COVID-19 Update: Is the Hospitalization Rate Stable or Rising?

by James A. Bacon

New COVID-19 hospitalizations in reported in Virginia yesterday shot up to a high of 139, but the spike came after a month-long low of 12 the previous day. It is reasonable to conclude that what we’re seeing is an artifact of data collection and reporting, not a reflection of the real world progress of the virus. If we average out the two days, we get an average of 75 each day, which is consistent with my contention that the spread of the virus has leveled off. The epidemic in Virginia not retreating, but it has leveled off.

Consistent with the new hospitalizations data from the Virginia Department of Health, we can see from Virginia Hospital and Healthcare Association (VHHA) that utilization of ICUs and ventilators are down. COVID-19 patients in ICUs hit a new low — 376, down from a peak of 469 — since the VHHA began reporting the data in early April. Likewise, the number of patients on ventilators remained at 217 for the third straight day, also the lowest reported.

As I have noted many times, the reported number of new confirmed cases of the virus is virtually worthless as an indicator of the progress of the disease. The number reflects the number of tests conducted, the protocols followed, and reporting delays far more than the prevalence of the virus.

Now, a more pessimistic presentation of the data from my collaborator in statistical malfeasance — OK, OK, I, not he, am the one guilty of statistical malfeasance — John Butcher:

By John’s reckoning, the number of total hospitalizations is clearly trending up. It just goes to show, you can take any set of data and present it in different ways to reach different conclusions. Pick the presentation that best suits your prejudices.

Meanwhile, we offer for your data delectation this chart from another collaborator, Carol Bova, which highlights the mismatch between the VDH new hospitalization numbers and the VHHA discharge numbers.

One would predict that the number of discharges would roughly match the number of admissions following a n approximately two-week treatment period (the average length of hospital stays for COVID-19 patients). In other words, if 100 patients go in one day, and they get treated for two weeks on average, then one would expect 100 (minus the handful who died) on average to be discharged two weeks later. There would be small daily variations, of course, but over time minor fluctuations would average out.

But that’s not what we’re seeing. While the number of new hospitalizations has trended higher, the number of discharges is lower than it was two weeks ago. Two possibilities present themselves: (1) We’re seeing changes in how and when these statistics are reported, or (2) there is a change in real-world behavior, and hospitals, for whatever reason, are hanging onto their patients longer.

We’ll delve deeper into this conundrum in another post.

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44 responses to “COVID-19 Update: Is the Hospitalization Rate Stable or Rising?

  1. re: ” The epidemic in Virginia not retreating, but it has leveled off”

    is that a function of the current level of restrictions and social distancing?

    If we loosen restrictions – what happens? Do we know?

    Some say that loosening the restriction will cause an increase but that “it’s worth it” even though we have no idea the actual consequences… of doing so.

    So some seem to be basically using this data to imply that leveling off means we can back off of restrictions – but is that true? They don’t come out and say so from one sentence to the next but it then feeds into a narrative that affirms it.

  2. No one on this blog is advocating rollback of all social-distancing and other restrictions all at once. I have advocated an approach that starts with taking low-risk steps, tracking the real-world response, and then, if there are no apparent negative results, moving to the next phase.

    • re: ” No one on this blog is advocating rollback of all social-distancing and other restrictions all at once.”

      No one is making comments here along those lines?

      Also – you got your ideas and 20 other people have theirs. What makes
      your ideas “right” compared to science and govt acting on science recommendations?

      All due respect, your “ideas” are basically your own reasoning without the benefit of the science which is what most scientists and govt are working off of.

      If I take your ideas and mix them with Kerry’s or DJ’s and Sbostian, etc, et al – what would we come up with as consensus – and would it conform to what science is saying?

      In some respects, this is a repeat of the “alarmist” argument for Climate change where we don’t believe the science and then come up with our own ideas as to what is “right”.

  3. OK, let’s start with this article …

    https://www.baconsrebellion.com/wp/about-the-governors-new-metrics/

    Then this statement from today ….

