STATE REPORT 10.18.2020 ALABAMA SUMMARY • As we continue to work with each of you on data quality and data reporting, we will continue to add relevant data to our joint understanding. We greatly appreciate the feedback and we use this to continually improve. This week, we have included the data reported to HHS from your hospitals regarding admissions and next, we will include PPE data reported. • Alabama is in the red zone for cases, indicating 101 or more new cases per 100,000 population last week, with the 22nd highest rate in the country. Alabama is in the orange zone for test positivity, indicating a rate between 8.0% and 10.0%, with the 13th highest rate in the country. • Alabama has seen stability in new cases and an increase in test positivity over the last week. • This early deterioration must be addressed aggressively as the spread is again very broad based in rural and urban areas. • The following three counties had the highest number of new cases over the last 3 weeks: 1. Jefferson County, 2. Tuscaloosa County, and 3. Madison County. These counties represent 23.5% of new cases in Alabama. • 82% of all counties in Alabama have moderate or high levels of community transmission (yellow, orange, or red zones), with 40% having high levels of community transmission (red zone). • During the week of Oct 5 - Oct 11, 15% of nursing homes had at least one new resident COVID-19 case, 26% had at least one new staff COVID-19 case, and 3% had at least one new resident COVID-19 death. • Alabama had 141 new cases per 100,000 population in the last week, compared to a national average of 117 per 100,000. • Current staff deployed from the federal government as assets to support the state response are: 38 to support operations activities from FEMA and 1 to support operations activities from USCG. • The federal government has supported surge testing in Birmingham, AL. • Between Oct 10 - Oct 16, on average, 118 patients with confirmed COVID-19 and 115 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in Alabama. An average of greater than 95% of hospitals reported either new confirmed or new suspected COVID patients each day during this period. RECOMMENDATIONS • We have included cases, test positivity, and deaths by month in the back of your packet to show the time sequence in Alabama and the country as a whole. These demonstrate the impact of comprehensive mitigation efforts when implemented effectively and that partial or incomplete mitigation leads to prolonged community spread and increased fatalities. • This time series also shows early signs of deterioration in the Sun Belt as mitigation efforts were decreased over the past couple of weeks. Also included are your reported hospitalizations of both confirmed and suspected COVID-19 patients. There is a slight uptick in confirmed COVID-19 new admissions. • Alabama must continue the strong mitigation efforts statewide. Mitigation efforts should continue to include mask wearing, physical distancing, hand hygiene, avoiding crowds in public and social gatherings in private, and ensuring flu immunizations. • Track test positivity, cases, and new daily hospitalizations in all counties and react to any week over week increases with increased mitigation in those counties and surged community level testing. • Ensure university students continue their mitigation behaviors to ensure no further outbreaks on or off campus as symptomatic cases and cases identified through surveillance testing decline. • Encourage outdoor activities and ensure mask and physical distancing messaging for all residents, both in public and private spaces. • We continue to see community spread initiated by social friends and family gatherings. People must remember that seemingly uninfected family members and friends may be infected but asymptomatic. Exposure to asymptomatic cases can easily lead to spread as people unmask in private gatherings. • Increase surveillance for silent community spread. Use the Abbott BinaxNOW or other antigen tests as weekly repeat surveillance in critical populations to monitor degree of silent (asymptomatic) community spread among community college students; K-12 teachers; staff working at nursing homes, assisted living, and other congregate living settings; prison staff; and first responders. All antigen positive results must be reported with both the number of positive results and total tests conducted; positives must be reported as COVID cases. Repeat testing of individuals as surveillance with confirmation of all positives with nucleic acid testing is the optimal use of antigen tests. • Ensure all nursing homes, assisted living, and elderly care sites have full testing capacity and are isolating positive staff and residents. Track positive staff members back to communities and surge testing to communities with evidence of asymptomatic spread. • Specific, detailed guidance on community mitigation measures can be found on the CDC website. The purpose of this report is to develop a shared understanding of the current status of the pandemic at the national, regional, state and local levels. We recognize that data at the state level may differ from that available at the federal level. Our objective is to use consistent data sources and methods that allow for comparisons to be made across localities. We appreciate your continued support in identifying data COVID-19 discrepancies and improving data completeness and sharing across systems. We look forward to your feedback. COVID-19 ALABAMA STATE REPORT | 10.18.2020 STATE, % CHANGE FEMA/HHS STATE, FROM PREVIOUS REGION, UNITED STATES, LAST WEEK WEEK LAST WEEK LAST WEEK NEW COVID-19 CASES 6,909 81,128 383,209 +2% (RATE PER 100,000) (141) (121) (117) VIRAL (RT-PCR) LAB 8.8% +1.3%* 6.7% 5.4% TEST POSITIVITY RATE TOTAL VIRAL (RT-PCR) LAB 72,617** 967,904** 7,141,821** +2%** TESTS (TESTS PER 100,000) (1,481) (1,447) (2,176) COVID-19 DEATHS 134 1,518 4,931 +30% (RATE PER 100,000) (2.7) (2.3) (1.5) SNFs WITH ≥1 NEW 15% -1%* 13% 10% RESIDENT COVID-19 CASE (26%) (-4%*) (26%) (22%) (≥1 NEW STAFF CASE) SNFs WITH ≥1 NEW 3% +1%* 5% 4% RESIDENT COVID-19 DEATH ADMISSIONS HOSPITAL * Indicates absolute change in percentage points. ** Due to delayed reporting, this figure may underestimate total diagnostic tests and week-on-week changes in diagnostic tests. DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, previous week is 10/3 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14, previous week is 10/1 - 10/7. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Last week is 10/5- 10/11, previous week is 9/28-10/4. Facilities that are undergoing reporting quality review are not included in the table, but may be included in other NHSN analyses. Hospitalizations: Unified hospitalization dataset in HHS Protect. These data exclude psychiatric, rehabilitation, and religious non-medical hospitals. In addition, hospitals explicitly identified by states/regions as those from which we should not expect reports were excluded from the percent reporting figure. COVID-19 ALABAMA STATE REPORT | 10.18.2020 COVID-19 COUNTY AND METRO ALERTS* Top 12 shown in table (full lists below) METRO AREA (CBSA) LAST WEEK COUNTY LAST WEEK Montgomery Tuscaloosa DeKalb Montgomery Morgan LOCALITIES 10 27 Decatur Limestone Fort Payne Calhoun IN RED Anniston-Oxford Etowah ZONE Gadsden Scottsboro St. Clair Jackson ▲ (+7) Talladega-Sylacauga ▲ (+11) Talladega Enterprise Coffee Eufaula Marengo Autauga Tuscaloosa Shelby Lee LOCALITIES 6 12 Birmingham-Hoover Elmore Huntsville Walker IN ORANGE Auburn-Opelika Marshall ZONE Jasper Albertville Colbert Geneva ▼ (-1) LaGrange ▼ (-5) Winston Cherokee Marion Macon Jefferson Madison Dothan Baldwin LOCALITIES 8 16 Daphne-Fairhope-Foley Houston Florence-Muscle Shoals Cullman IN YELLOW Cullman Lauderdale ZONE Ozark Alexander City Dale Covington ▼ (-2) Atmore ▼ (-4) Clarke Selma Russell Chambers Escambia Change from previous week’s alerts: ▲ Increase ■ Stable ▼ Decrease All Red Counties: Montgomery, DeKalb, Morgan, Limestone, Calhoun, Etowah, St. Clair, Jackson, Talladega, Coffee, Marengo, Autauga, Chilton, Franklin, Blount, Lawrence, Cleburne, Randolph, Henry, Pickens, Bibb, Clay, Barbour, Hale, Fayette, Lamar, Lowndes All Yellow Counties: Jefferson, Madison, Baldwin, Houston, Cullman, Lauderdale, Dale, Covington, Clarke, Russell, Chambers, Escambia, Butler, Dallas, Crenshaw, Perry * Localities with fewer than 10 cases last week have been excluded from these alerts. Note: Lists of red, orange, and yellow localities are sorted by the number of new cases in the last 3 weeks, from highest to lowest. Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. DATA SOURCES – Additional data details available under METHODS Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, three weeks is 9/26 - 10/16. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14. COVID-19 ALABAMA STATE REPORT | 10.18.2020 NEW CASES TESTING Top counties based on greatest number of new cases in last three weeks (9/26 - 10/16) TOP COUNTIES DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. COVID-19 Top 12 counties based on number of new cases in the last 3 weeks TOTAL DAILY CASES DATA SOURCES – Additional data details available under METHODS Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Last 3 weeks is 9/26 - 10/16. COVID-19 ALABAMA STATE REPORT | 10.18.2020 CASE RATES AND VIRAL LAB TEST POSITIVITY DURING THE LAST WEEK NEW CASES PER 100,000 DURING VIRAL (RT-PCR) LABORATORY TEST THE LAST WEEK POSITIVITY DURING THE LAST WEEK WEEKLY CHANGE IN NEW CASES WEEKLY CHANGE IN VIRAL (RT-PCR) PER 100,000 LABORATORY TEST POSITIVITY DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Last week is 10/10 - 10/16, previous week is 10/3 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14, previous week is 10/1 - 10/7. STATE REPORT 10.18.2020 ALASKA SUMMARY • As we continue to work with each of you on data quality and data reporting, we will continue to add relevant data to our joint understanding. We greatly appreciate the feedback and we use this to continually improve. This week, we have included the data reported to HHS from your hospitals regarding admissions and next, we will include PPE data reported. • Alaska is in the red zone for cases, indicating 101 or more new cases per 100,000 population last week, with the 14th highest rate in the country. Alaska is in the yellow zone for test positivity, indicating a rate between 5.0% and 7.9%, with the 28th highest rate in the country. • Alaska has seen an increase in new cases and stability in test positivity over the last week. • The following three boroughs had the highest number of new cases over the last 3 weeks: 1. Anchorage Municipality, 2. Fairbanks North Star Borough, and 3. Matanuska-Susitna Borough. These boroughs represent 80.7% of new cases in Alaska. • 17% of all boroughs in Alaska have moderate or high levels of community transmission (yellow, orange, or red zones), with 7% having high levels of community transmission (red zone). • The greatest increase in test positivity in areas with more than 25 cases occurred in North Slope Borough, Matanuska-Susitna Borough, Juneau, and Bethel Census Area. • State-level hospital capacity appears adequate, but inpatient bed utilization appears to be at 74% in Anchorage and Fairbanks, and ICU utilization appears to be 71% in Matanuska. There has been an increase in the number of hospitals reporting both current and anticipated critical staffing shortages. • During the week of Oct 5 - Oct 11, no nursing homes had at least one new resident COVID-19 case, 6% had at least one new staff COVID-19 case, and none had at least one new resident COVID-19 death. The number of facilities with cases and deaths have decreased from previous week. • Alaska had 187 new cases per 100,000 population in the last week, compared to a national average of 117 per 100,000. • Current staff deployed from the federal government as assets to support the state response are: 16 to support operations activities from FEMA; 2 to support medical activities from CDC; and 23 to support operations activities from USCG. • Between Oct 10 - Oct 16, on average, 9 patients with confirmed COVID-19 and 8 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in Alaska. An average of 91% of hospitals reported either new confirmed or new suspected COVID patients each day during this period; therefore, this may be an underestimate of the actual total number of COVID-related hospitalizations. Underreporting may lead to a lower allocation of critical supplies. RECOMMENDATIONS • We have included cases, test positivity, and deaths by month in the back of your packet to show the time sequence in Alaska and the country as a whole. These demonstrate the impact of comprehensive mitigation efforts when implemented effectively and that partial or incomplete mitigation leads to prolonged community spread and increased fatalities. • A key to Alaska’s ability to manage the epidemic when transmission flares has been the high level of testing. Maintain high level of testing (ideally above 2,000 per 100,000 population per week) in all boroughs and follow test positivity, hospitalizations, and hospital capacity at the local level closely. • Identify silent spread with enhanced surveillance through regular testing and closely monitoring incidence, test positivity, and hospitalizations among critical personnel, such as teachers; clinical staff; staff working at long-term care facilities and other congregate living settings; prisoners and prison staff; public transportation workers; and first responders. • Address silent spread by expanding education on the risks of smaller, more intimate social gatherings and reinvigorate critical mitigation behaviors with aggressive public messaging, such as avoidance of social gatherings, social distancing, the use of face coverings (even at indoor personal gatherings), and use of larger spaces with indoor-outdoor ventilation, if possible, for necessary gatherings. • Target messaging to elderly and those at risk for severe disease, instructing them to protect themselves by strictly avoiding social gatherings and maintaining social distance at all times. • Continue to promote diligent application of CDC recommended school-specific mitigation strategies. • Ensure and document (for your records) that all hospital staff, especially those in rural areas, have received or are receiving training on latest treatment COVID-19 treatment protocols, including early use of antiviral and antibody therapy for hospitalized patients who meet criteria and proper use of high-flow oxygen, positioning, and use of glucocorticoids. • Clarify state-level recommendations for community mitigation behaviors (face coverings, social distancing, and avoiding of gatherings) on the first page of state website. Encourage local ordinances by posting local case rates, existing ordinances, and local hospital capacity on front page of state website. • Consider adopting state-specific travel regulations to restrict travel from states with higher case rates. • Expand contact tracing by adjusting interview depth, scripting interviews, developing clear algorithms, expanding staff, and task- shifting. Ensure immediate isolation of cases upon diagnosis and contact interview is conducted within 48 hours and contacts are rapidly identified and quarantined. • Native and tribal communities remain at risk and should receive culturally specific education, easy access to testing, and adequate housing/spaces and food for true isolation and quarantine for the 10 to 14-day duration. • Specific, detailed guidance on community mitigation measures can be found on the CDC website. The purpose of this report is to develop a shared understanding of the current status of the pandemic at the national, regional, state and local levels. We recognize that data at the state level may differ from that available at the federal level. Our objective is to use consistent data sources and methods that allow for comparisons to be made across localities. We appreciate your continued support in identifying data COVID-19 discrepancies and improving data completeness and sharing across systems. We look forward to your feedback. COVID-19 ALASKA STATE REPORT | 10.18.2020 STATE, % CHANGE FEMA/HHS STATE, FROM PREVIOUS REGION, UNITED STATES, LAST WEEK WEEK LAST WEEK LAST WEEK NEW COVID-19 CASES 1,367 12,940 383,209 +23% (RATE PER 100,000) (187) (90) (117) VIRAL (RT-PCR) LAB 5.7% -0.3%* 6.3% 5.4% TEST POSITIVITY RATE TOTAL VIRAL (RT-PCR) LAB 38,898** 268,228** 7,141,821** +3%** TESTS (TESTS PER 100,000) (5,317) (1,869) (2,176) COVID-19 DEATHS 6 88 4,931 +100% (RATE PER 100,000) (0.8) (0.6) (1.5) SNFs WITH ≥1 NEW 0% -6%* 7% 10% RESIDENT COVID-19 CASE (6%) (-11%*) (18%) (22%) (≥1 NEW STAFF CASE) SNFs WITH ≥1 NEW 0% -6%* 2% 4% RESIDENT COVID-19 DEATH ADMISSIONS HOSPITAL * Indicates absolute change in percentage points. ** Due to delayed reporting, this figure may underestimate total diagnostic tests and week-on-week changes in diagnostic tests. DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases and Deaths: State values are calculated by aggregating borough-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, previous week is 10/3 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14, previous week is 10/1 - 10/7. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Last week is 10/5- 10/11, previous week is 9/28-10/4. Facilities that are undergoing reporting quality review are not included in the table, but may be included in other NHSN analyses. Hospitalizations: Unified hospitalization dataset in HHS Protect. These data exclude psychiatric, rehabilitation, and religious non-medical hospitals. In addition, hospitals explicitly identified by states/regions as those from which we should not expect reports were excluded from the percent reporting figure. COVID-19 ALASKA STATE REPORT | 10.18.2020 COVID-19 BOROUGH AND METRO ALERTS* Top 12 shown in table (full lists below) METRO AREA (CBSA) LAST WEEK BOROUGH LAST WEEK LOCALITIES IN RED ZONE 1 Fairbanks 2 Fairbanks North Star North Slope ■ (+0) ▲ (+1) LOCALITIES IN ORANGE ZONE 0 N/A 0 N/A ■ (+0) ▼ (-1) LOCALITIES IN YELLOW ZONE 1 Anchorage 3 Anchorage Municipality Matanuska-Susitna Valdez-Cordova Census Area ■ (+0) ▲ (+1) Change from previous week’s alerts: ▲ Increase ■ Stable ▼ Decrease * Localities with fewer than 10 cases last week have been excluded from these alerts. Note: Lists of red, orange, and yellow localities are sorted by the number of new cases in the last 3 weeks, from highest to lowest. Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. DATA SOURCES – Additional data details available under METHODS Cases and Deaths: State values are calculated by aggregating borough-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, three weeks is 9/26 - 10/16. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14. COVID-19 ALASKA STATE REPORT | 10.18.2020 NEW CASES TESTING Top boroughs based on greatest number of new cases in last three weeks (9/26 - 10/16) TOP BOROUGHS DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating borough-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. COVID-19 Top 12 boroughs based on number of new cases in the last 3 weeks TOTAL DAILY CASES DATA SOURCES – Additional data details available under METHODS Cases: State values are calculated by aggregating borough-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Last 3 weeks is 9/26 - 10/16. COVID-19 ALASKA STATE REPORT | 10.18.2020 CASE RATES AND VIRAL LAB TEST POSITIVITY DURING THE LAST WEEK NEW CASES PER 100,000 DURING VIRAL (RT-PCR) LABORATORY TEST THE LAST WEEK POSITIVITY DURING THE LAST WEEK WEEKLY CHANGE IN NEW CASES WEEKLY CHANGE IN VIRAL (RT-PCR) PER 100,000 LABORATORY TEST POSITIVITY DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating borough-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Last week is 10/10 - 10/16, previous week is 10/3 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14, previous week is 10/1 - 10/7. STATE REPORT 10.18.2020 ARIZONA SUMMARY • As we continue to work with each of you on data quality and data reporting, we will continue to add relevant data to our joint understanding. We greatly appreciate the feedback and we use this to continually improve. This week, we have included the data reported to HHS from your hospitals regarding admissions and next, we will include PPE data reported. • Arizona is in the orange zone for cases, indicating between 51 and 100 new cases per 100,000 population last week, with the 39th highest rate in the country. Arizona is in the yellow zone for test positivity, indicating a rate between 5.0% and 7.9%, with the 29th highest rate in the country. • Arizona has seen an increase in new cases and an increase in test positivity over the last week. • The following three counties had the highest number of new cases over the last 3 weeks: 1. Maricopa County, 2. Pima County, and 3. Pinal County. These counties represent 77.3% of new cases in Arizona. • 60% of all counties in Arizona have moderate or high levels of community transmission (yellow, orange, or red zones), with 13% having high levels of community transmission (red zone). • During the week of Oct 5 - Oct 11, 6% of nursing homes had at least one new resident COVID-19 case, 13% had at least one new staff COVID-19 case, and none had at least one new resident COVID-19 death. • Arizona had 74 new cases per 100,000 population in the last week, compared to a national average of 117 per 100,000. • Current staff deployed from the federal government as assets to support the state response are: 10 to support operations activities from FEMA and 2 to support epidemiology activities from CDC. • Between Oct 10 - Oct 16, on average, 73 patients with confirmed COVID-19 and 192 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in Arizona. An average of 86% of hospitals reported either new confirmed or new suspected COVID patients each day during this period; therefore, this may be an underestimate of the actual total number of COVID-related hospitalizations. Underreporting may lead to a lower allocation of critical supplies. RECOMMENDATIONS • We have included cases, test positivity, and deaths by month in the back of your packet to show the time sequence in Arizona and the country as a whole. These demonstrate the impact of comprehensive mitigation efforts when implemented effectively and that partial or incomplete mitigation leads to prolonged community spread and increased fatalities. • This time series also shows early signs of deterioration in the Sun Belt as mitigation efforts were decreased over the past couple of weeks. Also included are your reported hospitalizations of both confirmed and suspected COVID-19 patients. There is an uptick in confirmed COVID-19 new admissions. • In Arizona, we see increasing test positivity and increasing cases; aggressive communication and mitigation is critical. • Mitigation efforts should continue to include mask wearing, physical distancing, hand hygiene, avoiding crowds in public and social gatherings in private, and ensuring flu immunizations. • Track test positivity, cases, and new daily hospitalizations in all counties and react to any week over week increases with increased mitigation in those counties and surged community level testing. • Ensure university students continue their mitigation behaviors to ensure no further outbreaks on or off campus as symptomatic cases and cases identified through surveillance testing decline. • Encourage outdoor activities and ensure mask and physical distancing messaging for all residents, both in public and private spaces. • We continue to see community spread initiated by social friends and family gatherings. People must remember that seemingly uninfected family members and friends may be infected but asymptomatic. Exposure to asymptomatic cases can easily lead to spread as people unmask in private gatherings. • Increase surveillance for silent community spread. Use the Abbott BinaxNOW or other antigen tests as weekly repeat surveillance in critical populations to monitor degree of silent (asymptomatic) community spread among community college students; K-12 teachers; staff working at nursing homes, assisted living, and other congregate living settings; prison staff; and first responders. All antigen positive results must be reported with both the number of positive results and total tests conducted; positives must be reported as COVID cases. Repeat testing of individuals as surveillance with confirmation of all positives with nucleic acid testing is the optimal use of antigen tests. • Ensure all nursing homes, assisted living, and elderly care sites have full testing capacity and are isolating positive staff and residents. Track positive staff members back to communities and surge testing to communities with