Time-varying reproduction numbers of COVID-19 in Georgia, USA, March 2-June 14, 2020

150 Acknowledgment: G.C. received support from NSF grant 1414374 as part of the joint NSF-NIH-USDA Ecology and Evolution of Infectious Diseases program. I.C.-H.F. received salary support from the Centers for Disease Control and Prevention (CDC) (19IPA1908208). This article is not part of I.C.-H.F’s CDC- sponsored projects. We would like to acknowledge Bryan O. Sepulveda-Bahamundi, M.S. for his contribution in data collection for this project. Disclaimer: The opinions expressed in this paper does not necessarily represent the official positions of the CDC or the United States Government. . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint

(150, unstructured abstract, 150) In 2020, SARS-CoV-2 impacted Georgia, USA. Georgia announced state-wide shelter-in-place on April 2 and partially lifted restrictions on April 27. We analyzed daily incidence of confirmed COVID-19 cases by reporting date, March 2-June 14, in Georgia, Metro Atlanta, and Dougherty County and estimate the time-varying reproduction number, Rt, using R package EpiEstim. The median Rt estimate in Georgia dropped from between 2 and 4 in mid-March, to <2 in late March, and around 1 from mid-April to mid- June. Regarding Metro Atlanta, Rt fluctuated above 1.5 in March and around 1 since April. In Dougherty County, the median Rt declined from around 2 in late March to 0.32 on April 26. In Spring 2020, SARS- CoV-2 transmission in Georgia declined likely because of social distancing measures. However, as restrictions were relaxed in late April, community transmission continued with Rt fluctuating around 1 across Georgia, Metro Atlanta, and Dougherty County as of mid-June. Key Words (n=4): Coronavirus, COVID-19, Reproduction number, SARS-CoV-2 . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint

In 2020, the pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), impacted the state of Georgia (GA) as in other jurisdictions within the United States. Within Georgia, Metro Atlanta counties have been the hardest hit by the virus with thousands of confirmed cases cumulatively: 15,221 in Fulton, 14,801 in Gwinnett, and 10,767 in Dekalb as of July 24, 2020 (Georgia Department of Public Health 2020). Dougherty County, with Albany as the county seat, was a COVID-19 hotspot in southeast GA and reported a large number of cases (as of July 24, 2020: cumulative number = 2,428, with incidence rate, IR=2,701 per 100,000 individuals) (Georgia Department of Public Health 2020). In GA, every county government had the power to impose preventive measures to reduce viral transmission as they see fit, before the state imposed a state-wide emergency that overrode autonomy of county governments (Table 1). On March 23, 2020, the GA State Government issued an executive order requesting citizens with underlying conditions and those with a COVID-19 diagnosis to shelter-in-place (State of Georgia Government 2020a). Certain businesses were to remain closed and no more than 10 individuals could gather in a location without maintaining a distance of at least six feet. The order also called for restaurants to offer only curbside pick- ups or deliveries (State of Georgia Government 2020a). On April 2, 2020, a state-wide shelter-in-place ordinance was enacted by the Governor allowing only essential services to operate (implemented on April 3) (State of Georgia Government 2020c). The GA State Government announced on April 27, 2020 during a press conference that services, such as beauty salons, barber shops, stores, and restaurants, can reopen if they follow pertinent social distancing measures specified by the state (State of Georgia Government 2020b). As the COVID-19 epidemic in GA continues, it is important to quantify the epidemiologic characteristics of COVID-19 so that we may formulate policies and implement interventions to minimize transmission and mortality. To characterize the transmission potential of an epidemic, it is necessary to calculate the reproduction number based on the trajectory of the incidence curve (Vynnycky and White 2010). The basic reproduction number, R0, is the average number of secondary cases that one primary case can . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint generate in a completely susceptible population in the absence of behavioral changes or public health interventions (Vynnycky and White 2010). The estimated values of the R0 for SARS-CoV-2 vary across geographic locations. An early study of the epidemic in Wuhan reported a R0 of 2.2, assuming serial interval of 7.5 (Li et al. 2020). A more recent study of the epidemic in China, adjusted for the changing case definition, estimated R0 of 1.8-2.0 (assuming serial interval of 7.5) or 1.4-1.5 (assuming serial interval of 4.7) (Tsang et al. 2020). Assuming serial interval of 4.4, our analysis of confirmed COVID-19 cases in Iran estimated the mean R0 as 3.5 or 4.4, depending on the statistical method chosen (Muniz- Rodriguez et al. 2020). In contrast, the time-varying reproduction number, Rt, is a time-dependent estimate of the secondary cases that arise from one case at time t, when depletion of the susceptible population, behavioral changes, and measures to control transmission of disease have taken place (Cori et al. 2013; Thompson et al. 2019). As with R0, if Rt>1, it indicates there is sustainable transmission in the population. When Rt<1, disease transmission cannot be sustained, and it is used as an indication of the effectiveness of infection control measures (Vynnycky and White 2010; Thompson et al. 2019). Various statistical methods have been proposed to estimate Rt. Their strengths and weaknesses have been recently assessed by researchers who compared the performance of different methods using synthetic epidemic data (Gostic et al. 2020; O'Driscoll et al. 2020), and observed COVID-19 incidence data (Roosa et al. 2020). In this paper, we chose to use an oft-used method, known as the instantaneous reproduction number method, as implemented in the R package EpiEstim (Cori et al. 2013; Thompson et al. 2019). This Bayesian method provides an estimate of the average Rt over a short time window specified by the user (in this paper both a 7-day window and a 14-day window that end at time t). It treats the fluctuation in incidence data as signals of an increasing or decreasing reproduction number. This

has been used to estimate COVID-19 Rt in jurisdictions such as mainland China (Leung et al. 2020), Hong Kong (Cowling et al. 2020), Iran (Najafi et al. 2020), South Korea (Zhuang et al. 2020), Italy (Moirano et al. 2020), Nigeria (Adegboye et al. 2020), and Switzerland (Scire et al. 2020). . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint This study aimed to estimate Rt for COVID-19 in GA, Dougherty County, and Metro Atlanta counties, analyzing historical data from March 2 through June 14, 2020, as the state incrementally implemented and then relaxed social distancing interventions (Table 1).

This study uses historical data from the COVID-19 pandemic, March 2 — June 14, 2020, in the state of GA, Dougherty County, and all Metro Atlanta counties (Supplementary Materials Tables S1- S12). Metro Atlanta is defined by the United States Office of Management and Budget as the “Atlanta- Sandy Springs-Alpharetta, Georgia Metropolitan Statistical Area” (Office of Management and Budget 2015). The list of Metro Atlanta counties is provided in Table 2. Data acquisition We downloaded the cumulative data of confirmed cases from March 2 — June 14, 2020, for the entire state of GA and its counties from the New York Times (NYT) GitHub data repository (The New York Times 2020). Every jurisdiction in our study has a start date corresponding to the first reported case for the area, according to NYT (Table 2). The first case in GA was reported on March 2, 2020 (The New York Times 2020). Our cutoff point for all jurisdictions was June 14, 2020, 7 weeks after businesses in the state reopened on April 27, 2020, following social distancing and prevention measures (Table 1) (State of Georgia Government 2020b). We verified the numbers with official statistical reports from the Georgia Department of Public Health (GA-DPH) (Georgia Department of Public Health 2020). If any inconsistencies were found, the numbers from the GA-DPH were used as the standard. To estimate Rt, we transformed the cumulative numbers into daily number of cases reported to obtain daily SARS-CoV-2 incidence (Supplementary

Table S1-S12). We also searched the local government pages to verify if any control measures were established. Such information is presented in Table 1. Statistical analyses The instantaneous reproduction number (EpiEstim package) . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint The Rt estimated by the R package EpiEstim is also known as an instantaneous reproduction number (Cori et al. 2013). This measure is defined by Cori et al. (2013) as the ratio between It, the number of incident cases at time t, to Λt, the total infectiousness of all the infected individuals at time t. The latter is represented mathematically as 𝛬𝑡 = ∑ 𝐼𝑡−𝑠𝑤𝑠 𝑡 𝑠=1 , i.e., the sum of infection incidence up to time t-1, weighted by an infectivity function ws, which is a probability distribution describing the average infectiousness profile after infection and is usually represented by the serial interval distribution. Thus, the number of new cases at time t is Poisson-distributed with a mean of 𝑅𝑡 ∑ 𝐼𝑡−𝑠𝑤𝑠 𝑡 𝑠=1 . Conditional on the number of new cases in previous time points, I0, …, It-1, and given the reproduction number Rt, the likelihood of the incidence It is as follows: 𝑃(𝐼𝑡|𝐼0, … , 𝐼𝑡−1, 𝑤, 𝑅𝑡) = (𝑅𝑡𝛬𝑡)𝐼𝑡𝑒−𝑅𝑡𝛬𝑡 𝐼𝑡!⁄ where the total infectiousness of infected individuals at time t, 𝛬𝑡 = ∑ 𝐼𝑡−𝑠𝑤𝑠 𝑡 𝑠=1 .(Cori et al. 2013) In other words, 𝑅𝑡 = 𝐼𝑡/(∑ 𝐼𝑡−𝑠𝑤𝑠).𝑡 𝑠=1 This can be interpreted as the average number of secondary cases that an infectious individual will infect at time t, if conditions remain the same at time t. As this formulation may result in a highly variable Rt estimate over time, the instantaneous reproduction number method as implemented in EpiEstim assumes that the Rt is constant over a specified time window of size τ ending at time t. This will allow the estimate to be less variable and more precise. Given that transmissibility is assumed constant over a time period, from (t-τ+1) to t, and is denoted by a reproduction number, Rt,τ, the likelihood of the incidence during the time period, from I(t-τ+1) to It, conditional on incidence prior to the time period, from I0, to I(t-τ), is as follows (Cori et al. 2013): 𝑃(𝐼𝑡−𝜏+1, … , 𝐼𝑡|𝐼0, … , 𝐼𝑡−𝜏, 𝑤, 𝑅𝑡,𝜏) = ∏ [(𝑅𝑡,𝜏𝛬𝑠) 𝐼𝑠 𝑒−𝑅𝑡,𝜏𝛬𝑠 𝐼𝑠!⁄ ]𝑡 𝑠=𝑡−𝜏+1 Here, we used a time window of 7 days (main analysis) and that of 14 days (sensitivity analysis) respectively. Using a Bayesian framework with a Gamma-distributed prior for Rt,τ, Cori et al. derived an analytical expression of the posterior distribution of Rt and thus estimated its median, the variance, and the 95% credible interval (Cori et al. 2013). In this paper, the data was analyzed using EpiEstim version . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint 2.2-3 (Cori et al. 2013; Thompson et al. 2019) implemented in R Version 1.2.1335 Macintosh (R Core Team, Vienna, Austria). Ethics The Georgia Southern University Institutional Review Board made a non–human subjects determination for this project (H20364), under the G8 exemption category.

