JOHNSON CITY, Tenn. (WJHL) – While nothing is certain in the COVID-19 projection game, regional death rates are almost certain to begin rising again within weeks, Ballad Health’s chief of infection control said Friday.
During a conversation about how trends in new cases, hospitalizations and deaths interplay, Jamie Swift said the region’s current decrease in daily death rates remains linked to a decline in new cases that’s now several weeks past.
“We know that the death rate will probably keep level or trend off for a little bit because we had that leveling off of cases,” Swift said. “Now that we have spiked back up I certainly think in six to eight weeks we may very well see another increase in our death rate.”
The age and underlying health status of the people contracting COVID could impact the raw percentage of how many die, but the sheer increase in new cases makes a lagging increase in deaths almost certain.
Tale of two trends
From August 8 to Sept. 21, the 14-day rolling average of new daily cases in Northeast Tennessee dropped from 143 to 74. The 143 figure marked the peak of a five-week jump from just 15 new daily cases on July 4.
But during that July spike, the average deaths per day peaked at just above 1 — right at the end.
Yet as new case rates slowly decreased through late August and early September, the death rate continued rising. It hit a high of 3.57 on Sept. 24.
Then, predictably, the death rate began to tumble — about seven weeks after the new case rate had. That decline has continued even as the 14-day rate of average new cases has jumped from 80 to 141 in just 12 days.
That rapid rise has Swift concerned on multiple levels.
- It’s been accompanied by an increase in positivity rates, especially in Sullivan County.
- Its spread appears to include a segment of the population that interacts with the public.
- Even when it declined, the new case rate didn’t come anywhere close to desired levels that indicate a true handle on community spread.
- And — understandably but regrettably in her mind — people may have gotten too optimistic when that trend did fall by half from early August to mid-September.
“Even though our numbers were coming down and leveling off, they were leveling off at a rate higher than we wanted,” Swift said.
Ballad leaders were hoping to see rates drop to a 14-day average of 5 new cases per 100,000 per day. Instead, that low point Sept. 17 of 74 represented 14.7 new cases per 100,000 population per day — 74 divided by 5.05 for the 505,609 people living in Northeast Tennessee’s seven counties.
Interestingly, that is just above the CDC’s “red zone” of 100 new cases over seven days per 100,000.
“As people started to see numbers coming down they probably started getting a little more comfortable and now we’re starting to see spread actively increase.”
That 14.7 figure is now distant in the rear view mirror. The curve flattened in that range from Sept. 16 through Oct. 4 but has exploded since.
It dropped Friday — a day with extremely low test numbers but still a high positivity rate — but only from 28.4 to 28.0. And many of those testing positive, Swift said, are in roles that put them in contact with the public.
“What that tells me is we have a lot of people in the community who may be infected, may not know it,” Swift said. “They may either be asymptomatic or they may be in the infectious period before they develop symptoms – they’re going about their normal life and that’s how those people are most likely getting infected.”
The counterintuitive path to bending the curve
One of the most concerning factors has been a rise in positivity. Sullivan County has seen its percentage of people positive as a percent of total tests nearly double over the past several weeks.
The 14-day positivity percentage for Sullivan was 7.12 percent Oct. 1. By Friday it had risen to 13.12 percent in just 15 days.
Swift said the region can bend the curve back as the world awaits an effective vaccine that’s still likely months away from widespread availability.
“If you have a positivity rate that’s really high like that, the recommendation is you really need to increase testing,” Swift said.
“If you think you’ve been exposed, if you’ve had any symptoms, even if you think it’s just allergies, you know we really want people to have a low threshold for being tested because we know so much is circulating.”
If people follow that advice, numbers could spike even more in the short term, but Swift said that’s okay. It’s better to know as many of the people who are positive as possible.
“We have to break that cycle of infection and the way we break that cycle is knowing who’s positive in the community, knowing who their contacts are, quarantining those contacts so then you break that spread.”
Along with a new case rate of less than 5 per 100,000, positivity rates are recommended to be lower than 5 to indicate sufficient testing.
In Tennessee, several populous and urban counties have rates approaching that level or even below it. Davidson’s positivity rate (14-day average) is 4.1 percent. Hamilton County’s is 5.9 percent. Shelby’s is 6.8 percent.
That said, Davidson and Hamilton’s 14-day average new cases per 100,000 both sit at around 20 — not terribly far below Sullivan’s 28.
Will anything mitigate the death rate?
Swift said it’s possible that fewer older people will get the virus as a percentage of total cases than did in the first spike. A number of nursing homes had outbreaks and those have killed 96 people so far, but at this point they seem to have abated somewhat.
Just because a lower percentage of people may die during this spike isn’t a reason not to try every reasonable measure to mitigate spread now, Swift said.
“The only way we get through this is people understanding the virus is still here, we still need to do all the things that we talk about,” Swift said. “Masking every time you’re out, social distancing — I still don’t make unnecessary trips.
“Live your life but do it safely.”
And there are plenty of reasons to fear another difficult spike in deaths.
“We know that there are people that have other co morbidities that may not be over 70 but they certainly could still see the worst outcomes from this virus and that risk goes up as we expose more and more people to the virus.”
Finally, Swift answered a question about the recently released “Great Barrington Declaration.” Signed by a number of prominent scientists, it calls for a “Focused Protection” approach aimed toward achieving herd immunity while still protecting the vulnerable.
“Herd immunity is really not a strategy,” Swift said. “If you look there’s not been herd immunity to any virus without a vaccine. And so if we just sit back and say let’s not mitigate any risk, let’s let the virus spread and have herd immunity, we’re literally sacrificing our most vulnerable people.
“As a health care provider I am not ok with being ok with preventable death.”