North Central Health District COVID-19 Operational Summary June 29, 2020 This is an emerging and dynamic situation, therefore our data and recommendations are subject to change. North Central Health District (NCHD) is part of the Georgia Department of Public Health (DPH) and serves individuals residing in 13 Central Georgia counties: Baldwin, Bibb, Crawford, Hancock, Houston, Jasper, Jones, Monroe, Peach, Putnam, Twiggs, Washington, and Wilkinson. This report describes the NCHD operations in response to the COVID-19 pandemic. The purpose of this report is to provide situational awareness to our district partners and community members. 215 Workforce NCHD has a total of 314 employees. Since before the response to COVID-19 started, NCHD staff have been planning and preparing for the response. In January 2020, the Epidemiology and Emergency Preparedness programs began watching the situation closely, educating partners, and monitoring travelers. Today, we have scaled back our normal operations to be able to respond to this event appropriately and have employees dedicated full time to the response with many additional employees assisting on an as-needed basis. Public health staff are working on a variety of tasks from epidemiology (which includes data management, case investigation, contact tracing, and outbreak investigations), PPE Distribution, Partner Coordination, SPOC operations, and ensuring our regulated facilities are operating according to the newest executive order. In addition to our workforce, NCHD has assistance from National Guardsman for Courrier support and have received several temporary staff from the state office that are assisting with Epidemiology and SPOC operations. Public Health Responders 13 INCIDENT COMMAND/  ADMINISTRATION/LOGISTICS 27 COVID-19 REFERRAL LINE 50 EPIDEMIOLOGY 119 SPOC OPERATIONS 6 PPE DISTRIBUTION Personal Protective Equipment Supply Distribution The information in this portion of the report is accurate as of 6/21/2020 at 4PM. PPE has been an essential element for the safe response to COVID-19. Inventory stockpiled at the local, district, and regional Public Health, Healthcare Coalition, and EMA level, along with State Department of Public Health and GEMA levels, Federal supplies from CDC and HHS/ASPR Strategic National Stockpile, and FEMA acquired materials are all being pushed out to public health, healthcare, public safety, and critical infrastructure organizations and facilities. Items such as N95 masks, surgical masks, gowns, gloves, face shields, hand sanitizer, thermometers and other supplies are received as orders through either the Department of Public Health or County EMA resource request process, assessed and allocated at the State RSS warehouse, and ultimately shipped to and picked up from the District Public Health team. Allocations are shipped three times a week. PPE Type Distributed To: Healthcare Facilities Total: 256 EMA and Other Partners N95 Mask 201,543 188,655 Surgical Mask 241,550 31,500 Face Shields 50,246 3,444 Gowns 69,379 580 Gloves 771,240 111,490 24,571 3,881 Shoe Covers 9,555 50 Surgical Caps 1,500 Coveralls Thermometers 10 319 Safety Goggles 240 500 Hand Sanitizer 133,856 oz 24,401 oz Disinfectant Cleaner 91,531 oz Body Bags 45 Specimen Points of Collection (SPOC) On March 18, 2020, NCHD stood up our first SPOC in Houston County, in the following weeks we expanded to 3 additionals locations in Jasper, Jones, and Washington Counties. The activities of these locations were limited in capacity due to state-supplied specimen collection kits. On 4/17/2020, due to an increase in the state's capacity to supply specimen collection kits, we opened our fifth location in Bibb County. On 5/3/2020, we expanded testing to all 13 of our county health departments. Houston and Macon-Bibb County Health Department SPOCs will operate seven days each week while the other 11 county SPOCs will operate on select days of the week. Below is a summary of the Public Health SPOC activities. The information in this portion of the report is accurate as of 6/28/2020 at 4PM. 9,982 Number of Specimens Collected by Residency Specimens Collected 2,862 3k 2k 1k 862 182 361 293 479 381 465 511 439 408 85 179 Bi Cr bb aw fo rd H an co ck H ou st on Ja sp er Jo ne s M on ro e Pe ac h Pu tn am Tw ig W gs as hi ng to W n ilk O in ut so of n D ist ric t 0 Ba ld w in Number of Specimens 2,475 3.6 minutes is the average time spent per patient for specimen collection.  