It’s October 2021, how is Orange County doing with COVID-19?

We are nearing the tail end of the Delta surge. The October 1st 2021 DOH report shows that orange county had “only” 2,365 cases in the last week, and our 7 day test positivity rate has dropped down to 5% (for the first time in 3 months…).

The number of cases per day are still as bad as in January/Feb, April/May, so COVID is definitely spreading in the community, but “74% of those 12 and older have received at least one dose of the vaccine” according to Mayor Jerry Demings.  Although breakthrough infections are possible, being vaccinated gives strong protection against infection, and extremely strong protection against getting sick enough to need hospitalization or dying.

Orange county schools have reported 5909 student cases (and 1,114 employee cases) since August 2nd, and are still enforcing a mask mandate through the end of October.

Deaths

So far, Orange County FL has had 2,045 COVID-19 deaths out of a population of 1,457,445, or (140 deaths per 100,000 residents), which is a per-capita death rate higher than the countries of South Korea (5), Australia (6), Iceland (9), Japan (14), Norway (16), Egypt (17), India (33) and the Philippines (36) combined.

 

It’s September 2021, how is Orange County doing with COVID-19?

For the week ending August 27th, 2021, Orange County Florida had an average of 1,292 new cases per day. This is worse than the highest previous peak in January.  The exponential growth can be blamed on the Delta Variant and the relaxing of masking and social distancing.

However, the number of new cases each week appears to have plateaued, and the test positivity rate, at 14.9%, while still very high, has gone down from a peak of 20%, so it appears that we may have reached the peak of this delta variant surge.

Historically, Orange County has had a case fatality rate of near 1%, so that would indicate we are due to see about 12-13 deaths per day in the near future, but as death numbers are no longer part of the FDOH weekly reports for counties I have no way of knowing if the case fatality rate has started to drop due to vaccinations of high-risk groups or has increased due to the Delta variant.

We have vaccinated (at least a first dose) 858,281 people (out of a population of 1,457,445), or 59% of the total. If you discount children 12 and under who are not yet eligible for vaccination, Orange County has vaccinated 69% of the eligible population.  We vaccinated 77,829 people in August (Compared to 62,349 people in July, 65,206 in June, 88,482 in May and 151,176 in April.)

Hospitalizations

Although the FDOH is not reporting county level hospitalization numbers, we can assume that the admissions curves for Orange County are similar to the entire state of Florida. We currently have more people hospitalized with confirmed covid-19 cases than ever before. Elective surgeries are postponed,  hospital morgues are full  and portable morgue units are being deployed.

Deaths

The FDOH is not reporting death numbers directly for Orange County, but judging from the graphs for the entire state of Florida, deaths are also at an all time high.

The “actual date of death” data lags behind the “reported date of death” data, but as you can see from historical trends, the reported death data is indicating that the actual date of death data will set new records in Florida.

Orange County Public Schools

In the entire 2020-2021 school year (when around half of the students were remote) OCPS reported a total of 5,072 student cases of Covid-19.  (and 2,216 employee cases).

So far, in the first three weeks of the 2021-2022 school year (with the majority of students in-person) the OCPS dashboard has reported 2,599 student cases of Covid-19. (And 624 employee cases.)

Have we reached the peak?
In other countries surges driven by the Delta Variant have peaked hard and then receded quickly (after natural immunity is reached in the un-vaccinated population via infections) so we we may see a sharp decline in cases, hospitalizations, and deaths in September.

It’s August 1st, 2021, how is Orange County doing with COVID-19?

For the week ending July 29th 2021, Orange County Florida had an average of 1,130 new cases per day. The test positivity rate over the last week was 18.2%.
This is worse than the highest previous peak in January.  The exponential growth can be blamed on the Delta Variant and the relaxing of masking and social distancing.

Historically, Orange County has had a case fatality rate of near 1%, so that would indicate we are due to see about 11 deaths per day in the near future, but as death numbers are no longer part of the FDOH weekly reports for counties I have no way of knowing if the case fatality rate has started to drop due to vaccinations of high-risk groups or has increased due to the Delta variant.

We have vaccinated (at least a first dose) 780,452 people (out of a population of 1,457,445, or 54% of the total. If you discount children 12 and under who are not yet eligible for vaccination, Orange County has vaccinated 63% of the eligible population.  We vaccinated 62,349 people in July (Compared to 65,206 in June, 88,482 in May and 151,176 in April.)