evidence of asymptomatic spread. • Specific, detailed guidance on community mitigation measures can be found on the CDC website. The purpose of this report is to develop a shared understanding of the current status of the pandemic at the national, regional, state and local levels. We recognize that data at the state level may differ from that available at the federal level. Our objective is to use consistent data sources and methods that allow for comparisons to be made across localities. We appreciate your continued support in identifying data COVID-19 discrepancies and improving data completeness and sharing across systems. We look forward to your feedback. COVID-19 ARIZONA STATE REPORT | 10.18.2020 STATE, % CHANGE FEMA/HHS STATE, FROM PREVIOUS REGION, UNITED STATES, LAST WEEK WEEK LAST WEEK LAST WEEK NEW COVID-19 CASES 5,350 32,198 383,209 +24% (RATE PER 100,000) (74) (63) (117) VIRAL (RT-PCR) LAB 5.2% +1.0%* 3.7% 5.4% TEST POSITIVITY RATE TOTAL VIRAL (RT-PCR) LAB 91,381** 1,078,036** 7,141,821** -14%** TESTS (TESTS PER 100,000) (1,255) (2,102) (2,176) COVID-19 DEATHS 60 566 4,931 +13% (RATE PER 100,000) (0.8) (1.1) (1.5) SNFs WITH ≥1 NEW 6% +1%* 4% 10% RESIDENT COVID-19 CASE (13%) (+2%*) (8%) (22%) (≥1 NEW STAFF CASE) SNFs WITH ≥1 NEW 0% -2%* 1% 4% RESIDENT COVID-19 DEATH ADMISSIONS HOSPITAL * Indicates absolute change in percentage points. ** Due to delayed reporting, this figure may underestimate total diagnostic tests and week-on-week changes in diagnostic tests. DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, previous week is 10/3 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14, previous week is 10/1 - 10/7. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Last week is 10/5- 10/11, previous week is 9/28-10/4. Facilities that are undergoing reporting quality review are not included in the table, but may be included in other NHSN analyses. Hospitalizations: Unified hospitalization dataset in HHS Protect. These data exclude psychiatric, rehabilitation, and religious non-medical hospitals. In addition, hospitals explicitly identified by states/regions as those from which we should not expect reports were excluded from the percent reporting figure. COVID-19 ARIZONA STATE REPORT | 10.18.2020 COVID-19 COUNTY AND METRO ALERTS* Top 12 shown in table (full lists below) METRO AREA (CBSA) LAST WEEK COUNTY LAST WEEK LOCALITIES IN RED ZONE 2 Payson Safford 2 Gila Graham ▲ (+1) ▲ (+1) LOCALITIES IN ORANGE ZONE 2 Yuma Sierra Vista-Douglas 2 Yuma Cochise ■ (+0) ■ (+0) LOCALITIES 3 5 Pinal IN YELLOW Phoenix-Mesa-Chandler Flagstaff Coconino Apache ZONE Lake Havasu City-Kingman Mohave ▲ (+3) ▲ (+4) La Paz Change from previous week’s alerts: ▲ Increase ■ Stable ▼ Decrease * Localities with fewer than 10 cases last week have been excluded from these alerts. Note: Lists of red, orange, and yellow localities are sorted by the number of new cases in the last 3 weeks, from highest to lowest. Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. DATA SOURCES – Additional data details available under METHODS Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, three weeks is 9/26 - 10/16. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14. COVID-19 ARIZONA STATE REPORT | 10.18.2020 NEW CASES TESTING Top counties based on greatest number of new cases in last three weeks (9/26 - 10/16) TOP COUNTIES DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. COVID-19 Top 12 counties based on number of new cases in the last 3 weeks TOTAL DAILY CASES DATA SOURCES – Additional data details available under METHODS Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Last 3 weeks is 9/26 - 10/16. COVID-19 ARIZONA STATE REPORT | 10.18.2020 CASE RATES AND VIRAL LAB TEST POSITIVITY DURING THE LAST WEEK NEW CASES PER 100,000 DURING VIRAL (RT-PCR) LABORATORY TEST THE LAST WEEK POSITIVITY DURING THE LAST WEEK WEEKLY CHANGE IN NEW CASES WEEKLY CHANGE IN VIRAL (RT-PCR) PER 100,000 LABORATORY TEST POSITIVITY DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Last week is 10/10 - 10/16, previous week is 10/3 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14, previous week is 10/1 - 10/7. STATE REPORT 10.18.2020 ARKANSAS SUMMARY • As we continue to work with each of you on data quality and data reporting, we will continue to add relevant data to our joint understanding. We greatly appreciate the feedback and we use this to continually improve. This week, we have included the data reported to HHS from your hospitals regarding admissions and next, we will include PPE data reported. • Arkansas is in the red zone for cases, indicating 101 or more new cases per 100,000 population last week, with the 12th highest rate in the country. Arkansas is in the yellow zone for test positivity, indicating a rate between 5.0% and 7.9%, with the 19th highest rate in the country. • Arkansas has seen an increase in new cases and an increase in test positivity over the last week. • The following three counties had the highest number of new cases over the last 3 weeks: 1. Pulaski County, 2. Washington County, and 3. Craighead County. These counties represent 24.9% of new cases in Arkansas. • 72% of all counties in Arkansas have moderate or high levels of community transmission (yellow, orange, or red zones), with 21% having high levels of community transmission (red zone). • During the week of Oct 5 - Oct 11, 22% of nursing homes had at least one new resident COVID-19 case, 41% had at least one new staff COVID-19 case, and 8% had at least one new resident COVID-19 death. • Arkansas had 206 new cases per 100,000 population in the last week, compared to a national average of 117 per 100,000. • Current staff deployed from the federal government as assets to support the state response are: 5 to support operations activities from FEMA. • Between Oct 10 - Oct 16, on average, 89 patients with confirmed COVID-19 and 167 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in Arkansas. An average of 92% of hospitals reported either new confirmed or new suspected COVID patients each day during this period; therefore, this may be an underestimate of the actual total number of COVID-related hospitalizations. Underreporting may lead to a lower allocation of critical supplies. RECOMMENDATIONS • We have included cases, test positivity, and deaths by month in the back of your packet to show the time sequence in Arkansas and the country as a whole. These demonstrate the impact of comprehensive mitigation efforts when implemented effectively and that partial or incomplete mitigation leads to prolonged community spread and increased fatalities. • Arkansas must continue the strong mitigation efforts statewide. Mitigation efforts should continue to include mask wearing, physical distancing, hand hygiene, avoiding crowds in public and social gatherings in private, and ensuring flu immunizations. • In red and orange counties, both public and private gatherings should be as small as possible and optimally, not extend beyond immediate family. • Keep testing levels high across the state, particularly in red and orange counties, to quickly identify positives so they can isolate themselves and prevent ongoing transmission. • Fully deploy Abbott BinaxNOW tests statewide in sentinel sites and populations; weekly surveillance data will proactively identify emerging hotspots where immediate action should be taken to stop the spread within communities. All antigen tests must be reported with both the number of positive results and total tests conducted; positives must be reported as COVID cases. Repeat testing of individuals as surveillance with confirmation of all positives with nucleic acid testing is the optimal use of antigen tests. • With over 40% of nursing homes reporting at least one COVID positive staff member, work with nursing homes to trace exposures of positive staff to decrease introduction of community transmission to nursing homes. • In rural communities, highlight increasing hospital constraints so residents can do their part to slow the spread. • Ensure university students continue their mitigation behaviors to ensure no further outbreaks on or off campus as symptomatic cases and cases identified through surveillance testing decline. • Encourage use of retail establishments that are enforcing mitigation