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.
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.
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.
Cases
The 7-day average of new cases (320 per day) has continued to fall in February, but the rate of change has started to flatten out. The number of new cases per day is still higher than Aug/Sep of 2020, which was our previous low point.
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.
Continue reading
Seven day averages of new cases and new deaths in Orange County FL.
Cases
The 7-day average of new cases (848 per day) has reached levels only seen at the peak of the summer surge, bringing us firmly into “2nd wave” territory. There were dips in reported cases around the Thanksgiving and Christmas holidays as many testing sites were closed, but it is clear that these holidays drove a continuing increase in infections.
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. (Also, deaths lag infections by several weeks, so I expect these numbers to increase.)
In November, Orange County Florida had an average of 2.87 covid-19 deaths per day (86 total deaths). In December 2020, the average had risen to 3.35 deaths per day (104 total deaths). This is still 50% of the deaths reported in the summer peak (June 22nd 2020 to July 22nd, 2020) which had 6.97 average deaths per day (223 total deaths).
In the state of Florida overall, the total number of people hospitalized for covid-19 is slightly over 6,000 (but rising), while the summer peaked at almost 10,000. The deaths per day is also currently lower than the summer peak.
Hospitalization and Death trends for the entire state of Florida. (Hospitalization data was not reported by the Florida DOH until July 10th.)
Percent Positivity
The percent positivity metric has been above 6.55% in 14 of the last 14 days, indicating that community spread is not under control. 
How many people have been vaccinated
The Florida department of health reports that as of January 3rd 2020, 19,356 Orange County residents have received their first dose (out of two) of a COVID-19 Vaccine.
This is 1.3 % of the population (primarily front line healthcare workers and residents of long term care facilities) who have begun the vaccination process. [Note that full protection is not achieved until two weeks after the second dose, but some protection begins to appear within 10 days of the first dose.]
The US Census bureau estimated that Orange County Florida has a population of 1,393,452 people (July 1st, 2019). The Florida Department of health reports today that 78,512 cases of COVID-19 (confirmed by either a positive PCR or Antigen test result) have occurred in Orange County so far. That means at least 5.6 percent ( 78512/ 1393452 = .05634352 ) of the population has been infected. The actual percentage is likely to be much higher as many asymptomatic cases may never be detected.
Of those confirmed infected, 1,953 or 2.5 percent ( 1953 / 78512 = .02487517) have been hospitalized, and 750 have died. The death toll is currently 0.96 percent of all detected cases ( 750 / 78512 = 0.00955267).
Florida average percentages for hospitalizations and deaths are 4.7% and 1.6% so Orange County has done better than the rest of the state of Florida for hospitalizations and mortality so far.
Last month the median age of those infected was 35, while 42 was the median age over the last 7 days. [The median age of Florida residents is 42.2 ] While infections had trended towards the younger demographics in Sep/Oct/Nov, it appears that the age profile of those infected is now matching that of the overall population.
Orange County Schools
Orange county schools closed for winter break after December 18th. On November 27th they had 1,154 confirmed cases, while they had 2,096 on December 18th, a gain of 942 cases. School will resume on January 4th. The number of cases in the K-12 schools has reflected community spread primarily outside of the schools, which did not appear to be a major driver of new infections.
Predictions for January:
Case numbers have risen quickly in December. I expect them to continue to rise, especially in the next 7 days after New Year’s eve festivities. I expect the numbers for hospitalizations and deaths to increase in January.
I do not anticipate enough vaccinations to occur in January to have a significant impact on the number of new cases, which I expect to stay at or above current levels. However, I hope to see deaths begin to drop near the end of February as the most vulnerable population (those over 65) are prioritized for vaccinations.
[Charts/Numbers used can be found in this open document spreadsheet: orange_county_florida.ods ]
The rate of new cases had a slight rise in September, and continues to be on a slight upward trend in October. This upward trend accelerated in November. Orange County is averaging 469 confirmed new cases per day over the last two weeks (compared to 224 in the same period in October). While not quite as bad as the summer peak of 600-800 per day in July, these numbers are going in the wrong direction.
We had 96 people die from Covid-19 in Orange County in the last month (slightly better than the 105 in the prior month) and the total death count is at 642.
Continue reading
It’s October 28th, 2020, how is Orange County Florida doing with COVID-19?
The rate of decline in new cases had grown sluggish at the end of August, plateaued and then had a slight rise in September, and continues to be on a slight upward trend in October. Orange County is averaging 224 confirmed new cases per day over the last two weeks (compared to 147 in the same period in September). Compared to an average of 14 new cases per day in the first two weeks of April, the number of people infected each day is 16 times higher than in April.
We had 105 people die from Covid-19 in Orange County in the last month (slightly worse than the 79 in the prior month) and the total death count is at 549. Continue reading
It’s August 27th, 2020, how is Orange County Florida doing with COVID-19?