Community transmission of SARS-CoV-2 remained ongoing in GA based on incidence data by date of report from March 2 – June 14, 2020. As of June 14, 2020, the median EpiEstim Rt estimates were 1.14 (95% credible interval, CrI, 1.11, 1.17) for a 1-week-window and 1.07 (95% CrI, 1.05, 1.09) for a 2- week-window respectively. In Metro Atlanta, the transmission may have been under control, with Rt estimates being 1.02 (95% CrI, 0.98, 1.06) for a 1-week-window and 0.98 (95% CrI, 0.95, 1.01) for a 2- week-window. Likewise, in Dougherty County, the transmission with Rt estimates being 1.03 (95% CrI, 0.72, 1.41) for a 1-week-window and 0.93 (95% CrI, 0.72, 1.17) for a 2-week-window (Table 2). The EpiEstim Rt estimates were sensitive to fluctuation in incident cases. As social distancing measures unfolded and then relaxed in GA during our study period (March 2 – June 14, 2020), the median EpiEstim Rt estimate (1-week window) in Georgia dropped from between 2 and 4 in mid-March, to <2 in late March and early April. The median Rt dropped <1 for the first time on April 15. Rt fluctuated around 1 from mid-April to June 14. The 2-week window EpiEstim Rt estimate largely followed the trend of the 1-week window estimate, even though the 2-week estimate was smoother than the 1-week estimate when the Rt estimate fluctuated around 1 from late April to mid-June (Figure 1). Regarding Metro Atlanta (Figure 2), EpiEstim Rt estimates (both 1-week and 2-week window) fluctuated above 1.5 in March and gradually decreased to around 1 in April and continued to fluctuate above and below 1. The Rt estimates for each of the Metro Atlanta counties are presented in Figures S1 to S29 in the Supplementary Materials. . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Regarding Dougherty County (Figure 3), we observed a speedy decline in EpiEstim Rt estimates (both 1-week and 2-week window) from around 2 in late March to a low of 0.32 on April 26. This finding was primarily driven by the early epidemic observed in Dougherty County, which were large clusters of cases infected via two funerals that happened to be superspreading events (Barry 2020).

Community transmission of SARS-CoV-2 remained ongoing in GA as of June 14, 2020 (i.e., 10½ weeks after statewide shelter-in-place order was first imposed on April 2 and 7 weeks after businesses reopened under new social distancing guidance) (Table 1). The 95% CrI of both the 1-week and 2-week window EpiEstim Rt estimates were >1. On April 27, GA reopened some sectors of the economy, with specific guidelines pertinent to social distancing (State of Georgia Government 2020b). As the economy reopened and increased unprotected social mixing ensued, an increase in daily number of new confirmed cases was observed in June as SARS-CoV-2 transmission continued unabated (Georgia Department of Public Health 2020). Our study documented the decrease in Rt following social distancing interventions in GA and provided further evidence that social distancing measures remained important to keep COVID-19 under control. Furthermore, many residents in both rural and urban GA are medically vulnerable. A recent analysis by The Surgo Foundation estimated the COVID-19 community vulnerability index (CCVI) for Dougherty County, by combining epidemiologic risk factors for infection and sociodemographic factors, at very high levels (CCVI = 0.87) when compared with counties in Metro Atlanta (Fulton county’s CCVI = 0.42) (Surgo Foundation 2020). Although the EpiEstim Rt estimates for Dougherty County were <1 from April 14 to April 30, Rt rebounded since late April, and it has been fluctuating with 95% CrI including 1 most of the time from early May to mid-June (Figure 3). This corresponded to the partial reopening of the GA economy. The relaxation of social distancing measures should be implemented with an abundance of caution due to the population’s vulnerability. Another important factor for consideration is access to healthcare and surge capacity in hospitals, especially in rural GA. The healthcare system in . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Dougherty County was heavily impacted by the surge of COVID-19 patients driven by superspreading events (Barry 2020). While economic factors are legitimate concerns for decisionmakers, reopening the economy too soon led to the resurgence of COVID-19 cases in GA as observed in June. Further research into the spatiotemporal variation of SARS-CoV-2 transmission potential and its association with economic and medical vulnerability will shed light on the disease and economic burden of COVID-19 in GA. Our study estimated Rt using the instantaneous reproduction number method implemented in the R package EpiEstim (Cori et al. 2013; Thompson et al. 2019). The EpiEstim estimate is sensitive to fluctuation in daily incident case counts as the instantaneous reproduction number method treats such changes as meaningful signals reflecting genuine increases or decreases in transmission potential. The instantaneous reproduction number method in the EpiEstim package can be used if the purpose is to identify time-dependent changes in the Rt estimate that reflects the implementation or relaxation of social distancing measures over time. Regarding the time window chosen for EpiEstim, we used a window of 7 days in our main analysis and 14 days in our sensitivity analysis. We did not use a window of <7 days, because a weekend effect was observed in the data, i.e., the daily number of cases reported in the weekend was consistently smaller than those in the weekdays before or after the weekend. The 2-week window EpiEstim estimate lagged behind the 1-week window EpiEstim estimate when the Rt estimate fluctuates around 1. This result can be explained because the 2-week estimate was an average of 14 days and did not reflect the immediate change in transmission potential.

Our study is limited by several factors. First, we used the NYT dataset; data was recorded by reported date and not by day of symptom onset. Given the time difference between the transmission events and subsequent symptom onset, testing, and case reporting, the Rt estimates should reflect transmission that had happened several days ago (the sum of the incubation period and the delay to testing . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint and case reporting). Second, our data does not differentiate between imported and community transmission cases. Third, cases may be underreported due to limited testing capacity, or they may be mild or asymptomatic cases. Fourth, our analysis is right-censored by June 14, 2020. Future studies can further extend the analysis as the pandemic progresses. Fifth, in addition to the two methods utilized here, there are other statistical methods that estimate Rt (Gostic et al. 2020; O'Driscoll et al. 2020), e.g., the case reproduction number method as proposed by Walling and Teunis (2004) but they are out-of-scope for this paper.

In Spring 2020, social distancing measures reduced the transmission of SARS-CoV-2 in GA. However, the epidemic has not yet been suppressed. Rt was fluctuating around 1 for GA, Metro Atlanta and Dougherty County since GA economy reopened in late April 2020. Government agencies should carefully consider the next steps of their COVID-19 plans for their communities considering ongoing transmission across GA.