    “It is reasonable to conclude that what we’re seeing is an artifact of data collection and reporting, not a reflection of the real world progress of the virus.”

    So, we have a metrics-based plan to reopen the state’s economy but the state can’t accurately count something as discrete as hospitalizations?

    Meanwhile, as Kerry Dougherty describes in her post, “Why the secrecy about hospital beds and COVID” – we are being intentionally kept in the dark regarding the actual metrics by the very state government that wants metrics to reign supreme.

    Virginia’s localities need to start deciding for themselves whether they should continue enforcing all of Northam’s lockdown orders, some of Northam’s lockdown orders or none of Northam’s lockdown orders.

    Waiting for competence from Richmond is a losing proposition.

  4. “Pick the presentation that best suits your prejudices.” That is NOT the scientific methodology of research!! It IS exactly what we have to STOP doing! We need agreed upon parameters that are based on science, not what looks good politically or to tell a certain narrative. We don’t need to “build” data and charts that support our prejudices. Doing so just confuses everyone and allows politically motivated divisiveness to grow since no one trusts any source and no one knows what is truth. Stop it already!!!

    • Yep.. folks are doing what they have been doing which is looking at things they want to look at them and disregarding what science itself is saying. They’re stopping short of the name-calling we’ve seen with Climate Science – but same Church different pew… “science” is just another “opinion”.

    • I’m sorry you missed my sarcasm.

      Of course we should continually seek to ascertain the objective reality behind the numbers. My line, which so upset you, was more a sad reflection on what people are actually doing, which is cherry picking the data that supports their suppositiongs.

      • No one is “upset”… geeze… and excuse me if I did not recognize the “sarcasm”, there seems to be some of that going around right now!

        re: ” we should continually seek to ascertain the objective reality behind the numbers”

        One REALLY GOOD way to do this is consult the science.

        One REALLY BAD way to do it is for folks who have little or no background in what they are looking at – deciding that as long as they can see the numbers.. they “understand”.

        The prevailing narrative among the critics has been to ignore the science, decide what they think the numbers means – and then to attack the Govt for doing it “wrong” and bad faith.

        All of this goes into the echo chamber which is basically running a de facto disinformation campaign to attack science and govt and it becomes fuel for the “anti” blogs and the folks who go protest govt in general.

        I’m not “upset” but I do think we do need to call out what is going on.

        More than 80% of most people polled SUPPORT the science and the govt and we’re hearing from the 20% – and it’s a familiar refrain – from the same 20% on science and govt, just re-cast for COVID-19.

  5. Let’s have physical distancing but social connections. That will make it easier for all to follow practices that will get us out of this.

  6. Cheer up. You are not the first, and won’t be the last, person who cannot understand why the data does not fit your intuition. It’s what drove Kepler to cast a jaundiced eye on Copernicus’s measurements.

    Here’s a thought. Pick a State, any State, and compare their published numbers just to compare the quality of the data gathering and reporting.

    It’d be kinda like comparing any two of the yet unvalidated 111 new serum assay devices.

  7. Like VA’s neighbor to the north, the state of MD, following the recommended “gold standard” of 14 consecutive days of reduced number of hospitalizations, the state of VA needs to track and report on this number. Once it is known and transparently reported, then there could be consensus of moving to the next phase of the plan to partially re-open.

    https://www.baltimoresun.com/opinion/editorial/bs-ed-0428-maryland-coronavirus-lifting-restrictions-20200427-gg6tajlcmnh2rjobp2azte4eaa-story.html

  8. An observations on Bacon’s conundrum:

    The hospitals in Virginia are beginning to sound like Hotel California, more guests enter than leave.

    Perhaps, earlier expecting to be overwhelmed by Coved-19 patients, the original protocols required that only the most serious Coved-19 patients be hospitalized. All the rest were sent home to recover so as to keep a continuous supply of unoccupied hospital beds, and rested staff.

