Dr. Matyas responds to my request for daily updates on TOTAL hospitalizations since the pandemic began
By Roger Straw, September 28, 2020
On September 24, I wrote to Dr. Bela Matyas, asking him to restore a TOTAL count of COVID hospitalizations since the pandemic began:
Please consider this request: From the earliest days of the pandemic and through July 10, the County’s COVID dashboard showed Total Hospitalizations.
Beginning on July 13, the dashboard only shows Current Hospitalizations. The daily change in Current Hospitalizations must be the difference between admissions and discharges, plus or minus, which is important to know.
However, the public needs to also know how many NEW admissions on a daily basis in order to accurately understand spread. This can easily be seen in the daily update of Total Hospitalizations.
Please consider restoring Total Hospitalizations to the COVID dashboard.
Dr. Matyas sent the following reply on September 27:
“The daily change in total hospitalizations does not faithfully represent new hospitalizations; the majority of added hospitalizations day over day is from reconciliation of previously hospitalized cases that we learn about in arrears. It is likely to be a substantially under-reported number.
Hospitalization is not a reportable condition on an individual level; hospital capacity is the condition that we are monitoring, and total hospitalizations per day is the relevant metric. Reporting total hospitalizations to date on a daily basis would be a misleading indicator for tracking new hospitalizations both because of the timing of reports and the under-reporting of hospitalizations.”
My response today:
Dr. Matyas – Thank you for your response to my email. With respect, I think I disagree. Regardless whether a daily update of TOTAL hospitalizations since the outbreak began includes ONLY new hospitalizations TODAY or both new TODAY and “newly learned in arrears” hospitalizations, the metric of total hospitalizations (and a 7 or 14 day average graph showing the curve of that metric) would be of great significance in understanding the overall spread of the most serious cases.
This daily increase, whether learned in arrears or not, is important for the public’s awareness. MOST IMPORTANTLY, reporting on hospitalizations in this way might help in cautioning the public to take seriously the continuing need for masks, social distancing, hand washing, etc. As our public health officer, I’d hope you might stop and think about this again. Seems it wouldn’t hurt the cause at all to add this metric to the County’s COVID dashboard, and shouldn’t be too hard to calculate the data as I have been doing, working from the AGE GROUP data.
I will continue to add together the newly reported daily reported increase of hospitalizations in the AGE GROUP data in order to determine the daily increase in TOTAL hospitalizations. And I will continue to let the public know.
California could see an 89% increase in COVID-19 hospitalizations by the next month if coronavirus infections continue apace, a top state health official warned Friday.
Short-term forecasts indicate that hospitalizations could skyrocket from the 2,578 patients now hospitalized to 4,864 by this time in October, said California Health and Human Services Secretary Dr. Mark Ghaly during a Friday press briefing — a signal that Californians should stay vigilant as more parts of the economy open up.
“As we see these trend lines, which have been coming down and flattening, look like they’re coming up … we want to sound that bell for all of you,” Ghaly said. “We want to see us respond as a state to those slight increases.”
Although Ghaly praised the state’s “significant progress” in infection and hospitalization rates since mid-July — when a peak 7,170 COVID-19 patients were hospitalized — he flagged early signs that the state’s progress has begun to shift. Starting in mid-September, Ghaly said, infection rates have risen slightly across the state, while coronavirus-related emergency room visits have also climbed.
Although overall lower case rates have allowed many counties to reopen businesses within Gov. Gavin Newsom’s reopening system, the virus’ reproduction number has surpassed 1.0 in some regions, Ghaly said. Twenty-five of California’s 58 counties remain in the red or “widespread” tier, with another 19, including most of the Bay Area, in the purple or “substantial” tier, allowing for movie theaters and restaurants to welcome customers indoors at limited capacity.
Keeping case rates low means that the virus’ reproductive value has less of a dramatic effect on potential hospitalizations, Ghaly said — especially with the double whammy of flu season looming. But with more cases overall, “you can see how quickly case rates go up and how quickly that creates additional pressure on our hospitals,” he added.
