COVID Projections nov 18 2020

“We Admitted 10 Patients in Five Hours”: State, Hospitals Rapidly Approaching Critical Case Counts and Hospitalizations

by Carolyn Bick

The dire warnings the state’s top health officials shared with the public just last week appear to be coming to pass. 

In a Washington State Department of Health (DOH) COVID-19 briefing on Nov. 18, DOH Health Officer Kathy Lofy shared several charts that show what Lofy called a “dramatic,” exponential growth rate in cases of COVID-19 and “sharp increase” in hospitalizations in Western Washington. She also said that the effective reproductive number — also known as the R-naught or R0 number, which is the number of people one person will infect — has continued to rise. It now stands at 1.7 in Eastern Washington, and 1.8 in Western Washington.

“The growth of disease now is about what it was in March, when we saw our initial surge,” Lofy said. “I am particularly concerned about how sharp the [hospitalization] increase is in the number of occupied beds in Western Washington — both regular hospital beds and ICU beds that are occupied by COVID patients.”

Lofy also shared the state’s modelers’ predictions over the next few weeks, if Washington State continues the current rate of transmission. It shows numbers that are quickly dwarfing those from the outset of the novel coronavirus pandemic in March. The Emerald has included this graph below, but Lofy said it and other graphs shared during the briefing should be available later today on the Institute for Disease Modeling’s website.

Data shared by Dr. Kathy Lofy.

“If our outbreak continues to grow with an [R-naught] number of 1.7 or 1.8, we, in a few weeks, will be having almost 150 people admitted to our hospitals every day. … If the Nov. 16 restrictions are as successful as they were back in March, we can reverse this trend,” Lofy said, referring to the new restrictions Gov. Jay Inslee instituted on Sunday, Nov. 15.

A hospital admission rate of 150 people per day is not unimaginable, particularly given the what Dr. Elizabeth Wako, Vice President of Medical Affairs for Swedish’s First Hill location, reported later in the briefing.

“The cases here at First Hill … have tripled since Halloween, and just this morning, we admitted 10 patients in five hours,” Wako said. “That is exponential for us here.”

Lofy also shared a predictive graph that showed those who gather are at a very high risk of contracting the novel coronavirus and developing COVID-19. In a gathering of 200 people, such as a religious service, there is an 85 percent chance someone has the virus; in a grocery store setting with 75 people, there is a 60 percent chance someone has the virus; and in a gathering of 15 people, there is an 18 percent chance that someone has the virus. And because symptoms often don’t develop for up to two weeks, a newly infected person could easily infect several others, before they realize they are sick or get a test.

Data shared by Dr. Kathy Lofy.

This is why it is so important not to hold Thanksgiving dinners or gatherings of any kind — particularly indoors — next week, and why Inslee instituted new restrictions on gatherings and activities, several health experts during the Nov. 18 health briefing emphasized.

“It’s important to note that there are two risks here that we are thinking about right now: the risk for illness among people who attend that gathering, and then secondary risk of further disease transmission in future activities that those people undertake,” DOH deputy secretary of health for COVID-19 response Lacy Fehrenbach said. “Every single interaction matters. This is why we must limit our gatherings, and must act right now. With disease rates and trends where they are, it is simply too dangerous to gather right now. The safest option for you, your family, and your friends, and our community is to stay home.”

Michele Roberts, who heads the state’s COVID-19 vaccine planning team, said that the state still anticipates a vaccine will be approved before the end of the year. Both Pfizer and Moderna appear to have developed groundbreaking, mRNA-based vaccines that are highly effective against COVID-19. Earlier this week, Moderna reported a 94.5 percent effectiveness rate, and Pfizer today said that its vaccine was 95 percent effective and safe. Almost 400 health care providers have already enrolled to become vaccine distributors, Roberts said.

However, this does not mean the vaccine will immediately be available to everyone. Not only do both companies need to seek approval from the Food and Drug Administration — a process that, even when expedited under emergency circumstances, such as these, takes several weeks — but states must wait on the federal government’s timeline. Furthermore, there will be limited supplies of the vaccine.

When the Emerald asked how the state plans to prioritize vaccine distribution, Lofy said that the state has sought guidance from community groups and has a “working draft” of distribution prioritization, based on the guidance put out by the National Academies of Science, Engineering, and Medicine (NASEM). She did not share who these community groups are, and said that the state will be waiting to see what the Advisory Committee on Immunization Practices (ACIP) recommends. She said she expects that healthcare workers who either directly or indirectly work with COVID patients will be the first to be offered the vaccine.

Carolyn Bick is a journalist and photographer based in South Seattle. You may reach them here, here and here.

Featured image is a screenshot of the current COVID-19 case count trajectory, based on predictive modeling data shared by the Washington State Department of Health’s Health Officer Dr. Kathy Lofy, during the Nov. 18 press briefing.