This data only reflects specimens collected from NCHD public health points of collection. Epidemiology - Overview NCHD's Epidemiology Program is responsible for investigating every reported case of laboratory-confirmed COVID-19. The following information describes the activities of the epidemiology program and provides a description of the current situation with the district. NCHD Epidemiology, per reporting policy, only reports Confirmed cases that reside within the 13 counties that make up the district. Although serology (i.e. antibody tests) are reportable, they do not meet the CDC case definition for a confirmed case, therefore number of serology tests are not included in this report. Any reductions in numbers are a result of data error corrections (i.e. duplication, incorrect case classification, residency, etc). Data corrections are made as soon as they are found and data accuracy is checked daily by NCHD epidemiology staff. The NCHD Epidemiology program has closed 88% of laboratoryconfirmed cases that were reported prior to 6/21/2020. The information in this portion of the report is accurate as of 6/28/2020 at 4PM. *Based on patient county of residence when known The date indicated for the newly confirmed COVID-19 cases is based on the combination of dates based on: 1)date of symptom onset; 2)if the date is invalid or missing, the first postive collection date is used and 3) if both of those dates are invalid or missing, the date the case is reported is used. * 14-day window – Confirmed cases over the last 14 days may not be accounted for due to illnesses yet to be reported or test results may still be pending. Note - Data during the reporting period may be incomplete due to the lag in time between when the case was tested and/or reported and submitted to the Georgia DPH for reporting purposes. This delay can vary depending on the testing facility and/or jurisdiction. 2/ 20 2/ /20 25 20 /2 3/ 02 1/ 0 20 3/ 2 6/ 0 3/ 20 11 20 3/ /20 16 20 3/ /20 21 20 3/ /20 26 20 3/ /20 31 20 /2 4/ 02 5/ 0 4/ 20 10 20 4/ /20 15 20 4/ /20 20 20 4/ /20 25 20 4/ /20 30 20 /2 5/ 02 5/ 0 5/ 20 10 20 5/ /20 15 20 5/ /20 20 20 5/ /20 25 20 5/ /20 30 20 /2 6/ 02 4/ 0 2 6/ 02 9/ 0 6/ 20 14 20 6/ /20 19 20 6/ /20 24 20 /2 02 0 Count 2/ 20 2/ /20 25 20 /2 3/ 02 1/ 0 2 3/ 02 6/ 0 3/ 20 11 20 3/ /20 16 20 3/ /20 21 20 3/ /20 26 20 3/ /20 31 20 /2 4/ 02 5/ 0 4/ 20 10 20 4/ /20 15 20 4/ /20 20 20 4/ /20 25 20 4/ /20 30 20 /2 5/ 02 5/ 0 5/ 20 10 20 5/ /20 15 20 5/ /20 20 20 5/ /20 25 20 5/ /20 30 20 /2 6/ 02 4/ 0 6/ 202 9/ 0 6/ 20 14 20 6/ /20 19 20 6/ /20 24 20 /2 02 0 Count 2/ 20 2/ /20 25 20 /2 3/ 02 1/ 0 2 3/ 02 6/ 0 3/ 20 11 20 3/ /20 16 20 3/ /20 21 20 3/ /20 26 20 3/ /20 31 20 /2 4/ 02 5/ 0 4/ 20 10 20 4/ /20 15 20 4/ /20 20 20 4/ /20 25 20 4/ /20 30 20 /2 5/ 02 5/ 0 5/ 20 10 20 5/ /20 15 20 5/ /20 20 20 5/ /20 25 20 5/ /20 30 20 /2 6/ 02 4/ 0 6/ 202 9/ 0 6/ 20 14 20 6/ /20 19 20 6/ /20 24 20 /2 02 0 Count Epidemiology - Overview Hospitalizations Over Time 400 200 0 Date Deaths Over Time 100 0 Date Hospitalizations and Death By Date of Occurrence HOSP DEATHS 10 5 0 Date Epidemiology - Overview Number of Positive COVID-19 Cases By Day of Report to NCHD Count 75 50 25 3/ 10 3/ /20 14 2 3/ /20 0 18 2 3/ /20 0 22 2 0 / 3/ 20 26 2 3/ /20 0 30 2 /2 0 4/ 02 3/ 0 4/ 202 7/ 0 4/ 20 11 2 4/ /20 0 15 2 4/ /20 0 19 2 4/ /20 0 23 2 4/ /20 0 27 2 /2 0 5/ 02 1/ 0 5/ 202 5/ 0 5/ 202 9/ 0 5/ 20 13 2 5/ /20 0 17 2 5/ /20 0 21 2 5/ /20 0 25 2 0 / 5/ 20 29 2 /2 0 6/ 02 2/ 0 6/ 202 6/ 0 6/ 20 10 2 6/ /20 0 14 2 6/ /20 0 18 2 6/ /20 0 22 2 0 / 6/ 20 26 2 /2 0 02 0 0 Date 69% of Hospitalized Cases have been reported as being discharged. 