Focus on covid cases could be wrong way to interpret Allegheny County surge, experts say

Allegheny County’s surge in daily cases of covid-19 has suddenly become steep, but health experts say the tally does not show the full story.

“I think that focusing on the sheer number of cases is not the best way to look at this,” said Dr. Amesh Adalja, a Pittsburgh-based infectious disease and critical care physician.

The county is experiencing a rise in positive cases, with 109 cases reported Tuesday, the highest daily jump in case totals in the entirety of the pandemic. High daily tallies occurred most of last week and over the weekend, with 90 cases reported Saturday and 96 on Sunday. Deaths in the county have not increased in several days, with the total being 186 since Friday.

The rest of the country is no different, with cases rising in Florida, Texas and across the western part of the U.S. Anthony Fauci, the nation’s top infectious disease expert and a member of the administration’s original Coronavirus Task Force, told Congress on Tuesday the U.S. could reach 100,000 new covid-19 cases per day if the surge is not addressed.

Fauci told the Senate health committee the country is heading in the “wrong direction.”

It should not come as a surprise that cases are increasing, Adalja said, as businesses reopen and people start interacting with each other more. But covid-19 was never something that could be entirely eliminated from the population, he said, and following the case count “like a scoreboard” can be misleading.

“This is going to be the new normal until there is a vaccination,” said Adalja, a senior scholar with Johns Hopkins Center for Health Security. “We’re going to see periodic flare-ups.”

Adalja said individuals must pay attention to hospitalizations and available space in hospital intensive care units. As of Tuesday, Allegheny County has recorded 393 hospitalizations due to covid-19, 160 of which have been sent to intensive care units.

Allegheny County Health Director Dr. Debra Bogen cautioned Sunday that hospitalizations tend to lag behind new cases as infected individuals grow sicker, and that metric could see a spike in a few weeks. There were seven hospitalizations reported Tuesday.

Dr. Donald Yealy, UPMC’s chair of emergency medicine, said it’s difficult to predict a rise in hospitalizations — hospitals just have to be prepared for the worst. So far, the number of infected individuals that require hospital care has not grown significantly in the UPMC system, Yealy said Tuesday.

“It’s not time to declare victory, nor is it time to suggest everything has been a complete failure,” Yealy said.

Adalja added that as more young people become infected with the virus, it’s possible that many of them are in good health and will never need to be hospitalized.

More important context can be found by looking at the positivity rate in testing, Adalja said. As covid-19 tests increase in availability, the number of positive cases found will surely increase — but comparing the number of positive cases to the total amount of tests given is critical. Ideally, Adalja said, the percentage of positive cases on any given day would be less than 5%.

In recent days, the percentage of positive cases has risen to more than 10%.

“That’s a number that’s more useful to understanding what’s going on in the outbreak,” Adalja said.

While the health experts said the spike should not cause immediate panic, individuals should continue taking precautions during social interactions, paying attention to areas where transmission of the virus is likely.

Using contact tracing, Allegheny County has attributed much of the new cases to community spread at bars and restaurants, as well as out-of-state travel. Officials have not identified the Black Lives Matter protests, which have taken place almost daily throughout the county, as significant hotspots. This could be because the protests have been outdoors, Adalja said, while bars are prone to large crowds crammed inside close quarters. Many protesters also have worn masks.

Starting Tuesday evening, Allegheny County officials banned bars and restaurants from serving alcohol on the premises, arguing that people are less likely to follow the recommended guidelines when they’re drinking.

Adalja called the move a “blanket order” that doesn’t take into account the different atmospheres between a bar on Pittsburgh’s South Side and a restaurant that serves alcohol with food. He worried the ban was too broad and could cause more harm than good.

“One of the dangers I think about is when you’re targeting bars like this, you run the risk of driving these interactions underground,” he said.

Much of the discourse during the pandemic comes down to personal decisions, Yealy said. Mask-wearing, hand washing and people staying home when sick, Yealy said, will protect those who are most vulnerable.

“I would understand, easily, if the message seems confusing to people. Our experience with the virus has evolved over time,” Yealy said. “The durable part is to do the simple things.”

The solution to covid-19 won’t be a “magic bullet,” Yealy said.

Society will likely move on only with myriad mitigations in place, from social distancing and increased hygiene, to steroids and other developing treatments, to an eventual vaccine.

Until that resolution, every interaction is an opportunity to spread the virus, Adalja said.

“Just because Allegheny County has a ‘green’ designation, doesn’t mean the virus is gone,” he said.