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Scire J, Nadeau S, Vaughan T, Brupbacher G, Fuchs S, Sommer J, Koch KN, Misteli R, Mundorff L, Gotz T et al. 2020. Reproductive number of the COVID-19 epidemic in Switzerland with a focus on the Cantons of Basel-Stadt and Basel-Landschaft. Swiss Med Wkly. 150:w20271. State of Georgia Government. 2020a. Gov. Kemp Issues New Executive Orders, Provides COVID-19 Update (March 23, 2020). [accessed June 30, 2020]. https://gov.georgia.gov/press-releases/2020-03- 23/gov-kemp-issues-new-executive-orders-provides-covid-19-update. State of Georgia Government. 2020b. Governor Kemp Gives COVID-19 Update (April 27, 2020). [accessed June 30, 2020]. https://gov.georgia.gov/press-releases/2020-04-27/governor-kemp-gives- covid-19-update. . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint State of Georgia Government. 2020c. Governor Kemp Issues Shelter in Place Order (April 2, 2020). [accessed June 30, 2020]. https://gov.georgia.gov/press-releases/2020-04-02/governor-kemp-issues- shelter-place-order. State of Georgia Government. 2020d. News: Press Releases. Office of the Governor; [accessed June 30, 2020]. https://gov.georgia.gov/press-releases. Surgo Foundation. 2020. The COVID-19 Community Vulnerability Index (CCVI). Surgo Foundation; [accessed 2020 April 27, 2020]. https://precisionforcovid.org/ccvi?fbclid=IwAR0VsJVvj- RBnwEC62iJb32R1ZTVnWE0yT1H7SfUXeyF3JEBEKn69sY7JRs. The New York Times. 2020. Coronavirus (Covid-19) Data in the United States. GitHub; [updated June 15, 2020; accessed June 15, 2020]. https://github.com/nytimes/covid-19-data. Thompson RN, Stockwin JE, van Gaalen RD, Polonsky JA, Kamvar ZN, Demarsh PA, Dahlqwist E, Li S, Miguel E, Jombart T et al. 2019. Improved inference of time-varying reproduction numbers during infectious disease outbreaks. Epidemics. 29:100356. Tsang TK, Wu P, Lin Y, Lau EHY, Leung GM, Cowling BJ. 2020. Effect of changing case definitions for COVID-19 on the epidemic curve and transmission parameters in mainland China: a modelling study. The Lancet Public Health. Vynnycky E, White R. 2010. An Introduction to Infectious Disease Modelling. Oxford: Oxford University Press. Wallinga J, Teunis P. 2004. Different epidemic curves for severe acute respiratory syndrome reveal similar impacts of control measures. Am J Epidemiol. 160(6):509-516. Walton County. 2020. An Ordinance Declaring a State of Emergency Arising beacuse of COVID-19 and Taking Immediate Emergency Measures. [accessed April 17, 2020]. https://www.waltoncountyga.gov. Zhuang Z, Zhao S, Lin Q, Cao P, Lou Y, Yang L, Yang S, He D, Xiao L. 2020. Preliminary estimates of the reproduction number of the coronavirus disease (COVID-19) outbreak in Republic of Korea and Italy by 5 March 2020. Int J Infect Dis. 95:308-310. . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table 1. Control measures announced and implemented by state and local government agencies in the state of Georgia, in Metro Atlanta counties and Dougherty County in March-April, 2020. Note that most of these control measures began to be implemented the day after the announcement. For example, Georgia’s state-wide shelter-in-place was announced on April 2, 2020 to be implemented on April 3, 2020. Location Date Implemented measure(s) State of Georgia (State of Georgia Government 2020d) March 23, 2020 Executive order to limit physical interactions including shelter-in-place if diagnosed with underlying conditions, bar closed, and no gathering with more them 10 individuals should take place. April 2, 2020 State-wide shelter-in-place order. April 15, 2020 State-wide testing for all symptomatic individuals (referral is still needed). April 27, 2020 Businesses in the state will start opening following social distancing and prevention measures. Bartow County (Bartow County Commissioner 2020) March 20, 2020 State of emergency declared by county officials. March 26, 2020 Follow-up on the State Government Order to limit public gatherings to ten people. Restaurants will only be available for take-out or delivery. Establishments that require physical contact will be closed. Butts County (Board of Commissioners of Butts County 2020) March 24, 2020 County declared under state of emergency. Limit public gatherings to ten people. Restaurants will only be available for take-out or delivery. Establishments that require physical contact will be closed. Carroll County March 22, 2020 Shelter-in-place order for the county. No public gatherings of more than ten people, and food will be sold as take-out or delivery (Carroll County Facebook Page 2020). March 26, 2020 Citizens should stay home, and gatherings of any size are prohibited (Carroll County Board of Health 2020). Catoosa County (Catoosa County 2020) March 23, 2020 Follow-up on State government order to limit public gatherings to ten people. Restaurants will only be available for take-out or delivery. Establishments that require physical contact will be closed. Chattooga County (Chattooga County Health Department 2020) March 16, 2020 Recommendation to cancel events and large gatherings over 50 people and maintain physical distance of 6 feet. Cherokee County (Cherokee County Board of Commissioners 2020) March 25, 2020 Declare local state of emergency, limit public gatherings to ten people. Restaurants will only be available for take-out or delivery. Individuals of at-risk . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Location Date Implemented measure(s) groups should shelter-in-place, and those with a positive diagnosis will stay quarantined in their house. Clayton County (Clayton County Government 2020) March 13, 2020 Encouragement to citizens to avoid public gatherings and public events. March 24, 2020 State of emergency amended to include limiting gatherings to 10 individuals. Cobb County (Cobb County Board of Commissioners 2020) March 24, 2020 Declaration of state of emergency according to the state-level ordinance to emphasize social distancing. Essential business will open from 6:00 am to 9:00 pm, no dine-in services will be available. Coweta County (Board of Commissioners of Coweta County 2020) March 26, 2020 Declaration of state of emergency according to the state-level ordinance to emphasize social distancing. Declaration of voluntary shelter at home, no dine-in services will be available. DeKalb County (DeKalb County 2020) March 23, 2020 Prohibition of gathering with ten or more people, citizens will shelter-in-place, curfew established from 9 am to 6 am, playgrounds, parks and gyms will remain close, and food services will be delivery or take-out only. Dougherty County (Dougherty County Board of Commissioners 2020) March 21, 2020 Shelter-in-place order, non-essential activities will be canceled. Restaurants will provide drive-through, pickup/curbside, and delivery services. Douglas County (Douglas County Board of Health 2020) March 23, 2020 Shelter-in-place order for county residents. Public gatherings of more than 10 are prohibited, restaurants will only be available for take-out or delivery. Fayette County (Fayette County 2020) April 1, 2020 Public gatherings of ten or more are prohibited. Restaurants will only work curbside, take-out or delivery. April 8, 2020 Shelter-in-place in compliance with state-level ordinance. Forsyth County (Forsyth County Board of Commissioners 2020) March 18, 2020 Public gatherings of ten or more are prohibited. Fulton County (Fulton County 2020) March 18, 2020 Senior centers, art center and libraries will be closed to the public. March 24, 2020 All libraries will be closed to the public. March 24, 2020 Maintain less than 10 people in one location, restaurants will not have dine-in services, and residents must stay at home. April 8, 2020 Follow-up on Statewide Judicial Emergency. Services and hearings were suspended. . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Location Date Implemented measure(s) Hall County (Hall County Georgia 2020) March 13, 2020 Closure of libraries and parks in the County. March 19, 2020 Commissioners placed a stay at home mandate. March 24, 2020 Mandate closure of dine-in services. Haralson County (Haralson County Boards of Commissioners 2020) March 25, 2020 Shelter-in-place order, public gatherings are prohibited, travel only for essential activities. Heard County (Heard County Georgia 2020) March 26, 2020 Shelter-in-place order made official. Henry County (Henry County Board of Commissioners 2020) April 1, 2020 Shelter-in-place order for county residents. Public gatherings of more than 10 are prohibited, restaurants will only be available for take-out or delivery. Jasper County (Jasper County Board of Commissioners 2002) March 26, 2020 Curfew from 10:00 pm to 6:00 am. Public gatherings of ten or more are prohibited. Restaurants will only work curbside, take-out or delivery. Lamar County (Board of Commissioners Lamar County 2020) April 3, 2020 Shelter-in-place order by county government. Meriwether County (Meriwether County Georgia Board of Commissioners 2020) March 20, 2020 State of emergency declared by county officials. Curfew from 9:00 pm to 6:00 am. March 24, 2020 Public gatherings of ten or more are prohibited. Restaurants will only work curbside, take-out or delivery. Business were physical interaction is needed will be closed, and curfew is imposed from 9:00 pm to 6:00am. Newton County (Newton County 2020) March 31, 2020 Shelter-in-place order for county residents. Public gatherings of more than 10 are prohibited, restaurants will only be available for take-out or delivery. Paulding County (Paulding County Board of Commissioners 2020) March 26, 2020 Person showing symptoms shall refrain from entering public buildings; restaurants will refrain from in- dinning services; non-essential businesses will remain closed; no gatherings of more than 10 people are permitted. Pickens County (Pickens County 2020) March 24, 2020 Residents must shelter in their homes; all gatherings are suspended; all travel is limited to essential travel needs Walton County (Walton County 2020) March 26, 2020 Public gatherings of ten or more are prohibited. Restaurants will only work curbside, take-out or delivery. . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table 2. Estimates for the time-varying reproduction number, Rt, on June 14, 2020 for the state of Georgia, Dougherty County, and Metro Atlanta counties, using the instantaneous reproduction number method as implemented in the R package EpiEstim. The analysis used a serial interval following a gamma distribution with a mean of 4.60 days and a standard deviation of 5.55 days, and  = 0.05. EpiEstim (1-week window) EpiEstim (2-week window) Location First reported case (dd-mmm-yy) Median Rt (2.5%, 97.5% quantiles) Mean Rt (Standard Deviation) Median Rt (2.5%, 97.5% quantiles) Mean Rt (Standard Deviation) Georgia 2-Mar-20 1.14 (1.11, 1.17) 1.14 (0.02) 1.07 (1.05, 1.09) 1.07 (0.01) Dougherty 15-Mar-20 1.03 (0.72, 1.41) 1.04 (0.18) 0.93 (0.72, 1.17) 0.93 (0.11) Metro Atlanta 2-Mar-20 1.02 (0.98, 1.06) 1.02 (0.02) 0.98 (0.95, 1.01) 0.98 (0.01) Bartow 11-Mar-20 0.73 (0.46, 1.08) 0.74 (0.16) 0.95 (0.74, 1.20) 0.96 (0.12) Butts 22-Mar-20 0.47 (0.11, 1.27) 0.53 (0.30) 0.78 (0.46, 1.21) 0.79 (0.19) Carroll 20-Mar-20 0.89 (0.63, 1.22) 0.90 (0.15) 0.96 (0.77, 1.17) 0.96 (0.10) Cherokee 8-Mar-20 1.06 (0.83, 1.33) 1.07 (0.13) 0.87 (0.72, 1.03) 0.87 (0.08) Clayton 15-Mar-20 1.06 (0.79, 1.16) 1.07 (0.10) 1.02 (0.89, 1.16) 1.02 (0.07) Cobb 7-Mar-20 1.15 (1.03, 1.27) 1.15 (0.06) 1.03 (0.95, 1.12) 1.03 (0.04) Coweta 14-Mar-20 1.00 (0.75, 1.31) 1.01 (0.14) 0.96 (0.78, 1.17) 0.96 (0.10) Dawson 20-Mar-20 0.94 (0.36, 1.93) 0.99 (0.41) 0.86 (0.43, 1.53) 0.89 (0.28) Dekalb 9-Mar-20 0.97 (0.86, 1.08) 0.97 (0.06) 0.89 (0.82, 0.96) 0.89 (0.04) Douglas 20-Mar-20 1.10 (0.85, 1.40) 1.11 (0.14) 1.07 (0.88, 1.28) 1.07 (0.10) Fayette 9-Mar-20 1.15 (0.68, 1.79) 1.17 (0.28) 1.08 (0.72, 1.54) 1.09 (0.21) Forsyth 16-Mar-20 1.10 (0.82, 1.43) 1.10 (0.16) 1.00 (0.80, 1.23) 1.00 (0.11) Fulton 2-Mar-20 0.94 (0.83, 1.05) 0.94 (0.06) 0.88 (0.81, 0.95) 0.88 (0.04) Gwinnett 7-Mar-20 1.05 (0.97, 1.12) 1.05 (0.04) 1.05 (0.99, 1.10) 1.05 (0.03) Hall 16-Mar-20 0.96 (0.81, 1.13) 0.96 (0.08) 0.99 (0.88, 1.11) 0.99 (0.06) Haralson 26-Mar-20 0.90 (0.35, 1.85) 0.95 (0.39) 1.05 (0.60, 1.68) 1.07 (0.28) Heard 20-Mar-20 1.44 (0.65, 2.71) 1.50 (0.53) 0.97 (0.48, 1.72) 1.01 (0.32) Henry 13-Mar-20 1.16 (0.93, 1.43) 1.17 (0.13) 1.14 (0.97, 1.34) 1.15 (0.09) Jasper 24-Mar-20 0.89 (0.42, 1.62) 0.93 (0.31) 1.07 (0.67, 1.60) 1.08 (0.24) Lamar 20-Mar-20 0.68 (0.20, 1.63) 0.74 (0.37) 0.79 (0.43, 1.30) 0.81 (0.22) Meriwether 24-Mar-20 1.07 (0.66, 1.61) 1.08 (0.24) 1.19 (0.86, 1.59) 1.20 (0.19) Morgan 23-Mar-20 1.05 (0.15, 3.50) 1.25 (0.89) 1.10 (0.33, 2.63) 1.20 (0.60) Newton 15-Mar-20 0.91 (0.61, 1.31) 0.92 (0.18) 0.92 (0.71, 1.17) 0.93 (0.12) Paulding 16-Mar-20 1.15 (0.87, 1.49) 1.16 (0.16) 1.00 (0.79, 1.24) 1.01 (0.11) Pickens 20-Mar-20 1.48 (0.83, 2.40) 1.51 (0.40) 1.29 (0.78, 1.99) 1.32 (0.31) Pike 28-Mar-20 1.11 (0.52, 2.01) 1.15 (0.38) 1.24 (0.73, 1.96) 1.27 (0.32) Rockdale 19-Mar-20 1.18 (0.82, 1.63) 1.19 (0.21) 1.13 (0.86, 1.45) 1.13 (0.15) Spalding 20-Mar-20 1.04 (0.66, 1.56) 1.06 (0.23) 1.06 (0.77, 1.43) 1.07 (0.17) Walton 24-Mar-20 0.81 (0.54, 1.17) 0.82 (0.16) 0.82 (0.63, 1.05) 0.82 (0.11) Note. All data collection concluded on June 14, 2020. . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Figure Legends Figure 1. Comparison between Rt for Georgia, USA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure 2. Comparison between Rt for Metro Atlanta, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure 3. Comparison between Rt for Dougherty, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint 0.0 2.5 5.0 7.5 10.0 Mar Apr May Jun Date Rt EpiEstim 1wk EpiEstim 2wk Georgia . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint 0.0 2.5 5.0 7.5 10.0 Mar Apr May Jun Date Rt EpiEstim 1wk EpiEstim 2wk Metro Atlanta . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint 0.0 2.5 5.0 7.5 10.0 Mar Apr May Jun Date Rt EpiEstim 1wk EpiEstim 2wk Dougherty . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Time-varying reproduction numbers of COVID-19 in Georgia, USA, March 2-June 14, 2020 Online Supplementary Materials . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table S1. Daily number of COVID-19 cases reported in the state of Georgia, Dougherty County and Metro Atlanta counties, March 2—25, 2020. Location March 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Georgia 2 0 0 0 1 4 4 6 5 9 0 10 24 32 21 24 51 89 200 70 68 180 297 290 Dougherty 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 1 15 23 2 5 17 32 22 Metro Atlanta 2 0 0 0 0 4 4 5 4 6 0 8 23 21 18 19 44 57 133 31 46 122 151 146 Bartow 0 0 0 0 0 0 0 0 0 3 0 4 0 2 0 2 9 7 27 1 1 5 15 6 Butts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 1 Carroll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14 2 0 5 5 24 Cherokee 0 0 0 0 0 0 1 0 0 0 0 3 0 0 0 0 2 7 3 1 1 6 6 6 Clayton 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 0 1 0 4 2 1 6 2 8 Cobb 0 0 0 0 0 1 2 1 3 1 0 0 7 4 3 3 4 9 13 5 11 12 11 19 Coweta 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 1 0 0 3 2 1 0 1 0 Dawson 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 DeKalb 0 0 0 0 0 0 0 2 0 2 0 0 4 2 0 5 3 4 18 2 11 21 33 18 Douglas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 0 3 5 6 Fayette 0 0 0 0 0 0 0 1 0 0 0 0 3 1 0 0 2 1 0 1 0 2 1 0 Forsyth 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 2 1 2 Fulton 2 0 0 0 0 2 1 0 1 0 0 0 7 7 7 6 16 19 27 5 11 41 39 13 Gwinnett 0 0 0 0 0 1 0 1 0 0 0 0 0 2 1 2 0 5 11 0 4 8 11 23 Hall 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2 2 1 3 0 1 6 3 Haralson 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Heard 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 Henry 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 3 1 0 2 4 7 Jasper 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 Lamar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2 0 0 0 Meriwether 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Morgan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 Newton 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 2 0 1 0 0 0 2 2 Paulding 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2 0 0 1 0 1 1 0 Pickens 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 1 1 0 Pike 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rockdale 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 3 3 2 Spalding 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 2 1 5 Walton 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table S2. Daily number of COVID-19 cases reported in the state of Georgia, Dougherty County and Metro Atlanta counties, from March 26— April 18, 2020. Location March April 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Georgia 256 555 249 236 349 1085 631 696 523 416 359 816 1598 1048 681 974 402 191 1169 292 670 1061 1014 1183 Dougherty 41 39 21 23 31 188 24 31 86 78 3 34 251 28 41 30 30 76 67 52 23 38 27 24 Metro Atlanta 125 397 141 182 283 483 154 370 556 355 84 430 576 314 302 380 167 241 642 674 483 427 642 191 Bartow 11 14 10 2 6 12 10 6 6 1 0 22 9 4 8 5 3 2 10 7 7 3 5 1 Butts 0 0 2 0 1 2 0 1 0 1 2 5 1 5 2 2 1 1 1 5 1 2 2 1 Carroll 2 9 3 6 27 26 10 6 8 11 0 5 20 1 11 5 4 6 19 6 7 16 3 10 Cherokee 8 6 4 6 9 9 7 9 20 6 4 17 6 8 12 10 9 1 17 15 13 13 29 11 Clayton 8 16 4 2 3 50 16 37 41 29 3 16 24 11 9 30 11 33 24 39 27 11 26 6 Cobb 10 44 22 43 22 37 17 37 81 31 21 43 49 42 45 28 24 23 88 79 55 64 71 19 Coweta 4 5 1 3 14 4 1 6 8 8 3 9 4 2 5 13 1 5 15 14 3 4 11 7 Dawson 2 0 0 1 3 3 1 0 2 3 0 2 2 3 1 1 0 1 6 4 1 2 3 1 DeKalb 12 82 27 27 21 66 0 49 74 56 10 51 73 59 34 60 22 45 113 138 81 35 106 42 Douglas 0 14 3 3 5 8 5 10 12 6 7 14 12 7 10 14 3 8 18 12 12 8 13 7 Fayette 2 8 4 1 15 6 0 7 6 5 1 7 7 9 3 0 6 1 6 9 7 4 8 2 Forsyth 5 6 1 6 8 11 3 3 8 10 2 12 14 0 10 10 9 5 10 10 4 12 16 12 Fulton 27 116 31 47 78 96 39 109 163 49 11 83 132 76 75 81 29 49 140 177 90 43 92 28 Gwinnett 10 42 10 14 33 64 15 46 50 47 10 45 85 46 32 51 12 20 65 49 70 32 120 22 Hall 3 8 1 2 1 33 4 1 9 36 0 21 77 18 14 26 3 6 37 44 39 124 79 2 Haralson 1 0 1 0 2 1 1 0 4 0 0 4 0 1 0 0 1 0 2 1 0 0 1 0 Heard 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 2 Henry 9 15 6 6 12 18 9 20 28 24 1 13 27 11 14 16 5 9 26 17 22 2 20 5 Jasper 0 0 0 0 0 0 0 0 0 2 0 0 2 0 0 0 0 2 1 0 1 0 4 1 Lamar 0 0 0 0 0 0 1 2 0 1 0 8 0 0 0 0 0 2 1 2 1 0 1 2 Meriwether 2 0 0 2 1 0 1 2 1 1 0 4 3 0 0 1 4 0 0 1 4 7 5 0 Morgan 0 0 0 0 0 1 0 0 0 0 0 4 4 2 1 1 0 0 1 0 2 2 0 1 Newton 4 3 0 3 4 9 3 3 5 10 3 10 2 0 3 7 1 4 11 7 13 2 6 0 Paulding 1 6 7 3 3 5 2 2 11 4 1 6 5 4 3 5 5 5 16 15 3 5 9 1 Pickens 0 0 1 0 1 1 0 2 0 0 0 0 1 0 0 0 1 0 0 2 1 1 1 2 Pike 0 0 1 1 0 0 0 0 2 1 0 4 1 1 1 3 1 0 3 3 3 3 1 1 Rockdale 3 3 1 1 11 16 2 10 10 8 2 5 3 0 0 4 3 5 4 5 1 4 6 2 Spalding 1 0 0 1 2 1 2 0 6 3 0 18 10 2 4 5 4 4 5 5 13 26 2 2 Walton 0 0 1 2 1 4 4 2 1 2 3 2 2 2 5 2 4 4 3 7 2 2 2 1 . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table S3. Daily number of COVID-19 cases reported in the state of Georgia, Dougherty County and Metro Atlanta counties, April 19—May 2, 2020. Location April May 19 20 21 22 23 24 25 26 27 28 29 30 1 2 Georgia 605 828 742 910 806 670 650 234 770 378 693 1131 1005 832 Dougherty 16 11 20 0 0 9 5 0 10 13 7 6 25 3 Metro Atlanta 384 470 246 432 668 322 349 121 469 560 473 368 466 628 Bartow 4 5 1 3 5 9 10 3 3 17 3 6 8 1 Butts 9 30 1 44 0 0 0 1 0 4 4 11 6 0 Carroll 11 23 8 0 10 6 5 1 3 13 6 10 17 8 Cherokee 15 17 7 16 25 2 1 6 19 43 21 10 7 8 Clayton 15 20 7 2 67 13 12 0 8 23 21 23 17 44 Cobb 44 48 34 42 54 42 27 33 55 56 42 40 58 70 Coweta 4 5 0 0 8 10 0 1 2 1 4 0 16 2 Dawson 1 1 0 4 1 1 0 0 2 5 2 1 0 5 DeKalb 65 47 43 46 80 32 67 12 55 52 73 47 46 75 Douglas 4 10 3 13 14 3 0 2 6 16 11 8 10 6 Fayette 3 4 1 2 10 2 3 0 8 2 5 0 2 3 Forsyth 5 9 5 11 8 6 8 3 19 13 8 7 10 22 Fulton 66 67 8 49 181 64 43 2 135 73 32 36 59 48 Gwinnett 65 57 57 35 78 31 78 44 41 75 124 49 55 86 Hall 18 77 54 151 56 59 10 1 65 87 76 85 136 212 Haralson 0 2 3 0 1 0 0 0 1 1 0 0 1 0 Heard 0 0 1 0 1 0 0 0 1 0 0 0 1 0 Henry 16 11 2 2 27 6 17 15 13 24 4 0 0 20 Jasper 2 0 1 0 1 1 0 0 0 2 0 0 0 1 Lamar 1 2 2 0 2 0 2 0 1 1 2 1 1 1 Meriwether 2 4 1 1 1 0 0 0 0 4 1 0 0 0 Morgan 2 0 1 0 2 0 0 0 0 0 2 0 0 0 Newton 9 9 3 4 7 5 8 0 7 11 9 3 4 5 Paulding 4 4 0 4 3 8 3 1 6 6 4 13 1 4 Pickens 0 0 0 0 1 1 0 1 0 5 0 0 0 1 Pike 3 0 1 1 3 0 1 0 0 0 0 1 0 0 Rockdale 12 9 1 3 7 7 3 0 5 9 3 11 2 3 Spalding 2 7 1 0 4 4 45 1 7 4 4 5 4 1 Walton 2 2 0 10 8 11 5 0 3 13 8 5 3 3 . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table S4. Daily number of COVID-19 cases reported in the state of Georgia, Dougherty County and Metro Atlanta counties, May 3—26, 2020. Location May 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Georgia 350 732 526 848 800 565 392 786 181 863 555 556 820 413 299 680 580 948 807 765 674 581 425 652 Dougherty 2 7 7 5 11 17 4 6 16 34 1 0 18 0 0 2 4 4 44 7 2 2 3 0 Metro Atlanta 236 478 384 620 264 349 359 407 162 282 207 267 316 131 38 224 378 365 372 363 277 400 521 695 Bartow 1 16 10 8 0 2 0 2 1 4 9 5 3 0 0 11 14 9 5 3 17 0 0 8 Butts 0 0 5 5 4 4 1 8 9 2 1 4 0 1 0 2 0 6 0 1 2 1 2 3 Carroll 0 4 1 2 0 1 3 2 0 2 0 3 8 0 0 0 10 7 12 2 1 5 27 18 Cherokee 9 18 10 25 25 9 15 16 12 14 20 21 19 5 14 9 22 13 11 21 17 3 21 19 Clayton 16 11 9 36 29 10 13 20 23 7 4 28 16 3 3 4 1 24 13 24 18 30 13 41 Cobb 19 71 48 111 26 48 56 47 11 67 27 83 32 11 0 23 74 81 41 30 6 41 93 59 Coweta 17 12 2 2 11 0 8 11 2 2 0 0 2 3 0 0 1 0 17 8 5 15 45 7 Dawson 0 1 0 5 1 2 0 0 0 1 5 3 0 0 0 0 2 9 4 2 0 0 2 1 DeKalb 36 71 29 73 39 49 44 47 19 50 27 32 87 49 2 54 62 61 59 42 66 111 48 116 Douglas 6 2 10 10 3 32 2 14 3 0 5 7 4 5 0 1 6 7 3 23 9 3 14 13 Fayette 2 4 2 0 1 0 5 4 2 1 0 2 1 1 1 3 2 0 0 3 4 1 1 11 Forsyth 1 9 6 9 5 3 2 22 0 0 5 2 2 1 1 6 7 22 9 1 2 3 31 12 Fulton 53 76 108 85 10 57 68 124 7 79 19 11 78 46 10 0 36 0 77 59 46 77 26 150 Gwinnett 46 77 45 120 32 68 81 44 28 20 15 42 45 0 0 83 91 49 62 79 36 59 142 109 Hall 6 76 70 68 42 41 5 10 27 21 52 13 15 6 4 14 27 39 18 21 36 17 5 51 Haralson 0 0 1 1 1 0 0 0 0 1 1 0 0 0 0 0 1 0 1 0 0 0 0 4 Heard 3 0 0 0 0 0 0 0 1 2 0 0 0 0 0 0 3 3 1 2 0 0 2 0 Henry 8 0 7 19 12 8 27 11 6 0 1 0 0 0 0 0 0 4 8 4 0 5 9 14 Jasper 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0 1 Lamar 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 3 0 2 4 0 1 2 4 Meriwether 0 2 1 2 2 1 3 0 1 0 2 4 0 0 0 0 0 1 3 2 0 0 0 0 Morgan 0 1 1 0 0 0 2 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 Newton 3 7 7 10 4 4 12 6 2 1 0 0 0 0 3 0 2 9 5 6 3 15 7 24 Paulding 1 12 2 3 6 3 1 1 3 4 4 2 4 0 0 1 6 14 3 9 2 2 14 3 Pickens 2 0 0 0 2 1 1 0 0 2 1 0 0 0 0 2 1 0 1 1 2 0 0 0 Pike 0 0 0 0 1 0 0 3 0 0 0 0 0 0 0 0 0 1 0 3 0 1 1 2 Rockdale 1 4 5 19 3 2 2 9 4 2 3 1 0 0 0 1 1 0 3 3 1 7 2 1 Spalding 4 0 3 1 1 3 5 3 1 0 0 3 0 0 0 3 4 0 0 4 3 0 6 3 Walton 1 3 2 5 4 1 3 1 0 0 6 0 0 0 0 6 2 6 14 0 0 3 7 21 . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table S5. Daily number of COVID-19 cases reported in the state of Georgia, Dougherty County and Metro Atlanta counties, May 27—June 14, 2020. Location May June 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Georgia 647 650 525 448 715 706 306 648 817 752 663 428 624 774 696 867 869 977 696 Dougherty 0 40 0 0 0 10 4 6 4 2 7 0 3 12 2 7 1 5 4 Metro Atlanta 675 417 513 118 91 374 105 508 576 463 233 32 439 385 404 509 405 236 115 Bartow 6 11 8 1 0 3 4 11 8 10 7 1 1 4 3 2 7 3 1 Butts 5 4 6 0 0 0 5 3 3 2 1 0 0 0 0 0 0 0 2 Carroll 22 4 1 1 6 0 0 11 33 10 2 0 5 2 4 2 9 9 3 Cherokee 11 8 16 5 19 1 1 12 11 10 14 1 16 3 12 10 14 3 12 Clayton 16 15 13 0 5 13 4 22 22 28 13 5 15 19 16 21 14 14 4 Cobb 53 41 39 22 18 25 4 41 68 58 19 7 49 39 33 101 51 35 24 Coweta 14 6 11 1 2 4 1 10 8 18 5 0 5 6 2 12 19 2 2 Dawson 4 0 1 0 0 0 0 1 0 2 1 0 1 0 2 2 0 0 0 DeKalb 152 62 83 13 3 61 8 71 65 47 22 4 42 66 66 43 53 21 8 Douglas 4 7 11 0 4 3 3 7 15 12 9 0 9 11 12 10 7 10 4 Fayette 3 0 0 0 0 0 2 2 2 3 1 0 2 7 0 4 1 1 1 Forsyth 10 5 5 0 0 11 9 2 1 6 5 0 10 19 4 0 10 5 1 Fulton 79 58 123 17 17 97 17 50 36 66 32 1 64 38 64 42 38 31 6 Gwinnett 173 139 114 36 11 90 21 172 204 105 61 7 158 94 116 172 109 52 31 Hall 44 28 15 2 0 40 1 31 27 30 19 1 26 22 22 13 28 13 7 Haralson 0 2 1 0 0 2 2 2 1 1 1 0 0 2 2 0 1 0 0 Heard 2 2 0 1 1 0 1 0 1 0 0 0 0 1 2 2 1 0 1 Henry 17 0 14 2 2 3 2 21 26 9 5 0 11 12 8 23 19 10 2 Jasper 0 0 1 3 0 4 0 0 5 1 1 1 1 2 0 4 1 0 0 Lamar 3 6 1 0 0 4 0 2 2 1 0 0 0 0 2 1 0 0 0 Meriwether 3 1 2 1 0 1 1 8 4 6 1 0 3 1 4 5 4 2 0 Morgan 0 0 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 0 0 Newton 6 3 7 1 0 9 9 6 6 6 1 0 6 1 6 5 5 3 0 Paulding 11 4 11 6 2 0 2 4 6 7 4 1 2 17 11 15 4 1 3 Pickens 0 2 2 0 1 0 0 2 0 0 1 1 0 1 4 2 0 6 0 Pike 2 0 0 0 0 0 0 2 1 2 1 1 1 2 1 0 1 3 0 Rockdale 8 2 5 2 0 0 4 8 5 2 4 0 6 6 5 4 4 5 2 Spalding 2 3 8 0 0 2 0 3 1 11 2 0 2 5 1 6 1 4 1 Walton 25 4 15 4 0 0 4 4 15 9 1 1 4 4 2 8 4 3 0 . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table S6. Cumulative number of reported COVID-19 cases in the state of Georgia, Dougherty County and Metro Atlanta counties, March 2—16, 2020. Location March 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Georgia 2 2 2 2 3 7 11 17 22 31 31 41 65 97 118 Dougherty 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 Metro Atlanta 2 2 2 2 2 6 10 15 19 25 25 33 56 77 95 Bartow 0 0 0 0 0 0 0 0 0 3 3 7 7 9 9 Butts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Carroll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cherokee 0 0 0 0 0 0 1 1 1 1 1 4 4 4 4 Clayton 0 0 0 0 0 0 0 0 0 0 0 0 0 2 5 Cobb 0 0 0 0 0 1 3 4 7 8 8 8 15 19 22 Coweta 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 Dawson 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DeKalb 0 0 0 0 0 0 0 2 2 4 4 4 8 10 10 Douglas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Fayette 0 0 0 0 0 0 0 1 1 1 1 1 4 5 5 Forsyth 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Fulton 2 2 2 2 2 4 5 5 6 6 6 6 13 20 27 Gwinnett 0 0 0 0 0 1 1 2 2 2 2 2 2 4 5 Hall 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Haralson 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Heard 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Henry 0 0 0 0 0 0 0 0 0 0 0 1 1 1 2 Jasper 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Lamar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Meriwether 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Morgan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Newton 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 Paulding 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Pickens 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Pike 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rockdale 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Spalding 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Walton 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table S7. Cumulative number of reported COVID-19 cases in the state of Georgia, Dougherty County and Metro Atlanta counties, March 17—31, 2020. Date March 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Georgia 142 193 282 482 552 620 800 1097 1387 1643 2198 2447 2683 3032 4117 Dougherty 6 7 22 45 47 52 69 101 123 164 203 224 247 278 466 Metro Atlanta 114 158 215 348 379 425 547 698 844 969 1366 1507 1689 1972 2455 Bartow 11 20 27 54 55 56 61 76 82 93 107 117 119 125 137 Butts 0 0 0 0 0 2 2 2 3 3 3 5 5 6 8 Carroll 0 0 0 14 16 16 21 26 50 52 61 64 70 97 123 Cherokee 4 6 13 16 17 18 24 30 36 44 50 54 60 69 78 Clayton 5 6 6 10 12 13 19 21 29 37 53 57 59 62 112 Cobb 25 29 38 51 56 67 79 90 109 119 163 185 228 250 287 Coweta 3 3 3 6 8 9 9 10 10 14 19 20 23 37 41 Dawson 0 0 0 1 1 1 1 1 1 3 3 3 4 7 10 DeKalb 15 18 22 40 42 53 74 107 125 137 219 246 273 294 360 Douglas 0 0 0 1 4 4 7 12 18 18 32 35 38 43 51 Fayette 5 7 8 8 9 9 11 12 12 14 22 26 27 42 48 Forsyth 1 2 3 3 4 5 7 8 10 15 21 22 28 36 47 Fulton 33 49 68 95 100 111 152 191 204 231 347 378 425 503 599 Gwinnett 7 7 12 23 23 27 35 46 69 79 121 131 145 178 242 Hall 1 3 5 6 9 9 10 16 19 22 30 31 33 34 67 Haralson 0 0 0 0 0 0 0 0 0 1 1 2 2 4 5 Heard 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 Henry 2 2 3 6 7 7 9 13 20 29 44 50 56 68 86 Jasper 0 0 0 0 0 0 0 1 2 2 2 2 2 2 2 Lamar 0 0 0 1 1 3 3 3 3 3 3 3 3 3 3 Meriwether 0 0 0 0 0 0 0 1 1 3 3 3 5 6 6 Morgan 0 0 0 0 0 0 1 1 1 1 1 1 1 1 2 Newton 1 3 3 4 4 4 4 6 8 12 15 15 18 22 31 Paulding 1 3 3 3 4 4 5 6 6 7 13 20 23 26 31 Pickens 0 0 0 2 2 2 3 4 4 4 4 5 5 6 7 Pike 0 0 0 0 0 0 0 0 0 0 0 1 2 2 2 Rockdale 0 0 1 1 2 2 5 8 10 13 16 17 18 29 45 Spalding 0 0 0 2 2 2 4 5 10 11 11 11 12 14 15 Walton 0 0 0 0 0 0 0 1 1 1 1 2 4 5 9 . