Author: masscoronavirus_ene3yd

It’s deja vu all over again.  (But worse).  A few days before Thanksgiving, test positivity rates, which had begun to level off after sharply rising through much of the fall, began to increase significantly again. A few weeks after Thanksgiving, positivity rates had once again started to level off and even decline somewhat from the Thanksgiving surge. Unfortunately, on the 24th of December, positivity rates across all testing categories started to increase once again, with no short-term end in sight.

For newly tested individuals, the 7 day trailing positivity rate is at its highest level since April 23rd. Higher education positivity rates are at their highest recorded level, but the state didn’t break out this category until mid-August. Not surprisingly, higher education testing has declined significantly, currently accounting for about 10% of all tests. Conversely, the highest percentage of tests since early September are for people being tested for the first time.  This could be because of the drop in higher education testing (almost all repeat testing) or because more people are feeling symptomatic and are getting tested.

The number of patients in the hospital is also increasing, but at a slower rate than over the past week or month.  So far, hospitalizations are under control, but we haven’t seen the likely surge from the Christmas (and New Years?) positivity and case increases.  The percentage of hospitalized patients in the ICU has held steady at about 20% for quite some time, but the percentage of ICU patients who are intubated is increasing – clearly not a good sign but perhaps only temporary.

The inevitable consequence of rising positivity, case counts, and hospitalizations is deaths.  There had not been more than 100 reported deaths in one day since May 20th, and Massachusetts surpassed that threshold both on December 27th and December 30th, increasing the 7 day average number of reported deaths to its highest level since early June.  The percentage of deaths in long-term care continues to remain (relatively) low, even as the absolute number of long-term care deaths has risen with the total number of deaths.  Case counts have leveled off, although testing is down somewhat as a result of the holidays.

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Testing positivity rates remain at elevated levels, but are down from their highs – just in time for what will likely be a spike as a result of Christmas gatherings. All positivity rates are at levels last seen in early December, with the exception of the rate for repeat testers, which is at its highest level for the fall surge.  Unfortunately, the positivity rates are well above what they were prior to Thanksgiving.

As one would expect, the amount of higher education testing has dropped back to the levels seen at the beginning of September as colleges and universities have closed for the holiday break, and education testing is now only 20% of all testing statewide.

Given the number of current number of daily cases, hospitalizations will inevitably continue to increase for the foreseeable future. We’ve more than doubled the number of covid patients in the hospital, the number of patients in the ICU, and the number of intubated patients in the past four weeks.  While the net increase in these patient counts has slowed somewhat since the beginning of the month, it is likely that hospitals will come under increasing strain, especially several weeks after Christmas.

With test positivity rates down a bit, and the number of tests holding relatively constant, the number of cases are also off their highs.  The number of deaths is still rising, unfortunately.  Today’s reported death count of 81 is the second highest since May – there were 89 deaths reported on December 9th.  (As a side note, relatively high numbers of deaths are typically reported on Wednesday, as there is a lag in reporting deaths that have occurred over the weekend).  The highest number of deaths occurring on a single day during the fall surge was 60 on December 7th.

It has been over a week since my previous post, with very little change in the statistics other than hospitalizations. Testing positivity rates generally are somewhat higher than those reported in the prior post, but the large increases in positivity rates seem to be abating. However, even if the current case and positivity rates level off, the increasing strains on medical and hospital resources aren’t sustainable in the long run.

Keeping in mind that positivity rates are updated retroactively as more test results get reported, the positivity rate for newly tested individuals (that group represents 25% to 30% of all tests) has been essentially stable for over a week. The test positivity rates for other groups are roughly at the same levels as two weeks ago – other than repeat testers, for which positivity is continuing to increase slowly, and is at its highest level in almost five months. This may be because higher education testing, for which the positivity rate remains very low, has declined to about one-quarter of all testing, down from about 40% before Thanksgiving (virtually all higher education testing is repeat testing). Overall testing counts are higher again after dipping somewhat through Thanksgiving.

