A look at COVID-19 outbreaks in W.Va.
CHARLESTON — It’s common the hear Gov. Jim Justice talk about the number of active COVID-19 cases and outbreaks around West Virginia each week, but what does it mean for a community to have a coronavirus outbreak?
Community spread of the coronavirus affects a number of things: whether schools can open each week for in-person learning or if they have to close and switch to distance learning, whether nursing homes can allow family and visitors for the elderly residents of those facilities. It can even determine the gathering size of groups depending on the severity of infection spread in the county.
During Friday’s coronavirus briefing at the State Capitol Building, Justice announced 20 outbreaks with 82 cases in the public school system, 48 outbreaks in long-term care facilities, 16 outbreaks linked to churches in 13 counties and no active outbreaks among inmates in the state’s correctional system.
According to the U.S. Centers for Disease Control and Prevention, the definition for outbreak and epidemic is the same: “…one in which a group of persons are all exposed to an infectious agent or a toxin from the same source.” The CDC defines community spread as “…people have been infected with the virus in an area, including some who are not sure how or where they became infected.”
While there are some counties with small numbers of active COVID-19 active cases – Gilmer County only has one case, according to the state Department of Health and Human Resources Coronavirus Dashboard – most of West Virginia’s 55 counties have an outbreak or cluster of cases.
The number of cases plays into how the state calculates the colors for the County Alert System map. DHHR maintains a version of the County Alert System map updated daily, while the version that determines which county schools can open the following week is updated every Saturday at 5 p.m. on the Department of Education’s website.
While the Department of Education’s map determines what county school systems must close and switch to distance learning, the DHHR’s County Alert System map also determines what kinds of visitation is allowed at nursing homes depending on the color of the county, as well as placing limits on the size of outdoor gatherings as the color trends from good to bad.
Counties are given a color – green for good, transitioning from yellow, gold and orange to red for bad – based on the better of two types of metrics: the county’s rate of infection or the county’s percent of positivity.
The County Alert System, first unveiled Aug. 17, has been tweaked several times since the summer with the shifting of metrics, the addition of gold between yellow and orange and the addition of the percent of positivity on Sept. 25. Originally based on a similar map created by the Harvard Global Health Institute, the County Alert System has operated unchanged for more than a month.
Both metrics used to determine map colors — the infection rate and the percent of positivity — are based on a seven-day rolling average for counties with populations greater than 16,000 and a 14-day rolling average for counties with populations less than 16,000. The infection rate is based on the number of cases per 100,000 people using the rolling averages. The percent of positivity is based on the number of cases in a county compared to the number of tests being done.
Dr. Clay Marsh, the state coronavirus czar and the vice president/executive dean of Health Sciences at West Virginia University, worked with DHHR and other state health experts to create the County Alert System map. In a video, Marsh explained the current version of the map.
“We have adopted two different methodologies, two metrics, to use to make sure we are fairly assessing the public health spread of COVID-19 in each one of our counties,” Marsh said. “We wanted to go from a state strategy where we’re treating each county as part of a big state of West Virginia, which was the suppression phase … and we wanted to move to a more precise phase where we looked at each county more independently as 55 parts of a whole.”
Part of how those colors are calculated involves how outbreaks in nursing homes and prisons and even how cases on college campuses are counted. According to the most recent version of the metrics, outbreaks among residents of nursing homes and prisons/jails are not counted as individual cases but as one single case since neither nursing home residents nor prisoners are moving frequently in and out of the facilities.
That criteria only works for nursing home residents, prisoners and some college students. When it comes to calculating outbreaks on college campuses, infected students that choose to isolate in a designated dorm or building set aside by the college and university for infected students are also counted as one case instead of individual cases.
The staff at nursing homes and prisons are still counted individually since those employees interact more with the communities in which they live. For example, there were 56 active cases as of Friday among residents of the New Martinsville Center in Wetzel County and 39 cases among staff. But for the County Alert System metrics for Wetzel County, those 56 cases would count as one case while the 39 cases would count individually on the infection rate metrics.
According to the County Alert System map, Wetzel County has an infection rate of 42.67 cases per 100,000 people as of Sunday, putting it in the red. However, Wetzel County’s percent of positivity rate was 5.2 percent, which is an orange category. Since the percent of positivity was better than the infection rate, the county is orange instead of red.
Even though Wetzel County is orange on Sunday’s DHHR County Alert System map, it is yellow on Saturday’s Department of Education County Alert System Map and can open for in-person school this week if it chooses to. Decisions on the Department of Education map are made by the COVID-19 Data Review Panel, which looks ate the data every Friday and Saturday to eliminate duplicates or people listed as residents of the wrong county.
The key to the whole system is testing, Marsh said. By including the percent of positivity, it encourages people in the counties to go get tested. The more people get tested, the more asymptomatic and pre-symptomatic people can be identified and isolated. The more test numbers, the more the infection rate starts to go down in the counties.
“I think by doing this we’re really starting to reap benefits,” Marsh said. “Testing has picked up. We’re starting to see some of the infection rates go down, which is really really important and exciting. We know that when we start doing a lot more testing, we may see that infection rate – because it doesn’t account for how many tests we’re taking — go up transiently, but that’s not bad at all because it means we’re starting to identify more people who are infected.”
Steven Allen Adams can be reached at firstname.lastname@example.org.