72% of Deaths are associated with a congregate setting outbreak. 19% of Cases have been identified as Healthcare Workers. 40% of Cases are associated with a congregate setting outbreak. Age Distribution of Cases Race Distribution of Cases <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 5 10 15 20 Percentage of Total Cases Gender Distribution of Cases Male (42.12%) Unknown (1.59%) 25 Asian (1.3%) White (31.18%) Black (51.84%) Other (2.42%) Unknown (13.26%) Underlying Health Conditions Female (56.29%) Yes (49.6%) No (26.08%) Unknown (24.31%) Epidemiology - County and Outbreak Summaries The information in the rest of the report is a breakdown by county. The only outbreaks listed by location are for those in congregate settings that involve facilities regulated and reported by the Department of Community Health and Department of Corrections. Due to the reporting, interview, and data analysis processes, there may be delays in reporting cases as an outbreak. The Epidemiology Program is working closely with all partners to ensure data accuracy. An outbreak is considered closed if it has been 2 incubation periods since the last symptom onset date. Not all cases within an outbreak are counted within the county the outbreak occurs (i.e. staff of a facility may live in another county). 14-Day incidence rate indicates newly reported confirmed COVID-19 cases among county residents per 100,000 residents during the 14- day period indicated, using 2018 U.S. Census data to derive county population. Rates cannot be accurately calculated for Counties with <5 cases. Transmission Levels are based on the incidence rate and defined as: Substantial Spread: greater than 100 cases per 100,000 county residents Minimal/Moderate Spread: 6-100 cases per 100,000 county residents No/Low Spread: 1-5 cases per 100,000 county residents Insufficient Data: These counties may likely have low levels of transmission but may be affected by other factors such as levels of COVID-19 testing. Counties of Interest are identified by counties that have [>5% increase in COVID syndrome/ILI syndrome (if >2 visits) AND >5% increase in cases (if >2 cases)] OR [>50% change in cases AND >10 cases during most recent week]. Syndromic surveillance (SS) provides a method for timely detection of potential clusters or outbreaks of specified diseases/events. SS data include emergency department (ED) visits based on the patient’s chief complaint upon admission and/or discharge diagnosis. SS data used within this report is based on county of residence NOT facility. Approximately 90% of Georgia EDs currently report to DPH Most data available within 72 hours of patient visit 80% of facilities currently submitting discharge diagnosis information Final diagnosis may differ from submitted diagnosis Documentation of chief complaint varies by facility SS data does not necessarily depict the true burden of specified diseases/events Date represents the ED visit date Covid-19 Syndrome includes: Chief complaint text for “coronavirus”, “covid”, “c-19”, or “ncov”. Selected discharge diagnosis codes (ICD or Snomed) relevant to COVID-19; including confirmed COVID-19, suspected/probable COVID-19, unspecified coronavirus infection, exposure to COVID-19, or severe acute respiratory syndrome. ILI Syndrome includes: Chief complaint text for fever, influenza, RSV, viral infection, viral pneumonia, cough (if fever), or sore throat (if fever). Note: Covid-19 Syndrome excludes select visits related to Covid-19 testing or exposure with no mention of symptoms. Criteria for syndromes are subject to change as additional information is received. The information is accurate as of 6/28/2020 at 4PM. Baldwin County - Substantial Spread Emergency Department Visits captured in syndromic surveillance for Baldwin County residents with either a COVID-19 Syndrome or ILI Syndrome were less than 3 visits between 6/8/20206/21/2020. 