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COVID-19 Update: A Perplexing Discrepancy in the Data

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James A. Bacon
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by James A. Bacon

Make sense of this, if you can. Testing confirmed another 568 cases of COVID-19 in Virginia yesterday, according to Virginia Department of Health data published this morning. That was the biggest daily increase in new cases by far, bringing the total number of known cases to 5,077. Yet the number of COVID-19 cases admitted to hospitals for the virus each day hasn’t budged for eight days, and the utilization of ICUs and ventilators is down from four days ago.

Maybe this discrepancy is more apparent than real — the result of random fluctuations and reporting delays. But, then, maybe something is happening that is not fully understood. Here’s the daily data summary from VDH and the Virginia Hospital and Healthcare Association:

Total COVID-19 cases: 5,077, up 568 from the previous day
Total hospitalizations: 837, up 65 from the previous day
ICUs in use: 426, down 31
Ventilators in use: 283, up four
Total deaths: 130, up nine
Total tests: 37,999, up 2,540
% tests positive: 22.4%

Back in April 3, 66 new COVID-19 patients were admitted to hospitals. The number has bounced around between 40 and 90 in the days since, but stood at 65 yesterday. While the total number of people confirmed to have the disease has increased significantly, the number of people being hospitalized has been relatively stable. You can see the dramatic divergence here:

This divergence gives us some insight into why hospital capacity has yet to become a crisis beyond the shortage of personal protective equipment. For the moment at least, Virginia has an ample supply of acute care beds, ICU beds, and ventilators. That could change in a heartbeat — or a labored breath — if the virus spreads at an exponential rate and if hospitalizations start doing so as well. For whatever reason, though, the surge in new confirmed cases is not translating into a surge of hospitalized cases.

Here are John Butcher’s calculations of the doubling rate for key metrics:

Case count: 6.3 days
Hospitalizations: 6.6 days
Deaths: 4.0 days

What’s the bottom line here? If the data continue to show a divergence between COVID-19 cases and hospitalizations, it suggests that the disease is not as dangerous as we thought. Clearly, such a conclusion is highly tentative. And clearly we need to maintain social distancing to dampen the spread of the virus and ensure that hospitals aren’t overwhelmed. But perhaps we can look forward, in the not-to-distant future, to a time when we can institute baby steps to dial back the restrictions that are doing so much to damage the economy, create joblessness, and ruin peoples’ lives in ways — heightened depression, anxiety, drug and alcohol abuse, domestic abuse, suicide — that we cannot measure in real time.

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37 responses to “COVID-19 Update: A Perplexing Discrepancy in the Data”

  1. sbostian Avatar
    sbostian

    Several implications are possible: The continued increase in cases could be a result of greater physician awareness of coronavirus, with fewer cases being presumptively diagnosed as seasonal flu. The climbing number of confirmed cases with a stable growth of hospitalizations might mean that more cases are being identified in the “less vulnerable groups”, (i.e., younger people without serious pre-existing morbidities). Also, it is possible that the “nursing home” issue has peaked. By the way, NBC news published an article yesterday pointing out the inadequacy of federal and state tracking (and reporting) of seniors community coronavirus outbreaks. A week or so ago, I pointed this out and was told that it was irrelevant to public policy.

    1. Reed Fawell 3rd Avatar
      Reed Fawell 3rd

      Interestingly, I searched but could not find the tragic Henrico Virginia nursing home case listed in the Wall Street Journal’s list of examples published today in that newspaper. How could they have missed it?

  2. Anonymous Avatar
    Anonymous

    Given the shoddy and ambiguous data we get from the tests, how much does this matter?
    https://www.bbc.com/news/health-51491763
    https://pubs.rsna.org/doi/10.1148/radiol.2020200343
    Do these tests really tell us anything on which we should be relying for public policy?
    My opinion aside, when Stanford epidemiologists are publicly declaring that all of our official numbers are a big pile of *&%^%$% (my words, not his), we may have a problem so big we can’t solve it no matter how much tax money we give to the rich in bailouts.
    https://www.youtube.com/watch?v=QUvWaxuurzQ

    1. sbostian Avatar
      sbostian

      You must be aware of the “fear, uncertainty and dread” caucus here – hence your decision to post as “anonymous”, Any dissent from the MSM hysteria storyline here is countered with the “99% of scientists and politicians agree” mantra – without any attempt to verify 99% agreement on the part of scientists and without recognizing that 99% of politicians agree with anything that increases their power. The coronavirus is not a hoax – the virus exists. However, the media’s propaganda campaign and government response to the media created hysteria is one of the greatest hoaxes and assaults on constitutional liberty in the history of the United States.