Statewide, however, there was little change in the seven-day average of new infections and fatalities reported as of Friday. Both figures remained lower than where they were two weeks ago and significantly below their respective peaks. The 3,274 new cases and 85 deaths reported by county health departments Thursday kept each seven-day average about even — just over 3,500 cases and just below 84 deaths per day over the past week, according to data compiled by this news organization.
Ghaly’s hospitalization projection, meanwhile, would put the state on par with its Aug. 19 hospitalizations, when 4,890 people were hospitalized with COVID-19 — more than 2,000 people fewer than the state’s peak a month earlier.
“As Californians we’ve done a good job to avoid those situations, and we want to keep our guard up,” Ghaly said.
[Note that Solano County publishes a DAILY update, and displays past weeks and months in epidemic curve charts. However, the curve charts do not display an accurate number of cases for the most recent days, as there is a lag time in receiving test results. This methodology is accurate in a way, but it misleads the public by consistently displaying a recent downward curve which is often corrected upward on a later date. For a complete archive of day by day data, see my Excel ARCHIVE – R.S.]
Thursday, August 13: 120 new cases overnight, no new deaths. Since the outbreak started: 4,534 cases, 41 deaths.
Compare previous report, Wednesday Aug. 12:
Solano County reported 120 new cases today, total of 4,534 cases since the outbreak started. Over the last 7 days, Solano reported 575 new cases, an average of 82 per day.
Deaths – no new deaths today, total of 41 deaths.
Active cases – Solano reported 84 moreACTIVE cases today, total of 315, back to mid-July levels. Note that only 37 of these 315 people are hospitalized, so there are a lot of infected folks out among us, hopefully quarantined. I’ve been wondering for several weeks now… is the County equipped to contact trace so many infected persons? Who will research this? (See SF Chronicle report on contact tracing in Bay Area – “Solano County did not respond”.)
Hospitalizations – the number of currentlyhospitalized persons increased by 1today, total of 38. However, the total number hospitalized since the outbreak started increased significantly, adding 19, total of 195. Seemingly, 19 were admitted and 18 were discharged? (The County no longer reports Total Hospitalized, but I can add the new hospitalization numbers in the Age Group report – see below.) Again now for a third week, the County offers no information about availability of ICU beds and ventilators.
Testing – The County reports today that 1,612 more residents were tested, new total of 61,870. We still have a long way to go: only 13.8% of Solano County’s 447,643 residents (2019) have been tested.
Percent Positive Test Rate
Solano County reported today’s 7-day percent positive test rate rose from 4.1% Tuesday to 4.4% Wednesday and to 5.4% today. Solano had never registered below 5% since the County began publicly reporting test rates on July 13. (Note that the positive test rate graphic chart may be misleading – see NOTE at top of this page.) The County posted a high of 9.3% on July 22. CONTEXT: Health officials and news reports focus on percent positive test rates as one of the best metrics for measuring the spread of the virus. The California 7-day rate was reported today at6.7%.
By Age Group
Youth 17 and under – an uptick of 15 new cases today, total of 456 cases. AND… for the first time since July 6, Solano County is reporting new hospitalizations among this very young age group: 2 new hospitalizations, a total of 4 hospitalizations since the outbreak began. Still thankfully, no deaths. It is clear that our young people are catching the disease, some have required hospitalization, and it seems too many youth are ignoring public health orders. Cases among Solano youth are 10% of the 4,534 total confirmed cases.
Persons 18-49 years of age – 73 new cases today, total of 2,776 cases. This age group is 41% of the population in Solano, but represents over 61% of the 4,534 total cases, by far the highest percentage of all age groups. The County reported 9 new hospitalizations in this age group today, the highest single-day increase so far, now totaling 57 hospitalized since the outbreak began. No new deaths among this age group, total of 3 deaths. This young to middle age group is very active. Some are surely ignoring public health orders, and many are providing essential services among us. I expect his group is a major factor in the spread of the virus.