133 The incidence rate of COVID-19 for Baldwin County residents between 6/8/2020-6/21/2020 was 133 per 100,000 population (n=60; population=44,823). The prior 14-Day Incidence Rate (6/1-6/14) was 165 per 100,000 population. 14-Day Incidence Rate (6/8 - 6/21) 100% 100% increase in newly Confirmed COVID-19 Cases amongst Baldwin County residents between the week of 6/8/2020-6/14/2020 (n=20) and 6/15/2020-6/21/2020 (n=40). Age Distribution of Cases in Baldwin County Between 6/8/2020-6/21/2020 2 Week Period Total <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 2.5 5 7.5 10 12.5 15 17.5 20 22.5 25 27.5 30 Percentage of Total Cases 22% Outbreak Related (6/8-6/21) The cases reported in Baldwin County between 6/8/20206/21/2020 associated with an outbreak account for 22% (n=13) of the total cases reported during that time county-wide. The other 78% of cases reported during that timeframe in Baldwin County have not been attributed to a single area of concern and represent community level spread within the county. Since March 2020, 64% (305) of cases reported in Baldwin County have been linked to an outbreak. Bibb County - Minimal/Moderate Spread AREA OF CONCERN: Since June 8, confirmed case counts, as well as emergency room visits associated with COVID-19 and ILI Syndromes, have increased amongst Bibb County residents. The increase in cases cannot be attributed solely to congregate setting outbreaks, however, increases in those settings have been seen during this time. Due to this we are watching the situation closely and working with our partners to ensure that precautions amongst residents are encouraged. 80 14-Day Incidence Rate (6/8 - 6/21) 115% The incidence rate of COVID-19 for Bibb County residents between 6/8/2020-6/21/2020 was 62 per 100,000 population (n=123; population=153,095). The prior 14-Day Incidence Rate (6/1-6/14) was 80 per 100,000 population. 115% increase in newly Confirmed COVID-19 Cases amongst Bibb County residents between the week of 6/8/2020-6/14/2020 (n=39) and 6/15/20206/21/2020 (n=84). Age Distribution of Cases in Bibb County Between 6/8/2020-6/21/2020 2 Week Period Total <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 2.5 5 7.5 10 12.5 15 17.5 20 22.5 Percentage of Total Cases 7% Outbreak Related (6/8-6/21) The cases reported in Bibb County between 6/8/2020-6/21/2020 associated with an outbreak account for 7% (n=9) of the total cases reported during that time county-wide. The other 93% of cases reported during that timeframe in Bibb County have not been attributed to a single area of concern and represent community level spread within the county. Since March 2020, 34% (253) of cases reported in Bibb County have been linked to an outbreak. Crawford County - Minimal/Moderate Spread Emergency Department Visits captured in syndromic surveillance for residents of Crawford County with either a COVID-19 Syndrome or ILI Syndrome were less than 3 visits between 6/8/2020-6/21/2020. 48 14-Day Incidence Rate (6/8 - 6/21) 0% The incidence rate of COVID-19 for Crawford County residents between 6/8/2020-6/21/2020 was 48 per 100,000 population (n=6; population=12,318). The prior 14-Day Incidence Rate (6/1-6/14) was unable to be calculated due to insufficient data. There was no change in newly Confirmed COVID-19 Cases amongst Crawford County residents between the week of 6/8/2020-6/14/2020 (n=3) and 6/15/2020-6/21/2020 (n=3). Age Distribution of Cases in Crawford County Between 6/8/2020-6/21/2020 2 Week Period Total <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 5 10 15 20 25 30 Percentage of Total Cases 67% Outbreak Related (6/8-6/21) The cases reported in Crawford County between 6/8/20206/21/2020 associated with an outbreak account for 67% (n=6) of the total cases reported during that time county-wide. The other 33% of cases reported during that timeframe in Crawford County have not been attributed to a single area of concern and represent community level spread within the county. Since March 2020, 54% (21) of cases reported in Crawford County have been linked to an outbreak. Hancock County - Substantial Spread Emergency Department Visits captured in syndromic surveillance for residents of Hancock County with either a COVID-19 Syndrome or ILI Syndrome were less than 3 visits between 6/8/2020-6/21/2020. 