      1. Reed Fawell 3rd Avatar
        Reed Fawell 3rd

        “Any dissent from the MSM hysteria storyline here is countered with the “99% of scientists and politicians agree” mantra.”

        Excellent comment of overwhelming importance.

        1. Reed Fawell 3rd Avatar
          Reed Fawell 3rd

          Dr. Loannitis’s lecture above is excellent. He knows what he does not know. Hence, he is not a fool.

  3. cjbova Avatar
    cjbova

    We can’t trust the VDH numbers as a reliable indicator.

    When the numbers VDH reports are significantly delayed, and an unknown number of cases are not tested or reported, how can any predictions of doubling or other projections hold up? Remember the note on VDH’s COVID-19 page I commented about on April 5?

    I said: “We can’t count on short term reporting to know where we are, but it’s all we have on a day-to-day basis. There may be a lot more tested, but not yet reported in the stats. Nursing home patients may be being cared for in their facility, and not moved to a hospital. We just don’t know.

    “VDH still has this message on their Covid-19 page: “The Virginia Department of Health is conducting a large-scale investigation of a facility in the Richmond metropolitan area including extensive testing. The results from this investigation are still being tabulated and will be available in the daily report on Saturday, April 4, 2020.” What constitutes “large-scale?” Are results still pending?”

    Those numbers didn’t show up until April 9th. Multiple news sites reported on April 10 from a statement of Maria Reppas. This one from richmond.com:

    “Virginia’s COVID-19 death count more than doubled in the past three days, from 54 reported on Monday to 109 reported Thursday, according to data from the Virginia Department of Health.

    “The increase in deaths, however, did not happen over the past few days, according to Virginia Department of Health Communications Director Maria Reppas. Rather, the numbers reported each day by the VDH can lag behind actual numbers, as it takes staff time to collect and review data for accuracy, she said.

    “VDH has a lot of sources of incoming data that we use to calculate our COVID-19 statewide data,” Reppas said in a statement after the Times-Dispatch posted an article on the increase in the death count Thursday. “This information can change rapidly.”

    “The jump in deaths Thursday is attributable to the fact that the state had not yet entered deaths from the past two weeks at one Henrico nursing home, where 39 residents have reportedly died from COVID-19, into the state’s count until the past couple of days.

    “The largest portion of reported deaths have occurred in Central Virginia, which recorded 41 deaths as of VDH’s report Thursday, in spite of the fact that Northern Virginia has recorded the highest number of confirmed positive COVID-19 cases. Loudoun, Alexandria and Fairfax health districts alone have accounted for more than a quarter of all of the confirmed cases in the state.

    “However, the lag in state reporting of deaths, a significant lack of testing ability statewide and delays in labs processing results has stunted the state’s ability to track how many people in Virginia are infected with the virus or promptly report how many have died from it.”

  4. Acbar Avatar
    Acbar

    It’s all about testing, testing, testing. We insist, today, for the obvious reason that tests are rationed, on testing only those who present symptoms bad enough for the patient to seek medical help. Those “maybe it’s just the flu” cases rarely get tested; the asymptomatic cases almost never. Now we are beginning to do more random testing but the consistency and efficiency of that effort is much more variable. The only way to get a decent basis for Virginia to evaluate how fast this disease is spreading, how many have already had it (and may never have known), what percentage get sick enough to need a hospital bed, what subset become really ill with pulmonary impairment, what percentage die (the mortality rate) , to see what is really going on.

    How can we know how Virginia stacks up against the other states and their efforts without this data? How can we know when Virginian should expect to redraw the restrictions and take measured steps towards working again? How can we know whether such steps are too much, sending us into another surge, versus a balanced re-entry with a sustainable, treatable, steady rate of new cases? This is going to be the new reality for however long it takes (until a vaccine) and it depends on testing, tracing, and targeted quarantining.

