Kemp has started reopening Georgia. The data and Trump aren’t on his side, analysis shows
When President Donald Trump stood before reporters at the White House Wednesday, he singled out a lone Republican governor for re-opening a state too soon — Georgia’s Brian Kemp.
“It’s just too soon. I think it’s too soon,” Trump said. “They can wait just a little bit longer. Safety has to predominate.”
Trump, who just days before called on the Democrat-led states of Minnesota, Michigan and Virginia to “liberate” themselves in an apparent criticism of their leaders’ coronavirus restrictions, was the latest in a series of public officials and health experts who questioned Kemp’s decision to open barber shops, tattoo parlors and bowling alleys amidst a global pandemic.
Despite some promising data points, public health experts say that Kemp’s decision is a big risk when much about the disease’s impact in Georgia remains unknown.
Measures to contain and properly track cases aren’t in place, and some of the data used by state officials to justify a slow reopening of Georgia’s economy may be missing key information about the number of cases and deaths.
Other factors, like the state’s low testing per capita numbers, obscure the disease’s full impact in Georgia and makes it more difficult for the state to respond to the disease in the months ahead, experts say.
“We haven’t been seeing a flattening or downward trend long enough to know for certain that it’s true,” said Dr. Harry J. Heiman, a clinical associate professor at Georgia State University’s School of Public Health. “We don’t really have our hands around where we are.”
What does the coronavirus data say?
Before health experts and the president spoke out, Kemp and state health commissioner Kathleen Toomey said the data suggests Georgia is on track to meet a set of federal requirements to restart its economy.
In his Monday press conference, Kemp announced that gyms, barbershops and other businesses will be allowed to open April 24. Theaters, social clubs and dine-in services at restaurants can resume April 27. The re-openings, Kemp said, were “measured” and “a small step forward.”
“In the same way that we carefully closed businesses and urged operations to end to mitigate the virus’ spread, (we) are announcing plans to incrementally and safely reopen sectors of our economy,” Kemp said.
The University of Washington’s Institute for Health Metrics and Evaluation showed that Georgia reached its projected peak number of deaths per day on April 7 and peak hospital resource use on April 15.
The model, however, assumes that Georgia would continue its current social distancing measures until mid-June.
Public health officials warn that Kemp is inviting a new wave of infection, including Dr. Sanjay Gupta, an associate professor of neurosurgery at the Emory University School of Medicine and Chief Medical Correspondent for CNN, who called the state’s new measures “all risk and no reward.”
“It’s a very big risk,” Dr. Marc Lipsitch, a professor of epidemiology at the Harvard T.H. Chan School of Public Health, told the Atlanta Journal-Constitution. “If you open up enough, it’s almost for certain (the virus) will hit Georgia again. It’s just waiting for more susceptible people and more contacts. That’s how viruses work.”
Guidelines from the Trump administration propose that states meet these criteria before social distancing and other restrictions are eased:
A 14-day downward trajectory of reports for influenza-like illness and COVID-like symptoms.
Positive tests account for a smaller portion of the total number of tests conducted over a 14-day period or a downward trajectory in new cases over a 14-day period.
The ability to treat all patients without crisis care or a robust testing program in place for at-risk health care workers, including antibody testing.
Opening businesses such as gyms, barbershops and theaters are a part of the federal government’s first phase of reopening once the guidelines above are met. Trump was clear Wednesday saying that Kemp’s decision went against federal guidance.
Public health experts, data analyzed by McClatchy and other media reports suggest Georgia is not meeting these benchmarks yet, and the number of new documented cases may not be on a downward trend.
The Georgia Department of Public Health earlier this week published data measuring the seven-day average for the number of new coronavirus cases and deaths confirmed. The graphs show a decrease in both categories over the past week.
“What you can see is that in terms of COVID cases, particularly when you look at the rolling total, which smooths out that curve, it makes it easier to analyze,” Toomey said during Monday’s press conference. “We definitely have a plateauing and what appears to be now a decline … and certainly by the end of the shelter in place, that will be the two-week decline that’s required to remove the shelter in place.”
However, the state health department also acknowledges on its website that some cases and deaths since April 9 may not be reflected in the seven-day averages. This period of missing data coincides with the state’s claimed decline in the average number of new cases.
