Well, here we are again. Indiana’s numbers have been consistently trending downward. I feel comfortable saying we’ve passed the delta peak. The “good” news is that given recent infections—plus people who have been vaccinated—winter will be less peak and more plateau. Let’s look at some graphs from my dashboard.

Cases, hospitalizations, and deaths

The rate of change in cases stopped increasing in early August. By early September, they were dropping week-over-week. With school starting and then Labor Day, there was a potential for a big increase. Thankfully, we did not see that. Even more thankfully, kids 5–11 may be able to get their first shots before October.

Hospitalizations have been falling steadily in the past few weeks. If the trend holds, we may be below 2,000 by Monday. That would be the first time since August 23. ICU beds and ventilator usage peaked around September 13. Interestingly, the ventilator usage percentage then was higher than during the worst part of last winter. I’m not sure if that’s due to a reduction in capacity or what.

Deaths have also peaked. As of right now, it appears that the peak was September 15. However, the lag in reports seems to have increased, so it’s possible that date will shift forward a bit. In any case, the precipitous drop has become less precipitous. The peak daily death toll is near what we saw in spring 2020. I shudder to think how bad things would have been had the delta variant arrived pre-vaccine.

The future

The Institute for Health Metrics and Evaluation (IHME) model has varied a lot in the last month or so. The September 1 model run seems to have captured the increase the best, although it had a stronger and later peak than what is apparently the case. Although the state hasn’t made any changes, I’ve observed more people wearing masks and the state has seen an increase in vaccination. The earlier models took a pessimistic view of behavior, which may explain the difference.

Policy

The state has changed to updating its dashboard at 5pm instead of noon. This is ostensibly to allow more time for quality control and to catch missing data. Cynically, I think it’s because they’d been hours late regularly and decided to lean into it. The updates have been less reliable, too.

Given that the briefings are now being done irregularly and without the governor present, I must stick with my conclusion that he has abdicated any claim of leadership. The state seems to have no desire to give a damn about COVID-19.

About a month ago, I wrote that Indiana has surrendered to COVID-19. That remains the case. As you might expect, the trends have continued in the wrong direction. Since August 9, daily deaths are up 57%, hospitalizations 85%, and cases 150%. The lone comfort is that hospitalizations aren’t rising as fast as cases and deaths are rising even less. The vaccines work, if we can only get people to take them.

Recent trends

Not only have cases been increasing since early July, but the rate of increase has increased, too. Only in the last week or so has the week-over-week new case difference started to drop.

Hospitalizations had been showing an alarmingly exponential rise. In late July, we saw the highest week-over-week since records began on April 8 of 2020. This has slowed recently, although it still rivals the increases we saw last fall.

The death rate appears to be leveling off. However, this could be due to reporting delays, so it’s a little early to feel good about it yet. Especially since COVID-19 remains the number two cause of death in Indiana in the past week.

In a Twitter thread on Friday, I used November 9, 2020 as comparison to where we are right now. That date had a comparable number of hospitalizations as we currently have and it was on the upswing. At that point, we were about three weeks away from peak hospitalization. However, the rate then was higher, so we may peak earlier. Alternatively, we may have a broader peak since we have fewer mitigations in place as we did then and—while non-zero—our vaccination rate remains infuriatingly low.

I also looked at ICU bed usage and ventilator usage. The ICU beds devoted to COVID-19 patients is about the same (27.8% of total capacity then compared to 28.4% now). Ventilator usage is higher now (10.4% compared to 8.5% then), which is a cause for concern. What’s not clear to me is if capacity is reported as physical beds and ventilators or the number that can be appropriately staffed. I suspect the state is using the physical counts, which makes me wonder what the true utilization is. Local hospitals say they’re at a breaking point, and things are likely to get worse before they get better.

Future projections

The Institute for Health Metrics and Evaluation (IHME) have increased the daily deaths in the last few model runs. However, the most recent one dialed the forecast back a bit. The bad news is that we’re tracking it pretty well so far. The good news is that their model is running high on the hospitalizations, so that may mean the death toll is over-forecast, too. We should hope this continues, because both overall hospital and ICU bed usage is forecast to enter the “extreme stress” category later this month. We did not reach that category during last winter’s surge.

It feels like there are more uncertainties now than a few months ago. The IHME model does not explicitly account for school reopenings. The note that “[t]he second Delta surge in Scotland after a peak and a decline when schools opened is potentially a warning sign on the potential for school openings to drive increases in transmission.” Additionally, while mask usage has increased, we’re only at about 25% of adults saying they mask up when they leave the house. And the percentage of Hoosiers that say they have been or probably would be vaccinated remains steady just below 60%. If either of those numbers increase significantly, things could be much less bad than expected.