    1. Anonymous Avatar
      Anonymous

      “How can we know whether such steps are too much, sending us into another surge, versus a balanced re-entry with a sustainable, steady rate of new cases?”

      Couldn’t be easier– we won’t.

      The ugly truth under much of the panic is that people are freaking out because they are recognizing that the facade of managed control by giant organizations like “the government” or huge corporations in which we drape ourselves, the “Great Trade” of freedom and risk for a narrow, safe life, has been ripped permanently. Our elites have been revealed, not merely as violent and vicious and selfish (we already knew that) but as incompetent.

      It’s going to be a long summer in front of us spent admitting to each other that we _don’t_ have a technological answer for a plague and that we’re not going to develop a magic injection to “fix” it, any more than the flu vaccine “fixed” the flu. Tens of thousands of people in this country, mostly old or infirm or both, die every year of the flu. That’s not changing anytime soon. So far, the best models are now predicting that a few tens of thousands more than usual are going to die this year thanks to this new disease. Whether that’s a good reason to make hundreds of thousands more die early of poverty and desperation is increasingly in public debate.

      We aren’t going to make a careful, well-planned, closely-observed and controlled “reentry”. What is going to happen is going to be haphazard, confused, and it will not be led by the most competent public health officials with their expert knowledge, but more simply by the boldest executives in government and business who will make decisions that amount to gambles. In some ways, that’s a profoundly ugly and disquieting thought, but it won’t matter too much in the end.

      All the sophisticated, junky, tweaked, abstruse, unrealistic modelling in the world won’t ultimately let us control the scary world inside our bodies any more than it has let us control the scary world outside them. How’s that working out for Wall Street?

    2. virginiagal2 Avatar
      virginiagal2

      It’s mostly just common sense.

      Do you have tested treatments generally available? Right now we have survivor antibodies, and several antivirals being tested. Good availability of treatments reduces risk of reopening. Not there yet, but coming.

      Can you identify people who have recovered, and are you confident they’re immune? This is being rapidly worked on, and once you can say yes, you have a whole group of people who can safely work. Getting there, rapidly.

      Do you have adequate rapid testing capacity to test suspected cases and their contacts? Yes means you can quickly squash new outbreaks.

      Do you have adequate protective equipment and hospital capacity for new cases? Not there yet, but being able to say yes reduces risk.

      Do you have enough PPE that ordinary people can buy masks, wipes, and sanitizer readily? This helps people take precautions.

      We’re not there yet, but these are things we can work on in the short term.

  5. LarrytheG Avatar
    LarrytheG

    This is the very kind of thing that sends modelling folks back to the table.

    Models are just graphical representations of equations – and equations are representations of data and if the data is wonky – then work needs to be done to understand and sometimes the quality of the data itself is at issue.

    This is stuff that takes folks years in school and then in a related occupation to do. It’s not something the average person is going to “read” about and acquire all that understanding that took others years of schooling to get.

  6. S. E. Warwick Avatar
    S. E. Warwick

    Does anyone know if the fatalities from Canterbury rehab were ever included in the VDH statistics?

    1. cjbova Avatar
      cjbova

      Yes. From Maria Reppas (VDH Communications Director) statement on 4/10:
      “The jump in deaths Thursday is attributable to the fact that the state had not yet entered deaths from the past two weeks at one Henrico nursing home, where 39 residents have reportedly died from COVID-19, into the state’s count until the past couple of days.”

  7. Nancy_Naive Avatar
    Nancy_Naive

    Well, a few things come to mind,
    1) a change in “who to test” criteria. Early on, ya had to have a fever. Maybe they’re testing milder symptoms?
    2) who is getting sick. People with existing conditions may be staying inside and only the healthy are venturing out?
    3) a different strain?

    Be grateful for small favors?

    1. ksmith8953 Avatar
      ksmith8953

      I agree. Small favors are good!

    2. cjbova Avatar
      cjbova

      Nancy, VDH testing guidelines for DCLS and clinicians have not been relaxed since March 20.

      1. Healthcare worker or first responder with fever OR signs/symptoms of a lower respiratory illness.

      2. Potential cluster of unknown respiratory illness, with priority for healthcare facility outbreaks. All suspected clusters or outbreaks should be reported to the local health department immediately.

      3. Person hospitalized with fever OR signs of lower respiratory illness. Priority will be given to patients where circumstances require a confirmed COVID-19 diagnosis for compassionate use treatment with antivirals.

