What our COVID-19 daily diary tells us
Good data on cases, tests – not so good on hospitalizations
AT 4 P.M. EVERY DAY, the state Department of Public Health releases its daily diary of the coronavirus epidemic. The numbers on confirmed cases, tests, and hospitalizations rip through the news media and the public, acting as a barometer of how the state is doing in responding to the pandemic.
The trend lines are fairly clear in some categories, but in a number of instances the data show just how little we know.
The number of confirmed COVID-19 cases was 92 on March 10 when Gov. Charlie Baker declared a state of emergency. On Thursday, nine days later, it was up to 328.
Twelve Massachusetts counties now have at least one confirmed case of COVID-19. Hampshire was added to the list on Thursday when its first case was reported. Dukes and Nantucket counties still don’t have any confirmed cases. Middlesex is tops with 119 cases, followed by Suffolk (72), Norfolk (52), Essex (19), and Berkshire (18).
Some of the other data reported on the state’s daily COVID-19 report is less helpful and becoming less so with every day that passes. Gov. Charlie Baker has repeatedly suggested roughly 80 percent of those who test positive for COVID-19 will just be sent home to deal with mild, flu-like symptoms.
At first blush, Thursday’s report would seem to support that theory, as just 43, or 13 percent, of the 328 people with COVID-19 are being hospitalized. But that number may be misleading. The hospital status of 125 of the 328 was listed as unknown and still being investigated, while 150 were categorized as not hospitalized. The bottom line: We don’t really know with any certainty how many of those patients with COVID-19 are ending up in the hospital or going home.
Hospitals also appear to be admitting a large number of patients who are exhibiting symptoms of COVID-19 but haven’t been confirmed as having the disease yet. On Wednesday, UMass Memorial Health Care in Worcester told the Boston Globe that the number of patients with possible coronavirus who were either already hospitalized or waiting for a bed had risen to 100. Doctors at Massachusetts General Hospital said on Wednesday afternoon that 73 patients had been admitted who were still awaiting rest results, while seven had been admitted who were already confirmed with COVID-19. Five were so seriously ill that they were in the intensive care unit.
Those numbers would appear to indicate that many people are being admitted to hospitals without official confirmation that they actually have COVID-19, suggesting the numbers on hospitalization are likely to grow dramatically. Still, it’s unclear how big a group this is because, without more testing, it’s nearly impossible to say. We don’t know the denominator — the number of people infected.
One hopeful sign is that there isn’t even a category on the Department of Public Health list for deaths because there hasn’t been one yet in Massachusetts.
The DPH data break down the COVID-19 confirmed cases by male and female, which is mildly interesting because men with the disease tend to slightly outnumber women. On Thursday’s report, there were 169 men with the disease and 159 women.
What would be more helpful is to know the proportion of people infected by age group and the proportion of these age-stratified groups who become hospitalized. Baker has said COVID-19 is a big health threat to people over 60 or people with other pre-existing health conditions. But we can’t determine yet absolutely whether that’s the case from the data being gathered by the Department of Public Health. The hospitalization data isn’t broken down by age and not enough testing has been done yet to determine whether those coming into hospitals are representative of the larger population already infected.
Deborah Birx, a top official on the White House’s coronavirus task force, said on Wednesday that preliminary data from Europe suggests younger adults can get very sick. “There are concerning reports coming out of France and Italy about some young people getting seriously ill, and very seriously ill in the ICUs,” said Birx.Similarly, at a World Health Organization briefing on Wednesday, health officials stressed that cases of severe illness were not restricted to older people. “The idea that this is a disease that causes death in older people, we need to be very, very careful with,” said Mike Ryan, the head of the WHO’s emergency program, who noted that almost 20 percent of deaths in South Korea were among people younger than 60. “Physicians again in Italy will attest to this, and in Korea. This isn’t just a disease of the elderly. There is no question that younger, healthier people experience an overall less serious disease. But a significant number of otherwise healthy adults can develop a more severe form of the disease.”
Dr. Jarone Lee, who works in intensive care at Massachusetts General Hospital, said his hospital is also seeing patients of all ages, not just older people. “In the ICU we are seeing everyone,” he said. “What I mean by that is that even though, as you would expect, older people with underlying chronic conditions are clearly the modal sort of patients that are now in the ICU, we are seeing people under age 60 as well. It looks like we are seeing statistics similar to those reported this morning from the Centers for Disease Control. We have some patients that are younger adults, with no apparent underlying medical condition that would put them at greater risk for requiring hospitalization and ICU-level care.