    But now with that emergency deemed passed, a new one has raised its ugly head. Virginia’s hospitals are going broke, thanks to Va. Governor. Thus Virginia’s hospitals are grabbing and keeping all the Coved-19 patients they can get and keeping them beyond their needed stay to generate desperately needed income. What other alternative is there? Hopefully there are not undisclosed or unrecorded deceased.

    • By George, I think he’s got it.

      Carol Bova and I have been discussing offline what might account for the discrepancy between admissions and discharges. Changing admission protocols could be one answer. Hanging onto patients as long as possible might be another. Something is going on.

      Whatever the X Factor is, as long as Governor Northam makes progress in hospitalizations one of his criteria for relaxing the shutdown, we need to know more.

    • Try drowning in your own snot then say the hospital is keeping you too long. The average time on a ventilator is in days with COV2 patients going weeks.

      These folks have some thoughts https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/

      • Yup. I thought I read that more than 80% who go on ventilators don’t survive. So how do so many get this part so wrong?

        • They stop breathing??

          • Ventilators could be further harming coronavirus patients, some doctors say
            Some doctors are also concerned that ventilators could be further harming certain coronavirus patients, as the treatment is hard on the lungs, the AP reported.

            Dr. Tiffany Osborn, a critical-care specialist at the Washington University School of Medicine, told NPR on April 1 that ventilators could actually damage a patient’s lungs.

            “The ventilator itself can do damage to the lung tissue based on how much pressure is required to help oxygen get processed by the lungs,” she said.

            Dr. Negin Hajizadeh, a pulmonary critical-care doctor at New York’s Hofstra/Northwell School of Medicine, also told NPR that while ventilators worked well for people with diseases like pneumonia, they don’t necessarily also work for coronavirus patients.

            She said that most coronavirus patients in her hospital system who were put on a ventilator had not recovered.

            https://www.businessinsider.com/coronavirus-ventilators-some-doctors-try-reduce-use-new-york-death-rate-2020-4

  9. Perhaps Northam can add Count Von Count to his COVID-19 task force to handle statistics. Why not? We have a cartoon character for a governor why not a puppet in charge of data collection and reporting?

    A third year student at Virginia’s McIntyre School of Commerce could tell you that any plan based on metrics needs accurate data.

  10. Unlike statewide data, DOC data is simple and easy to understand.

    Today’s report is a positive one. The total was 310 positive cases, with 7 in a hospital, compared to the prior report of 294 total with 7 in a hospital.

    The increase of 16 can be accounted for by big swings in two facilities: a decrease of 14 in the Harrisonburg community unit and an increase of 30 in Dillwyn. A DOC official has confirmed to me that the agency is now testing all inmates and staff at Dillwyn; that would account for the big overnight jump and more could be expected as more test results come in.

    The box score so far for DOC:

    Total positive inmate cases: 364
    Deaths: 2
    Currently active (in hospital or correctional facility): 310
    Recovered: 52

    • Well, if TV shows about life on the inside is right, they spend a lot of time “getting buff” and staying in shape, so…

    • Actually, your captive audience does qualify as a random sample. It would appear from this one experiment that the death rate is currently at about 1/2%. If you scale it to the nation, that’s 2,000,000 dead, which I believe was the pre-lockdown estimate given in March.

  11. This is probably an ignorant comment but are the prisons headed towards some version of herd immunity?

  12. For some reason, DOC statistics do not seem to be included in VDH reports, which indicate that there have been no deaths at correctional facilities.

    • The inmates are not actually dying in prison, but in a hospital, probably MCV. That may account for the discrepancy in the VDH data. VDH may be including those deaths in the reports from the hospital and attributing them to Richmond.

  13. “Perhaps Northam can add Count Von Count to his COVID-19 task force to handle statistics. Why not?”

    Well, reading the opinions and comments here makes me want to shout, “one batty bat, two batty bats,…” Let me just cut to the chase, “How many batty, uh, people are registered with the VGOP?”

  14. Jim is correct – the total number of confirmed infections is not significant in determining when to open the economy. The rate of change of hospitalization rates together with the mortality rate and the availability of hospital beds are.