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table S8. Cumulative number of reported COVID-19 cases in the state of Georgia, Dougherty County and Metro Atlanta counties, April 1—18, 2020. Location April 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Georgia 4748 5444 5967 6383 6742 7558 9156 10204 10885 11859 12261 12452 13621 13913 14583 15644 16658 17841 Dougherty 490 521 607 685 688 722 973 1001 1042 1072 1102 1178 1245 1297 1320 1358 1385 1409 Metro Atlanta 2609 2979 3535 3890 3974 4404 4980 5294 5596 5976 6143 6384 7026 7700 8183 8610 9252 9443 Bartow 147 153 159 160 160 182 191 195 203 208 211 213 223 230 237 240 245 246 Butts 8 9 9 10 12 17 18 23 25 27 28 29 30 35 36 38 40 41 Carroll 133 139 147 158 158 163 183 184 195 200 204 210 229 235 242 258 261 271 Cherokee 85 94 114 120 124 141 147 155 167 177 186 187 204 219 232 245 274 285 Clayton 128 165 206 235 238 254 278 289 298 328 339 372 396 435 462 473 499 505 Cobb 304 341 422 453 474 517 566 608 653 681 705 728 816 895 950 1014 1085 1104 Coweta 42 48 56 64 67 76 80 82 87 100 101 106 121 135 138 142 153 160 Dawson 11 11 13 16 16 18 20 23 24 25 25 26 32 36 37 39 42 43 DeKalb 360 409 483 539 549 600 673 732 766 826 848 893 1006 1144 1225 1260 1366 1408 Douglas 56 66 78 84 91 105 117 124 134 148 151 159 177 189 201 209 222 229 Fayette 48 55 61 66 67 74 81 90 93 93 99 100 106 115 122 126 134 136 Forsyth 50 53 61 71 73 85 99 99 109 119 128 133 143 153 157 169 185 197 Fulton 638 747 910 959 970 1053 1185 1261 1336 1417 1446 1495 1635 1812 1902 1945 2037 2065 Gwinnett 257 303 353 400 410 455 540 586 618 669 681 701 766 815 885 917 1037 1059 Hall 71 72 81 117 117 138 215 233 247 273 276 282 319 363 402 526 605 607 Haralson 6 6 10 10 10 14 14 15 15 15 16 16 18 19 19 19 20 20 Heard 2 2 2 2 2 2 3 3 3 3 4 4 4 5 5 5 5 7 Henry 95 115 143 167 168 181 208 219 233 249 254 263 289 306 328 330 350 355 Jasper 2 2 2 4 4 4 6 6 6 6 6 8 9 9 10 10 14 15 Lamar 4 6 6 7 7 15 15 15 15 15 15 17 18 20 21 21 22 24 Meriwether 7 9 10 11 11 15 18 18 18 19 23 23 23 24 28 35 40 40 Morgan 2 2 2 2 2 6 10 12 13 14 14 14 15 15 17 19 19 20 Newton 34 37 42 52 55 65 67 67 70 77 78 82 93 100 113 115 121 121 Paulding 33 35 46 50 51 57 62 66 69 74 79 84 100 115 118 123 132 133 Pickens 7 9 9 9 9 9 10 10 10 10 11 11 11 13 14 15 16 18 Pike 2 2 4 5 5 9 10 11 12 15 16 16 19 22 25 28 29 30 Rockdale 47 57 67 75 77 82 85 85 85 89 92 97 101 106 107 111 117 119 Spalding 17 17 23 26 26 44 54 56 60 65 69 73 78 83 96 122 124 126 Walton 13 15 16 18 21 23 25 27 32 34 38 42 45 52 54 56 58 59 . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table S9. Cumulative number of reported COVID-19 cases in the state of Georgia, Dougherty County and Metro Atlanta counties, April 19—30, 2020. Location April 19 20 21 22 23 24 25 26 27 28 29 30 Georgia 17619 18447 19189 20099 20905 21575 22225 22459 23229 23607 24300 25431 Dougherty 1425 1436 1456 1456 1456 1465 1470 1470 1480 1493 1500 1506 Metro Atlanta 9827 10297 10543 10975 11643 11965 12314 12435 12904 13464 13937 14305 Bartow 250 255 256 259 264 273 283 286 289 306 309 315 Butts 50 80 81 125 125 125 125 126 126 130 134 145 Carroll 282 305 313 313 314 320 325 326 329 342 348 358 Cherokee 300 317 324 340 365 367 368 374 393 436 457 467 Clayton 520 540 547 549 616 629 641 641 649 672 693 716 Cobb 1148 1196 1230 1272 1326 1368 1395 1428 1483 1539 1581 1621 Coweta 164 169 169 169 177 187 187 188 190 191 195 195 Dawson 44 45 45 49 50 51 51 51 53 58 60 61 DeKalb 1473 1520 1563 1609 1689 1721 1788 1800 1855 1907 1980 2027 Douglas 233 243 246 259 273 276 276 278 284 300 311 319 Fayette 139 143 144 146 156 158 161 161 169 171 176 176 Forsyth 202 211 216 227 235 241 249 252 271 284 292 299 Fulton 2131 2198 2206 2255 2436 2500 2543 2545 2680 2753 2785 2821 Gwinnett 1124 1181 1238 1273 1351 1382 1460 1504 1545 1620 1744 1793 Hall 625 702 756 907 963 1022 1032 1033 1098 1185 1261 1346 Haralson 20 22 25 25 26 26 26 26 27 28 28 28 Heard 7 7 8 8 9 9 9 9 10 10 10 10 Henry 371 382 384 386 413 419 436 451 464 488 492 492 Jasper 17 17 18 18 19 20 20 20 20 22 22 22 Lamar 25 27 29 29 31 31 33 33 34 35 37 38 Meriwether 42 46 47 48 49 49 49 49 49 53 54 54 Morgan 22 22 23 23 25 25 25 25 25 25 27 27 Newton 130 139 142 146 153 158 166 166 173 184 193 196 Paulding 137 141 141 145 148 156 159 160 166 172 176 189 Pickens 18 18 18 18 19 20 20 21 21 26 26 26 Pike 33 33 34 35 38 38 39 39 39 39 39 40 Rockdale 131 140 141 144 151 158 161 161 166 175 178 189 Spalding 128 135 136 136 140 144 189 190 197 201 205 210 Walton 61 63 63 73 81 92 97 97 100 113 121 126 . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table S10. Cumulative number of COVID-19 cases reported in the state of Georgia, Dougherty County and Metro Atlanta counties, May 1—15, 2020. Location May 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Georgia 26436 27268 27618 28350 28876 29724 30524 31089 31481 32267 32448 33311 33866 34422 35242 Dougherty 1531 1534 1536 1543 1550 1555 1566 1583 1587 1593 1609 1643 1644 1643 1662 Metro Atlanta 14771 15399 15638 16108 16497 17119 17382 17731 18089 18502 18668 18948 19155 19426 19749 Bartow 323 324 325 341 351 359 359 361 361 363 364 368 377 382 385 Butts 151 151 150 152 158 163 167 171 172 180 189 191 192 196 196 Carroll 375 383 386 382 387 391 389 390 393 395 395 398 397 400 408 Cherokee 474 482 491 509 519 544 569 578 593 609 621 635 655 676 695 Clayton 733 777 793 804 813 849 878 888 901 921 944 951 955 983 999 Cobb 1679 1749 1768 1839 1887 1998 2024 2072 2128 2175 2186 2253 2280 2363 2395 Coweta 211 213 230 242 244 246 257 257 265 276 278 280 280 280 282 Dawson 61 66 66 67 67 72 73 75 75 81 81 76 81 84 84 DeKalb 2073 2148 2184 2255 2284 2357 2396 2445 2489 2536 2555 2605 2632 2664 2751 Douglas 329 335 341 343 353 363 366 398 400 414 417 417 422 429 433 Fayette 178 181 183 187 189 188 191 190 195 199 201 202 202 204 205 Forsyth 309 331 332 341 347 356 361 364 366 388 391 386 393 395 397 Fulton 2880 2928 2981 3057 3165 3250 3260 3317 3385 3509 3516 3595 3614 3625 3703 Gwinnett 1848 1934 1980 2057 2102 2222 2254 2322 2403 2447 2475 2495 2510 2552 2597 Hall 1482 1694 1700 1776 1846 1914 1956 1997 2002 2012 2039 2060 2112 2125 2140 Haralson 29 29 29 29 30 31 32 32 32 32 32 33 34 34 34 Heard 11 11 14 13 14 14 14 14 14 14 15 17 17 17 17 Henry 492 512 520 520 527 546 558 566 593 604 610 614 615 621 628 Jasper 22 23 24 25 25 26 26 26 25 25 25 26 26 26 26 Lamar 39 40 40 39 39 39 38 39 39 40 40 40 40 41 41 Meriwether 54 54 54 56 57 59 61 62 65 65 66 66 68 72 73 Morgan 27 27 28 29 30 30 30 30 32 33 33 33 33 33 33 Newton 200 205 208 215 222 232 236 240 252 258 260 261 262 263 262 Paulding 190 194 195 207 209 212 218 221 222 223 226 230 234 236 240 Pickens 26 27 29 29 28 29 31 32 33 33 33 35 36 35 35 Pike 40 40 40 40 40 40 41 41 41 44 44 47 45 44 44 Rockdale 191 194 195 199 204 223 226 228 230 239 243 245 248 249 249 Spalding 214 215 219 219 222 223 224 227 232 235 237 237 236 239 239 Walton 129 132 133 136 138 143 147 148 151 152 152 152 159 158 158 . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table S11. Cumulative number of COVID-19 cases reported in the state of Georgia, Dougherty County and Metro Atlanta counties, May 16—31, 2020. Location May 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Georgia 35655 35954 36634 37214 38162 38969 39734 40408 40989 41414 42066 42713 43363 43888 44336 45051 Dougherty 1662 1661 1664 1668 1672 1716 1723 1725 1727 1730 1774 1784 1764 1763 1770 1770 Metro Atlanta 19884 19899 20130 20502 20873 21239 21602 21878 22278 22799 23495 24170 24583 25099 25218 25308 Bartow 385 384 396 410 419 424 427 444 443 443 452 458 469 477 478 478 Butts 197 197 199 199 205 205 206 208 209 211 214 219 223 229 229 228 Carroll 409 406 408 418 425 437 439 440 445 472 490 512 516 517 518 525 Cherokee 700 714 723 745 758 769 790 807 810 831 850 861 869 885 890 909 Clayton 1002 1005 1009 1010 1034 1047 1071 1089 1119 1132 1173 1189 1204 1217 1217 1221 Cobb 2407 2406 2429 2503 2584 2625 2655 2661 2702 2795 2854 2907 2948 2987 3009 3027 Coweta 285 284 285 287 286 303 311 316 331 376 383 397 403 414 415 417 Dawson 84 83 84 86 95 99 101 101 101 103 104 108 108 109 109 109 DeKalb 2800 2802 2856 2918 2979 3038 3080 3146 3257 3305 3421 3573 3635 3718 3731 3734 Douglas 438 437 439 445 452 455 478 487 490 504 517 521 528 539 539 543 Fayette 206 207 210 212 215 212 215 219 220 221 232 235 231 234 235 235 Forsyth 398 399 405 412 434 443 444 446 449 480 492 502 507 512 512 512 Fulton 3749 3759 3751 3795 3793 3872 3931 3977 4054 4080 4230 4309 4367 4490 4507 4524 Gwinnett 2597 2594 2680 2771 2820 2882 2961 2997 3056 3198 3307 3480 3619 3733 3769 3780 Hall 2146 2150 2164 2191 2230 2248 2269 2305 2322 2327 2378 2422 2450 2465 2467 2467 Haralson 34 34 34 35 35 36 36 36 36 36 40 40 42 43 43 43 Heard 17 17 17 20 23 24 26 26 26 28 28 30 32 32 33 34 Henry 630 627 627 611 615 623 627 626 632 641 655 672 672 686 688 690 Jasper 26 26 26 26 26 26 31 31 31 31 32 32 32 33 36 36 Lamar 41 41 41 44 44 46 50 50 51 53 57 60 66 67 67 67 Meriwether 72 72 70 70 73 76 78 78 78 78 78 81 82 84 85 85 Morgan 33 33 34 34 34 34 35 36 36 37 37 37 37 37 37 37 Newton 261 257 264 266 275 280 286 289 304 311 335 341 344 351 352 352 Paulding 242 240 241 247 261 264 273 275 277 291 294 305 309 320 326 328 Pickens 35 35 38 39 39 40 41 43 43 43 43 43 45 47 47 48 Pike 44 44 44 44 45 45 48 48 49 50 52 54 54 54 54 54 Rockdale 249 249 250 252 251 254 257 258 265 267 268 276 278 283 285 285 Spalding 239 239 242 246 251 246 250 253 253 259 262 264 267 275 275 275 Walton 158 158 164 166 172 186 186 186 189 196 217 242 246 261 265 265 . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Table S12. Cumulative number of COVID-19 cases reported in the state of Georgia, Dougherty County and Metro Atlanta counties, June 1—14, 2020. Location June 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Georgia 45757 46063 46711 47528 48280 48943 49371 49995 50769 51465 52332 53201 54178 54874 Dougherty 1780 1784 1790 1794 1796 1803 1803 1806 1818 1820 1827 1828 1833 1837 Metro Atlanta 25683 25786 26295 26872 27334 27567 27600 28039 28433 28838 29348 29740 29977 30092 Bartow 481 485 496 504 514 521 522 523 527 530 532 539 542 543 Butts 228 234 237 240 242 243 244 244 253 254 255 242 243 245 Carroll 526 524 535 568 578 580 580 585 587 591 593 602 611 614 Cherokee 910 911 923 934 944 958 959 975 978 990 1000 1014 1017 1029 Clayton 1234 1238 1260 1282 1310 1323 1328 1343 1362 1378 1399 1413 1427 1431 Cobb 3052 3056 3097 3165 3223 3242 3249 3298 3337 3370 3471 3522 3557 3581 Coweta 421 422 432 440 458 463 463 468 474 476 488 507 509 511 Dawson 109 109 110 110 112 113 113 114 114 116 118 118 118 118 DeKalb 3795 3803 3874 3939 3986 4008 4012 4054 4120 4186 4229 4282 4303 4311 Douglas 546 549 556 571 583 592 592 601 612 624 634 641 651 655 Fayette 235 237 239 241 244 245 245 247 254 254 258 259 260 261 Forsyth 523 532 534 535 541 546 546 556 575 579 579 589 594 595 Fulton 4621 4638 4688 4724 4790 4822 4823 4887 4925 4989 5031 5069 5100 5106 Gwinnett 3870 3891 4063 4267 4372 4433 4440 4598 4692 4808 4980 5089 5141 5172 Hall 2507 2508 2539 2566 2596 2615 2616 2642 2664 2686 2699 2727 2740 2747 Haralson 45 47 49 50 51 52 52 52 54 56 56 57 57 57 Heard 34 35 35 37 36 36 36 36 37 39 41 42 42 43 Henry 693 695 716 742 751 756 756 767 779 787 810 829 839 841 Jasper 40 39 40 45 46 47 48 49 51 51 55 56 56 56 Lamar 71 71 73 75 76 76 76 76 76 78 79 79 79 79 Meriwether 86 87 95 99 105 106 106 109 110 114 119 123 125 125 Morgan 38 38 38 38 39 39 39 39 40 40 40 40 40 40 Newton 361 370 376 382 388 389 389 395 396 402 407 412 415 415 Paulding 328 330 334 340 347 351 352 354 371 382 397 401 402 405 Pickens 48 48 50 50 50 51 52 52 53 57 59 59 65 65 Pike 54 54 56 57 59 60 61 62 64 65 65 66 69 69 Rockdale 285 289 297 302 304 308 308 314 320 325 329 333 338 340 Spalding 277 277 280 281 292 294 294 296 301 302 308 309 313 314 Walton 265 269 273 288 297 298 299 303 307 309 317 321 324 324 . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint Legends of Supplementary Figures: Results for Counties in Metro Atlanta, GA, USA. Figure S1. Comparison between Rt for Bartow County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S2. Comparison between Rt for Butts County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S3. Comparison between Rt for Carroll County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S4. Comparison between Rt for Cherokee County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S5. Comparison between Rt for Clayton County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S6. Comparison between Rt for Cobb County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S7. Comparison between Rt for Coweta County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S8. Comparison between Rt for Dawson County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S9. Comparison between Rt for DeKalb County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S10. Comparison between Rt for Douglas County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S11. Comparison between Rt for Fayette County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S12. Comparison between Rt for Forsyth County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S13. Comparison between Rt for Fulton County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S14. Comparison between Rt for Gwinnett County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S15. Comparison between Rt for Hall County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S16. Comparison between Rt for Haralson County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S17. Comparison between Rt for Heard County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S18. Comparison between Rt for Henry County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S19. Comparison between Rt for Jasper County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S20. Comparison between Rt for Lamar County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 28, 2020. ; https://doi.org/10.1101/2020.05.19.20107219doi: medRxiv preprint and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S21. Comparison between Rt for Meriwether County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S22. Comparison between Rt for Morgan County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S23. Comparison between Rt for Newton County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S24. Comparison between Rt for Paulding County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S25. Comparison between Rt for Pickens County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S26. Comparison between Rt for Pike County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S27. Comparison between Rt for Rockdale County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S28. Comparison between Rt for Spalding County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. Figure S29. Comparison between Rt for Walton County, GA, March 2—June 14, 2020, estimated using the instantaneous reproduction number method implemented in EpiEstim package (grey: 1-week window and black: 2-week window). Solid lines represent the median estimates and the dashed line represent the 2.5 and 97.5 quantiles. . CC-BY-NC-ND 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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