108 The incidence rate of COVID-19 for Hancock County residents between 6/8/2020-6/21/2020 was 108 per 100,000 population (n=9; population=8,348). The prior 14-Day Incidence Rate (6/1-6/14) was unable to be calculated due to insufficient data. 14-Day Incidence Rate (6/8 - 6/21) 50% 50% decrease in newly Confirmed COVID-19 Cases amongst Hancock County residents between the week of 6/8/2020-6/14/2020 (n=6) and 6/15/20206/21/2020 (n=3). Age Distribution of Cases in Hancock County Between 6/8/2020-6/21/2020 2 Week Period Total <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 5 10 15 20 25 30 35 40 45 Percentage of Total Cases 11% Outbreak Related (6/8-6/21) The cases reported in Hancock County between 6/8/20206/21/2020 associated with an outbreak account for 11% (n=1) of the total cases reported during that time county-wide. The other 89% of cases reported during that timeframe in Hancock County have not been attributed to a single area of concern and represent community level spread within the county. Since March 2020, 65% (136) of cases reported in Hancock County have been linked to an outbreak. Houston County - Minimal/Moderate Spread AREA OF CONCERN: Since May 25, confirmed case counts, as well as emergency room visits associated with COVID-19 and ILI Syndromes, have increased amongst Houston County residents. The increase in cases cannot be attributed solely to congregate setting outbreaks, however, increases in those settings have been seen during this time. Due to this we are watching the situation closely and working with our partners to ensure that precautions amongst residents are encouraged. 77 The incidence rate of COVID-19 for Houston County residents between 6/8/2020-6/21/2020 was 77 per 100,000 population (n=121; population=155,469). The prior 14-Day Incidence Rate (6/1-6/14) was 45 per 100,000 population. 14-Day Incidence Rate (6/8 - 6/21) 22% 22% increase in newly Confirmed COVID-19 Cases amongst Houston County residents between the week of 6/8/2020-6/14/2020 (n=55) and 6/15/2020-6/21/2020 (n=66). Age Distribution of Cases in Houston County Between 6/8/2020-6/21/2020 2 Week Period Total <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 2.5 5 7.5 10 12.5 15 17.5 20 22.5 25 27.5 Percentage of Total Cases 32% Outbreak Related (6/8-6/21) The cases reported in Houston County between 6/8/20206/21/2020 associated with an outbreak account for 32% (n=39) of the total cases reported during that time county-wide. The other 68% of cases reported during that timeframe in Houston County have not been attributed to a single area of concern and represent community level spread within the county. Since March 2020, 26% (153) of cases reported in Houston County have been linked to an outbreak. Jasper County - Minimal/Moderate Spread Emergency Department Visits captured in syndromic surveillance for residents of Jasper County with either a COVID-19 Syndrome or ILI Syndrome were less than 3 visits between 6/8/2020-6/21/2020. 50 14-Day Incidence Rate (6/8 - 6/21) 33% The incidence rate of COVID-19 for Jasper County residents between 6/8/2020-6/21/2020 was 50 per 100,000 population (n=7; population=14,040). The prior 14-Day Incidence Rate (6/1-6/14) was 143 per 100,000 population. 