The pandemic is getting worse.
I’m sure you’ve seen the news that we just crossed 10 million COVID cases. We’ve crossed the ominous threshold of over 100,000 infections per day for the past week.
This is really bad. But the top line numbers, which give the biggest “oh shit” factor, are only the tip of the iceberg. These aren’t the numbers that should make you the most frightened.
There’s a consistent pattern that we’ve seen play out over and over again:
Increase in absolute number of infections
2 weeks later, an increase in hospitalizations
2 weeks after that, an increase in deaths
We’re still in a place with 1000 American COVID deaths per day. That number is going to go up before it goes down.
We don’t yet know what 100,000 new detected cases per day means for our hospitals, our ICUs, and our health care providers. But beneath the headline numbers, there’s even greater cause for alarm.
The percent positive test rate is creeping up, and this is really bad news
If you want to understand the trajectory of the pandemic in your area, you need to look at the percent positive testing rate.
The higher this number is, the higher the percent of COVID tests that are performed come back positive. Our trend is bad:
In a pandemic, high numbers of percent positive tests don’t mean that the test is high quality and that we’re identifying the cases. It doesn’t mean we’re getting better at finding COVID.
High percent positive test numbers mean that we’re missing a lot of cases and that there’s a lot of undetected positives that can spread the virus. So when we have a day with 120,000 positive tests with a 9% positive rate, it may mean that we actually have 300-400,000 new COVID cases that day.
Here’s a tracker from Johns Hopkins where you can search this information by state.
When I see these numbers going up, I get really worried. Starting the winter with percent positives going up is particularly worrisome.
Winter has potential to be really bad
We’re going to be spending more time indoors. We’re going to be entering flu season. We’re all getting frustrated with wearing masks and missing our normal social interactions.
But giving up now means a lot of unnecessary suffering.
These numbers mean that the current wave is just beginning. Take the pattern I mentioned above and add the crucial first step that we’re dealing with right now:
Percent positive test rate goes up, which means community spread is increasing
Increase in infections
More hospitalizations
Higher and higher numbers of deaths
We know a lot more about how to treat COVID when people get sick enough to warrant medical attention.
Take a listen to this podcast if you want to learn about how doctors approach what we’ve learned about how to take care of these patients.
But improved COVID care presumes that we aren’t overwhelmed with cases. You remember the flatten the curve graphs from the beginning of the pandemic - the whole point of that concept is to avoid an overwhelmed health care system.
One concern I have is that we lose a lot of the improvement we’ve made in taking care of COVID patients when our healthcare system becomes overwhelmed.
How much worse is the COVID mortality rate when the hospital is filling up?
We don’t know the answer to this. But a lot of quality medical care is predicated upon having the resources to adequately care for patients.
And I don’t just mean in terms of running out of hospital beds, although I’m concerned about that. At the height of the pandemic earlier this year, we had shortages of other vital parts of patients care: medications, ventilators, and PPE.
How thin do we get spread when we start the winter this far behind the 8-ball?
How many more people are going to die?
How much more frontline worker burnout and PTSD will we see?
Taking care of these patients is really hard. It’s emotionally, mentally, and physically draining to be wearing an N95 all day, donning and doffing PPE, and having a unit filled with patients who all have the same disease.
It’s not just doctors. All of our front line workers - nurses, respiratory therapists, phlebotomists, janitors, patient transporters - are going through the same thing. We’re all worried.
The numbers paint a scary picture.
Winter is coming.
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