The First Part of the Waiting Game

First: A very preliminary congratulations are in order.

With San Francisco’s hospitalization data thrown into the mix I am more confident saying that the social isolation / sheltering in place taking place in the Bay Area having the desired effect. The hospitalization rates do seem to be flattening and may even be plateauing. Everyone who is putting in such tremendous effort to achieve this flattening should be congratulated. However this is a very tenuous gain.

There is a sister post to this one in which I plot up the Bay Area case counts and show the flattening curve.

Epidemiologists can use the time we are giving them to investigate spikes in hospitalizations and rises in COVID-19 cases.

Right now if I were an epidemiologist in a Bay Area county public health department I would be thinking two things. My first thought would be that I hope that everyone in the Bay Area still remains tightly sheltered in place. My second thought would be that if this tight sheltering in place continues it would give me time to try to identify the reasons behind any any spikes in hospitalization or case numbers.

For the past month or so epidemiologists haven’t had the time or the testing tools to really attack COVID-19 with precision. Instead of removing it from our community with a surgeon’s blade, COVID-19 has been so wide spread and growing so quickly that they’ve had to use the sledgehammer of social isolation. With a little breathing room, they can start turning back to more precise tools. Epidemiologists can figure out how COVID-19 spreads in particular cases and figure out how to protect our most vulnerable populations. (I’ll have more to say about this later.)

Keeping the hospitalization number below the hospital capacity means constant vigilance.

Let us keep an eye on these numbers over the next week or two. It is hard to discern a pattern right now. If I squint my eyes and wish hard, then what I’m currently seeing is periods of plateaus followed by a growth in the hospitalizations. For our community to remain within the capacity of our hospitals we need to figure out why the increases are occurring and what to do to keep similar case or hospitalization growth from occurring in the future. The first step to understanding why any increases occur is to determine whether the increase in cases share any common facts.

Lag between testing positive and hospitalization.

Many of you have noted that there is a lag between the time someone tests positive for COVID-19 and the time that they are hospitalized. This is true and epidemiologists need to be focused on both rises in caseload (that are not due to increased test availability) and rises in hospitalization. There needs to be a focus on the increase in cases because these are closest in time to the spread of the infection. A rise in cases will be easier to track because not as much time will have elapsed between the infection and the positive test when compared to the time elapsed between infection and hospitalization. The hospitalizations are important to track because right now this is the number that matters the most. This is the number that needs to stay under the hospitals’ capacity. This is the number that truly changes a person’s life.