November 19, 2020
COVID-19 is exploding across the United States! The long-predicted fall/winter surge in the number of SARS-CoV-2 infected individuals has started a climb that looks like the initial steep hill of a crazy roller coaster. And we have not yet reached the top of that big hill. Over the past 10 days, new records of newly infected Americans have been established day-after-day. In the early months of March and April the daily rate of new cases was tracking at 30-35,000 per day. In the second national surge during June to August, national rates for new cases ranged between 50-70,000 per day. As of November 18th, the number of new cases reported to the CDC per day is 164,382.1 The US was at 10 million total cases as of November 15th after 1 million cases were added in the previous 10 days. As of November 18th (just 3 days later) an additional 1.5 million new cases were added taking the count to 11.5 million.2 These numbers illustrate the extraordinary “explosive” rate of increase in COVID-19 across the US.
So, we are in for a terrible and challenging time this winter season. As we have established over time in this blog post series3, the trend-curve for ‘number of hospitalizations’ follows the ‘number infected’ curve by 10-14 days, and the trend-curve for ‘number of deaths’ from COVID-19 follows hospitalizations by another 7 to 14 days. Based on improvements of care and available medications (e.g. dexamethasone), hospital-based death rates from COVID-19 have improved significantly over the past 10 months3. However, the recent surge in the number of new cases by three (3) to six (6) times (compared to July and April 2020 respectively) is predicted to generate an accelerating ‘number of deaths’ to all-time highs over the next 3 to 4 weeks despite those care improvements.
One of the underlying risks of an overwhelming surge in the number of cases is the overload of hospital resources. Hospitals are dependent on the number of available clinical staff that will care for the acute COVID-19 patients. As illustrated in the CDC map above4, this third wave of the pandemic has centered in the upper and central mid-west and mountain states. Mayo Clinic in Rochester, Minnesota is in the center of the COVID-19 firestorm geography. On November 17th, Dr. Amy Williams, dean of clinical practice at Mayo Clinic reported that over 900 Mayo Clinic staff have contracted COVID-19 in the past two weeks.5 “Williams said that 93% of staff who have contracted the virus did so in the community, and that the majority of those who contracted the virus at work did so while eating in a break room with a mask off. Employees also could have been exposed while eating with a mask off in campus cafeterias.”
This Mayo Clinic example reflects how hospital staffs are not immune from the ‘community spread’ even if maximizing PPE and safety protocols while working in the hospital. “The 900 staff newly diagnosed with COVID-19 equals over one-third of the 2,981 Mayo employees diagnosed since the start of the outbreak. When you add in staff who are quarantined or taken offline to care for relatives, the clinic is currently experiencing a stable shortage of 1,500 staff system-wide, 1,000 [of these] in Rochester.” Staff shortages such as these impact the capability of the hospital to serve its role in the pandemic fight.
The highlighted counties on this week’s “Top 10 Counties” displaying rapid acceleration of percent (%) positivity (+) on COVID-19 PCR testing as recorded by https://cv19Dashboard.org are Waukesha and Kenosha counties in southeast Wisconsin. Wisconsin has stood out as one of the worst-hit states in this third US wave in 2020. As a licensed physician in that state, I have received repeated solicitations to reactivate my Wisconsin medical license, leave Texas where I now live and work, and join in the battlelines there. Waukesha is a suburban county directly west of Milwaukee, and Kenosha is directly south. Public Health officials cannot definitively define the source of this acceleration but the recent Election-2020 Rallies in Waukesha and the high southeast Wisconsin participation in the summer super-spreader event in Sturgis, SD are contributing factors.
In Kenosha county, the Local Risk Index (LRI) has been on the rise throughout much of the past 30 days as reflected by the Average % positivity in Viral PCR testing over the past 7-days vs. the previous 7-day average (7/7 graph). This results in a current % Positivity rate that gradually increased to >27, or more than 1 in 4 tested.
Although Waukesha County LRI rates were half of Kenosha County’s rate of on October 27th, the 7/7 of Waukesha County rapidly increased starting October 31st 5-days after an outdoor campaign rally late in the evening of October 25/26th. That is in the typical range of the known incubation period of 4.5 to 11 days for COVID-19. Local news stations reported6 “thousands of supporters [were] in attendance, many without masks, despite the state ranking one of the worst in the country.” Waukesha LRI started to rise 2-days later and the rapid rise from the super-spreader event peaked at 42 over a 12-day period. That means 4 out of 10 of those tested in Waukesha County were (+) for the virus. Thank goodness the 2020 campaign rallies are over.
On the brighter side going forward, the emergence of two very effective vaccines (>90% effective) have been announced by Pfizer and Moderna. This sounds like the bugle blast and a Cavalry Charge on the horizon that will provide an ultimate solution to this oppressive pandemic. The military is standing by to distribute the vaccine materials as soon as approved by the FDA for “Emergency Use Authorization (EUA.)”
About the Author
Peter J. Plantes, M.D. has three decades of experience creating service and delivery solutions that enhance marketplace success and clinical performance for clinical practice groups, academic faculty group practices, hospitals, health systems, and health care organizations. His success stems from his ability to blend and synergize clinical knowledge, operational expertise, financial performance, and collaborative methodology with his deep commitment to serve patients and improve the health of the community. Dr. Plantes has served in CEO & Physician Executive roles for a number of large healthcare clinical delivery networks including regional community networks, academic practices, national hospital networks, international health systems (Chile, Colombia), and corporate managed care/HMO networks.