7 March 2021 Blog: Continued Improvement in COVID-19 Case Numbers – Los Angeles County

social@drbretsky.com
social@drbretsky.com

Two weeks in a row of good news seems to be uncharted territory when it comes to COVID-19 cases in Los Angeles County.  Yet here we are.

For the week ending 3/1/2021 the County’s incidence rate dropped to 6.7 new daily cases per 100,000 (Figure 1).  From the State’s “Blueprint for a Safer Economy”, Los Angeles should have moved from the purple most restrictive tier (widespread) to red (substantial.  Link:  https://covid19.ca.gov/safer-economy/). Curiously, we did not. Test positivity rates are at 2.8% for the last 14 days and 2.6% for the last 7 days – both well within the red tier parameters.

Prevalence (the percentage of individuals who are currently infected with COVID-19 in the County) is now down to 0.2% from a high of 24.4% the week ending 1/5/2021 (Figure 2).

Mortality too (always a lagging indicator) has dropped to 0.4 daily deaths per 100,000 population which is a level last seen the first week of December (Figure 3).

But, confusingly, headlines in the popular press tell a different story:

The mismatch between press headlines and our epidemiologic reality likely reflects a fear driven reaction from County officials.  As such, they have abandoned the tier system entirely (which may not be a bad thing). But by moving away from such, they no longer have a concrete metric by which they can consistently communicate risk to the general public. I first saw evidence of this abandonment when the December/January surge really took hold and Governor Newsom began using ICU capacity as a metric for reopening.  I think that occurred because the incident case numbers were of such an enormous magnitude that it rendered the tier system moot. 

Why might it not be such a bad thing to move away from the tier system? Well, simply stated, California’s tier system is neither tied to actual data nor coupled with any public health initiatives. A better metric is found in the Harvard / Brown Global Health Initiative (link: https://globalepidemics.org/key-metrics-for-covid-suppression/) which suggests that a rate “on the path to containment” is a rate less than 1 new daily case per 100,000 population. Even at our current rate of 6.7 we are still experiencing significant community spread – so rigorous test and trace programs should be in place.

The fact is that we are getting better and only 2 per 1000 individuals in the county are currently infected with COVID-19.  Of course we need to avoid Spring Break travel and continue with risk mitigation efforts – but why? Because our goal should be to drive that incidence rate below 1. 

Contact tracing in the county is improving but is still abysmal – in the past 7 days 51.2% of cases have completed a tracing interview, as compared to 44.6% cumulatively (link: https://globalepidemics.org/key-metrics-for-covid-suppression/).  But to be truly effective, the Health Department needs to have about a 90% completion rate. I have little confidence that they will achieve this goal, given that they have made themselves responsible for the entirety of the vaccine rollout rather than distributing the load. An already overworked, underfunded and now likely burnt out group is unlikely to do two things well. They should ask for help.

So where are we at?  Well we’ve had two weeks of improvement.  Cases haven’t been this low since April 14th, 2020. But we aren’t there yet – we need to be aiming for even lower incidence case rates and our County Health Department needs to work harder than ever to get there.

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