8 July 2020 Blog Post: COVID-19 in Los Angeles; Increasing Rates, Declining Mortality

8 July 2020 Blog Post: COVID-19 in Los Angeles; Increasing Rates, Declining Mortality

For those who have followed my posts, I have previously referenced how mortality rates have been decreasing in LA County in spite of a rise in cases. Now public health officials, including Public Health chief Barbara Ferrer are grappling for an explanation.
 
Before discussing such, however, it is critical to point out that case rates in Los Angeles continue to rise, now reaching a new record of 19.67 daily cases per 100,000 population (Figure 1). Testing rates remain essentially flat with 155.71 daily tests performed per 100,000 this week and 151.69 the week before. An 11.3% increase in number of cases but only a 2.6% increase in testing. Not a good trend.

Coronavirus has led to 3,534 deaths and infected more than a confirmed 116,000 people in Los Angeles County.

As cases increase, why are we not also seeing increased rates of mortality? As seen in Figure 2, the most recent mortality rate is 42% lower than its maximum seen the week ending 4/24/2020. (But, before celebrating this welcome trend – it is critical to note that the mortality rate in Los Angeles remains 19 times higher than that of San Francisco).

Dr. Ferrer trots out the usual explanations for the decreasing death rate – namely that the newly infectious are younger and therefore less likely to succumb to the virus, that spread in nursing homes has stopped (there have been no new cases at skilled nursing facilities in the last 14 days), and that mortality is a ‘lagging indicator’.

“The real factor that is playing into the numbers we are seeing now is that we often have a lag time in deaths, from when we start seeing increases and hospitalizations,” Ferrer said. “Deaths will often lag behind slightly as much as one, two, three weeks.”

But data in Los Angeles directly contradict her point about lag time in mortality. Death rates have been in steep decline for at least 8 weeks, case rates have increased in every week save one (5/8/2020) since March.

More likely what is occurring (and is covered in introductory Statistics) is Simpson’s paradox. This phenomenon occurs when pooled data cause an apparent reversal of the true data trend. The classic example is one of apparent gender bias among graduate school admissions to University of California, Berkeley showing that men were more likely than women to be admitted. However, when examining the individual departments, it was shown that women tended to apply to competitive departments with low rates of admission whereas men tended to apply to less-competitive departments with high rates of admission.

So in the case of COVID-19 deaths, it is possible that mortality rates are indeed rising in every age group – but the overall death rate can appear to be decreasing as the proportion of cases in young people rises and falls among older people.

Los Angeles County does not publish age-specific details of each case, opting instead to tabulate totals by age group to date. With more granular data, it would be possible to better understand the true risk to Los Angeles County.

But, nevertheless, mortality rates are still 19 fold higher in LA than in San Francisco.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

Dig deeper into the health topics you care about most by signing up for our newsletter.

by submitting this form you indicate you have
read and agree to our Privacy Policy and Terms
of Use. Please contact us to for us for more
information.

7 July 2020 Blog Post: COVID-19 and Riverside County: The United States in Micro

7 July 2020 Blog Post: COVID-19 and Riverside County: The United States in Micro

On the evening of May 8th 2020, the Riverside County Board of Supervisors felt they had seen enough to make an informed decision. There had been 4817 COVID-19 infections and 204 deaths in the County since the outbreak started,
 
That night the Supervisors voted 5-0 forcing Dr. Cameron Kaiser, the county’s public health officer, to lift most of his orders. Prior to that fateful night, Riverside County’s response was, at first, more restrictive than the state’s. From April to early May, the county required face coverings and social distancing in public to prevent COVID-19’s spread at a time when the state and federal governments merely suggested those measures. He did so the following day and also followed the board’s wishes in exempting trade schools and higher education from a school closure order.
 
Also on May 8th, Riverside County Sheriff Chad Bianco said he had no plans to cite people for defying mask-wearing orders or disregarding other public health directives. Appearing on “Fox & Friends” with host Steve Doocy, Bianco explained that the “situation” in Riverside County under state orders is “nothing like they told us it was going to be in the beginning.”
 
