Florida’s Delta Wave Appears to Peak

Here’s the weekly Florida COVID-19 report with data from Orlando, Orange County, and around Walt Disney World as of August 23, 2021. This provides an update on new cases, positivity, hospitalization, etc., plus public health expert commentary and a look at some of the headlines that made national news in the last week.

As always, this information is assembled since it’s potentially relevant news to out-of-staters planning or on the fence about a vacation to Walt Disney World. The goal with these updates distilling data and information from multiple sources, free of hyperbole, sensationalism, and commentary–just a straightforward report on current circumstances in Central Florida.

We’ll start with numbers from the state, with the Florida Department of Health releasing its weekly ‘situation report’ through last Thursday, with over 150,000 new cases for the second straight week. However, that number ticked down slightly, from 151,468 the previous week. That’s the first of a few early signs that new cases have already peaked in Florida…

The CDC reported 22,133 new cases in Florida for August 20, 2021 (the most recent date for which there’s data). No new daily records this past week in terms of cases. To the contrary, Florida’s seven-day average of new cases has decreased from last week’s record number of 21,662 to 20,134.

Again, this is a relatively small decrease, but it comes against the backdrop of schools going back into session and is a contrast to the sharp spike that occurred from late July through mid-August. One month ago, Florida’s 7-day average was 8,913 cases per the CDC. The shot up quickly, hitting 20,057 by August 8. Numbers continued to tick up after that, before plateauing and now starting to decline.

Most Florida school districts (including Osceola and Orange Counties) have now been back in session for two weeks, which likely explains the prolonged plateau. As you can see in the CDC graph below, no past wave of cases has decreased and then increased shortly thereafter. (It appears that happened between Christmas and New Year’s, but that was because testing stations were closed for much/most of that holiday week.)

While that presents reason for optimism, hospitalizations and deaths–both of which lag new cases–have not yet declined. Florida is seeing its COVID-19 hospitalizations plateau, with 16,937 COVID patients as of Sunday according to the Florida Hospital Association. This is still higher than last week, but that number has been in the 15,000 to 17,000 range for the last couple of weeks. (See graph below.)

Per numbers from the Department of Health and Human Services, coronavirus patients accounted for 29.87% of Florida’s inpatient beds and 53.3% of ICU beds. In total, 85% of hospital beds in Florida are in use.

AdventHealth provided a briefing at the end of last week, indicating that 1,620 people are hospitalized at AdventHealth’s Central Florida hospitals. Last week, that number was 1,580 patients. That’s an increase of only 40 patients, which also suggests a plateau of this wave in Central Florida. During the peak of this wave, hospitalization numbers were jumping by 300 or more each week.

Of AdventHealth’s COVID patients, approximately half are under 40. In past waves, the average age of those hospitalized was approximately 60 years old, per Dr. Vincent Hsu, Executive Director of Infection Prevention for AdventHealth.

This tracks with the aforementioned weekly situation report from the Florida Department of Health, which shows residents from lower age brackets making up a disproportionate number of cases (as compared to past waves). However, that too is explained via Florida’s data: over 80% of residents above the age of 60 are vaccinated, whereas less than half of those under age 30 are fully vaccinated.

Today, Orange County held its latest health press conference, which you can watch for yourself above. (As with the last couple of weeks, this one is not particularly worthwhile–if you have limited time but want to watch something, see the two interviews below.)

We’re going to start by jumping ahead to the Q&A, during which Orange County Mayor Jerry Demings was asked whether residents will need to reduce water use or face a boil warning. He stated that those were prudent decisions and requests made by Orlando and Winter Park based upon their water use rates. A representative from Orange County Utilities further addressed this, stating that the shortages are not impacting Orange County customers at all.

Prior to this, Central Florida made headlines late last week as Orlando Mayor Buddy Dyer and the City of Winter Park urged residents to stop watering their lawns (landscape irrigation consumes about 40% of the water provided by local utilities companies).

This is because hospitals are increasingly utilizing treatment that involves high flows of supplemental oxygen for patients. That’s triggered a nationwide shortage for liquid oxygen, which has been exacerbated by typical supply chain and labor woes–a lack of available tanker trucks and drivers. The end result is that Central Florida has access to less liquid oxygen and greater demand for it–and liquid oxygen is also used by Orlando Utilities Commission in its higher-end treatment process for the city’s water. Most other counties and cities do not use this same process, which is likely why Orlando made headlines while other locations did not.

As with last week, Orange County Utilities also shared preliminary data from its participation in the CDC National Wastewater Surveillance System. This program provides an advance warning of infections through analysis of RNA concentrations in water reclamation facilities across the United States.

Orange County Utility facilities went from around 200,000 gene copies of the virus per liter in May when the program started to 2,000,000 in early August. As of today, all three facilities are elevated but generally trending downward; the Southern and Eastern are still above 1.4 million copies per liter. Specifics were not provided for the Northwest Water Reclamation Facility, but it was already dropping as of last week.

Alvina K. Chu MHS, the Epidemiology Program Manager at the Florida Department of Health in Orange County spoke at the press conference, sharing new data for Orange County. She shared that the recovery rate is above 99%, and the 14-day average test positivity rate is 20.01%, which is right around where it has been for the last couple of weeks. There were 1,278 new cases yesterday, and Orange County is currently seeing 555 new cases per 100,000 people.