Hospitalizations

Although the FDOH is not reporting county level hospitalization numbers, we can assume that the admissions curves for Orange County are similar to the entire state of Florida.

AdventHealth has entered ‘black’ status and postponed all non-emergency surgeries confirming that they have more hospitalizations than in January, which matches the state level graph.

Nursing Homes

We are seeing a small uptick in covid-19 cases in nursing homes. According to the AARP, in Florida’s nursing homes “Roughly 3 in 10 nursing home residents and 3 in 5 health care staffers are not fully vaccinated. The state’s nursing home vaccination rates are well below national averages”.

End in sight?

In the United Kingdom, which was hit by the Delta variant earlier than the US, daily case numbers are starting to drop.  It may be possible that through vaccinations and “naturally obtained immunity” that the UK is reaching the herd immunity threshold. As the delta variant tears through the remaining unvaccinated population in the US we may see a corresponding drop in infections next month.

It’s July 2nd 2021, how is Orange County Florida doing with Covid-19?

Well, it’s hard to tell for sure, as the Florida Department of health has stopped issuing daily reports, and has switched to weekly reports. They have also stopped releasing per-county death numbers, among other omissions and simplifications.  You may notice that the graph I have to display is simplified this month.


What we do know is that the number of cases per week had been decreasing since mid-April, but in the last two weeks the number of cases per week has started to increase again. On June 1st the 7-day average was 145 cases per day, while as of July 2nd it is 171 cases per day, and the case positivity rate has raised to 5.3%.

Historically, Orange County had a case fatality rate of near 1%, so that would indicate about 1.7 deaths per day, but those numbers are no longer part of the FDOH weekly reports so I have no way of knowing if the case fatality rate has started to drop due to vaccinations of high-risk groups or has increased due to the Delta variant.

We have vaccinated (at least a first dose) 718,103 people (out of a population of 1,457,445, or 49% of the total). If you discount children 12 and under who are not yet eligible for vaccination, Orange County has vaccinated 58% of the eligible population.  We vaccinated  65,206 people in the month of June. (Compared to 88,482 in May and  154,176 in April.)

The rate of vaccination has slowed and I expect it to continue to slow, while the total number climbs upward slowly. I expect that fewer than 60 thousand people will be vaccinated in July.

I believe the uptick in case numbers is primarily among the un-vaccinated 51% of the population, due to a combination of the more infectious Delta variant and relaxation of mask usage and social distancing.

[Charts/Numbers used can be found in this open document spreadsheet: orange_county_florida.ods ]

It’s June 1st 2021, how is Orange County Florida doing with COVID-19?

Cases
Continuing vaccination efforts have continued the decline in cases since the mid-April mini-spike.  The 7-day average of new cases (145 per day) has reached the level achieved in Aug/Sep of 2020, which was our previous low point.  These new cases are primarily occurring within the remaining unvaccinated population.

Median Age of the infected

At the end of April, the median age of those infected  was  32.7 years old. Over the last seven days the average age has risen slightly to 33.8, and I expect this average age to increase as more children in the 12-16 age group are vaccinated.

Deaths
The number of deaths per day has held relatively steady at a reported 1.93 per day, (60 total) in May. (Compared to 2 per day in April.)  The summer peak (June 22nd 2020 to July 22nd, 2020)  had 6.97 average deaths per day (223 total deaths), so the number of deaths is around 25% of our worst month. Total reported COVID-19 deaths overall in Orange County  Florida is at 1309 as of June 1st 2021.

Percent Positivity
These numbers are significantly better than in April, with every day out of the last 14 under 5%, and 13 days under 4%.    Community spread is starting to be under control.

This is a significant improvement over the end of last month:

How many people have been vaccinated

The Florida department of health reports that as of May 27th 2021, 510,582 Orange County residents  (36.6% of the total population) have been fully vaccinated. Children under the age of 12 are not yet eligible for vaccination, but also have minimal direct health risks from catching covid-19 (other than the risk of transmission to others.)

The rate of vaccination uptake has slowed, large community vaccination sites are being shuttered and replaced by smaller pop-up clinics at targeted sites as well as distribution via local pharmacy’s.

Predictions for June:

I expect that daily case numbers will decline in June, hopefully going below 100-per day by the end of the month. Deaths are also likely to slowly reduce over time. My prediction would be between 30-45 deaths in June (1-1.5 per day).

