29 September 2020 Blog Post: COVID Chronicles: When Data Don’t Match the Message

29 September 2020 Blog Post: COVID Chronicles: When Data Don't Match the Message

A curious thing happens if you Google Los Angeles County coronavirus – you see a lot of positive messaging.
 
My favorite thus far is “No coronavirus surge post-Labor Day in LA County, officials say” (link below). Quoted in the article is LA County Health Director Dr. Barbara Ferrer who says, “That’s in part because people took actions to make sure we didn’t see that surge.”
 
Other headlines include:
 
“No Post-Labor Day Spike In COVID Cases Pushes LA County Closer To Reopening”
“LA County COVID-19 Hospitalizations Continue Decline, Approach Early Pandemic Levels”
“Los Angeles County Coronavirus Update: L.A. Records Only 1 Death Related To COVID-19 On Monday; No Labor Day Surge Emerges; Lowest Total Since March”
 
As a graduate student in Epidemiology, I took a seminar in outbreak investigation. A fundamental exercise was simply looking at an epidemic curve and being asked “what do you see?”
 
Let’s do the same exercise with Los Angeles’ coronavirus epidemic curve (Figure 1 below). What do we see? We have a graph showing essentially a steady uptrend to a July 17th peak with a rapid acceleration beginning June 19th. The curve the drops quite steadily until 9/11. But the last two weeks have shown increases – from 7.77 new daily cases per 100,000 population to 8.71 and 9.04. This is a 16.3% increase.
On July 3rd the Los Angeles County case rate stood at 26.89. On July 17th, that rate hit its maximum of 29.47 – a 9.6% increase. By my math, a 16.3% increase is greater than a 9.6% increase. So, if we are calling the July 4th increase a ‘surge’, then the percentage increase since Labor Day is even more of a dramatic surge.
 
The process of looking further into data is best summed up in Hans Rosling’s book Factfulness (which I cannot recommend highly enough). In it, he says ““If you are offered one number, always ask for at least one more. Something to compare it with.”
 
In this case – if you are told that there is no ‘surge’, it is worthwhile asking Dr. Ferrer how she defines a “surge” numerically. Because it sure seems like we are having one, when you compare July 4th to Labor Day.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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26 September 2020 Post: Discussion of the San Francisco “miracle”

26 September 2020 Post: Discussion of the San Francisco “miracle”

Discussion of the San Francisco “miracle” in regard to #covid_19 containment may not be entirely accurate. While I agree that @SF_DPH has had an extraordinary response to coronavirus (with 99 deaths to date), the city still has ongoing challenges. This epidemic curve shows that SF suffered the same July 4th weekend spike as did the rest of the US and continues to have an incident case rate (7.51 new daily cases per 100,000) the exceeds containment.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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25 September 2020 Blog Post: COVID-19 Update A Tale of Three Counties

25 September 2020 Blog Post: COVID-19 Update of Three Countries

Three regional counties believe that they have qualified to ‘reopen further’ based on their latest COVID-19 numbers. These include Los Angeles, Orange and Riverside County. This post explores their epidemic curves and how they arrived at the cusp of ‘reopening’ (or, more accurately, if they actually qualify for such – spoiler alert: two don’t).
 
On September 22nd,L.A. County Director of Health and Human Services Barbara Ferrer said that according to state metrics, “we’ve posted number that qualifies us to reopen further.” Really? Let’s explore.
 
The Figure below has Los Angeles County as the blue line. It shows that cases began to accelerate in mid-June, hitting an initial peak the week of July 3rd and then edging further upwards the week of July 17th. Although officials have employed the July 4th weekend surge blame game, in actuality the epidemic curve was already in rapid acceleration before the holiday. The more likely cause of this surge was Dr. Ferrer’s ill fated decision to open gyms, pools, hotels, professional sports and TV production on June 12th.
The current case rate in Los Angeles County is 8.49 new daily cases per 100,000 population. Since 8.49 is greater than 7, the County remains in the “purple” zone or “widespread” which is the highest risk level (see link below for a description of the new risk levels). So, no Dr. Ferrar, Los Angeles has not posted a number that qualifies for further reopening.
 
