Last month

Last week

Growth rate (%/day)

Fairfax Co

Vienna

 6.1

7.0

 0.0

McLean

 5.1

4.4

 0.3

So. Alexandria

 11.2

9.9

 1.0

Reston/Herndon

 8.6

8.3

 -3.5

Annandale/Fall Church

 11.9

9.3

 1.8

Fairfax

 7.4

6.8

 -2.7

Arlington/Alexandria

No. Arlington

 6.8

6.0

 -2.8

So. Arlington

11.0

9.7

 0.3

Alexandria City

13.3

10

 3.8

 

Looking at the data, it is possible that the surge in Vienna was related to infected JMU  students returning home, but if that is the case, I would expect the other parts of northern VA to show a similar uptick. 


Age Distribution: 

We see the bump in the age distribution from the JMU students returning home There are about about 150 cases more than I would expect in the last two days for teens.  Since there are probably about 1500 JMU freshman from northern VA (that is a guess), 150 cases is about right.  We are now back to the baseline number for that age group (the polynomial soothing I apply makes it look like there are fewer cases). The concern is that the JMU students will infect their families, but so far, that has not occurred.  If that happens, we will know it in a week. My best estimate is 300 parents, or about 50 per day in the middle aged, which will show up

Note, I will talk about the age distribution in college communities under "college communities"


             <10        0-19.      20-39.     39-59.      60+
  NOVA  0.9897    0.9796    0.9854    0.9911    1.0076 
  AllVA   0.9857    1.0006    0.9909    0.9933    0.9995   





College

Before I get into details, there are at least four COVID hospitalizations in colleges that are from ages consistent with college students.  2 at JMU,  1 at VT and 1 at Radford.  There could be more, if upon admission, the student gave the home address.  In addition, I am basing this on age and location rather than enrollment status (which I do not know)..  There are also ad hoc reports of students in observation in Harrisonburg.

My process combines the VA Department of Health data and what is reported by the colleges.  The report is as of 11:09 ET.   I need to point out that the VDH cases may include cases not affiliated with the university as I am using geographic surveillance.  It is also worth noting that all assume that students feeling ill are going to health service; I have heard anecdotal reports of people not doing that because they did not want to quarantine.  

Note:  I have also added estimated cases within the last week.  


RED means there is clear evidence for community spread
YELLOW means there may be community spread; still ambiguous
GREEN means no evidence of community spread
BLACK means they went online.

College

% Positive

VDH Cases*

Estimates Cases Tot/LW **

Dashboard Cases

% of population infected ***

Va Tech

16.7

1051 

3606/1106

769

10.6

GMU

3.4

16

32/0

21

0.1

UVA

13.1

215

625/195

330*****

2.6

ODU

8.0

33

53/42

51*****

0.3

JMU

37.3

1234

5798/1615

 1376

27.3

CNU

7.0

0

0

1******

0

UMW

6.2

0

0

8*****

0

Radford

28.6

551

 2634/210

397*****

33.0

VCU

5.6

149

 309/20

227

1.0

W&M

2.2

0

0

<10

0


*
 estimated from the number of cases in the zip codes associated with the university removing the pre-student arrival case rate
** 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.
****** Active cases, not total cases




Large Scale Community Spread:

RADFORD 

I would consider moving Radford to the "Watch list" once the percent positive drops below 10%.  But, with close to 30% of COVID tests being positive, I can not move it.  Note that this is a significant improvement from two weeks ago when 80-90% were positive.  By all metrics, though, the outbreak seems to have peaked.  It is not clear how many students at Radford contracted COVID-19.  It would not surprise me to see enough that the community, when isolated effectively has herd immunity (meaning over 60-80% contracted COVID-19).  The only way to know would be antibody studies.  Hopefully, VDH will look into that. 

JMU is online.  JMU has been fairly transparent with the situation, but could not get ahead of it.  At this point, it is mitigation.  Harrisonburg is still running 37% positive.  They sent the healthy students home, and are allowing the positive to stay on campus, which is critical for society as a whole.  It is worth noting that sending the on-campus students home seems to correlate with an increase in cases in that age group in Northern VA.   There are now multiple hospitalizations in Harrisonburg that are of the age group expected for College students.  JMU did not require testing prior to arrival on campus.
We have seen the prevalence of the virus in Blacksburg increase with the return of the students. Each day, there are 30 and 100 new cases validated; anecdotally, I have heard stories of students not getting tested because they do not want to quarantine.    The most concerning aspect of Va Tech is 20 % of the tests are coming back positive.  That suggests that either they are rationing tests, or they are undercounting.  Either way, I estimate indicate more than 5%, and probably 10% of the student body is positive.  Short of a two week pause, I am not sure how Tech will contain the spread. It is worth noting that the outbreak has also impacted the VT football team; they are having to halt practice and delay the start of the season. Virginia Tech tested only on-campus students.  
With the students return, there has been a marked increase in cases. The earlier community spread may be contained. With a small decrease in percent positive, UVA could return to the watch list.  UVA tested all students prior to arrival on campus.

