The public is understandably alarmed by the COVID-19 pandemic that we have been experiencing since February. We all know someone who has been infected and many of us know someone who got very sick or even died. With the dramatic changes in our lives and the great economic losses suffered by households, business owners, employees and students, it is important to critically examine the evidence so far. We admit that we are not epidemiologists, but as economists we have extensive training in statistics, modeling, and program evaluation. Our analysis provides a context that can be helpful to you.
The “increase” in cases you’ve heard of in the past few months is due in part to increased testing and a change in the people being tested. In the spring, tests focused on health care workers and people with severe symptoms, with a few hundred tests per day out of about a thousand performed positive.
There have been around 20,000 tests a day since September, and now it’s students, athletes, and people planning on traveling. When tested, over 2,000 cases are detected each day. The positivity rate, the ratio of confirmed positive cases to tests performed, has fluctuated between 2% and 12% since the April increase (from 17%), regardless of whether or not strict public health regulations were in place.
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Increase in infections
Infections have increased lately, but many infected people are missing from testing. The spring infection rate was ten times that of the limited tests and is still twice as high today as the tests show, as the state relies on tests from test subjects as opposed to a representative sample of the population. You miss hundreds of thousands of people who are infected but asymptomatic and never tested.
Measuring positive cases from voluntary testing, rather than estimating the actual number of people infected, leads to large biases in reported prevalence and death rates.
Who is being tested?
The state does not publish data on the characteristics of who is being tested. Understanding who is being tested can make a big difference in drawing conclusions about the spread of the virus and health effects. Young people are much more likely than older people to have COVID-19 and never need treatment. Colleges and universities have had to test students since the end of August, which presumably increases the number of positive cases but does not pose a real threat to the health system.
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How are the hospitals doing?
Recently, the number of people in hospitals, including intensive care units, being treated for COVID-19 has increased. However, this does not mean that our hospitals are overcrowded with patients. COVID-19 patients make up about 15% of hospital beds in Kentucky today. Until COVID-19, the nationwide average hospital occupancy rate for the past decade was less than 50%. The utilization of the intensive care unit is now at the highest level this year. Hundreds of beds are still available in the intensive care unit, but the pressure has increased in recent weeks. Several hospitals are reporting staffing issues as COVID-19 patients require more care than the average hospital patient.
The rising number of deaths
Unfortunately, most of the deaths from COVID-19 were among residents of long-term care facilities and other institutional settings. This is not really surprising as the virus can be fatal to people with compromised immune systems. However, it is especially sad as many patients have been quarantined and have not been able to get the full support and love from their families. We need to better support our nursing homes and other community facilities. Fortunately, death rates from COVID-19 continue to decline as our great medical professionals learn more effective treatments. Currently about six tenths of one percent of those infected die from the disease.
Personal schools vs. virtual ones
There is no evidence of school closings and the Centers for Disease Control and Prevention has long recommended the continuation of personal education, and this has been reiterated by them over the past two weeks. The state’s database shows that parish and other private schools have held face-to-face courses since August with no significant health issues, including staff or student deaths.
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The need for better data
Government policy relied primarily on “case numbers” that never accurately reflected the actual spread or lethality of the virus. Better data, including regular representative random samples of the population (as is the case with the Co-Immunity Project at the University of Louisville), would allow the state to better target its resources to fight the virus and further reduce the death rate .
Paul Coomes is Professor Emeritus of Economics at the University of Louisville, and Kenneth Troske is the Richard W. and Janis H. Furst Endowed Chair in Economics at the University of Kentucky. Reach Coomes at [email protected] and Troske at [email protected] See also the white paper on this topic at: isfe.uky.edu/research/2020/measuring-spread-covid-19-kentucky-do-we-have-right-data.