efforts. • Provide specific mitigation messaging to individuals 65 years and older through senior citizen networks. • Ensure all hospitals have access to antivirals and antibodies and ensure early use as treatment (within 48 hours). • Specific, detailed guidance on community mitigation measures can be found on the CDC website. The purpose of this report is to develop a shared understanding of the current status of the pandemic at the national, regional, state and local levels. We recognize that data at the state level may differ from that available at the federal level. Our objective is to use consistent data sources and methods that allow for comparisons to be made across localities. We appreciate your continued support in identifying data COVID-19 discrepancies and improving data completeness and sharing across systems. We look forward to your feedback. COVID-19 ARKANSAS STATE REPORT | 10.18.2020 STATE, % CHANGE FEMA/HHS STATE, FROM PREVIOUS REGION, UNITED STATES, LAST WEEK WEEK LAST WEEK LAST WEEK NEW COVID-19 CASES 6,226 54,086 383,209 +12% (RATE PER 100,000) (206) (127) (117) VIRAL (RT-PCR) LAB 7.6% +1.0%* 7.4% 5.4% TEST POSITIVITY RATE TOTAL VIRAL (RT-PCR) LAB 73,219** 607,668** 7,141,821** +2%** TESTS (TESTS PER 100,000) (2,426) (1,423) (2,176) COVID-19 DEATHS 135 805 4,931 -1% (RATE PER 100,000) (4.5) (1.9) (1.5) SNFs WITH ≥1 NEW 22% -3%* 13% 10% RESIDENT COVID-19 CASE (41%) (-2%*) (23%) (22%) (≥1 NEW STAFF CASE) SNFs WITH ≥1 NEW 8% -2%* 4% 4% RESIDENT COVID-19 DEATH ADMISSIONS HOSPITAL * Indicates absolute change in percentage points. ** Due to delayed reporting, this figure may underestimate total diagnostic tests and week-on-week changes in diagnostic tests. DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, previous week is 10/3 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14, previous week is 10/1 - 10/7. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Last week is 10/5- 10/11, previous week is 9/28-10/4. Facilities that are undergoing reporting quality review are not included in the table, but may be included in other NHSN analyses. Hospitalizations: Unified hospitalization dataset in HHS Protect. These data exclude psychiatric, rehabilitation, and religious non-medical hospitals. In addition, hospitals explicitly identified by states/regions as those from which we should not expect reports were excluded from the percent reporting figure. COVID-19 ARKANSAS STATE REPORT | 10.18.2020 COVID-19 COUNTY AND METRO ALERTS* Top 12 shown in table (full lists below) METRO AREA (CBSA) LAST WEEK COUNTY LAST WEEK Craighead Greene Mississippi LOCALITIES 5 16 Miller Jonesboro Independence IN RED Texarkana Paragould Lawrence ZONE Blytheville Carroll Jackson ▲ (+1) Mountain Home ▲ (+1) Poinsett Arkansas Baxter Izard Sebastian Jefferson Lincoln LOCALITIES 5 12 Phillips Fort Smith Franklin IN ORANGE Pine Bluff Batesville Randolph ZONE Helena-West Helena St. Francis Hempstead ▼ (-1) Forrest City ■ (+0) Johnson Little River Newton Woodruff Pulaski Little Rock-North Little Rock-Conway Washington Fayetteville-Springdale-Rogers Benton Russellville LOCALITIES 11 26 Faulkner Hot Springs Saline IN YELLOW Harrison Memphis Crawford ZONE Malvern Pope Garland ▲ (+3) Magnolia Hope ▲ (+6) Crittenden Hot Spring Arkadelphia Columbia Camden Logan Change from previous week’s alerts: ▲ Increase ■ Stable ▼ Decrease All Red Counties: Craighead, Greene, Mississippi, Miller, Independence, Lawrence, Carroll, Jackson, Poinsett, Arkansas, Baxter, Izard, Clay, Fulton, Monroe, Prairie All Yellow Counties: Pulaski, Washington, Benton, Faulkner, Saline, Crawford, Pope, Garland, Crittenden, Hot Spring, Columbia, Logan, Clark, Cross, Cleburne, Grant, Polk, Desha, Ouachita, Howard, Ashley, Stone, Scott, Lafayette, Nevada, Drew * Localities with fewer than 10 cases last week have been excluded from these alerts. Note: Lists of red, orange, and yellow localities are sorted by the number of new cases in the last 3 weeks, from highest to lowest. Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. DATA SOURCES – Additional data details available under METHODS Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, three weeks is 9/26 - 10/16. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14. COVID-19 ARKANSAS STATE REPORT | 10.18.2020 NEW CASES TESTING Top counties based on greatest number of new cases in last three weeks (9/26 - 10/16) TOP COUNTIES DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. COVID-19 Top 12 counties based on number of new cases in the last 3 weeks TOTAL DAILY CASES DATA SOURCES – Additional data details available under METHODS Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Last 3 weeks is 9/26 - 10/16. COVID-19 ARKANSAS STATE REPORT | 10.18.2020 CASE RATES AND VIRAL LAB TEST POSITIVITY DURING THE LAST WEEK NEW CASES PER 100,000 DURING VIRAL (RT-PCR) LABORATORY TEST THE LAST WEEK POSITIVITY DURING THE LAST WEEK WEEKLY CHANGE IN NEW CASES WEEKLY CHANGE IN VIRAL (RT-PCR) PER 100,000 LABORATORY TEST POSITIVITY DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Last week is 10/10 - 10/16, previous week is 10/3 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14, previous week is 10/1 - 10/7. STATE REPORT 10.18.2020 CALIFORNIA SUMMARY • As we continue to work with each of you on data quality and data reporting, we will continue to add relevant data to our joint understanding. We greatly appreciate the feedback and we use this to continually improve. This week, we have included the data reported to HHS from your hospitals regarding admissions and next, we will include PPE data reported. • California continues to be in a plateau with stable disease activity for several weeks, as there has been a gradual relaxation of mandated mitigation measures in an increasing number of counties. California is in the orange zone for cases, indicating between 51 and 100 new cases per 100,000 population last week, with the 46th highest rate in the country. California is in the green zone for test positivity, indicating a rate at or below 4.9%, with the 41st highest rate in the country. • California has seen stability in new cases and a decrease in test positivity over the last week. Hospitalizations remained stable. • The following three counties had the highest number of new cases over the last 3 weeks: 1. Los Angeles County, 2. San Bernardino County, and 3. San Diego County. These counties represent 48.8% of new cases in California. Shasta, Kings, and Imperial counties were the only counties to report more than 100 cases per 100,000 population last week. • 9% of all counties in California have moderate or high levels of community transmission (yellow, orange, or red zones), with none having high levels of community transmission (red zone). • During the week of Oct 5 - Oct 11, 4% of nursing homes had at least one new resident COVID-19 case, 6% had at least one new staff COVID-19 case, and 1% had at least one new resident COVID-19 death. • California had 56 new cases per 100,000 population in the last week, compared to a national average of 117 per 100,000. • Current staff deployed from the federal government as assets to support the state response are: 142 to support operations activities from FEMA; 6 to support operations activities from ASPR; and 276 to support operations activities from USCG. • The federal government has supported surge testing in Bakersfield, CA. • Between Oct 10 - Oct 16, on average, 288 patients with confirmed COVID-19 and 531 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in California. An average of 90% of hospitals reported either new confirmed or new suspected COVID patients each day during this period; therefore, this may be an underestimate of the actual total number of COVID-related hospitalizations. Underreporting may lead to a lower allocation of critical supplies. RECOMMENDATIONS • We have included cases, test positivity, and deaths by month in the back of your packet to show the time sequence in California and the country as a whole. These demonstrate the impact of comprehensive mitigation efforts when implemented effectively and that partial or incomplete mitigation leads to prolonged community spread and increased fatalities. • California has had strong success with the gradated series of mitigation measures applied to localities