Today's focus will be about the current wave of Fatalities and how a spike in death numbers go hand-in-hand with declining hospitalizations. . The subject goes along with the "decline" in Hospitalization Load. When combined with with Case Reports, the indication is of a Texas plateau (mesa?) whereby vaccinations are keeping further spread at bay. This is disappointing in light of several counties reaching the 70% threshhold, a milestone worth celebrating.
Fatalities Report
Before the August, 2020 Texas DSHS Network upgrade, Texas-DSHS reported Fatalities as they were called in daily by Hospitals in the different TSAs (Trauma Service Areas). Along the bureaucratic way, data from different hospitals was merged and reported to the public through local dashboards and/or public notifications (e.g. Twitter, local newspapers). Beginning one year ago, Medical Examiners were assigned this responsibility and the death certificate date became the basis for the fatalities metric. While the reported death numbers were still made available, the official Death Certificate result can take as long as six to eight weeks to come out (even though the law requires 10 days). Presumably, the lag is associated with getting the count from the medical examiner to the State who then back-files it into their electronic records and dashboard plots. My Fatalities spreadsheet runs 2-months short of the rest of the data in order to download the results when, for a given week, all of the deaths for that time interval have been accounted for.
Recently, Galveston County reported the first death of a child. This news was front-page material. One week afterwards, there was a question as to whether she died from Covid-19 since her death was very sudden and her symptoms did not agree with symptoms that pediatricians had learned to expect.
This changing story supports a period of documentation whereby the Medical Examiner confirms that Covid-19 was the cause of death. When data is surging, the Examiner cannot process all the reports and the data gets backlogged.
Figure 1 reports Covid-19 Occupancy Rates (blue bars with scale on the left y-axis) for the three largest regions: Central, Gulf Coast, and North Texas. These are overlaid with Fatalities, vertical lines whose length is tied to the scale on the right y-axis.
The Fatalities Wave begins 3 to 4 weeks after Delta cases began to arrive in Hospitals. Prior to this, Governor Abbot tweeted on May 17, 2021, that the pandemic had been arrested. Instead, Covid-19 Hospitalization trends changed from decreasing to holding constant indicating that a change was working its way through the population. In June, a tipping point was reached where the plateau turned into a period of doubling followed by the recent plateau at a higher Hospitalization level a now that vaccinations (and other mitigations such as wearing masks and limiting attendance at concerts, etc.) across the state are resetting Delta's spread rate.
Fatalities were flat in June and then increased along with a step change in hospitalizations with a 1-week lag during late July. Now, in September, when Covid-19 Hospitalizations are falling, cases are not coming in fast enough to fill the space left by recent fatalities. As Fatalities data is completed for the month of August, it will be interesting to compare the three regions with earlier surges where the Gulf Coast showed a better patient outcome than Central and North Texas.
Figure 2 indicaates that ICU usage is still high despite a reduction in Covid-19 Hospitalizations. And, even though Hospitals may be seeing some relief compared to August, occupancy levels are at still at their peak.
Cases Report
Three weeks have passed since Labor Day. Schools have resumed and the Texas Gulf Coast dodged a bullet insofar as Hurricane Nicholas was concerned. Power outages may have inconvenienced large parts of this region and interrupted Vaccination activities. However, the case reports maintained levels that correspond to Full Hospitals based on a comparison of the latest data with results from last Winter's surge. Figure 3 shows Week79 Cases in agreement with those of the previous 4-5 weeks. There has not been a downward trend; instead,
such results suggest that Hospitalization Levels will also plateau once the wave of Fatalities from this Summer's Surge is over.
Vaccination Report
Last week's report introduced a plot tied to a companion graphic in the NYTimes. There was a discrepancy between my Texas Vaccination % and their value shown in the Texas row. I have traced this to the fact that my plots and Vaccination tables are based on the fraction of those eligible to receive a vaccine. Currently, this includes all people ages 12-years old and up. The NYTimes definition is based on total population numbers. Since the Texas DSHS is my Covid-19 go-to source and since they base their % reporting on a 12+ category, I will continue to follow their lead. My NYTimes numbers will be now be scaled based on a multiplier that corrects for the ratio between number of 12+ individuals and the total population. Will this total be the 2019 estimate that goes back to all the 2020 data? Or, will it be the now-available, latest-and-greatest Census numbers? My decision is to continue with the 2019 estimates and cut-over to the Census figures once 5-12 year-olds start receiving vaccines (maybe as early as October).
Figure 4 provides the Week 79 per-population Cases vs. %Eligible Vaccinated graphic update. The NYTimes Texas data is scaled according to the ratio discussed in the previous paragraph. The other states are not scaled. It will take some time to obtain their
population breakdown and, until then, their coordinates will be need to be referenced with a * that calls out the difference between the label on the x-axis and the values obtained from the NYTimes Covid-19 pageshttps://www.nytimes.com/interactive/2021/us/covid-cases.html?pageType=LegacyCollection&collectionName=Maps+and+Trackers&label=Maps+and+Trackers&module=hub_Band®ion=inline&template=storyline_band_recirc
The important takeaway is for Readers to always establish and confirm the denominator used for calculation of % Vaccinated. My Vaccination Tables provide all the numbers with dates so that my followers know what I am using from one week to the next. Figure 5 has the latest results and shows a strong increase in coverage for all parts of the state. While the Chronicle has concerns that people are not showing up for their second doses, I prefer to report that an additional 360k newly fully inoculated individuals did get in line during Week 79. This amounts to 1.5% of the eligible population became fully vaccinated.
This statewide result includes a strong showing for the Panhandle whose coverage is far behind the other four regions. Both Central Texas and the Gulf Coast have broken through the 60% level and are looking at making the 70% milestone before November. Of course, since the arrival of Delta, the goalpost has moved and now 90% of the population is necessary to keep the spread to a minimum (i.e. flatten the curve) and avoid straining hospital resources. Note that as of this week: Travis County is a member of the 70+ club; Presidio County will no doubt reach 100%; and, all of these will be adjusted down with the cutover to a Vaccination Basis that includes 5-12 year-olds and numbers that go with the 2020 count. I will write a separate article that documents the bridge between the two sets of results.
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