      4. Person who resides or works in a congregate setting (e.g., homeless shelter, assisted living facility, group home, prison, detention center, jail, or nursing home) AND who has fever or signs/symptoms of a lower respiratory illness.

    3. Acbar Avatar
      Acbar

      Get with it, VDH. Get the tests, and test everybody who can get to a drive-through test location even if it’s by skateboard.

  8. virginiagal2 Avatar
    virginiagal2

    It’s probably timing and your sample set.

    Timing. Hospitalization generally lags diagnosis. ICU admission generally lags hospitalization. Death generally lags ICU admission.

    So you’re diagnosed, several days later you might wind up in hospital, a few days after that you might wind up in ICU if things go badly, and a several days after that, if things go badly, someone might die.

    As the curve changes, the lagging indicators change, well, later.

    Sample set, if you’re testing more people before they’re symptomatic and more people with mild symptoms, your denominator increases, so your ratio goes down. Not an actual change, but a shift in sampling, and expected.

    1. ksmith8953 Avatar
      ksmith8953

      Great thinking!!!!!!!!

      Don’t over think this folks. Government conspiracy doesn’t apply here. Common sense does!

      Virginiagal is right. You get sick, it gets worse, etc. Makes sense to me!

      1. Acbar Avatar
        Acbar

        I agree KS8953 — too easy to blame a conspiracy when it’s merely bureaucracy at work. But I won’t let the Gov. off the hook for lack of leadership here, or excuse the State- level incompetence that JS has been reporting.

        1. LarrytheG Avatar
          LarrytheG

          Even in places like NY, there are not enough tests. FDNY EMS folks are getting the virus and not able to be tested often enough.

          Northams problem is not that he’s not trying to do something. He probably cannot get enough tests either but Cuomo gets up on TV and makes a big deal about – so does Hogan who also said he could not get enough tests – Northam just says nothing.

          I just don’t think that’s any more incompetent than say Hogan.

          1. Acbar Avatar
            Acbar

            There’s incompetent governance, and incompetent leadership. I am more focused on the latter. Leadership includes constant communication and relentless transparency with the public. Where the hell has this guy Northam been? Hogan’s press conferences are all over the local t.v. news and Metro section of the paper. Cuomo has a daily, scheduled, open-to-the-public news conference that’s webcast and goes on up to an hour. He talks about his frustrations as well as his small victories; he tells the statistics and why he doesn’t know even more; he tells what things are like in the hospitals and how his scavenging for resources is coming; he brings in his staff for their reports, live. Northam’s management style seems to be opaque by default: “If you can’t tell what I’m doing then you can’t blame me for what goes wrong.” This is incompetent leadership in a public health crisis. If there’s incompetent management too, incompetent governance, we may never know it directly but I sure am coming to suspect that’s also the case.

          2. LarrytheG Avatar
            LarrytheG

            re: ” There’s incompetent governance, and incompetent leadership. ”

            yep, but the latter is bit more subjective. A poll of Virginians will tell that tale I suspect.

            He lacks competent advisors on this issue. He must not have a real PR person or something. Most Govs need a staff person to guide them on their public appearances.

            So he does have his flaws but to his credit he does not hold press conferences where he makes personal attacks on others, says really untrue and outlandish things, contradicting his own advisors , and threatens the counties that if they talk bad about him, he’ll deny them aid. None of that.

  9. Nancy_Naive Avatar
    Nancy_Naive

    Turns out there are indeed two strains of SARS-Cov-2, S and L.
    https://www.newscientist.com/article/2236544-coronavirus-are-there-two-strains-and-is-one-more-deadly/

  10. Acbar Avatar
    Acbar

    Re: ” mostly just common sense” — Good response, VG2. There’s a valid point of view that flattening the curve delays but in no way eliminates the risk of infection until either herd immunity or a vaccine intervenes. But those who’ve recovered from this are almost surely going to prove immune or at least highly resistant for a time; and, post-peak, if VA can identify the smaller number of active cases among the rest of us by testing and tracing contacts efficiently then maybe we can relax somewhat. This will be an ongoing effort but it’s not hopeless.

  11. LarrytheG Avatar
    LarrytheG

    It’s a stiff challenge – not impossible – but less than the full effort is not
    going to work well.