according to local epidemiological trends. Mitigation efforts should continue to include mask wearing, physical distancing, hand hygiene, avoiding crowds in public and social gatherings in private, and ensuring flu immunizations everywhere. Continue the tailored business and public venue measures for counties with different levels of incidence. • Continue to use testing and case investigations strategically to identify and mitigate these high incidence jurisdictions and transmission venues. Use of rapid tests can be extremely helpful in doing this. • Encourage outdoor activities and ensure mask and physical distancing messages for all residents in both public and private spaces. • Ensure university students continue their mitigation behaviors to ensure no further outbreaks on or off campus as symptomatic cases and cases identified through surveillance testing on campus decline. • Concern remains for further increases in community transmission with increasing hospitalizations and deaths, given the continued spread among younger age groups, much of which is asymptomatic, as has been seen in “hotspot” counties generally (MMWR Early Release/October 9, 2020). • Community transmission is frequently occurring in smaller gatherings of family and friends, especially among young adults, where masking and social distancing recommendations are not followed. With weather conditions increasingly forcing activities indoors, recommend increased messaging regarding the need to take these measures, especially given the element of "prevention fatigue.” • Continue testing programs in long-term care facilities (LTCFs), with prompt testing of all residents in any facility with an active case and repeat testing for all staff. Utilize point-of-care testing platforms to facilitate rapid COVID-19 case identification. • Continue to implement plans to increase surveillance for community spread using the Abbott BinaxNOW or other antigen tests, especially to protect the elderly and other vulnerable populations. Establish weekly surveillance to monitor degree of community spread among K-12 teachers; staff working at nursing homes, assisted living, and other congregate living settings; prison staff; and first responders as tests become available. Increased rates of infection seen among LTCF workers indicate significant transmission in their communities and those transmission settings must be identified and mitigated. • Specific, detailed guidance on community mitigation measures can be found on the CDC website. The purpose of this report is to develop a shared understanding of the current status of the pandemic at the national, regional, state and local levels. We recognize that data at the state level may differ from that available at the federal level. Our objective is to use consistent data sources and methods that allow for comparisons to be made across localities. We appreciate your continued support in identifying data COVID-19 discrepancies and improving data completeness and sharing across systems. We look forward to your feedback. COVID-19 CALIFORNIA STATE REPORT | 10.18.2020 STATE, % CHANGE FEMA/HHS STATE, FROM PREVIOUS REGION, UNITED STATES, LAST WEEK WEEK LAST WEEK LAST WEEK NEW COVID-19 CASES 22,224 32,198 383,209 -3% (RATE PER 100,000) (56) (63) (117) VIRAL (RT-PCR) LAB 3.2% -7.5%* 3.7% 5.4% TEST POSITIVITY RATE TOTAL VIRAL (RT-PCR) LAB 907,538** 1,078,036** 7,141,821** -9%** TESTS (TESTS PER 100,000) (2,297) (2,102) (2,176) COVID-19 DEATHS 437 566 4,931 +5% (RATE PER 100,000) (1.1) (1.1) (1.5) SNFs WITH ≥1 NEW 4% -4%* 4% 10% RESIDENT COVID-19 CASE (6%) (-11%*) (8%) (22%) (≥1 NEW STAFF CASE) SNFs WITH ≥1 NEW 1% -2%* 1% 4% RESIDENT COVID-19 DEATH ADMISSIONS HOSPITAL * Indicates absolute change in percentage points. ** Due to delayed reporting, this figure may underestimate total diagnostic tests and week-on-week changes in diagnostic tests. DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, previous week is 10/3 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14, previous week is 10/1 - 10/7. There may be increases in tests reported on a particular day; however, these tests were conducted over the span of pandemic. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Last week is 10/5-10/11, previous week is 9/28-10/4. Facilities that are undergoing reporting quality review are not included in the table, but may be included in other NHSN analyses. Hospitalizations: Unified hospitalization dataset in HHS Protect. These data exclude psychiatric, rehabilitation, and religious non-medical hospitals. In addition, hospitals explicitly identified by states/regions as those from which we should not expect reports were excluded from the percent reporting figure. COVID-19 CALIFORNIA STATE REPORT | 10.18.2020 COVID-19 COUNTY AND METRO ALERTS* Top 12 shown in table (full lists below) METRO AREA (CBSA) LAST WEEK COUNTY LAST WEEK LOCALITIES IN RED ZONE 0 N/A 0 N/A ■ (+0) ■ (+0) LOCALITIES IN ORANGE ZONE 0 N/A 0 N/A ▼ (-1) ▼ (-1) LOCALITIES 4 5 San Bernardino Riverside-San Bernardino-Ontario IN YELLOW Visalia Riverside Tulare ZONE Redding El Centro Shasta ▼ (-4) ▼ (-4) Imperial Change from previous week’s alerts: ▲ Increase ■ Stable ▼ Decrease * Localities with fewer than 10 cases last week have been excluded from these alerts. Note: Lists of red, orange, and yellow localities are sorted by the number of new cases in the last 3 weeks, from highest to lowest. Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. DATA SOURCES – Additional data details available under METHODS Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, three weeks is 9/26 - 10/16. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14. There may be increases in tests reported on a particular day; however, these tests were conducted over the span of pandemic. COVID-19 CALIFORNIA STATE REPORT | 10.18.2020 NEW CASES TESTING Top counties based on greatest number of new cases in last three weeks (9/26 - 10/16) TOP COUNTIES DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. There may be increases in tests reported on a particular day; however, these tests were conducted over the span of pandemic. COVID-19 Top 12 counties based on number of new cases in the last 3 weeks TOTAL DAILY CASES DATA SOURCES – Additional data details available under METHODS Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Last 3 weeks is 9/26 - 10/16. COVID-19 CALIFORNIA STATE REPORT | 10.18.2020 CASE RATES AND VIRAL LAB TEST POSITIVITY DURING THE LAST WEEK NEW CASES PER 100,000 DURING VIRAL (RT-PCR) LABORATORY TEST THE LAST WEEK POSITIVITY DURING THE LAST WEEK WEEKLY CHANGE IN NEW CASES WEEKLY CHANGE IN VIRAL (RT-PCR) PER 100,000 LABORATORY TEST POSITIVITY DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Last week is 10/10 - 10/16, previous week is 10/3 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14, previous week is 10/1 - 10/7. There may be increases in tests reported on a particular day; however, these tests were conducted over the span of pandemic. STATE REPORT 10.18.2020 COLORADO SUMMARY • As we continue to work with each of you on data quality and data reporting, we will continue to add relevant data to our joint understanding. We greatly appreciate the feedback and we use this to continually improve. This week, we have included the data reported to HHS from your hospitals regarding admissions and next, we will include PPE data reported. • Colorado is in the red zone for cases, indicating 101 or more new cases per 100,000 population last week, with the 27th highest rate in the country. Colorado is in the yellow zone for test positivity, indicating a rate between 5.0% and 7.9%, with the 32nd highest rate in the country. • Colorado has seen a continued increase in new cases and an increase in test positivity over the last week. • Cases remain concentrated near the Front Range urban centers but has extended to additional counties west of these centers and further south. Fremont County had the largest increase in incidence last week, reporting more than half of its cumulative cases since the beginning of the epidemic, with many cases linked to a correctional facility. The following three counties had the highest number of new cases over the last 3 weeks: 1. Denver County, 2. Adams County, and 3. Arapahoe County. These counties