Vaccinated, yes; but we are also in the midst of a huge surge

When people ask me why I am still avoiding indoor gatherings at Kendal and minimizing errands away from Kendal, I ask them if they have been watching the Covid rates in Chester County. Generally, they haven’t been. I encourage them to do so, and then to wait a bit before risking too much exposure—even if they’re vaccinated.

Back in early July, when we really began opening up and removing restrictions, the county rate of Covid infection was in the low single digits (generally around 4 per 100,000 of population). I considered the infection risk to be minimal, and I wasn’t worried about shopping and eating in a restaurant.

Now, though, the rate is about 30 times higher—well over 100 per 100,000. And it is still growing (although it shows signs of at least leveling off). Here’s the chart from the New York Times, showing infections in Chester County.

It’s not nearly as bad as it was last winter (when Chester County exceeded 300 cases per 100,000, and when no one was yet vaccinated), but it is certainly worrisome.

The rate of test positivity in Chester County, which our medical staff follows closely, has been above 6% for several weeks. A value above 5% is considered cause for concern.

The worst of this surge is probably yet to come. The local situation is likely to get worse before it gets better. The website Covidestim.org (which is maintained by a team from the schools of Public Health at Yale, Harvard, and Stanford) calculates the factor R_t (“R sub T”), which is a measure of the rate of Covid transmission, for every county. For Chester County, it is around 1.2. Anything over 1.0 indicates the outbreak is still growing. Our rate of 1.2 means that, on average, an infected person will infect about 1.2 additional people. That’s a recipe for continued growth of cases. Chester County is an exception: most of the Pennsylvania counties around us have dropped below 1.0. (New Castle County, our neighboring county in Delaware, is also an exception, with an R_t similar to ours.)

The chances of picking up Covid on campus are small, given our vaccination rate, the fact that our staff is almost all vaccinated, and all our other precautions. But away from campus, it’s another matter.

How are Chester and Delaware County retirement communities doing? Using data from the CDC’s National Healthcare Safety Network system, I took a look at all the “nursing homes” in Chester and Delaware counties. The group includes nursing facilities in retirement communities (such as Kendal). This is the same group I examined in a previous post, and they are doing much better now. That’s what you would expect, of course, given that most of these residents are now vaccinated and precautions that were spotty earlier in the pandemic are now routine. Still, there continue to be cases. I assume they are mostly “breakthrough” cases among the vaccinated population.

The trend is not good, however. Since reaching a low point of no reported cases at all at nursing homes in our area in the weeks of July 4 and July 11, cases have been gradually rising. In the week of September 5 (the most recent week for which data is available) there were 16 new cases among the 49 facilities reporting in our two counties. There were 55 cases in all (9 of them at Kendal) between July 4 and September 5.

The situation with staff cases is worse than with resident cases. There were 74 new staff cases reported since July 4 at the 49 facilities. The higher rate of staff cases presumably reflects a lower vaccination rate among staff, as well as the likelihood that staff receive more frequent exposure in the surrounding community. Although there is no data about who infects whom, it is easy to imagine that catching Covid from infected staff could be an important factor in the continuing rate of infection among residents. I am glad to see that Kendal has taken strong steps toward getting all staff vaccinated.

Keep your guard up. As I hope I have convinced you, we are still in the middle of a surge in Covid cases, and although we are mostly vaccinated, we are vulnerable. For the vaccinated, Covid is generally not life-threatening, but it can make you really sick. This is not a time for reduced vigilance.

Personally, I intend to continue avoiding indoor gatherings when there is an alternative (such as Zoom). Different people will make these personal choices differently; but for the time being, Jan and I have chosen to avoid eating in the dining room and we will definitely not be eating indoors at local restaurants. (I would consider outdoor meals and other outdoor gatherings to be very low risk, however.)  

I’m waiting for a strong decline in local cases as a sign it is safe to relax. If our county R_t dropped below 1.0 and the rate of new cases dropped below 50 per 100,000 (from around 120 per 100,000 at the moment), I would start to feel good about our situation. But not yet.