Persons 50-64 years of age – 23 new cases today, total of 866 cases. This age group represents 19% of the 4,534 total cases. The County reported 2 new hospitalizations in this age group today, total of 57 hospitalized since the outbreak began. No new deaths among this age group, total of 4 deaths.
Persons 65 years or older – 9 new cases today, total of 435 cases. This age group represents 9.6% of the 4,534 total cases. 6 new hospitalizations today,total of 77 hospitalized since the outbreak began. No new deaths in this age group today, total of 34. In this older age group, almost 18% of cases required hospitalization at one time, a substantially higher percentage than in the lower age groups. This group accounts for 34 of the 41 deaths, or 83%.
Benicia added 4 new cases today, total of 108 cases since the outbreak began.
Dixonadded 17 new cases today, total of 296 cases.
Fairfield added 26 new cases today, total of 1,436.
Rio Vista remained steady today, total of 32 cases.
Suisun City added 5 new cases today, total of 330 cases.
Vacaville added 25 new cases today, total of 777 cases.
Vallejoadded 43 (!) new cases today, total of 1,539 cases.
Unincorporated areas – Unincorporated areas remained steady today, total of 16 cases.
Race / Ethnicity
The County report on race / ethnicity includes case numbers, hospitalizations, deaths and Solano population statistics. There are also tabs showing a calculated rate per 100,000 by race/ethnicity for each of these boxes. This information is discouragingly similar to national reportsthat indicate worse outcomes among black and brown Americans. As of today:
White Americans are 39% of the population in Solano County, but only account for 21% of cases, 24% of hospitalizations and 24% of deaths.
Black Americans are 14% of Solano’s population, and account for 13% of cases, but 20% of hospitalizations, and 27% of deaths.
Latinx Americans are 26% of Solano’s population, but account for 27% of cases, 33% of hospitalizations, and 24% of deaths.
Asian Americans are 14% of Solano’s population, and account for 9% of cases and 13% of hospitalizations, but 16% of deaths.
[Solano County’s COVID age group data doesn’t mesh with age group data given in this report. But I can report that 10% of Solano cases are youth under 18, significantly higher than in April. And although the 18-49 age group is 41% of the County population, it represents over 61% of total cases, by far the highest percentage of all age groups. More Solano data here. – R.S.]
Troubling trend in pandemic: More young people infected, ill
As the coronavirus enters its eighth month, a troubling trend has emerged in the Bay Area and around the nation: More young people are getting sick, in numbers so large that in some regions they now make up the largest and fastest-growing demographic contracting the virus.
It marks a dramatic shift from the narrative that dominated the early weeks of the pandemic, when health experts emphasized that older adults, in part due to the higher likelihood of chronic health conditions, were most at risk of falling ill.
“We are seeing increased rates of infection among young adults,” Santa Clara County public health officer Dr. Sara Cody said at a July county board of supervisors meeting. “It’s where the epidemic is spreading the most quickly. … This is disproportionately accelerating among young adults.”
In six Bay Area counties, people in their 30s or younger make up the largest proportion of cases. In San Francisco, for instance, 18-to-40-year-olds represent 48% of all cases; in Santa Clara County, 20-39year-olds represent 39% of all cases. Anecdotally, the region’s medical clinics are reporting a major uptick in younger people coming in with COVID-19 symptoms like shortness of breath, fever and cough.
Statewide, the number of cases among people ages 18 to 34 shot up 1358% between May 1 and Aug. 1, from 12,373 to 180,354 — representing an increase from 24% of all cases to 35% of all cases, according to the California Department of Public Health. During the same period, the number of cases among people 65 and older grew more slowly, 387%, from 11,547 to 56,206 — representing a drop from 22% of all cases to 11% of all cases.
At the Stanford coronavirus outpatient clinic, the proportion of patients under age 40 has more than doubled since April, from about 25% to 55%, said Dr. Maja Artandi, the clinic’s medical director.