Not surprisingly, hospitalizations continue to increase.   Unfortunately, case levels from several weeks back were sufficiently high that the number of new admissions to hospitals is greater than the number of discharges (and deaths), which leads to more covid hospitalizations.  The only positive news is that the number of net hospital admissions hasn’t changed much over the prior four weeks.  Unfortunately, that isn’t the case with ICU or intubated patients, as the net patient increases are trending higher.

Cases and death counts are essentially stable from one week ago.  The percentage of deaths in long-term care facilities are also stable, and have decreased substantially since four weeks ago and from earlier in the pandemic. Since deaths overall are significantly higher than four weeks ago, this means that deaths outside of long-term care account for the bulk of the increase from four weeks ago.

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There is some evidence that testing positivity rates are leveling off after the Thanksgiving surge (the surge actually predates Thanksgiving by a few days). For example, the all test positivity rate of 5.7% is at its lowest level since December 1. The repeat tester positivity rate has held steady at 0.9% since late November.  In addition, both the higher education positivity rate, and the positivity rate outside of higher education have declined slightly in the past several days. Hopefully, this trend will continue into Christmas.

Overall testing has declined somewhat, led by the decline in higher education testing – over 40% less testing compared to four weeks ago as students headed home for Thanksgiving.

Good news on the testing front, but not such good news on the hospitalization front, as hospitalizations have been increasing at roughly the same rate for several weeks.  Over the past week, we’ve admitted almost 200 new patients a day with covid (the net is lower because patients are discharged and unfortunately die), but the net increase has declined relative to a week ago.  If we’re lucky, new admissions will stabilize before hospitals become severely overcrowded.

The 7 day average of reported and suspected cases actually dropped slightly from its pandemic high of over 5,000 reached yesterday.  It is amazing that at these high levels this 7 day average increased almost 50% from one week ago (although the averages one week ago might  have been suppressed slightly because of the Thanksgiving weekend). Unfortunately, the 7 day average of reported deaths continued up, reaching a fall surge high water mark (and the highest total since June 7).

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I’m not totally sure there is any point to doing these periodic updates on the covid statistics in Massachusetts, as cases, hospitalizations, and deaths continue to increase rapidly. There are perhaps some signs that test positivity rates are beginning to level off, albeit at staggeringly high levels compared to the lulls of the late spring and summer.  But I’ve been lured into thinking that before, only to be blindsided by higher rates shortly thereafter.

As high as these test positivity rates are, some have held steady or even dropped over the past few days.  Nonetheless, it seems clear that positivity rates this high aren’t sustainable for long without putting tremendous strain on our hospital resources.  As expected, higher education testing began to drop significantly as students headed home for Thanksgiving.   This, coupled with reduced testing outside of higher ed because of the holiday, accounts for the drop in the week-over-week testing totals in Table 1.

And of course, high positivity rates and high numbers of new cases translate eventually to more hospitalized patients, with the 7 day average increasing one-third week over week.  ICU patients and intubated patients each increased 25% week over week,.

Cases continue to increase at a staggering clip.  Over the past week, we’ve averaged almost 50% more reported and suspected cases per day than the highest one day total in the spring.  Deaths, of course, are also rapidly increasing.  Although deaths in long-term care facilities are a smaller percentage of deaths than at any time previously during the pandemic, the absolute number of long-term care deaths are still as high as early July.

It looks to me that things are spinning out of control. By all measures, testing, hospitalization, case, and death statistics are getting worse.  Despite this, I expect no action from Governor Baker other than entreaties to avoid holiday gatherings.

The 7 day trailing positivity rate for newly tested patients is the highest it has been since May 4th, when testing was much less available. It is more than 50% higher than one week ago. The all test positivity rate is 44% higher than one week ago, and the positivity rate outside of higher education is 39% higher.  The all test positivity rate and the newly tested positivity rates have each more than doubled in the past four weeks.

