December 27, 2020 - Surge on Surge

Surge on Surge

December 27, 2020

ADPH’s reported case count today is an illusion. On its face, 2,170 daily cases (incl. 568 probables) may seem low compared to the prior 7-day average of more than 3,300 cases per day. Scratch the surface, however, and two facts stand out. First, only 4,106 tests were reported, fewer than on any day since mid-November. Therefore, today’s positivity rate is very high - 52.9% -  and the 7-day moving average is in the range of 35-36%. 

Second, statewide hospitalizations rose  to 2,585 patients, 115 more than yesterday (96 reporting hospitals - same as yesterday). On a typical weekday, 105-110 hospitals submit patient load reports. If they all average 27 patients, like the 96 reporting hospitals did today, then we can expect between 2,800 and 2,900 COVID patients statewide. That is 15-20% above the statewide level of hospitalizations on Christmas Eve.

On December 21, 1918, weekly Spanish Flu deaths in the UK had fallen to 1,029 from the peak of over 7,000 deaths during the first week of November of that year. With no available scientific explanation for the drop in deaths, British citizens were anxious to celebrate the Christmas season and the end of the Great War. So, they did so with reckless abandon, despite their overcrowded hospitals. The result: the emergence of a third wave of infections by mid-January, which devastated the country (ultimately infecting President Woodrow Wilson) and lasted until the Summer of 1919.*

So much has changed since 1918 that it may be tenuous, at best, to draw parallels between two pandemics separated by 102 years. Still, we are entering a dangerous period in the next few weeks -some are calling it the surge on surge - when hospitals are overflowing and medical personnel are overstretched. This morning, Dr. David Thrasher, a Montgomery-area critical care pulmonologist, told local reporters that four of his partners and one nurse practitioner in his group are now battling COVID themselves. Only three doctors remain in his group to handle a patient load that is 50 percent higher than last winter. Thrasher added that he is now personally treating 34 doctors.

This is why the new vaccines are so vital and the pace of distribution needs urgent acceleration. Tomorrow marks the start of week 3 since receipt of the Pfizer vaccine and week 2 for the Moderna vaccine. As of Christmas Eve, although Alabama had been allotted 154,500 doses, only 15,286 people had been vaccinated so far. The Pfizer and Moderna vaccines may soon be supplemented by ones produced by Johnson & Johnson and AstraZeneca (AZ’s vaccine is expected to receive approval by UK authorities this week). It may not be long before supplies of vaccine outstrip our ability to administer them. Here are the latest 14-day totals:

12/14 - 2264

12/15 - 3638

12/16 - 4107

12/17 - 4695

12/18 - 5348

12/19 - 4221

12/20 - 2548

12/21 - 2380

12/22 - 4979

12/23 - 4758

12/24 - 4232

12/25 - 3625

12/26 - 1032

12/27 - 2170

* For more discussion of the first and second waves of the 1918 pandemic, see the newsletter dated October 15, 2020, which can be accessed, together with all prior newsletters back to May 1, 2020 by going to frankmcphillips.substack.com.