Indiana COVID-19 update: 15 January 2022

Welcome to the new year, where we’re still dealing with COVID-19. The stats are a little muddy, both because of the holidays throwing a wrench into the reporting and also because I’m seeing some things I don’t quite expect. More on that below.

The recent past

In my last update just before Christmas, I noted that we had reached a peak in cases and hospitalizations. Possibly deaths as well, although that remained unclear. The cases and hospitalizations continued to slowly decline over the next few days, until beginning to rise again Christmas weekend.

Current state

Last month, I wrote “With vaccines available, we should see hospitalization and death rates far below [winter 2020–1]. On the other hand, indoor masking is nearly non-existent and the Omicron variant presents a rather significant unknown.” Omicron is no longer an unknown.

Cases

As Micah Pollak predicted, Indiana is seeing record levels of new cases. His “optimistic” (my word) scenario had 7,800 new cases today. His “pessimistic” scenario had us at 8,200 ten days ago. The pessimistic scenario was close: the 7-day moving average of new cases crossed 8,200 on January 3. As of yesterday’s update, the average is 13,935—79% higher than the optimistic scenario.

There’s some indication that we’re approaching the peak for new infections. Week-over-week and week-over-two-week changes in new cases are trending downward, as is the difference in weekly cumulative cases. While still higher than almost any other time during the pandemic, the slowing is a good sign. However, there are a few caveats:

  • Test availability, particularly for rapid tests, is pretty limited anecdotally
  • At-home tests are not included in the state’s data
  • Omicron has a higher percentage of asymptomatic infections (source, p1), which could plausibly mean a smaller percentage of infections are being detected.
Week-over-week (blue) and week-over-two-week (red) changes in COVID-19 cases

So we’re maybe peaking, maybe not. Some states have already peaked, which lends some credence to the “actually peaking” scenario. From what I’ve seen, case rates drop dramatically after the peak. Presumably because there’s just no one left to infect? 42.5% (and climbing!) of people reporting test data to the state are testing positive right now. At this point, there’s basically nothing we can do about it.

Our models suggest that transmission is so intense, and the wave is cresting so fast, that policy interventions such as mask mandates, increased third-dose vaccination coverage, and increased vaccination of the hesitant will have no real impact on this wave. … Given that transmission cannot be controlled, the toolkit used during previous waves of the pandemic will not work. In our models, testing strategies will not curtail the rapid Omicron wave, nor will increased mask use.

Insitute For Health Metrics and Evaluation, January 13, 2022 US policy report

Hospitalizations

COVID-19 is overwhelming hospitals. The nine-country district that includes Lafayette has 0–3 available ICU beds most days. Statewide, we have set several new hospitalization counts in the last week. This is a little misleading: the Institute for Health Metrics and Evaluation (IHME) estimates roughly half of COVID-19 nationwide are hospitalized with COVID, not for COVID. Nonetheless, they’re still occupying beds, which are increasingly harder to come by. COVID ventilator usage remains at a higher percentage of total capacity than in last winter’s surge.

Daily (blue) and weekly (red) changes in COVID-19 hospitalizations.

What encourages me is that the increase in hospitalizations is rising more slowly than the increase in cases. This was not the case in previous waves. It suggests we’re seeing what others have reported: Omicron is individually less severe. From a public health perspective, of course, it’s still a huge problem. Don’t get in a car accident or have a heart attack for a while.

Deaths

This is where I get confused. Weekly cumulative deaths continue to decrease. Weekly cumulative deaths (the total of deaths in the last 7 days minus the total of deaths in the 7 days before that) have been decreasing since about December 20. Given that hospitalizations began to rise around Christmas, I’d expect to see an increase in the deaths by now. We’re not seeing that yet. I’m glad if that pattern holds, but it confuses me. With hospitalizations still on the rise, we’ll have to wait and see.

Daily COVID-19 deaths

I want to take a moment to note that over 30% of Indiana’s COVID-19 deaths have occurred since July 1, 2021. This represents almost 6,000 Hoosiers who didn’t have to die. The vaccines are lifesavers and anyone who claims otherwise is morally responsible for these deaths.

Looking ahead

IHME’s latest model run shows that we peaked in estimated infections earlier this week. Reported infections will peak in about 10 days. By mid-March, infections will be back down to about 1,200 per day. That’s a rate we haven’t seen since the beginning of the Delta wave in early August. Hospitalizations will peak at the beginning of February. The model predicts both all-bed and ICU usage will be nearly twice the December 2020 peak.

The near-term historical death data on IHME’s page does not match reality, so I won’t incorporate it into my dashboard or give it any credence here. I suspect it may be that the historical data is based on day-of-report, not day-of-death. However, that theory has a lot of holes.

Instead, I’ll talk about the previous run, which matched reality much better. And it turns out it’s the first model run I’ve added to my dashboard since the end of September. Oops.

Currently, the January 8 model is under counting daily deaths by about eight per day. The model shows a minimum on the 8th, with a rise to 60 by the end of the month. This is about half of last winter’s peak day, or about the same as we were in the week before Christmas 2021.

Observed and projected COVID-19 deaths.

This model run forecasts a return to single digit daily deaths the second week of March. The last time we were in single digits was August 7, 2021.

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