Neither has Riverside County qualified for further reopening as their rate stands at 8.29 new daily cases per 100,000 population (epidemic curve line in orange). You would think otherwise based on press headlines and health official Dr. Cameron Kaiser’s remarks to the Board of Supervisors. Curiously, the county is listed in the “red” zone of “substantial” spread defined as 4-7 cases per 100,000. By my math, 8.29 is greater than 7. The data which I analyzed comes directly from Riverside County’s reporting website.
 
Another interesting feature of Riverside County’s epidemic curve is a distinctive two peak appearance – no other county has this feature. Riverside County reported quite low numbers from late April until early June – generally about 50% of those rates seen in neighboring Los Angeles. However, after a disastrous May 8th Board of Supervisors meeting where officials unanimously voted to overturn the same public health mandates keeping the county safe, infection rates skyrocketed. Distinct maximums are noted at 7/17 and again 8/14. While the 7/17 peak most likely reflects increased transmission from the July 4th Holiday, the cause 8/14 peak is less clear. Inexplicably, Supervisor Jeff Hewitt is now advocating for Riverside County to again set its own course rather than following State guidelines. I’m not sure why constituents would give the ball in the 9th inning to the same guy who seriously blew his last save.
 
Best of the counties is Orange County. Justifiably vilified for their very public June 8th rejection of public health mandates (and death threats against Health Director Dr. Nichole Quick, who later resigned), the county had a rapid rise in cases soon afterwards, peaking the week of July 3rd. Interestingly, Orange County did not see a surge of cases due to the July 4th Holiday and has had a steady march downwards in cases since their peak. Currently there are 4.85 new daily cases per 100,000 population, placing them in the “red” or substantial category (curiously the State website lists them in “orange” but substantial when orange is actually moderate – is your head spinning with colors yet?). They are on the edge of “moderate” defined as 1-3.9 cases per 100,000.
 
Orange County press reports describe their case numbers as “rosy” (to add to the color coordination confusion). Although they are best in regional class, they did increase from the week of 9/11 to 9/18 (4.78 to 4.85). In fact, all three counties had increased rates from 9/11 to 9/18 which, perhaps, could be a prelude to a Labor Day surge.
 
Time will tell. I’d caution against getting ahead of ourselves – we’ve learned this lesson once – well, actually three times. Once in each county.
 
Los Angeles County Reopening
 
 
 

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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22 September 2020 Blog Post: Riverside County Update Different Month, Same Mistake

22 September 2020 Blog Post: Riverside County Update Different Month, Same Mistake

“Those who don’t learn from history are doomed to repeat it,” is a variation on the famous quote by George Santayana and is applicable to Riverside County Supervisor Jeff Hewitt. He “wants to reject the state’s coronavirus reopening framework in favor of a county-controlled plan that would allow businesses to reopen faster and with no restrictions like capacity limits.”
 
You may remember Supervisor Hewitt from his (in)famous vote to rescind all public health mandates directed at slowing the spread of COVID-19 on May 8th, 2020. During the meeting, 5th District Supervisor Jeff Hewitt said that he didn’t feel he needed to wear a mask, citing conflicting evidence of its benefits, but that he would continue to do so if certain businesses require it. “That’s my personal choice,” he said. “I think that people are smart enough to make [that] decision themselves.”
 
On May 8th, the daily incidence rate of COVID-19 stood at 4.63 daily cases per 100,000 population. By July 17th, that rate had climbed to 31.46 – a staggering 679% increase (Figure 1 below).
Past ineptitude not withstanding, Supervisor Hewitt doubled down on his ignorance stating: ““Putting some arbitrary percentage point on something doesn’t address anything … you end up one size fitting nobody,” Hewitt said.
 
