These Are the COVID Stats to Use to “Open Up” Your Family
With so many statistics available, it’s hard to know which are most important—so here’s how to tell & why
by Steve Silvestro, MD @zendocsteve
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We’re about nine months into this pandemic—do you feel like you have a handle on how to tell if it’s getting better or worse? Do you have a sense of how to know when it’s OK for your family to “open up“ and start doing some things you’ve been holding back on?
If your answer either of those questions is “no,” you’re not alone. Absolutely. Not. Alone.
We are nearly a year into this thing, and yet the messaging to the average person—you, me, our families—still isn’t clear. Part of the problem is that we’re still learning about this virus as we go. But perhaps a bigger problem for the average person trying to tease out useful information is that it’s challenging to figure out exactly what information is indeed useful. There are a dozen different types of statistics discussed in the news or online dashboards, let alone different ways to measure them and different ways the numbers are spun depending on who’s doing the talking.
So I’m here to simplify this for you.
When it comes to understanding where your community stands with coronavirus and where it is headed, there really are only two numbers you need to look at—the number of new cases per 100,000 people and the reproduction number (Rt).
So let’s go through why these “Big Two” are the numbers the average person should focus on, and how you can use them to make smart decisions about your family.
THE NUMBER OF NEW DAILY CASES PER 100,000 PEOPLE = WHERE YOUR COMMUNITY IS NOW
Throughout this whole pandemic, the headline-grabbing numbers have primarily been the number of people who’ve sadly died because of COVID. (Perhaps sadder still is the fact that we’ve gotten so accustomed to hearing about tens of thousands dead that the statistic of 200,000 gone doesn’t seem to give some people pause—perhaps thinking of it as “nearly a quarter million people dead” would instead…).
But while the nation’s total number of infected people or deaths from the virus are important markers of how we’re doing as a country, with so much variability in communities across the United States, the better number for you to focus on is your region’s number of daily new infections per 100,000 people.
Before we dig into why, there are a few technical details to know in order to understand this better.
First, we look at the number of cases “per 100,000 people” so that we can standardize and be able to compare communities. For example, 88 new cases a day in a town of 300 people means the virus is blazing like a fire compared to 88 cases in a city of 3 million people. Just knowing that there are 88 infections per day in each area doesn’t help much until we put it in perspective—so, we standardize all the numbers to how many per 100,000 people. By doing so, we see that the town of 300 people has an alarming rate of 29,333 infections per 100K people, whereas the city of 3 million only has a rate of 2.9 infections per 100K people. Standardizing the numbers to “per 100,000 people” helps us better compare how communities are doing.
The second thing to know is that, technically, the number of daily new infections per 100K people tells you where your community stood a few days ago, not exactly today. Because it can sometimes take several days for test results to come back, plus an additional several days for different regions to report those numbers publicly, the number of daily new cases per 100K people is really a glimpse at how many new infections your community saw several days back.
All that said, for general purposes, the number of daily new infections per 100K people is the best number that you can use to get a sense of where the virus currently stands in your community.
One more technical detail…I said there are only two numbers to pay attention to, but really there are two and a half. That extra number is the Test Positivity Rate—which is the percentage of tests in your area that turn up positive. This number tells you how reliable your infections per 100K number is. How? Let’s say your town of 100K people has 2 infections per 100K—which means only two people are recognized as sick. If you only tested those 2 people, your positivity rate is 100% and common sense says you’re likely missing other infected people out there because the odds that you tested the only sick people are pretty slim. But if you’ve tested 500 people and only got 2 positive—which gives you a positivity rate of 0.4%—then you’re much less likely to be missing anyone. It’s widely accepted that when the test positivity rate is less than 5%, that means your community is testing enough people to pick up most of the virus. Why do I say you only need to “half” pay attention to this? Well, the exact positivity rate won’t matter too much for your family’s decision making, but in order to have faith in your area’s infections per 100K number, you’ll want to see that your region’s test positivity rate is 5% or less.
The generally accepted goal is for a region to have 4 or fewer new cases per day per 100K people. To put this in perspective, when New York was at the peak of its COVID surge, there were a recognized 51 new daily infections per 100K people. As I write this on September 12th, that number in New York is currently at 3.5. Vermont is currently doing a great job controlling the virus—they currently have only 0.5 daily cases per 100K people. North Dakota, on the other hand, is blowing up with 34 per 100K (and their positive test rate is 21.6%, which means they’re not even recognizing a ton of infections).