represent 46.2% of new cases in Colorado. • Current hospitalizations have begun to increase more rapidly and are now approximately twice as high as three weeks ago. Deaths have also increased. • Institutions of higher education (IHE): While IHEs continue to report moderate numbers of cases linked to active outbreaks, mitigation measures have limited broad scale transmission. New reported cases among UC Boulder students are similar in number to the previous week, but lower than four weeks ago. • 19% of all counties in Colorado have moderate or high levels of community transmission (yellow, orange, or red zones), with none having high levels of community transmission (red zone). • During the week of Oct 5 - Oct 11, 6% of nursing homes had at least one new resident COVID-19 case, 14% had at least one new staff COVID-19 case, and 2% had at least one new resident COVID-19 death. • Colorado had 115 new cases per 100,000 population in the last week, compared to a national average of 117 per 100,000. • Current staff deployed from the federal government as assets to support the state response are: 64 to support operations activities from FEMA; 5 to support operations activities from ASPR; 2 to support epidemiology activities from CDC; and 1 to support operations activities from USCG. • Between Oct 10 - Oct 16, on average, 64 patients with confirmed COVID-19 and 94 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in Colorado. An average of 92% of hospitals reported either new confirmed or new suspected COVID patients each day during this period; therefore, this may be an underestimate of the actual total number of COVID-related hospitalizations. Underreporting may lead to a lower allocation of critical supplies. RECOMMENDATIONS • We have included cases, test positivity, and deaths by month in the back of your packet to show the time sequence in Colorado and the country as a whole. These demonstrate the impact of comprehensive mitigation efforts when implemented effectively and that partial or incomplete mitigation leads to prolonged community spread and increased fatalities. • We share the concern of the state leaders that the current situation can continue to worsen and is at a critical juncture. Colorado’s ability to limit further cases and avoid increases in hospitalizations and deaths will depend on increased observation of social distancing mitigation measures by the community until cases decline. The Governor’s guidance on these measures is commended. • Colorado has had considerable success in limiting morbidity and mortality. State and local leaders should work intensely with communities to ensure a clear and shared message and continue to ask Coloradans to wear masks, physically distance, and avoid gatherings in both public and private spaces, especially indoors. Lack of compliance with these measures will lead to preventable deaths. • In red and orange counties, both public and private gatherings should be as small as possible and optimally, not extend beyond immediate family. • Community transmission is frequently occurring in smaller gatherings of family and friends where masking and social distancing recommendations are not followed. Continue to encourage outdoor activities and ensure mask and physical distancing messages for all residents, both in public and private spaces. With weather conditions increasingly forcing activities indoors, recommend increased messaging regarding the need to take these measures, especially given the element of "prevention fatigue.” • Recommendations from previous weeks continue. • Specific, detailed guidance on community mitigation measures can be found on the CDC website. The purpose of this report is to develop a shared understanding of the current status of the pandemic at the national, regional, state and local levels. We recognize that data at the state level may differ from that available at the federal level. Our objective is to use consistent data sources and methods that allow for comparisons to be made across localities. We appreciate your continued support in identifying data COVID-19 discrepancies and improving data completeness and sharing across systems. We look forward to your feedback. COVID-19 COLORADO STATE REPORT | 10.18.2020 STATE, % CHANGE FEMA/HHS STATE, FROM PREVIOUS REGION, UNITED STATES, LAST WEEK WEEK LAST WEEK LAST WEEK NEW COVID-19 CASES 6,616 29,893 383,209 +40% (RATE PER 100,000) (115) (244) (117) VIRAL (RT-PCR) LAB 5.0% +1.2%* 10.2% 5.4% TEST POSITIVITY RATE TOTAL VIRAL (RT-PCR) LAB 118,247** 321,945** 7,141,821** +6%** TESTS (TESTS PER 100,000) (2,053) (2,626) (2,176) COVID-19 DEATHS 69 232 4,931 +50% (RATE PER 100,000) (1.2) (1.9) (1.5) SNFs WITH ≥1 NEW 6% +1%* 11% 10% RESIDENT COVID-19 CASE (14%) (-2%*) (30%) (22%) (≥1 NEW STAFF CASE) SNFs WITH ≥1 NEW 2% +2%* 5% 4% RESIDENT COVID-19 DEATH ADMISSIONS HOSPITAL * Indicates absolute change in percentage points. ** Due to delayed reporting, this figure may underestimate total diagnostic tests and week-on-week changes in diagnostic tests. DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, previous week is 10/3 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14, previous week is 10/1 - 10/7. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Last week is 10/5- 10/11, previous week is 9/28-10/4. Facilities that are undergoing reporting quality review are not included in the table, but may be included in other NHSN analyses. Hospitalizations: Unified hospitalization dataset in HHS Protect. These data exclude psychiatric, rehabilitation, and religious non-medical hospitals. In addition, hospitals explicitly identified by states/regions as those from which we should not expect reports were excluded from the percent reporting figure. COVID-19 COLORADO STATE REPORT | 10.18.2020 COVID-19 COUNTY AND METRO ALERTS* Top 12 shown in table (full lists below) METRO AREA (CBSA) LAST WEEK COUNTY LAST WEEK LOCALITIES IN RED ZONE 0 N/A 0 N/A ■ (+0) ▼ (-2) LOCALITIES IN ORANGE ZONE 0 N/A 2 Yuma Lake ■ (+0) ▲ (+2) Denver Adams Denver-Aurora-Lakewood LOCALITIES 7 10 Arapahoe Greeley Weld IN YELLOW Cañon City Sterling Fremont ZONE Breckenridge Logan Summit ▲ (+5) Fort Morgan Montrose ▲ (+4) Morgan Grand Montrose Change from previous week’s alerts: ▲ Increase ■ Stable ▼ Decrease * Localities with fewer than 10 cases last week have been excluded from these alerts. Note: Lists of red, orange, and yellow localities are sorted by the number of new cases in the last 3 weeks, from highest to lowest. Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. DATA SOURCES – Additional data details available under METHODS Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, three weeks is 9/26 - 10/16. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14. COVID-19 COLORADO STATE REPORT | 10.18.2020 NEW CASES TESTING Top counties based on greatest number of new cases in last three weeks (9/26 - 10/16) TOP COUNTIES DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. COVID-19 Top 12 counties based on number of new cases in the last 3 weeks TOTAL DAILY CASES DATA SOURCES – Additional data details available under METHODS Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Last 3 weeks is 9/26 - 10/16. COVID-19 COLORADO STATE REPORT | 10.18.2020 CASE RATES AND VIRAL LAB TEST POSITIVITY DURING THE LAST WEEK NEW CASES PER 100,000 DURING VIRAL (RT-PCR) LABORATORY TEST THE LAST WEEK POSITIVITY DURING THE LAST WEEK WEEKLY CHANGE IN NEW CASES WEEKLY CHANGE IN VIRAL (RT-PCR) PER 100,000 LABORATORY TEST POSITIVITY DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Last week is 10/10 - 10/16, previous week is 10/3 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14, previous week is 10/1 - 10/7. STATE REPORT 10.18.2020 CONNECTICUT SUMMARY • As we continue to work with each of you on data quality and data reporting, we will continue to add relevant data to our joint understanding. We greatly appreciate the feedback and we use this to continually improve. This week, we have included the data reported to HHS from your hospitals regarding admissions and next, we will include PPE data reported. • Connecticut’s control of the epidemic has worsened. Connecticut is in the orange zone for cases, indicating between 51 and 100 new cases per 100,000 population last week, with the 37th