Post #1264: COVID-19 trend to 9/23/2021, staying on track.

Posted on September 24, 2021


I had no COVID-19 update yesterday because I could not obtain the data.  The New York Times did not update their publicly-available files, and still has not.  For now, I’ve switched to COVID-19 case counts from The Johns Hopkins Center for Systems Science and Engineering.

Source:  The usual NY Times data source through 9/21/2021, and Johns Hopkins Center for Systems Science and Engineering through 9/23/2021.

Obviously, those match pretty well.  I’d characterize this as “off by just enough to be annoying”.

The down-slope of the U.S. Delta wave continues on course and is picking up steam  Over the past seven days, 42 states saw a decline in their new case rates.

Of note, within the state-level data:

  • Alaska is at 125 cases per 100K and rising at 30% per week.
  • West Virginia is at 92 cases per 100K and falling at 12% per week.
  • Wyoming is at 90 cases per 100K and stable.

Idaho is the only other state of particular interest right now.  Idaho is at 74 new cases per 100K per day, and stable.  As noted in earlier posts, Idaho’s problem isn’t so much that they have a super-high case load, it’s that they have few hospital beds per capita.

Idaho, along with Alaska, has instituted “crisis standards of care” in its hospitals. That’s a formal declaration by the state government, and it controls how physicians are allowed to triage patients.  It has both medical and legal implications.

In normal times, care is provided first to those in direst need.  The point of that standard is to try to prevent deaths.  Under crisis standards, where hospital beds are full, physicians are empowered to deny care to those deemed least likely to survive.  Oddly enough, the point of that standard is also to prevent deaths.  It just acknowledges that there are not enough beds to go around to allow physicians to make a try at preventing every death.  If necessary, physicians are asked to choose which patients they will simply allow to die, untreated, in the hopes of saving those who can be saved with the available resources for treatment.

My understanding is that this formal declaration by a state’s governor provides the legal basis for physicians to make treatment decisions in that fashion.  In theory, it shields them from malpractice lawsuits for having let people die when hospitals were full.

Otherwise, with the two exceptions noted above, it appears that the rest of the U.S. states will get through this wave relatively unscathed.  We remain in this odd situation where hospitalizations per case are up, relative to historical norms, but deaths per case are down, modestly.  Likely, that has to do with the high vaccination rates of the elderly, who would normally make up the bulk of COVID-19 deaths.

Below, the red line is cases, the yellow line alternates between hospitalizations and deaths.  Focus on the right edge of the graph.

Source:  CDC COVID data tracker.

It’s worthwhile to see how that same graph looks for Alaska and Idaho.  The point being that, while there has been this legal declaration that some COVID-19 patients may be left to die, that by itself does not necessarily mean that large numbers of COVID-19 patients actually are being left to die.

Both states have such low populations that there will be a lot of statistical “noise” in the data.  In particular, the deaths data are so unstable as to be unusable for this sort of short-run analysis.

That said, we can check whether or not we can observe a depressed rate of hospitalizations now that the respective hospital systems have exceeded their capacity.  If a lot of COVID-19 patients are being left to die, we should see a distinct flattening of the hospitalization curve relative to the new-cases curve.


Source:  CDC COVID data tracker.

As I read it, there’s no case at all for that in Idaho, and there’s too much statistical noise to make a case for it in Alaska (yet). COVID hospitalizations in Idaho continue to keep pace with COVID cases.  COVID hospitalizations in Alaska do not, but the fact that the hospitalization line has shown similar zig-zags before means we can’t conclude (yet) that COVID-19 patients are being denied care.

My best guess as to what that means is that, in all likelihood, the declaration of crisis standards may have been done proactively.  That is, done before all the available hospitals and overflow capacity sites were completely and totally full.  So, while there is the potential for American COVID-19 patients to be dying for lack of hospital facilities in those states, the hospital data suggest that if that is occurring, it’s not occurring (yet) in large numbers.