33% increase in newly Confirmed COVID-19 Cases amongst Jasper County residents between the week of 6/8/2020-6/14/2020 (n=3) and 6/8/20206/21/2020 (n=4). Age Distribution of Cases in Jasper County Between 6/8/2020-6/21/2020 2 Week Period Total <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 5 10 15 20 25 30 35 Percentage of Total Cases 14% Outbreak Related (6/8-6/21) The cases reported in Jasper County between 6/8/20206/21/2020 associated with an outbreak account for 14% (n=1) of the total cases reported during that time county-wide. The other 86% of cases reported during that timeframe in Jasper County have not been attributed to a single area of concern and represent community level spread within the county. Since March 2020, 11% (n=7) of cases reported in Jasper County have been linked to an outbreak. There are no public health confirmed reports of congregate setting outbreaks within Jasper County at this time. Jones County - Low/Insufficient Data Emergency Department Visits captured in syndromic surveillance for residents of Jones County with either a COVID-19 Syndrome or ILI Syndrome were less than 3 visits between 6/8/2020-6/21/2020. NA 14-Day Incidence Rate (6/8 - 6/21) NA The incidence rate of COVID-19 for Jones County residents between 6/8/2020-6/21/2020 can not be calculated due to insufficient data (n=3; population=28,616). The prior 14-Day Incidence Rate (6/1-6/14) was 38 per 100,000 population. A percent change in newly Confirmed COVID-19 Cases amongst Jones County residents can not be calculated due to insufficient data. However, the county did see an increase in reports between the week of 6/8/20206/14/2020 (n=0) and 6/15/2020-6/21/2020 (n=3). Age Distribution of Cases in Jones County Between 6/8/2020-6/21/2020 2 Week Period Total <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 5 10 15 20 25 30 Percentage of Total Cases 0% Outbreak Related (6/8-6/21) The cases reported in Jones County between 6/8/2020-6/21/2020 associated with an outbreak account for 0% (n=0) of the total cases reported during that time county-wide. The other 100% of cases reported during that timeframe in Jones County have not been attributed to a single area of concern and represent community level spread within the county. Since March 2020, 28% (n=17) of cases reported in Jones County have been linked to an outbreak. Monroe County - Minimal/Moderate Spread Emergency Department Visits captured in syndromic surveillance for residents of Jones County with either a COVID-19 Syndrome or ILI Syndrome were less than 3 visits between 6/8/2020-6/21/2020. 62 The incidence rate of COVID-19 for Monroe County residents between 6/18/2020-6/21/2020 was 62 per 100,000 population (n=17; population=27,520). The prior 14-Day Incidence Rate (6/1-6/14) was 40 per 100,000 population. 14-Day Incidence Rate (6/8 - 6/21) 140% 140% increase in newly Confirmed COVID-19 Cases amongst Monroe County residents between the week of 6/8/2020-6/21/2020 (n=5) and 6/15/2020-6/21/2020 (n=12). Age Distribution of Cases in Monroe County Between 6/8/2020-6/21/2020 2 Week Period Total <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 5 10 15 20 25 30 35 40 45 50 55 Percentage of Total Cases 0% Outbreak Related (6/8-6/21) The cases reported in Monroe County between 6/8/20206/21/2020 associated with an outbreak account for 0% (n=0) of the total cases reported during that time county-wide. The other 100% of cases reported during that timeframe in Monroe County have not been attributed to a single area of concern and represent community level spread within the county. Since March 2020, 54% (n=85) of cases reported in Monroe County have been linked to an outbreak. Peach County - Minimal/Moderate Spread Emergency Department Visits captured in syndromic surveillance for residents of Peach County with either a COVID-19 Syndrome or ILI Syndrome increased between 6/8/20206/21/2020. 44 14-Day Incidence Rate (6/8 - 6/21) 80% The incidence rate of COVID-19 for Peach County residents between 6/8/2020-6/21/2020 was 44 per 100,000 population (n=12; population=27,297). The prior 14-Day Incidence Rate (6/1-6/14) was 62 per 100,000 population. 