highest rate in the country. Connecticut is in the green zone for test positivity, indicating a rate at or below 4.9%, with the 43rd highest rate in the country. • Connecticut has seen a significant increase in new cases and stability in test positivity over the last week. Test positivity has continued to exceed 2% after an extended period in the summer below 1%. • Cases continue to disproportionately affect young adults both at institutions of higher education (IHEs) and in the community. Transmission in family and small group settings is a major contributor to community spread. Current hospitalizations continued to increase last week being more than double the level of a month ago. • Connecticut moved to level 3 (of 4) of lower social distancing restrictions on Oct 8; bars remain closed. Governor Lamont is recommending that towns with upticks in COVID-19 cases roll back to phase-2 of recovery. Connecticut is considering requiring testing or quarantine for all visitors. • The following three counties had the highest number of new cases over the last 3 weeks: 1. Hartford County, 2. Fairfield County, and 3. New London County. These counties represent 69.3% of new cases in Connecticut. Southeastern Connecticut continued to be the most affected portion of the state with 9 of 11 state designated hot spots. • IHE: Reported cases continued to be at low levels at UConn with university and public health measures leading to less transmission. Trinity College (Hartford County) and Fairfield University (Fairfield County) reported sharp increases in cases, contributing to large increases in reported cases from the counties. • No counties in Connecticut have moderate or high levels of community transmission (yellow, orange, or red zones). • During the week of Oct 5 - Oct 11, 4% of nursing homes had at least one new resident COVID-19 case, 16% had at least one new staff COVID-19 case, and 1% had at least one new resident COVID-19 death. • Connecticut had 78 new cases per 100,000 population in the last week, compared to a national average of 117 per 100,000. • Current staff deployed from the federal government as assets to support the state response are: 2 to support operations activities from FEMA and 9 to support operations activities from USCG. • Between Oct 10 - Oct 16, on average, 23 patients with confirmed COVID-19 and 88 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in Connecticut. An average of greater than 95% of hospitals reported either new confirmed or new suspected COVID patients each day during this period. RECOMMENDATIONS • We have included cases, test positivity, and deaths by month in the back of your packet to show the time sequence in Connecticut and the country as a whole. These demonstrate the impact of comprehensive mitigation efforts when implemented effectively and that partial or incomplete mitigation leads to prolonged community spread and increased fatalities. • Connecticut’s ability to limit further cases and avoid increases in hospitalizations and deaths will depend on increased observation of social distancing mitigation measures by the community until cases decline. The state’s guidance on these measures is commended. • Connecticut has had considerable success in limiting morbidity and mortality using gradated mitigation measures. Continue to use testing and case investigations strategically to identify and mitigate high incidence jurisdictions and transmission venues. Use of rapid tests can be extremely helpful in doing this. • Community leaders should continue to weigh how to most effectively mitigate increasing cases while maximizing economic activity based on the evidence from these investigations. Maintaining or increasing restrictions on indoor gathering sizes, both public and private, will help limit the super-spreader events that appear to be critical to rapid epidemic spread. This is especially important in the next few weeks given the recent increased transmission with larger numbers of infectious individuals. • State and local leaders should work intensely with communities to ensure a clear and shared message and continue to ask Connecticuters to wear masks, physically distance, and avoid gatherings, especially indoors. • Both public and private gatherings should be as small as possible and optimally, not extend beyond immediate family. • Continued efforts to increase testing capacity and access are important given the increasing numbers of cases in Connecticut and across the region. • Consider making rapid antigen tests, such as Abbott BinaxNOW, available to first responders statewide for minimizing the downtime of this limited pool of skilled personnel. Rapid antigen tests were recently made available to first responders in New Hampshire and appear to be successful in reducing responder downtime, which can be as great as 72 hours when PCR testing is used. • Specific, detailed guidance on community mitigation measures can be found on the CDC website. The purpose of this report is to develop a shared understanding of the current status of the pandemic at the national, regional, state and local levels. We recognize that data at the state level may differ from that available at the federal level. Our objective is to use consistent data sources and methods that allow for comparisons to be made across localities. We appreciate your continued support in identifying data COVID-19 discrepancies and improving data completeness and sharing across systems. We look forward to your feedback. COVID-19 CONNECTICUT STATE REPORT | 10.18.2020 STATE, % CHANGE FEMA/HHS STATE, FROM PREVIOUS REGION, UNITED STATES, LAST WEEK WEEK LAST WEEK LAST WEEK NEW COVID-19 CASES 2,792 9,684 383,209 +60% (RATE PER 100,000) (78) (65) (117) VIRAL (RT-PCR) LAB 2.8% +0.4%* 1.5% 5.4% TEST POSITIVITY RATE TOTAL VIRAL (RT-PCR) LAB 57,716** 565,441** 7,141,821** +0%** TESTS (TESTS PER 100,000) (1,619) (3,809) (2,176) COVID-19 DEATHS 12 176 4,931 -29% (RATE PER 100,000) (0.3) (1.2) (1.5) SNFs WITH ≥1 NEW 4% -3%* 3% 10% RESIDENT COVID-19 CASE (16%) (+3%*) (11%) (22%) (≥1 NEW STAFF CASE) SNFs WITH ≥1 NEW 1% +0%* 1% 4% RESIDENT COVID-19 DEATH ADMISSIONS HOSPITAL * Indicates absolute change in percentage points. ** Due to delayed reporting, this figure may underestimate total diagnostic tests and week-on-week changes in diagnostic tests. DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, previous week is 10/3 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14, previous week is 10/1 - 10/7. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Last week is 10/5- 10/11, previous week is 9/28-10/4. Facilities that are undergoing reporting quality review are not included in the table, but may be included in other NHSN analyses. Hospitalizations: Unified hospitalization dataset in HHS Protect. These data exclude psychiatric, rehabilitation, and religious non-medical hospitals. In addition, hospitals explicitly identified by states/regions as those from which we should not expect reports were excluded from the percent reporting figure. COVID-19 CONNECTICUT STATE REPORT | 10.18.2020 COVID-19 COUNTY AND METRO ALERTS* Top 12 shown in table (full lists below) METRO AREA (CBSA) LAST WEEK COUNTY LAST WEEK LOCALITIES IN RED ZONE 0 N/A 0 N/A ■ (+0) ■ (+0) LOCALITIES IN ORANGE ZONE 0 N/A 0 N/A ■ (+0) ■ (+0) LOCALITIES IN YELLOW ZONE 0 N/A 0 N/A ▼ (-1) ▼ (-1) Change from previous week’s alerts: ▲ Increase ■ Stable ▼ Decrease * Localities with fewer than 10 cases last week have been excluded from these alerts. Note: Lists of red, orange, and yellow localities are sorted by the number of new cases in the last 3 weeks, from highest to lowest. Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. DATA SOURCES – Additional data details available under METHODS Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020; last week is 10/10 - 10/16, three weeks is 9/26 - 10/16. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020. Last week is 10/8 - 10/14. COVID-19 CONNECTICUT STATE REPORT | 10.18.2020 NEW CASES TESTING Top counties based on greatest number of new cases in last three weeks (9/26 - 10/16) TOP COUNTIES DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/16/2020. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/14/2020.
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