Watch List: 

VCU

VCU seems to have the virus under control -- it was promoted from RED to YELLOW.  The numbers have shown no significant increase in the last several days; quarantine and isolation space is becoming more prevalent.   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 & Mary -- so far so good -- No evidence of community spread.  There are now cases on campus.  W&M says less than 10 cases, but they also are reporting .11% positive in the last week when they tested 2800 students.  That suggests 3 students on campus are positive, which is consistent with the state numbers for Williamsburg. It is worth noting that pre-arrival testing has identified 20 cases, which were not allowed on campus. W&M tested all students prior to arrival in town. 

CNU -- Students have been back upwards 1 month. A few cases.  Under control.

ODU -- Nothing noteworthy.  My concern with ODU is they did not test the students, so there may be asymptomatic/presymptomatic spreaders on campus (see JMU). Yesterday, they updated the dashboard to show 51 cases on campus, which is about what I would expect based on non-tested students.  But the dashboard has not been updated since Sunday. They update it once per week.  We will see if they infected other students.  

UMW -- Nothing noteworthy.  A few cases but they just returned.  I am concerned because they did not test all students.

GMU -- Nothing noteworthy.  GMU tested all students.

College Communities:

When I started talking about communities, the  focus was on the safety for incoming students.  Unfortunately, that concept as changed.  Now, we are seeing the colleges impacting the surrounding communities.  If we look at the age distribution of cases in the communities of JMU, Radford and VT (New River, and Central Shenandoah health districts), we see that, starting about 1 week ago, number of cases for non-college age citizens is increasing -- about two weeks behind the college age curve.  This suggests the disease is infecting the general population.  The numbers are small, but it is very concerning because that age groups does not have a good outcome.  







Commentary:


Donald Trump yesterday said that without blue states, the death rate would be much better.  He needs to stop using alternate facts.  Red and blue are defined by who the state voted for in 2016.  47% of the deaths come from red states, which is about his percent of the popular vote.  But, more importantly, after June first, when states could use science to mitigate the virus, 65% of the deaths are from red states.  Facts matter.



I have thoughts on the spread in college communities which can be seen here.  This is the same link at the top of the write-up.

The CDC did a study comparing a group that contracted COVID to one that did not. The key finding were dining in bar/restaurants (not takeout) correlated with COVID exposures, particularly when masks were not worn.  That was the second riskiest activity identified, second only to having an infected family member in the house. The study can be seen here.

I try to be apolitical in this blog, but today, I want to say:  we need to demand honesty from our national leadership with the pandemic.  When our leaders are talking about "not panicking the people" what they are saying is we unable to make informed decisions about the disease or other things.  


Also, Masks are our friends.  Masks significantly reduce the risk of disease transmission, if they are worn correctly.  The purpose of masks are 1) to contain any virus you may discharge through breathing, talking, coughing or sneezing, and 2) to protect you from incoming viruses with your breathing.  In order for the mask to function, it must cover the mouth and nostrils.  The chin and neck do not need protection (unless you have a tracheotomy).  I am seeing too many people with the nose and/or mouth exposed.  And I have even seen town employees with the masks that way.  Confronting does not seem to work, except sometimes with a neck mask, people just forgot to put it on.   It is not enough to have a mask; it most be worn properly.  WHO put the following graphic:





I try to keep my political biases out of it.  Unfortunately, some politicians have turned data into a political issue.  Yesterday, while driving home, I heard a prominent politician state that the America's numbers would be much better if we excluded NY.  I am not sure when the quote was captured.  But, I am a data and science person; based on that, I wonder how policy can follow when data is fabricated.  The data for cases in the USA, with and without NY are shown below. In April, our cases there about 50% NY, since then NY has been doing better.  Since June 1, NY has accounted for 1.5% of the cases nationally, even though it has 5.8% of the population.  So, currently, NY is outperforming the country.  Even including the early days, NY is at 7.2% the cumulative cases, about 25% higher than you would expect.  By comparison, Florida accounts for 10.2% of the cases but 6.3% of the population.  And FL should have known better.  (VA is at 2% of all cases, and 2.5% of the population).

The numbers do not lie.



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

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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