I haven’t written an update in nearly two full months. This is only slightly due to laziness. Mostly, it’s because the state’s numbers have been unremarkable. I mean that in a good way. We’ve consistently trended downward in infections (and positivity), hospitalizations, and deaths. However, we seem to have reached the floor and I’m concerned that the early indications suggest an increase. As usual, I am updating my dashboard most days.
Changes in trends
Five days in the past week (including the three most recent) had a daily increase in the hospitalization count. Two days had a 7% or greater daily increase. These are some of the largest increases on record. The hospitalization count is 12% higher than a week ago. Meanwhile, we’ve had a full week of week-over-week increases in positive cases. Only one day in the last 10 showed a week-over-week decline.
Deaths continue to slowly trend downward, but if the increase in hospitalization holds, expect an uptick in deaths soon. After under-predicting the deaths during the surge in the fall, the Institute for Health Metrics and Evaluation (IHME) models are consistently over-predicting deaths. However, it does not appear that the most recent model run takes the end of the mask mandate (see “Changes in policy”), so it will be interesting to see how they fare in a month.
Changes in behavior
The IHME’s latest policy brief says mobility in Indiana is 8% below the pre-pandemic baseline. This is a big jump from the 20–25% of just a month or so ago. Meanwhile, mask usage has fallen slightly to 72%. Given these, it’s not hard to see why the numbers are picking back up again. These are both trends specifically called out as factoring into the “worst-case scenario.” (Note that the “reference scenario”—or most likely scenario—is what I plot on my dashboard.)
Changes in policy
Governor Holcomb announced earlier this week that the mask mandate will be gone on April 6. This is bad policy. While all Hoosiers 16+ will be eligible for vaccination beginning on March 31, the earliest a newly-eligible person will be fully vaccinated is April 14. And that assumes that the person can get the vaccine that day and that they receive the one-dose Johnson & Johnson vaccine. Recall that the CDC says people reach full vaccination two weeks after receiving the last shot.
In other words, in the impossibly-best case scenario, the mask mandate ends a week before the state’s (adult) population is fully vaccinated. The more likely case is that we don’t hit the 70% threshold for weeks, perhaps months. Holcomb says “Hoosiers know the science” and will continue to wear masks and follow distancing guidelines once the mandate becomes an advisory. I wonder what Hoosiers the governor has been talking to. Considering how many crowded restaurant parking lots and improperly-worn masks I’ve seen in the past week, I don’t believe him.
This is infuriating, because a mask mandate is essentially free. This is particularly true given how little effort the state put in to enforcing it. Ending the mandate early sends the wrong message. We can only hope that vaccinations outpace the virus. We deserve better than this.
The missing deaths stretch as far back as early April, but the bulk came in November through January. This is also when the overall death rate was the highest. On the whole, approximately 15% of COVID-19 deaths were not included on the state’s dashboard prior to February 4. But on 48 days, the missing deaths exceeded 20%. On December 18, 31 deaths (29% of the total) were missing. Instead of having a peak death count of 97, we’ve instead exceeded 100 deaths on several days with a peak of 118.
I wrote in the last update that I thought deaths were missing, particularly given the abrupt drop in December. It turns out that I was more right than I could have imagined. “I’m not trying to sound like a conspiracy theorist,” I wrote. “I don’t think there was any malfeasance.” I’m trying very hard to continue believing that.
At the very least, this represents appalling incompetence. This isn’t just a problem for making graphs. The death toll of this pandemic is serious. Losing 15% of the deaths is not only disrespectful to the dead and their families, but it robs decision-makers of reliable data. What decisions would have been made differently if we knew the true death toll.
Of course, we may never be sure of the true death toll, particularly early in the pandemic. At the time, testing was scarce. I’ve heard anecdotes from several reliable friends of loved ones not getting testing after death. We can compare 2020’s overall death to previous years, but that will not be definitive.
The good news is that the overall numbers continue to trend in the right direction. Yesterday, hospitalizations were below 1500 for the first time since October 20. Deaths, new cases, hospitalization, and positivity all continue to drop. Mask usage is up and mobility remains 20% below the baseline, per the Institute of Health Metrics and Evaluation (IHME). Perversely, the corrected death totals represent a positive of sorts: the recent model runs have proven more accurate than it appeared.
As best I can tell, IHME’s most recent model run did not include the adjusted death totals, so it will be interesting to see how much changes in the next update. The observed death trend is dropping at a faster rate than the models would suggest, but that may flatten a bit over the coming days. Still, the trends are encouraging.
Causes for concern
But all is not well. Although IHME’s latest model run does not show an increase in deaths through the end of May, they say some states will see that. But even more worrying, it appears some of the new variants may lead to reinfection in people who already have immunity.
The Novavax Phase III trial in South Africa placebo arm found that prior infection provided no protection from variant B.1.351. The implication of this finding is that herd immunity is only variant-specific; if this finding is confirmed in the Johnson & Johnson placebo arm data, our worse scenario is likely too optimistic.