When asked by McClatchy how the missing data affects the decrease in the average number of new cases, representatives for the governor’s office did not respond. The Georgia Department of Public Health did not clarify.
“Those numbers were still going up until about (last week,)” Heiman said. “Every day, they look back at the prior seven days and average the number. For the past seven to 10 days, we’re still getting new information.”
Based on data analyzed by McClatchy, Georgia’s seven-day average for new coronavirus cases is up and down, hitting its current highest point around April 13. The totals dropped slightly but began increasing again soon after. Georgia sees its smallest increases in new cases over weekends.
Some private labs don’t report test results to the state over the weekend, said Michael Hokanson, spokesperson for the North Central Health District in Macon.
The data compares 24 hours of coronavirus data pulled from the Georgia Department of Public Health’s 7 p.m. updates each day. The New York Times shows similar trends, and statistician Nate Silver, editor of the data-driven news website FiveThirtyEight, said on Twitter that Georgia hasn’t seen a sustained decrease in cases.
The Washington Post reported April 20 that Georgia did not currently meet all the criteria to reopen. Bloomberg News reports the statistical case for reopening the state is “weak.”
“It raises many many concerns,” Heiman said. “As we’ve all heard from mayors and business owners around the state, there’s a lack of confidence that this is the right thing to do at this time.”
Georgia doing very little COVID-19 testing per capita
Despite efforts from Kemp and other state officials, Georgia’s testing per capita numbers continue to lag behind nearly every other state in the country.
As of April 22, the Georgia Public Health Laboratory and private labs have processed a little over 94,000 tests — representing less than 1% of the state’s estimated population.
Kemp himself has acknowledged that the state is not testing enough people.
“For weeks, I’ve expressed my frustration with the status of testing and committed more resources to expansion,” Kemp said Monday. “As I’ve said before, testing defines the battlefield and informs our longterm strategy.”
Georgia ranks 39 out of 50 states for the number of coronavirus tests per capita, according to the COVID Mapping Project, a website that monitors coronavirus data.
While the state is testing all people with coronavirus symptoms and increasing the number of tests it can process in a day, there’s still a large segment of the population that isn’t being tested, Heiman said.
“We’re still not testing (virtually) anyone who is asymptomatic,” he said. “We’re still testing very few people with mild symptoms. ...All of these numbers are artificially depressed because of testing capacity.”
Public health experts have warned that increasing testing capacity and the ability to trace people who’ve come in contact with coronavirus patients is needed before the country can reopen. Health experts told NBC that the United States would need to double or triple its current testing levels before the economy partially reopened.
“We are an order of magnitude off right now from where we should be,” said Dylan George, an expert in infectious disease modeling who advised the administration of President Barack Obama during the Ebola epidemic, in an interview with NBC. “Testing is the perpetual problem here.”
Georgia and contact tracing
A key part of Georgia’s coronavirus strategy will be contact tracing, finding people who’ve come in contact with someone infected with COVID-19.
“This is the way we’re going to stop the virus,’ Toomey said during Monday’s press conference. “This is the way we’re going to keep spread from occurring, even as we begin to gradually open up the state. ...It’s literally going to take a village for us to work together to do this.”
Toomey said epidemiologists at the state health department are working on training videos for staff at local health districts and other volunteers. The state is recruiting medical students who aren’t in class to help the state with contact tracing.
A computer-based app will help Georgia’s health department to keep track of the data, monitor patients and help find additional contacts. The app will be finalized soon, Toomey said.
Officials at local health districts in Columbus and Macon recently said contact tracing there is not possible due to the sheer number of cases and a lack of staff.
“When there are a few cases of something, that’s when they’d do that contact tracing and have the time to really research. But in a pandemic there are just so many cases,” said Pamela Kirkland, spokesperson for the West Central Health District in Columbus. “It just kind of snowballs and they aren’t able to keep up. ...We’re doing the best we can do.”
Heiman, the Georgia State professor, says estimates show nearly 1,500 people would be needed to properly handle the state’s response, adding that the policies from Kemp and Toomey are just plans at this stage. None of them are ready to be implemented yet.
“Those are critical parts of the infrastructure that have to be ready to go before we start opening things up,” he said. “By their own words, they’re still very much in the planning stages. ...To say we have this plan but all of these key elements are not in place, I think, is incredibly risky.”
This story was originally published April 23, 2020 at 10:36 AM.