What to expect

It’s clear to me that Governor Holcomb will continue to do nothing. I’m not sure what it would take at this point. In fact, his recent executive order apparently reduced quarantine requirements for schools. Someone at the state health department had a moment of clarity, which was deleted.

I’m hoping to spend some time today adding Tippecanoe County school stats to my COVID-19 dashboard.

I’d really hoped to not have to write another of these. The optimism I felt at the end of March when all the numbers were on the way down and vaccination was becoming widely available has now vanished. As the so-called delta variant races through the country, all of Indiana’s numbers are heading upward again.

Recent trends

After a slow downward trend to start the summer, the last few weeks have shown an increase in COVID-19 deaths.

This is to be expected given the increase in cases and hospitalizations. In fact, the hospitalizations have increased faster than any time since the state started keeping records in early April of 2020.

The state had over 1,000 people in the hospital on Thursday (the latest data available) for the first time since May 4. If Friday was also above 1,000, that will mark the first time with consecutive 1,000+ days since mid-February. Hospitalizations have gone up 146% in the last month.

Indiana surrenders

The state used to update its COVID-19 dashboard daily. Then it stopped on Sundays. Now it’s just updated on weekdays. There’s no sign that the state government will do anything to require either masks or vaccination. Some local governments are re-implementing (or at least considering) mask mandates. I haven’t heard much about vaccination mandates except for at universities.

With schools starting or about to start, some districts have decided to have a mask mandate after all. (My kids school is among those, thankfully.) Others are leaving it up to individual families. Considering roughly half of K-12 students are not eligible to be vaccinated yet, this seems like a monumental policy failure. This is even more true if the delta variant is more severe in children than previous versions of the virus. At the moment, that appears to be more than a hypothetical.

It seems to me that the state has just surrendered. The governor is nowhere to be found on this, despite doing fairly well in the early days. In a recent press briefing, the state’s Health Commissioner was very diplomatic, but my interpretation of her answer to a few questions was “I wish we’d stop being dumb as a state and have some smart policy here. But my hands are tied without support from the Governor or the General Assembly.”

Projections

Unsurprisingly, the Institute for Health Metrics and Evaluation (IHME) forecast model continues the trends for the next few months. The latest model run projects a peak in daily deaths in the low-30s in mid-October. This is the “reference” scenario. The “worse” scenario peaks around 55. The worse scenario isn’t out of the question with an increase in in-person school and work. So much will depend on whether or not people wear masks and get vaccinated.

The good news is that if the reference scenario verifies, it will be lower than the previous two major peaks in deaths. The bad news is that a lot of people will still die unnecessarily.

As you may notice in the graph above, I had a long gap where I wasn’t adding new IHME model runs. Since it’s now clear that we won’t be done with COVID-19 any time soon, I’ll probably go back in the next few days and fill in that gap a bit. This way we can get a better sense of how the early summer model runs did.

Dashboard changes

I’ve made a few changes to my dashboard this weekend. First, I’ve changed the moving averages to be centered instead of trailing on all of the graphs. This keeps the last few days of data from distorting the trend.

In addition, I’ve added columns for a percentage change in deaths and cases week-over-week. The idea here is to produce a graph that shows the trends in cases, hospitalizations, and deaths. This would allow the viewer to see the relationship and delay between the three measures. To make it less noisy, it’s actually a comparison in the cumulative data over a seven-day window. That’s not necessary in the hospitalization data because that census is conducted every day. But cases are subject to a lot of variation throughout the week, and even the same-day-last-week comparisons seemed all over the place. Deaths are a relatively small number so small changes can be a big percentage.

I’m not going to bother putting the resulting graph in this post. It’s still a lot of spaghetti and not particularly informative. Later on I might play around with doing a second derivative. Perhaps showing how the rate of change is changing will be easier to understand.

Future dashboard changes

I’m beginning to hit annoyances with Google Sheets. In particular, inserting a new column (unless it’s at the far right of the data) means I have to re-adjust all of my graphs. I’ve been toying with the idea of using the Python Pandas package to do analysis and graphing. Then I could publish the graphs to a static website. It would also allow me to do a little more analysis, like listing the top 10 days for a particular stat or trend.

Another option I’ve been thinking about is splitting the sheet into multiple tabs. I could have a tab for the observations, another for models, etc. I’m not sure how well Google Sheets would like that, but it’s something to toy around with. It doesn’t seem like as much work as completely rebuilding it in a new system, but it’s also not trivial.

Given my lack of free time and the amount of effort that either of these options would require, I wouldn’t expect to see either happen for a while. However, it seems like I’ll be maintaining the dashboard for quite a while, so who knows?

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.