    Whether the data is precise day-to-day is less important than whether it is giving a relatively good picture of the trend. Trends by definition require multiple data points – two days do not make a trend. If we had enough data to create a basic process control chart, we could see which variations are within and outside of the ‘process’ norm.

    However, a quick look at Jim’s chart suggests there is a steady increase in hospitalizations over the past 1, 2 and 3 weeks, consistent with John Butcher’s chart. (Jim, you say the average for the last two days is 75 hospital admissions. Is that correct? On my computer screen, it looks like 32 on April 27 and 139 on April 28, for an average of 85.)

    Even so, there is still an argument to be made that certain types of businesses in certain regions of the state could be considered for opening if local conditions give confidence that they can be opened safely.

    Regarding the gap between admissions and discharges, I was wondering if someone could explain the chart showing admissions and discharges. The red line is supposed to show the number of admissions above discharges. If the number of discharges (gray line) declines, I would expect the number of admissions above discharges to increase. But the chart shows them moving in the same direction.

    As for ventilators, this is a novel virus, and we are still learning how it affects our bodies. As LarryG notes, there is some evidence that ventilators are doing more harm than good. We’re also learning that the virus damages the lungs, reducing oxygen flow, before the patient experiences symptoms, by which time the damage is significant. And few suggested that it would cause blood clotting, leading to increased strokes.

    • Inthemiddle, actually, the red line shows the total new admissions each day and the grey the total discharges each day. When the red line is higher, it means more admissions than discharges that day.

      If you look at the VHHA number hospitalized on April 26, it was 1436.
      on the 27th, 1455, the 28th 1508 and today 1566.

      To account for the two things that happen each day: new patients admitted, and current patients discharged, you need to account for both to see the net change in hospitalizations each day. The admission total went up 19 on the 27th, but 28 were also discharged, so for the number to rise. another 47 had to be admitted: 1436-28+47 = 1455 on the 27th.
      The 28th, 71 were discharged, so 1455-71 + 124 =1508.
      The 29th, 128 discharged means 186 had to be admitted to get a total of 1566 today. 1508-128+186=1566.
      So when the total number of hospitalized drops, then there will be more discharges than admissions and the discharge line will rise above the admission line on the chart.

  15. I’d actually ask and argue that if you want to open up the economy that you need to know if you reduce restrictions does it result in an up-tick in people testing positive in a timely way.

    If you wait until hospitalizations – you’re going to be weeks behind the trend and by that time – really bad stuff could happen.

    It would be like trying to steer a car with a quarter-turn play in the steering wheel.

  16. LarryG, I should have clarified that I was not suggesting that all restrictions be lifted. But as the number of hospitalizations fall, there will be opportunities to allow certain types of businesses to open based on their ability to maintain social distancing, and depending on the level of infection in the region.

    Small steps could be taken in two week intervals to account for the time needed for symptoms to show. If hospitalizations increase dramatically, we go back to the restrictions. If they don’t, we open a little more.

  17. Inthemiddle – here is my concern about using hospitalization to guide policy to lift restrictions.

    There is a lag time. You life restrictions and it takes a couple of three results to see if you lifted it too much… then what do you do? If you
    go back to the restrictions – you still have 2-3 weeks for increasing cases.

    This is why I feel testing is so important because you find the infected quicker and isolate them and find who they had contact with quicker and isolate them.

    The testing gives you a much more real time assessment of the infection rate.

    What say you?

  18. Inthemiddle – here is my concern about using hospitalization to guide policy to lift restrictions.

    There is a lag time. You lift restrictions and it takes a couple of three weeks to see if you lifted it too much… then what do you do?

    Do you drop back to the original restrictions all the way or half way or what?

    Even then, you still have another 2-3 weeks to see if you guessed right.

    This is why I feel testing is so important because you find the infected quicker and their contacts… and isolate them before infection spreads further.

    The testing gives you a much more real time assessment of the infection rate.