In the South Bay, Kaiser is seeing more patients under age 30 getting hospitalized with COVID-19, which was unusual during the first surge in March. And more patients in their 20s are also seeking medical care for the virus from their primary care doctors.
“It’s worrisome,” said Dr. Charu Ramaprasad, an infectious disease physician in Kaiser’s San Jose Medical Center, who has been leading much of the health system’s coronavirus response.
Health officials and physicians have not pinpointed exactly why younger adults appear to be driving the latest surge in infections. But many believe it is likely because young people have been going out more — either for jobs that require them to interact with the public frequently, or in social settings — and are being more lax about social distancing and wearing masks.
And younger people may experience less severe symptoms, which may lead them to think it’s OK to gather with friends if they have just a minor cough or a scratchy throat, said Dr. Aisha Mays, medical director of the Dream Youth Clinic at Roots Community Health Center in Oakland.
“We have seen our young folks have a false sense of security that make them more susceptible to contracting COVID,” Mays said. “In the beginning, we were really concerned about our elderly population because they are so much more susceptible to the negative effects of COVID, including death. At the same time, it might have sent an unintended message to our young people that they were more immune to contracting COVID.
“We know that’s not true. We know young people can still contract COVID as easily as anyone else.”
People in their 20s and 30s are less likely to be hospitalized or die from the coronavirus than people in their 60s and 70s. Eight out of 10 coronavirus-related deaths in the United States have been among adults 65 or older, according to the U.S. Centers for Disease Control and Prevention. And hospitalization rates for people between 18 to 29 years old are 56 per 100,000, compared to 281 per 100,000 for people between 65 and 74 years old.
Still, many young people have symptoms severe enough to send them to the emergency room or intensive care. And even if they have mild symptoms, they still risk exposing older family members or friends who may get much sicker from the virus.
One of them is Tyler Lopez, 27, who in June began experiencing fatigue and chest congestion and lost his sense of smell. Lopez tested positive for the coronavirus, quarantined for 10 days and felt like he had recovered — but was soon hit with a second and much more severe wave of symptoms.
His heart rate repeatedly shot up to above 120, at times going as high as 140, even when he was sitting or lying down, and he had a fever and chest pain so bad it felt like the inside of his chest was inflamed, he said.
Lopez, who lives in Riverside, was admitted to a hospital twice. Doctors ran tests and concluded the COVID-19 infection likely caused inflammation in the tissue surrounding the heart, and that he could’ve gone into cardiac arrest if the medication he received at the hospital had not reduced the inflammation fast enough, he said.
“It’s just crazy what COVID can do,” said Lopez, who was released from the hospital last week and is recovering at home. He plans to go back to his doctor next week to see if he can get cleared to return to work — nearly two months after he first noticed symptoms. “The past couple months, it totally changed my life.”
Before he got sick, Lopez said, he did not take the virus seriously and continued going to the gym and meeting up with friends.
“I was like, ‘It’s not that big of a deal, whatever, if I get it, I get it,’ ” he said. “I was just living life without taking that extra precaution.”
He now wishes he had been more careful.
“It jacked me up,” he said. “I wouldn’t wish this on my worst enemy.”
Local health officials recently launched initiatives to urge people in their teens and 20s to practice social distancing, wear masks and limit activities to the outdoors like biking or hiking. Contra Costa County beginning Aug. 10 will start training hundreds of youth ambassadors to help get the message out to their peers.
A regional effort led by seven Bay Area public health departments, Crushing the Curve, has a similar aim.
Brandi House, 19, will participate in both programs as a youth leader. She said many of her acquaintances and coworkers have been going to parties during the pandemic, not believing the virus is serious or that they will get sick. She hopes to help dispel such attitudes.
“The message I’d like to put out for young people is to know this is real,” said House, of Richmond. “I know a lot of people not believing COVID is real. I know people that are still going to parties and stuff. I’m like, ‘Why are you going to parties during this time?’
“There’s a lot of people that have been getting sick and passing from it. That’s one message I want to get out.”