As a reminder, the CDC’s criteria for moving down to the moderate level (where face masks are no longer recommended indoors) is under 50 total new cases per 100,000 persons in the past 7 days and under 8% test positivity during the past 7 days.

Dr. Chu indicated that Orange County has identified 1,716 breakthrough cases among those who are vaccinated. Most are asymptomatic or mild cases, with the hospitalization rate being very low among the fully vaccinated, as well as the death rate. Greater than 95% of cases are occurring in those who are unvaccinated.

“The breakthrough cases get a lot of media play,” said Dr. Chu. “But it is a very small percentage of the cases that are happening now. A very small percentage happens in vaccinated persons. Predominantly, the pandemic is spreading in unvaccinated persons.”

On the topic of vaccinations, Dr. Chu shared that 66.07% of the eligible population has received at least one dose of the vaccine. Greater than 83% of Orange County residents age 65 and older have received at least one dose of the vaccine. For those who are 12-17 years old, approximately 51% have received at least one dose of the vaccines.

On another optimistic note, vaccinations continue to increase in both Florida and the United States as a whole. After bottoming out in July, shots are on the rise again. Over a million inoculations per day have occurred for the past 4 days.

Thursday marked the first time there have been at least 1 million doses administered in close to seven weeks, which is a 31% percent week-over-week increase. (And numbers were already up the last two weeks.) Just over 51% of the United States population is fully vaccinated with one of the country’s three options from Pfizer, Moderna, or Johnson & Johnson.

Those daily vaccination numbers should continue to hold steady or even increase, as the United States Food and Drug Administration gave full approval to Pfizer’s COVID-19 vaccine today. This milestone may help lift public confidence in the shots as many Americans have expressed hesitation about being inoculated under only the emergency use authorization. It will also likely lead to an increase in workplace vaccine mandates.

“The public can be very confident that this vaccine meets the high standards for safety, effectiveness and manufacturing quality the FDA requires of an approved product,” said FDA Commissioner Janet Woodcock in a statement. The Pfizer-BioNTech vaccine now carries the strongest endorsement from the FDA, which indicated it has never before had so much evidence to judge a shot’s safety. More than 200 million Pfizer doses already have been administered in the U.S. — and hundreds of millions more worldwide — since emergency use began in December.

Turning to the experts, former FDA commissioner Dr. Scott Gottlieb appeared on CBS Face the Nation yesterday. He explained that the rate of transmission is below one across the South, which means the pandemic is contracting rather than expanding.

In analyzing Rt data from Harvard Chan School’s covidestim.org, Gottlieb explained: “Florida has been the epicenter of the epidemic in this country, [but] if you look across different age categories in Florida, every age category shows a declining number of cases day over day, except for school age kids, kids ages 6 to 19.” (Note: covidactnow shows a slightly higher Rt, but its data also suggests the pandemic is at or near the contraction point in Florida.)

Per Gottlieb: “Now there’s still very hard weeks ahead because they’re still going to continue to accrue more hospitalizations and there’s extreme pressure on those health care systems. But there is evidence that the epidemic is starting to slow and the day over day cases are starting to decline.”

Dr. Gottlieb’s interview covered a range of other topics, with the first half focusing on school reopenings and how closures and student quarantines can be avoided. We don’t focus on the school side of this, but his commentary on the subject is well worth watching if you’re a parent or curious about the pandemic’s trajectory.

On the topic of modeling the pandemic’s current wave, that’s exactly what a couple of Florida universities have also been doing. University of Florida’s model (see above) predicted the peak as shown in CDC’s data.

That model has accurately forecast past waves, and predicts plummeting numbers throughout September and into early October. Interestingly, it does not project another wave this holiday season.

In an interview last week with WPBF 25 News (only 2 minutes long, very much worth watching), Dr. Edwin Michael of University of South Florida’s College of Public Health stated that his computer model predicts a peak on August 24, 2021. Michael said shortly after reaching that peak in new cases on August 24, the number of people who been vaccinated, naturally infected, or otherwise have COVID-19 resistance will reach 90%. Dr. Michael’s prediction is that Florida will likely reach herd immunity by around September 11, 2021.

In explaining the accelerated timeline for Florida reaching herd immunity, Dr. Michael said: “You’re burning through the susceptibles, the delta variant is highly contagious. It’s burning through.” Once that happens, there’s hardly anyone else left to infect, Michael indicated. After that, the models show COVID-19 will continue to pop up in small spikes, but deaths will end and COVID eventually will die out by early next year. “We are predicting by early next year this will just go away,” Dr. Michael said.

Dr. Michael said the USF computer models parallel those done by the Institute of Health Metrics and Evaluation at the University of Washington. That could explain why another holiday surge is not forecast be either of these models from universities in Florida. With that said, Dr. Michael cautions that there are variables and unknowns. If immunity turns out to not be long-lasting, the virus could re-emerge and reinfect the population. However, even if antibodies or immunity wanes, a high percentage of Floridians will have strong B and T cell immune memory. That should dramatically decrease severe outcomes in any future waves or flare ups that may emerge next year or beyond.

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