It has been over a month since I’ve written one of these. Part of that was because I had other things to do. Part of that was a lack of updated projections from the Institute of Health Metrics and Evaluation (IHME). And part of it was that I didn’t believe the state’s numbers. I kept updating my dashboard regularly, but it seemed like something was missing: deaths.
I’m not trying to sound like a conspiracy theorist. I don’t think there was any malfeasance. But the data doesn’t always come in right away. I’m not sure what the reporting chain is like, but there are probably a few steps before it gets to the Indiana State Department of Health. The latency increased in December, so I figured any day the numbers would catch up. The drop from 90 deaths a day to 45 was so rapid that it couldn’t be real.
Well I’ve been waiting for weeks and the trend has held. I’m not sure what happened, but about the second week of December the COVID deaths and hospitalizations plummeted. This is a very good thing, even if the explanation isn’t obvious.
The experts at the IHME model run from November 23 just about nailed it in retrospect. Subsequent runs seemed to over correct based on the state’s run of higher-than-forecast fatalities. The model run published yesterday comes closer to reality, but it is still running a bit hot.
The good news is that IHME’s U.S. policy briefing says the peak is behind us (although the model does not account for the recently-discovered strains that are more transmissible).The briefing isn’t all good news, though. Looking forward to teh end of the year, IHME has this to say:
We do not expect the US to reach a level of herd immunity that would prevent a third wave next winter. This is because a quarter of Americans state they will not take the vaccine and a further quarter state they are unsure. In addition, we do not have clear evidence on how much vaccination stops transmission as opposed to preventing severe disease and death. Scale-up of vaccination does mean, however, that the number of deaths in a third wave, if it occurs, would be greatly reduced.
It’s been a while since I’ve written one of these posts. Partly due to being busy, partly due to being burnt out, partly due to “how can I write ‘yep, everything is still terrible’ each week without repeating myself?”. And honestly, it’s been weird to realize that even though the situation in Indiana is worse than it has been at any point in the pandemic, it doesn’t feel that much worse to me. I realize how incredibly fortunate I am to be able to say that.
Since my last update, vaccines have received emergency use authorization and are in the early stages of being distributed. It will be months before we have widespread vaccination, but at least there’s hope. Of all the jobs I’m glad I don’t have, “decider of who gets vaccinated first” is one that I’m most glad about.
I haven’t made any major structural changes to my dashboard. The main difference is some tweaks to the model forecast graph to make it easier to read (I hope).
Anyway, the Institutes for Health Metrics and Evaluation (IHME) model runs keep nudging the total fatalities up. This is a reflection of how rapidly deaths have risen in the last month. The latest model run brings us to a peak of ~102 daily deaths in Indiana on January 5. It seems to track the general trend in the reported data pretty well, if you ignore the last few days. As the number of deaths has risen, it seems that the counts now frequently go up significantly for two or three days after, instead of just the day after. If anything, the model may be too optimistic.
There is good news, though. While October and November featured a rapid rise in hospitalizations, with new records set almost every day, that trend has largely reversed. Even with the Thanksgiving holiday, we’re starting to see declines in hospitalizations most days. If that holds for a few more days, we might get below the 3,000 mark for the first time in over a month. As it stands, yesterday’s hospital census had about 13% fewer patients than the peak on November 30.
Despite the downward trend in hospitalizations, the available ICU bed capacity continues to hold steady near 20%. Interestingly, non-COVID cases are driving this, according to the state’s dashboard. COVID ICU bed and ventilator usage, while still much higher than over the summer, is trending downward.
What I’m watching
In the coming week, I’ll be watching to see if the lower death tolls the last few days hold. It seems unlikely that there’s such a sudden drop in deaths. Tuesday and Wednesday of this week had a bunch of backdated deaths added to the report. I would expect the same next week.
With the coming Christmas and New Year holidays, the testing and new case data is about to get unreliable. But I’m interested to see if the apparent uptick in positivity holds or if we return to the general downward trend of the last two weeks. As of today’s update, we’re at 12.4% for all tests (24.4% individuals) statewide. This is very bad.
Two weeks ago, I wrote “the news has been “good”-ish. More accurately: it’s getting less bad.” What an idiot. Since then, hospitalizations set a new record almost every day. Yesterday’s patient count was 52% higher than two weeks ago. We also set several new case records, including our first time above 5000, 6000, and 8000. We’re adding roughly twice as many new cases as we were a week ago, while only conducting about 35% more tests.
The Governor has finally given up on Stage 5 in favor of county-level restrictions based on weekly metrics updates. Doug Masson has a good discussion of it. It seems like where we should have been in September or earlier. I’m not sure how effective it will be, but it does seem to be relatively well-adapted to our current understanding, at least compared to previous plans.
The Institutes for Health Metrics and Evaluation (IHME) did not publish a new model run last week. I suppose there was other news that folks were paying attention to. Anyway, their new model run this week lowers Indiana’s peak death count slightly. It’s also earlier and with sharper ramp up and down times.
The death count continues to exceed the October model forecasts, but it may be below the November runs. In the next few weeks, the increases in cases and hospitalizations will probably result in an increase in fatality.
Other than adding the hospitalization change graph below, I haven’t made any structural changes to my dashboard in the last few weeks.