Allegheny County’s sudden increase in daily covid-19 cases has suddenly become abrupt, but health experts say the count doesn’t show the full story.
“I think focusing on the large number of cases is not the best way to see this,” said Dr. Amesh Adalja, a Pittsburgh-based infectious disease and critical care physician.
The county is experiencing an increase in positive cases, with 109 cases reported Tuesday, the highest daily jump in total cases in the entire pandemic. High daily records occurred most of last week and over the weekend, with 90 cases reported on Saturday and 96 on Sunday. Deaths in the county have not increased for several days, totaling 186 since Friday.
The rest of the country is no different, with cases on the rise in Florida, Texas, and the western part of the US Anthony Fauci, the nation’s leading infectious disease expert and member of the original Coronavirus Task Force of the The administration told Congress Tuesday that the United States could reach 100,000 new cases of covid-19 per day if the increase is not addressed.
Fauci told the Senate health committee that the country is headed in the “wrong direction.”
It should come as no surprise that cases are on the rise, Adalja said, as companies reopen and people begin to interact more with each other. But covid-19 was never something that could be completely removed from the population, he said, and following the case count “like a marker” can be misleading.
“This will be the new normal until there is a vaccine,” said Adalja, a principal investigator for the Johns Hopkins Center for Health Safety. “We are going to see periodic outbreaks.”
Adalja said that people should pay attention to hospitalizations and the space available in the hospital’s intensive care units. As of Tuesday, Allegheny County has recorded 393 hospitalizations for covid-19, 160 of which have been sent to intensive care units.
Dr. Debra Bogen, Allegheny County Health Director, warned Sunday that hospitalizations tend to lag behind new cases as infected people get more sick, and that the metric could see an increase in a few weeks. There were seven hospitalizations reported Tuesday.
Dr. Donald Yealy, UPMC President of Emergency Medicine, said an increase in hospitalizations is difficult to predict: Hospitals just have to be prepared for the worst. So far, the number of infected people requiring hospital care has not grown significantly in the UPMC system, Yealy said Tuesday.
“It is not time to declare victory, nor is it time to suggest that everything has been a complete failure,” Yealy said.
Adalja added that as more young people become infected with the virus, many of them may be in good health and never need to be hospitalized.
A more important context can be found by looking at the positivity rate in the tests, Adalja said. As the covid-19 tests increase in availability, the number of positive cases found will surely increase, but it is critical to compare the number of positive cases with the total number of tests administered. Ideally, Adalja said, the percentage of positive cases on a given day would be less than 5%.
In recent days, the percentage of positive cases has increased to more than 10%.
“That is a number that is most useful for understanding what is happening in the outbreak,” said Adalja.
While health experts said the spike shouldn’t cause immediate panic, people should continue to take 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 the spread of the community in bars and restaurants, as well as out-of-state travel. Authorities have not identified the Black Lives Matter protests, which have taken place almost daily across the county, as major hot spots. This could be because the protests have been outdoors, Adalja said, while the bars are prone to large crowds crowded indoors. Many protesters have also worn masks.
Starting Tuesday night, Allegheny County officials banned bars and restaurants from serving alcohol on the premises, arguing that people are less likely to follow recommended guidelines when drinking.
Adalja called the measure a “general order” that does not take into account the different atmospheres between a bar on the South Side of Pittsburgh and a restaurant that serves alcohol with food. She was concerned that the ban was too broad and could cause more harm than good.
“One of the dangers I think about is that when you are targeting bars like this, you risk driving these interactions underground,” he said.
Much of the speech during the pandemic comes down to personal decisions, Yealy said. Wearing masks, washing hands and people who stay home when they are sick, Yealy said, will protect the most vulnerable.
“I would easily understand if the message seems confusing to people. Our experience with the virus has evolved over time, “said Yealy. “The enduring part is doing the simple things.”
The solution to covid-19 will not be a “magic bullet,” Yealy said.
Society is likely to move forward with only a myriad of mitigations, from social distancing and increased hygiene, to steroids and other treatments under development, to an eventual vaccine.
Until that resolution, each interaction is an opportunity to spread the virus, Adalja said.
“Just because Allegheny County has a ‘green’ designation does not mean that the virus is gone,” he said.
Teghan Simonton is a writer for the Tribune-Review. You can contact Teghan at 724-226-4680, [email protected] or via Twitter.
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