[Charts/Numbers used can be found in this open document spreadsheet: orange_county_florida.ods  ]

It’s May 1st, how is Orange County Florida doing with COVID-19?

Cases
Despite continued vaccination efforts, the small spike in cases in March continued into April, most likely due to new more contagious variants of the virus (B.1.1.7) and relaxing of social distancing by the population. It appears we reached the top of this peak mid-April as the the 7-day average of new cases (355 per day) is below the peak.  The number of new cases per day is still higher than Aug/Sep of 2020, which was our previous low point.

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What can we learn from a nursing home COVID-19 outbreak?

In March of 2021, an outbreak of COVID-19 spread through a nursing home in Kentucky.   The “Skilled Nursing Facility” had 83 residents (assumed to be in the “older” demographic) and 116 Health Care Personal (HCP) [Which we will assume to generally fall in the “under 65” demographic].  They had all been offered the Pfizer-BioNTech mRNA vaccine.

75 residents (90.4%) and 61 HCP (52.6%) received two doses of the vaccine.

HCP at the nursing home were tested for SARS-CoV-2 twice weekly, so we have a good understanding of when the outbreak started and how it arrived in the facility.  After the outbreak was identified, residents were also tested daily with an antigen test.  The variant responsible (identified with whole genome sequencing) came from the R1 linage and had several spike protein mutations.

Overall, 26 residents and 20 HCP tested positive for a COVID-19 infection. 18 of those residents and 4 of those HCP had been fully vaccinated.

Lesson 1: Full vaccination does not offer 100% protection from infection, especially in the “older” demographic which may not mount a robust immune response.

Only 28 of these people showed symptoms, 8 of whom were vaccinated, and 20 of whom were un-vaccinated.] 18 people who tested positive did not show symptoms.

Lesson 2: Asymptomatic infections occur.

“Attack rates in unvaccinated residents (75.0%) were 3 times as high as those in vaccinated residents (25.4%)”

Lesson 3: Being vaccinated does provide significant protection from getting infected, even if you are “older”.

“[attack rates] in unvaccinated HCP (29.6%) were 4.1 times as high as those in vaccinated HCP (7.1%)

Lesson 4: Vaccines provide better protection for younger individuals.

Four “possible reinfections”  (a positive SARS-CoV-2 test result more than three months after a previous laboratory-confirmed infection) were identified, giving “evidence of limited or waning natural immunity to this [R.1] variant.” All four of these re-infections were symptomatic.

Lesson 5: It is possible to be re-infected by a different variant, even if you have already been infected.

“[Vaccine effectiveness] against hospitalization was 94.4% …among residents; no HCP were hospitalized.”

Lesson 6: Unless you are a nursing home resident, vaccination provides very good protection from hospitalization and death.

“estimated [Vaccine effectiveness] for COVID-19 symptom prevention (86.5% for residents; 87.1% for HCP) demonstrates a strong protective effect of vaccination.”

Lesson 7: Vaccination will protect most people from symptomatic illness.

“The index case occurred in an unvaccinated, symptomatic HCP [Health Care Personal]”

Lesson 8: The more people who are vaccinated, the less likely an outbreak is to occur in the first place.

It’s March 31st, how is Orange County Florida doing with COVID-19?

Graph showing infections & deaths
Cases
Despite vaccination efforts, March had a small spike in cases, most likely due to new more contagious variants of the virus (B.1.1.7) and relaxing of social distancing by the population. It appears we may be reaching the top of this small peak as the the 7-day average of new cases (352 per day) is below the peak.  The number of new cases per day is still higher than Aug/Sep of 2020, which was our previous low point.

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It’s February 1st 2021, how is Orange County Florida doing with Covid-19?


Cases

The 7-day average of new cases (628 per day) has fallen from the post Holiday peak, and is comparable to that of the summer surge. I am hopeful that this decline will continue.

Deaths
The number of deaths per day are going up, but as physicians have learned better ways to treat patients we are not yet having as many deaths as in the summer peak.
In December 2020, Orange County Florida had an average of 3.35 covid-19 deaths per day (104 total deaths). In January 2021, the average had risen to 6.7 deaths per day (208 total deaths). The summer peak (June 22nd 2020 to July 22nd, 2020)  had 6.97 average deaths per day (223 total deaths).

In the state of Florida overall, the number of people hospitalized with COVID-19 has started to decline, indicating that we may be close to the peak of deaths.
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