    And some folks perhaps SHOULD have “immunity certificates” that allow
    them more free moments. My understanding is that this could actually be on a cell phone in addition to paper.

    The same approach could be used to show your last negative test – so that if someone you came into contact with – was infected – you know you have to be tested again.

    The is a huge logistical effort. It does not need to be done solely by the govt – it actually should be more like what we do right now for electronic medical records… that are portable … there needs to be a standardized approach – so that, for instance, all “immunity cards” are the same and “official” much like drivers license… perhaps.

    But if we do not do something like this and “go back to work”, all who are not now infected, are going to get infected , just a matter of when.

    The trick is keeping the number of infected less than our hospitals capacities.

  12. Nancy_Naive Avatar
    Nancy_Naive

    Forget testing, game’s changed
    https://www.usnews.com/news/world-report/articles/2020-04-10/south-korea-says-recovered-coronavirus-patients-test-positive-again

    The problem with mankind is that we all know we are going to die. We just don’t believe it.

    1. LarrytheG Avatar
      LarrytheG

      ho boy! does that mean if they test positive again they gotta get isolated again? Do they every test negative after that?

      something sounds a little screwy… eh?

      We should be able to collect similar data from our folks that have recovered. Are we not seeing that or not re-testing or what?

      1. Nancy_Naive Avatar
        Nancy_Naive

        Herpes?

        1. LarrytheG Avatar
          LarrytheG

          well no. Don’t we also have people who have recovered?

          Are we testing them to see if they are negative or positive?

          1. cjbova Avatar
            cjbova

            Yes, Larry. People have recovered, but no one’s keeping track, and it’s taking a long time for some to fully recover.

            No. Currently, there’s no testing for them. Those who have fully recovered though, are being asked to donate plasma to test whether their antibodies can help seriously ill COVID-19 patients.
            https://www.redcrossblood.org/donate-blood/dlp/plasma-donations-from-recovered-covid-19-patients.html

          2. Reed Fawell 3rd Avatar
            Reed Fawell 3rd

            Sounds like Virginia kept better records in its 19th century Civil War than it keeps today in its 21th century war against COVET-19.

  13. LarrytheG Avatar
    LarrytheG

    Yep Carol – been following that… and one would think that we should be keeping track… if those folks are ones that can go back to work and/or be resistant to further infection.

    Do you know if the antibodies actually do work? Seems like if they do, that we ought to ramp that up significantly.

    We’re going to get through this – but it won’t be as quick as we want.

    I’m hearing epidemiologists that are saying this virus is going to be with us for a while…unless we get a vaccine.

    1. cjbova Avatar
      cjbova

      That’s the purpose of the Red Cross/FDA effort — to evaluate whether the antibodies can help someone with the disease.

      Mayo Clinic has a good explanation:
      The U.S. Food and Drug Administration has outlined the requirements that individuals must meet to donate blood for this research. Before donated blood can be used, it must be tested for safety. It then goes through a process to separate out blood cells so that all that’s left is plasma with antibodies.

      The immediate goal of this research is to determine if convalescent plasma can improve the chance of recovery for people with the most severe disease. A second goal is to test whether convalescent plasma can help keep people who are moderately sick from getting sicker.

      Full article here: https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/convalescent-plasma/faq-20484383

      Here’s another on the first testing in Dayton:
      https://www.daytondailynews.com/news/local/first-nation-blood-center-premier-using-recovered-patients-plasma-fight-covid/XyeMuglt8Tr4uSucZqfBnO/

      1. LarrytheG Avatar
        LarrytheG

        Carol – how do you feel about re-opening the economy? Do you think we should be testing much, much more both for virus and antibody?

        How should we go about opening back up in your view?

        1. cjbova Avatar
          cjbova

          Sorry.I can’t answer on how to re-open.

          My personal view on testing is “should” doesn’t come into play when something’s not currently possible. We don’t have enough tests available now. Antibody work is just beginning. It may go quickly; it may take longer than expected to evaluate; it may fail; it may be the next miracle cure. There may be a slow start because you have to have had a lab confirmation of COVID-19 or be given a test for antibodies to donate “convalescent plasma.”

          1. LarrytheG Avatar
            LarrytheG

            So… we’re not yet ready? And the point about “should” – yep.

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