Hospitalizations are back to mid-June levels. In June, of course, hospitalizations were decreasing, rather than increasing.  Over the past week, we’ve added a net 45 confirmed covid patients per day (this accounts for discharges and deaths), and the7 day average patient and ICU count has increased 20% from a week ago and almost two and one-half times from four weeks ago. The number of intubated patients increased by more than 30% in the past week.

The 7 day new confirmed case average is now the highest for the entire pandemic.  Yes, testing has increased significantly, but today’s reported case increase of over 4,600 is staggering (and the total is 5,000 if suspected cases are included). Like hospitalizations, deaths are now at mid-June levels, and the 7 day average has increased over 20% in a week and 70% in four weeks. 

Well, I was wrong. I thought we’d have to wait for about another week to potentially see higher test positivity rates – at the last update four days ago, it appeared rates were headed down coming into the Thanksgiving holiday. But they bottomed last Monday, and have spiked significantly since then. This does not bode well for the coming weeks. (One note: since testing rates are based on the day the tests are performed rather than reported, they change as new test results come in and the dashboard updated. My November 25 update reported the 7 day newly tested positivity rate as 9.3% using data through November 24.   The 7 day rate for November 24th is now 9.9%).

In fact, every positivity rate is higher or the same as it was a week ago, with the exception of the higher education rate, which dropped slightly. However, the percentage of tests associated with higher education fell to about 31% from close to 45% four weeks ago – I’d expect the higher education testing percentages to remain at these levels or drop lower through at least the end of the year as college students begin to return home from fall classes. Since higher education has had the lowest positivity rate among the reported categories in Table 1, this will put upward pressure on the all test positivity rate and the repeat tester positivity rate as the testing mix changes.  The repeat tester positivity rate is at its highest level in over three months.

There had been a temporarily lull in the rate of increase in hospitalized patients; that is now over.  There have been over 1000 covid patients in Massachusetts hospitals for the past tow days, and the 7 day average is inching closer to 1000.  The average number of new admissions for the week ending November 24 is almost 20% higher than the previous week.  ICU and intubated patient averages have continued to rise as well – the 7 day average of number of intubated patients increased more than 35% week over week.

The average number of cases may be leveling off, but it is a bit too soon to tell if this is just a reporting artifact from Thanksgiving.  Given the higher positivity rates from Table 1, I’d guess this is just a lull. Deaths, as a lagging indicator, are continuing to tick up.

Happy Thanksgiving.  Apparently, there were technical glitches that delayed yesterday’s dashboard report, and it covers a 30 hour period, rather than 24 hour period.  Take that with a grain of salt as the number of reported confirmed cases yesterday hit a pandemic record, besting the prior record on April 23rd.  Of course, there is significantly more testing now  (more than seven times as much).

Despite that apparently bad news, most testing positivity rates have been level or moving down the past few days – a definitely positive sign that may come to an end after Thanksgiving.  The 7 day average positivity rate for newly tested individuals (9.3%), the overall positivity rate (3.0%), the higher education positivity rate (0.3%), and the rate outside higher education (4.6%) all hit their lowest levels in over two weeks.  Only the rate for repeat testers (0.7%) edged up. 

The overall number of tests and the number of new individuals tested are at their highest levels ever, which at least partly explains the increased number of cases even with lower positivity rates.

The number of hospitalized covid patients is also increasing, of course, but the rate of increase appears to be slowing, as the 7 day average of net new hospitalized patients dropped from 32 one week ago to 8, more in line with the increases from four weeks ago.  Unfortunately, patients are being admitted to the ICU and intubated at a faster clip than one week ago.   Both these counts hit their highest levels in the fall surge on November 24th.

The 7 day average of cases continues to increase, but at a slower rate than previously (up a bit more than 4% compared to a week ago), reflecting the decreasing positivity rates among newly tested individuals.  The impact of the 30 hour reporting window should be seen in Friday’s report (no report today). Deaths are continuing to edge up slowly, even as the percentage of deaths in long-term care facilities is lower than it had been through much of the pandemic.