Week in Brief: Cases are up significantly, primarily within the younger population. Testing is also way up, but % positive increased. Death reports were much lower this week. Hospitalizations are up, but rates of hospitalized/ICU cases are down.
Cases & Testing
This weekly report includes plenty of information about testing and cases, but I’m less focused on daily new cases at the state-wide level right now, because with expanded testing and contact tracing, we’re finding more cases in younger people and more asymptomatic cases. We’re also seeing more localized outbreaks that aren’t well represented by a state-wide numbers. Read more about this shift.
In the graph below, I show cases and testing (note that in some weeks, I am using estimated number of viral tests after removing antibody tests). The percent of positive tests is shown at the bottom of each bar. A low rate of positive tests means that we have to look a lot harder to find around the same number of cases.
If you want to see a table of the raw numbers with additional explanation of the numbers, I created a separate page for the chart of Weekly Testing and Cases.
Early on, we were missing a lot of symptomatic people because we didn’t have enough tests. It’s very likely our actual number of cases peaked in late March, based on state-wide hospitalizations by lab date, which shows that new hospital cases peaked in Georgia on March 29 and then dropped steadily from then until mid-May. In addition, data from Kinsa shows influenza-like illness peaked in Fulton County March 14. We also know that deaths in Georgia peaked in mid-April. As testing has increased and become available to anyone, we are now able to identify many more mild and asymptomatic cases that would have been missed earlier. The CDC estimates case numbers have only captured about 10% of infections.
Many of the cases we’re finding now are asymptomatic, whereas in March and early April, we were only testing the sickest of patients for COVID. In March and most of April, our % positive was over 20%. With the age of new cases trending much younger and more mild/asymptomatic, outcomes should be much better than in early in the pandemic. Doctors have also learned a lot about how to treat sick patients. And by identifying infected people more quickly via contact tracing, we should be able to contain the spread.
Generally, when testing increases, cases increase, and % positive decreases. When testing decreases, case counts are lower, but % positive increases, because we’re testing a higher percentage of symptomatic people. This week we saw an increase in % positive along with increased testing. This is probably partly due to increased spread, but it is also impacted by the recent emphasis on contact tracing. We are now testing coworkers and other contacts of infected individuals, which is helping us to quickly find more infected people, even if they aren’t showing symptoms or have very mild symptoms.
Weekly Increase in Total Cases
Cases were increasing very rapidly in late March and early April, doubling or more every week. Recently, the increase has been substantially less, even as testing has increased and Georgia has reopened. With the increased cases this week, our doubling time has shorted further from last week. At the current rate, our estimated doubling time is around three weeks.
We had a big increase in cases among out-of-state residents this week. There were 1808 new cases in the Non-Georgia Resident category for the week, more than double the week before. These cases are probably a combination of visitors, college students, and migrant farm workers, but without more information, we don’t know a lot more at this point.
Reported Deaths vs. Actual
Earlier in June, we had a lot of reported deaths were from much older weeks. Georgia records deaths by actual date of death on their graph on the DPH web site, and I track this, so that I can report on how many of the reported deaths are recent deaths vs. older deaths.
The week ending June 13, GA DPH entered 108 much older deaths. They later explained this was the result of a new system that helps them match cases with death reports. With this new system in place, I’ve seen a huge change in how efficiently deaths can be recorded now. Most deaths have been added within a week, often sooner, so we should see much less lag and reports of older deaths going forward. This means the date of death graph on the DPH web site should be fairly stable after about a week, and especially outside the 14-day window.
There is still lower reporting on the weekends, and fluctuations from day to day, so it remains important not to focus on the number of reported deaths in a single day. It does not reflect the number of actual deaths that actually occurred that day. Read more about how deaths are reported in Georgia.
In the graph below, the blue lines represent the number of reported deaths in a given week, and the orange squares represent the number of known COVID deaths that actually occurred that week. All of the actual death numbers (orange squares) are subject to change some over time. However, the majority of changes will occur within the two final weeks. This week’s actual deaths are the lowest they have been since I started tracking this in mid-April, and they should also increase less in the coming weeks, although it’s hard to say for sure.
You can see that early on, many more people were dying than we knew, so new death reports were undercounted each week. Now that we are identifying cases quicker and filling in older data, deaths being reported typically exceed actual deaths in a given week. Actual deaths peaked in late April, and they have been declining or level since.
I’ve also seen that in many Georgia counties, deaths have been declining steadily, while a few counties who were mostly spared from the initial spikes in cases back in the Spring are now seeing outbreaks of cases and small increases in deaths. These smaller, later death peaks in other areas of the state are what is keeping our deaths from declining more rapidly.
The week ending June 27 has slightly more deaths than the previous week, lead by deaths in Fulton (8), Gwinnett (6), and Cobb (6), plus Muscogee (8), Richmond (7), Lowndes (5), Troup (5), and Walker (4). Counties with the biggest increase from June 20 to June 27 are Lowndes (from 1 to 5) and four counties that had no deaths the week of June 20, but 3 deaths the week of June 27: Bartow, Bibb, Cherokee, and Jackson. So far, the week ending July 4 is showing decreases in almost every county, although this data is incomplete as additional deaths will be added in the coming week.
Reported Cases vs. Actual
In the graph below, the blue lines represent the number of reported deaths in a given week, and the orange squares represent the number of known COVID deaths that actually occurred that week, as of July 4. All of the actual case total (in orange) are subject to change some over time. However, the majority of changes will occur in the final week of the graph, which is likely less than half of the final amount it will be, and the previous weeks should see smaller changes.
You can see that weekly reported cases have tracked fairly closely with actual cases, until recently when we’ve started to see more delayed reporting due to increasing lab volume. (And the most recent week, which is quite incomplete.)
Current hospitalizations declined significantly from their highs in April, which means less people are in the hospital with COVID than they were earlier on in this pandemic. Current hospitalizations have started increasing in recent weeks after they hit a plateau in late May. More discussion about this number and other hospitalization data is available on my Hospitalizations page.
One key thing to note when comparing current hospitalizations from recent weeks to earlier dates is that there’s also a category of hospitalizations called PUI (“patients under investigation” for COVID). When testing was limited, these numbers were almost as high as confirmed COVID patients. In April, when we had about 1600 COVID + patients in the hospital, we also had 1300-1400 PUI at any given time. Now with improved testing, we have significantly less PUI compared to confirmed COVID patients, so the number of COVID + and PUI hospitalizations combined is likely less than it was before.
Georgia also reports on how many patients test positive for COVID while hospitalized, as well as how many cases have been identified in the ICU. I’ve also graphed the percentage of cases identified in the hospital. The hospital case number used to have huge one-day reporting spikes every few weeks, and you can see that in the higher numbers the week ending May 2, May 16, and June 6, but they seem to have corrected that reporting lag. I also show the percent of cases that require hospitalization or ICU admission. These rates have been declining, so while cases are increasing, they seem to be milder cases requiring less intervention. Read more about the two different hospitalization numbers.
Hospital utilization, which I have added to my Hospitalizations page, fluctuates, but ICU (critical care) beds and ventilator usage have been fairly stable. Keep in mind, these are primarily not for COVID patients. Hospitals have re-opened to important elective surgeries and people are less afraid to go to the hospital now, which increases bed utilization, especially in the ER and general beds. Like hotels, hospitals need to fill beds in order to stay financially viable, and hospitals frequently run at 85% utilization or higher in their ICU’s especially, and they have surge capacity they can implement if needed.