The State’s current color coded scheme isn’t arbitrary but instead is a carbon copy of the metrics set out by the Harvard Global Health Institute (Link below). Currently Riverside County has 8.29 daily new cases per 100,000 population placing it in Harvard’s Yellow Zone which recommends rigorous test and trace programs. At 10 or more cases, Harvard describes a ‘tipping point’ of accelerated spread where stay-at-home orders may need to be resumed.
 
Supervisor Hewitt has advocated for poor public health policy in the past, leading to unnecessary morbidity and mortality in Riverside County. Lest he (and the other Supervisors) presume that their foray into the public’s health was without consequence, Figure 2 tells a different story. Mortality rates increased dramatically in July and August, peaking at a rate 3 times higher than that seen that fateful week in May. A total of 949 Riverside County residents have died as a results of COVID-19 since May 9th, 2020.

LINKS:

Supervisor Hewitt Story Link

Harvard Global Health Institute

 

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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18 September 2020 Blog Post: The San Francisco “Miracle” and Need for Continued Vigilance

18 September 2020 Blog Post: The San Francisco "Miracle" and Need for Continued Vigilance

A thoughtful article was published this week by Dr. Martha Lincoln, a medical and cultural anthropologist at San Francisco State University. She points out (with numerous examples) that countries viewing themselves as “exceptional” or “outliers” have had worse public-health outcomes when it has come to COVID-19 response (link).
 
Similarly, San Francisco has been viewed as having an “exceptional” early response to coronavirus particularly at the outset of the pandemic. In fact, I have used the San Francisco Health Department as a example in my blog posts of a constructive epidemic response.
 
Their epidemic curve (presented below), with rates once 10 to 15 fold lower than those in Los Angeles suffered the same mid-July surge seen here. For the week ending 9/11, Los Angeles had 7.53 daily cases per 100,000 population; San Francisco 6.51.
 
Managing a respiratory pandemic requires singular and sustained focus. While we are all cheering lower numbers, these current rates are still too high. According to the Harvard Global Health Initiative, rates between 1-9 cases per 100,000 population require rigorous test and trace programs to ward off accelerated spread.
 
I think any of us when we take an objective look at COVID-19 testing, tracing and supported isolation efforts in California all know that we are hardly being rigorous. San Francisco did an amazing job in containing COVID-19 – until they didn’t.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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17 September 2020 Post: Coronavirus testing rates continue to trend downwards in Los Angeles

17 September 2020 Post: Coronavirus testing rates continue to trend downwards in Los Angeles

 

 

 

Coronavirus testing rates continue to trend downwards in Los Angeles. Making it more difficult to interpret lower case rates when the amount of testing has decreased so dramatically.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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14 September 2020 Blog Post: COVID-19 Case Trends in Los Angeles and Santa Monica

14 September 2020 Blog Post: COVID-19 Case Trends in Los Angeles and Santa Monica

It has been a few weeks since I have published case rate graphs for our local area. Presented below, I have graphed together LA County numbers (in blue) and Santa Monica numbers (in red).
As coronavirus began community spread in March and April, the County as a whole fared more poorly than Santa Monica. This became particularly clear in the late June to early July acceleration and peak when case rates were up to 6 times higher in LA County as compared to Santa Monica.
 
Since that time, however, an interesting phenomenon has occurred – Los Angeles County cases are dropping steeply with a clear downward trend. On the other hand, Santa Monica numbers are fairly steady – emblematic of a ‘smoldering’ epidemic.
 
The danger with these steady numbers is the risk for a geometric explosion in cases. Much like the embers of a wildfire that persist, a slight change can cause this to flare up again. You need to look no further than the case rates in the County for the month of May. County officials at that time pushed for reopening erroneously thinking that steady case rates were a sign of an outbreak under control. We were then left with the disastrous effects seen in June and July.
 
Data for the week ending 9/11 are not yet available, but it appears that Los Angeles County and Santa Monica are on case rate curves that will soon cross. The last time that Santa Monica had a higher case rate than Los Angeles County was the last week of March.
 
Neither the County nor Santa Monica are close to a more wide reopening according to the latest State guidelines. We would need to decrease to less than 1 new daily case per 100,000 population.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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