If your area has more than 4 per 100K people, it doesn’t necessarily mean that your area is grossly unsafe. However, the farther away from 4 per 100K your area is, the more present the virus is in your community. If I lived in Vermont, I’d gladly send my kid to a friend’s house right now—whereas in North Dakota, I’d probably be locking all the doors.
THE REPRODUCTION NUMBER (Rt) = WHERE YOUR COMMUNITY IS HEADED
The second big number to pay attention to is your area’s Reproduction Number, sometimes abbreviated “Rt.” You’ll also find some websites calling this the “transmission rate” or the “infection rate.”
The Rt represents how many other people the average sick person infects. When the Rt is 1, then the average sick person infects one other person—which means the pandemic keeps plugging along at a steady rate. When the Rt is a lot higher than 1—say, an Rt of 15—then every single sick person infects a lot of other people and the pandemic spreads like wildfire. On the other hand, when the Rt is less than 1, that means that not every infected person infects someone else. So when the Rt is less than 1, you begin to see fewer new infections each day and the pandemic fizzles out—and the closer to 0 the Rt gets, the faster it fizzles.
Having good testing capabilities and contact tracing systems—basically, being able to recognize newly infected people and keep them and their contacts isolated—can help drive the Rt down.
Think of the Rt as a window into the future. If your area has a high Rt, then you’re likely to start seeing a lot more new infections. But if your region’s Rt is under 1, then the pandemic is losing ground in your area.
SO WHAT NUMBERS DO YOU WANT TO SEE TO MAKE SMART DECISIONS FOR YOUR FAMILY?
Alright, we know that we have a public goal of 4 or fewer new cases per 100,000 people and a reproduction number under 1 and as close to zero as possible.
But what numbers should help you make a decision to start doing things again?
It’s hard to give very specific numbers that would say “This number means it’s okay to let people into your home” or “This number means it’s safe to eat at a restaurant.” However, there are great sites that can help you visualize the data and get a good sense of the direction your area is headed.
My favorite site right now is CovidActNow.org, which is a joint project partnering Georgetown and Stanford Universities. The team at this site qualifies a Rt of 1-1.1 as “Medium Risk,” 1.1-1.4 as “High Risk,” and over 1.5 as “Critical.” With regard to daily new cases per 100K people, CovidActNow rates 1-10 cases as “Medium Risk,” 10-25 as “High Risk,” and over 25 as “Critical.”
One of the best aspects of the site is that they put these Big Two stats front and center for each state and county. They also use clear, color-coded graphs that make it easy to get a sense of where your region currently stands and where it’s headed.
Looking at the data, it’s clear that almost every single state still has work to do to get this virus under control. In fact, at time of writing, only Vermont qualifies as “on track to contain COVID” according to CovidActNow.
So what does that mean?
For most areas, I’m currently discouraging any socializing indoors—I have been since the start, and there’s no evidence yet that this can change. If someone needs to enter your home—to use the bathroom, to do work—or if you need to enter someone else’s, then you’ll want to keep the amount of time spent inside to a minimum & it’s imperative to wear a mask. Gyms, restaurants, bars—these are all open for economic reasons and to make us feel good, but there really isn’t evidence that they should be open for most areas, especially after a recent study showing that infected people were twice as likely to have recently eaten in a restaurant than non-infected people. I’m still not even recommending eating at an outdoor restaurant table with people that are outside of your immediate circle—you’ll still want to be at least 6 feet away even outside, which isn’t happening at most outdoor restaurant tables—and I’d suggest avoiding outdoor dining altogether in areas with red-zone “critical” numbers.
Smartly spending time outside is going to be the best way for families to socialize for the foreseeable future, especially while the weather is still good in many places. Masks are still strongly recommended even outside, as is distancing—but masks may be a little less important if you can keep a wide distance or are moving, like a hike or a bike ride, or sitting in chairs on opposite sides of a large porch.
This has been a stressful year, and unfortunately, we’re likely to face continued challenges in the months ahead. But one stress you can avoid is the overwhelming bombardment of too much confusing COVID information. By focusing in on the Big Two of your area’s daily new cases per 100,000 people and the local reproduction number (Rt), you can get a pretty clear sense of how your community is doing with managing COVID-19. And the more aware we are of our communities’ situation, the better we can make smart choices for our families and the faster we can kick this pandemic to the curb.
Dr. Steve Silvestro is a pediatrician and consultant who aims to distill complex medical information into memorable, impactful content. He hosts The Child Repair Guide Podcast, and can be found on Instagram, YouTube, and Facebook, or playing guitar.