The number of new cases per day has seen steady decreases since late July, possibly due to a mandatory mask ordinance. The rate of decline has grown sluggish for the last two weeks and the number of daily cases is still ten times that recorded in April. Orange County is averaging 191 confirmed new cases per day over the last two weeks, compared to an average of 14 new cases per day in the first two weeks of April.
Deaths are lagging new cases by about 3 weeks and as the number of new cases have declined, the rate of deaths has also declined, averaging only 3 per day in the last two weeks. Unfortunately, the total number of deaths in Orange County has gone from 179 on July 27th to 369 today (adding 190 deaths), a doubling of total deaths in the last month.
If the new deaths curve is actually lagging the new cases curve by 3 weeks, and also plateaus at the current levels, we will have a sustained period of 5-8 deaths per day for the next month, doubling the total number of deaths to date in the next month. [My unfortunately correct prediction from last month.]
A Positive Sign
A positive sign is that the percent positivity rate on tests has hovered just above the 5% goal (and has actually been below 5% for 4 of the last 14 days), indicating that community spread is almost at a manageable level.
The US Census bureau estimated that Orange County Florida has a population of 1,393,452 people (July 1st, 2019). The Florida Department of health reports today that 35,245 cases of COVID-19 (confirmed by either a positive PCR or Antigen test result) have occurred in Orange County so far. That means at least 2.5 percent (35245/1393452 =.02529330) of the population has been infected.
The actual number is likely to be higher, as many infections are asymptomatic, or not confirmed with a lab test. Robert Redfield, the director of the CDC estimates that the number of people actually infected may be up to 10 times higher than confirmed with lab tests, putting an upper bound of 25% of the population of Orange County as already having been infected.
Of those confirmed infected, 1,089 or 3 percent ( 1089 / 35245 = .0309) have been hospitalized, and 369 have died. The death toll is currently 1 percent of all detected cases (369 / 35245 = 0.0104695701 ).
In the last month (July 27th to August 28th) the number of dead has doubled (from 179 to 369).
Florida average percentages for hospitalizations and deaths are 6.2% and 1.8% so Orange County has fared better than the rest of the state of Florida for hospitalizations and mortality so far.
Last month the median age of those infected was 42 , and this has held relatively steady, as 37 was the median age over the last 7 days. [The median age of Florida residents is 42.2 ]
However, Orange County schools have re-opened on Friday Aug 21st, with at least 30% of the students opting for in-person schooling. I would not be surprised to see a dip in the median age as school age children begin to be infected at school. Fortunately, young children vary rarely face serious consequences from infection, but they may drive an uptick in community spread leading to deaths in older adults.
[Charts/Numbers used can be found in this open document spreadsheet: orange_county_florida ]
It’s July 28th, 2020, how is Orange County Florida doing with COVID-19?
The number of new cases per day has surged up, but appears to have plateaued at an average of 606 new cases a day for the last month. Deaths appear to lag new cases by about 3 weeks and have reached a rate of 7-8 per day.
If the new deaths curve is actually lagging the new cases curve by 3 weeks, and also plateaus at the current levels, we will have a sustained period of 5-8 deaths per day for the next month, doubling the total number of deaths to date in the next month.
The US Census bureau estimated that Orange County Florida has a population of 1,393,452 people (July 1st, 2019). The Florida Department of health reports today that 27,820 cases of COVID-19 (confirmed by either a positive PCR or Antigen test result) have occurred in Orange County so far. That means at least 2 percent (27820/1393452 = 0.019964) of the population has been infected.
The actual number is likely to be higher, as many infections are asymptomatic, or not confirmed with a lab test. Robert Redfield, the director of the CDC estimates that the number of people actually infected may be up to 10 times higher than confirmed with lab tests, putting an upper bound of 20% of the population of Orange County as already having been infected.
Of those confirmed infected, 756 or 2.7 percent ( 756 / 27820 = 0.02717469 ) have been hospitalized, and 179 have died. The death toll is currently 0.64 percent of all detected cases (179 / 27820= 0.00643421).
In the last month (June 27th to July 27th) the number of dead has tripled (from 56 to 179).
Florida average percentages for hospitalizations and deaths are 5.6% and 1.38% so Orange County has fared better than the rest of the state of Florida for hospitalizations and mortality so far. This may be due to the fact that South Florida was hit hard first, giving Central Florida a stark warning and time to prepare.
Unfortunately, the median age of the infected is rising. The first big surge of cases detected in mid-June (after bars reopened) were primarily very young individuals, with a median age of 22 for new cases. The current median age is 42, a generation older. As more older individuals are infected the percentages for hospitalizations and deaths may increase in Orange County to match the averages seen in the rest of Florida.
[Charts/Numbers used can be found in this open document spreadsheet: orange_county_florida.ods ]