‘Cautiously optimistic.’ Why it’s too soon to read into Lexington’s low COVID-19 numbers.
On Saturday, the Lexington-Fayette County Health Department reported one of its largest amounts of new COVID-19 cases all week — four.
As the number of COVID-19 cases has ballooned in other parts of the state — Louisville announced Saturday that it’s up to 854 cases, nearly four times as many as Lexington’s 221 cases — Kentucky’s second largest city has repeatedly been reporting new cases in the single digits. The city hasn’t announced a single coronavirus-related death in nearly two weeks.
On Monday, the health department reported no new coronavirus cases and no new deaths.
Is this the light at the end of the tunnel? Not quite.
“It’s too early to tell because we’ve only seen a decrease in the trajectory of our rate in the past week or so,” said Dr. Kraig Humbaugh, Lexington’s commissioner of health. “So we’re hopeful that that’s what we’re seeing now, the benefits of those social distancing policies.”
Kevin Hall, a spokesman for the Lexington-Fayette County Health Department, said Monday’s zero new positives was likely the result of health care providers’ offices being closed over the weekend.
A couple of factors make it too soon to tell if Lexington’s low numbers mean that the city’s social distancing efforts have worked.
First, it takes time — between two and 14 days — for people to develop symptoms from exposure to the virus. If the symptomatic people are tested, it can take anywhere between a day and a week to get results back.
“That’s why it really takes three weeks or so to notice changes in our numbers,” Humbaugh said.
Humbaugh said he is “cautiously optimistic” about the relatively low number of cases in Lexington (as of Sunday, Lexington had 68.39 cases per 100,000 people, the 24th highest in the state). But he also declined to speculate why Lexington may be an outlier when the rest of the state’s new infections still appear to be on the upswing.
The most obvious culprit, however, is the lack of testing. Across the country, limitations on testing kits and protective equipment have prevented people from being tested. According to official numbers released by Gov. Andy Beshear, only around .7 percent of the population of Kentucky has been tested so far.
For the most part, tests remain limited to the most severe cases, healthcare workers and first responders. Lexington has a testing facility at the University of Kentucky clinical microbiology lab. But for patients with COVID-19 symptoms that don’t require hospital care, tests are still scarce. Some doctors can order tests from private labs, but many of those labs are overburdened. It can take more than a week to get results back.
Humbaugh did not have a number for how many tests of Fayette County residents have been performed. He estimated that there are a few hundred tests run every day.
The health department said it’s impossible to know how many Fayette County doctors’ offices and clinics have COVID-19 tests. That number changes constantly.
There is no lack of desire for testing.
“The hospitals have a real incentive to test people, especially those that are hospitalized because they want to know if the person is COVID positive or not because that really impacts their use and utilization of personal protective equipment,” Humbaugh said.
For restrictions to start loosening in Kentucky, the state will have to see a decrease in new cases of COVID-19 over 14 days, according to guidelines issued by the White House.
And while the numbers in Lexington appear to have plateaued over the past week, Dr. Kathleen Winter, an infectious disease specialist at the University of Kentucky College of Public Health, said that could change very, very quickly.
Winter is working with the Lexington-Fayette County Health Department during the COVID-19 pandemic.
“We have seen a flattening, but it’s a very fragile flattening,” Winter said.
If there is an outbreak in a nursing home, jail or prison, those numbers could dramatically jump as could the number of deaths, she said.
Some of the places in Kentucky with the highest rates of COVID-19 per population are places where a nursing home has been hit by the virus. Jackson County, where the rate is the second highest in the state, announced 13 new cases Sunday, 12 of which were tied to Signature Healthcare at Jackson Manor, a nursing home in the area.
Only one known staff member at a Fayette County nursing home has tested positive for COVID-19. Two staffers at the Fayette County Detention Center have tested positive.
Small counties where nursing homes have been hit also have some of the highest death rates in the state. In Hopkins County, where nine people have died, at least three were nursing home residents.
To date, Fayette County has had seven people die from the illness. That’s about 2.2 per 100,000 people, one of the lowest death rates of the counties that have announced deaths so far.
But Winter said the rate is still troubling. There are still people from Fayette County and across the state that are critically ill with the virus, she said.
“It’s still very high,” Winter said of the percentage of patients that have died from COVID-19 (around 3 percent). “That’s much higher than what we see for other infectious diseases. That could change dramatically on any given day.”
While a sustained decrease in new infections in Lexington will be a positive sign, it’s unlikely to make much of a difference in determining when restrictions are loosened. Those decisions are likely to be made at the state level since it’s difficult to limit travel between counties. Beshear has said county lines are arbitrary when dealing with a virus.
Any reopening will also be incremental. Even after seeing a 14-day decrease in cases, the White House still recommends that schools stay closed and social distancing protocols remain in place.
“We potentially risk a reversal of what we think we’re accomplishing now with all the measures we’re putting into place when we talk about loosening our restrictions,” Humbaugh said.
This story was originally published April 20, 2020 at 1:36 PM.