    What say you?

  19. LarryG, thanks for your comments.

    We both see the need to manage the risk of exponential increase in infections.

    I’ve suggested that we take small risks, through incremental steps, checking the results between steps, because I’m not sure that testing will provide the information we need to make the decision to relax the restrictions. And I think it is possible to manage the risk of relaxing restrictions rather than stay totally locked down until a vaccine is found.

    Regarding testing, as Jim has noted, the challenge posed by coronavirus is not that many people get sick, it’s that many people get sick enough to overwhelm the health care system. Which is why the trend of hospitalizations and deaths gives more useful information for the decision to relax some restrictions.

    We might be entering a world where at risk individuals avoid crowds; where factories place plastic barriers separating workers in the workplace and cafeterias; where greater restrictions are placed on visitors to elderly health facilities.

    But that still leaves the possibility that our total lockdown can be relaxed in steps.

  20. Inthemiddle – continuing the conversation:

    how do we define – as a standard – what “small incremental steps” are ?
    I’ve not seen much in that regard at all by anyone so far.

    In terms of a Vaccine – I’m proceeding as if there may not be one or if there is – it’s a ways away… hope for the best, prepare for the worst.

    re: ”
    Regarding testing, as Jim has noted, the challenge posed by coronavirus is not that many people get sick, it’s that many people get sick enough to overwhelm the health care system”

    testing tells you who is infected – BEFORE some of them require hospitalization and it actually prevents more infections… it’s a proactive approach to identifying WHO is infected BEFORE some of them need hospitalization. Testing actually is how you reduce hospitalizations.

    If you don’t test, you’re just waiting to see how many get hospitalized and by that time – you’ve got another 3 weeks after you’ve shut back down.

    Testing is how you calibrate the effect of incrementally reducing restrictions…. you find out almost immediately if reducing restrictions results in more infections.

    An undetected asymptomatic person can infect dozens, hundreds of others and you won’t see them until they hit
    the hospital if you don’t test.

    I see this clearly (I think), but apparently others don’t see it or don’t agree what testing actually does accomplish compared to waiting to see hospitalizations…

  21. Fair points.

    I just took another look at what Northam’s order actually closed, and it’s primarily recreation and entertainment. Other businesses can remain open if they can maintain the guidelines. So perhaps there are no additional small steps to take, other than for businesses to reorganize their physical plant to comply with the guidelines.

    I can’t argue about testing. Among other things, it will give more data about the nature of the virus.

    But what does it mean when someone tests positive? It would enable us to isolate that person so they don’t infect others. But we don’t have the resources to track all of the previous contacts, so we won’t know how many more people have already been infected.

    But even if testing is effective, it’s not clear how we would be able to test enough in terms of total tests, frequency of tests, and speed of getting results to help in our decision making. If someone tests negative, do we test them daily?

    In any case, the hospitalizations are increasing, which suggests this is not the time to relax any restrictions.

  22. re: ” But what does it mean when someone tests positive? It would enable us to isolate that person so they don’t infect others. But we don’t have the resources to track all of the previous contacts, so we won’t know how many more people have already been infected.”

    But we NEED to DO THAT – contact tracing and it’s not like we don’t have a slew of unemployed to do it!

    re: ” But even if testing is effective, it’s not clear how we would be able to test enough in terms of total tests, frequency of tests, and speed of getting results to help in our decision making. If someone tests negative, do we test them daily?”

    that we do with prioritization and triage… we do as much as we can while we try to ramp up more… we cannot wait until we have “enough”. Anything we CAN do right now will reduce infections.

    re: ” In any case, the hospitalizations are increasing, which suggests this is not the time to relax any restrictions.”

    yes.. and not only are they days behind the initial infections, we don’t even know what changes might have caused the increased infections.

    There is no way out of this as long as the infection is with us. We have to do what seems almost insurmountable in terms of testing because otherwise, we’re just flying blind on changes we’d make versus their impact on infection rates.

    I just don’t understand why this is so hard for folks to get.

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