For one week, the Sheriff and the Supervisors probably thought they had done the right thing. New infection rates declined to 3.89 daily cases per 100,000 population. That was the last week of coronavirus being “nothing like they told us.” Since then, it has been exactly as we feared. Currently, Riverside County has a new infection rate of 19.30 daily cases per 100,000 population, an increase of 496%.
 
Riverside County’s spike is so concerning, Governor Gavin Newsom ordered the accelerated reopenings to be dialed back. Restaurants can no longer have indoor dining and bars were ordered closed. The county’s positivity rate for COVID-19 screening is running close to 12%, while the state’s preferred benchmark is 8%. Hospital bed usage rate countywide is between 61% and 68%. Intensive care bed usage is between 95% and 99%.
 
Riverside County is but one of the many stories that now dot the United States’ COVID-19 landscape. Without a doubt, similar faulty decision making lies behind each local outbreak which, in turn, has spiraled to encompass the entire country.
 
And for those making decisions in each of these municipalities – in California, Texas, Florida, Arizona, Montana, Wisconsin, Wyoming, West Virginia, Oklahoma, Nevada, Idaho – coronavirus is exactly like they said it could be.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

Dig deeper into the health topics you care about most by signing up for our newsletter.

by submitting this form you indicate you have
read and agree to our Privacy Policy and Terms
of Use. Please contact us to for us for more
information.

7 July 2020 Blog Post: COVID-19 and Riverside County; The United States in Micro

7 July 2020 Blog Post: COVID-19 and Riverside County; The United States in Micro

On the evening of May 8th 2020, the Riverside County Board of Supervisors felt they had seen enough to make an informed decision. There had been 4817 COVID-19 infections and 204 deaths in the County since the outbreak started.

That night the Supervisors voted 5-0 forcing Dr. Cameron Kaiser, the county’s public health officer, to lift most of his orders. Prior to that fateful night, Riverside County’s response was, at first, more restrictive than the state’s. From April to early May, the county required face coverings and social distancing in public to prevent COVID-19’s spread at a time when the state and federal governments merely suggested those measures. He did so the following day and also followed the board’s wishes in exempting trade schools and higher education from a school closure order.

Also on May 8th, Riverside County Sheriff Chad Bianco said he had no plans to cite people for defying mask-wearing orders or disregarding other public health directives. Appearing on “Fox & Friends” with host Steve Doocy, Bianco explained that the “situation” in Riverside County under state orders is “nothing like they told us it was going to be in the beginning.”

For one week, the Sheriff and the Supervisors probably thought they had done the right thing. New infection rates declined to 3.89 daily cases per 100,000 population. That was the last week of coronavirus being “nothing like they told us.” Since then, it has been exactly as we feared. Currently, Riverside County has a new infection rate of 19.30 daily cases per 100,000 population, an increase of 496%.

Riverside County’s spike is so concerning, Governor Gavin Newsom ordered the accelerated reopenings to be dialed back. Restaurants can no longer have indoor dining and bars were ordered closed. The county’s positivity rate for COVID-19 screening is running close to 12%, while the state’s preferred benchmark is 8%. Hospital bed usage rate countywide is between 61% and 68%. Intensive care bed usage is between 95% and 99%.

Riverside County is but one of the many stories that now dot the United States’ COVID-19 landscape. Without a doubt, similar faulty decision making lies behind each local outbreak which, in turn, has spiraled to encompass the entire country.

And for those making decisions in each of these municipalities – in California, Texas, Florida, Arizona, Montana, Wisconsin, Wyoming, West Virginia, Oklahoma, Nevada, Idaho – coronavirus is exactly like they said it could be.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

Dig deeper into the health topics you care about most by signing up for our newsletter.

by submitting this form you indicate you have
read and agree to our Privacy Policy and Terms
of Use. Please contact us to for us for more
information.