80% decrease in newly Confirmed COVID-19 Cases amongst Peach County residents between the week of 6/8/2020-6/14/2020 (n=10) and 6/15/20206/21/2020 (n=2). Age Distribution of Cases in Peach County Between 6/8/2020-6/21/2020 2 Week Period Total <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 5 10 15 20 25 30 Percentage of Total Cases 17% Outbreak Related (6/8-6/21) The cases reported in Peach County between 6/8/20206/21/2020 associated with an outbreak account for 17% (n=2) of the total cases reported during that time county-wide. The other 83% of cases reported during that timeframe in Peach County have not been attributed to a single area of concern and represent community level spread within the county. Since March 2020, 21% (n=21) of cases reported in Peach County have been linked to an outbreak. There are no active investigations regarding congregate setting outbreaks within Peach County at this time. Putnam County - Substantial Spread Emergency Department Visits captured in syndromic surveillance for residents of Putnam County with either a COVID-19 Syndrome or ILI Syndrome were less than 3 visits between 6/8/2020-6/21/2020. 115 The incidence rate of COVID-19 for Putnam County residents between 6/8/2020-6/21/2020 was 115 per 100,000 population (n=25; population=21,809). The prior 14-Day Incidence Rate (6/1-6/14) was 96 per 100,000 population. 14-Day Incidence Rate (6/8 - 6/21) 113% 113% increase in newly Confirmed COVID-19 Cases amongst Putnam County residents between the week of 6/8/2020-6/14/2020 (n=8) and 6/15/2020-6/21/2020 (n=17). Age Distribution of Cases in Putnam County Between 6/8/2020-6/21/2020 2 Week Period Total <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 2.5 5 7.5 10 12.5 15 17.5 20 22.5 25 Percentage of Total Cases 8% Outbreak Related (6/8-6/21) The cases reported in Putnam County between 6/8/20206/21/2020 associated with an outbreak account for 8% (n=2) of the total cases reported during that time county-wide. The other 92% of cases reported during that timeframe in Putnam County have not been attributed to a single area of concern and represent community level spread within the county. Since March 2020, 38% (n=52) of cases reported in Putnam County have been linked to an outbreak. There are no active investigations regarding congregate setting outbreaks within Putnam County at this time. Twiggs County - Low/Insufficient Data Emergency Department Visits captured in syndromic surveillance for residents of Putnam County with either a COVID-19 Syndrome or ILI Syndrome were less than 3 visits between 6/8/2020-6/21/2020. NA The incidence rate of COVID-19 for Twiggs County residents between 6/8/2020-6/21/2020 can not be calculated due to insufficient data (n=2; population=8,188). The prior 14-Day Incidence Rate (6/1-6/14) was unable to be calculated due to insufficient data. 14-Day Incidence Rate (6/8 - 6/21) 100% 100% decrease in newly Confirmed COVID-19 Cases amongst Twiggs County residents between the week of 6/8/2020-6/14/2020 (n=2) and 6/15/2020-6/21/2020 (n=0). Age Distribution of Cases in Twiggs County Between 6/8/2020-6/21/2020 2 Week Period Total <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 5 10 15 20 25 30 35 40 45 50 Percentage of Total Cases 0% Outbreak Related (6/8-6/21) The cases reported in Twiggs County between 6/8/20206/21/2020 associated with an outbreak account for 0% (n=0) of the total cases reported during that time county-wide. The other 100% of cases reported during that timeframe in Twiggs County have not been attributed to a single area of concern and represent community level spread within the county. Since March 2020, 17% (n=4) of cases reported in Twiggs County have been linked to an outbreak. There are no public health confirmed reports of congregate setting outbreaks within Twiggs County at this time. Washington County - Minimal/Moderate Spread Emergency Department Visits captured in syndromic surveillance for residents of Washington County with either a COVID-19 Syndrome or ILI Syndrome were less than 3 visits between 6/8/2020-6/21/2020. 59 14-Day Incidence Rate (6/1 - 6/14) 400% The incidence rate of COVID-19 for Washington County residents between 6/8/2020-6/21/2020 was 59 per 100,000 (n=12; population=20,386). The prior 14-Day Incidence Rate (6/1-6/14) was unable to be calculated due to insufficient data. 400% increase in newly Confirmed COVID-19 Cases amongst Washington County residents between the week of 6/8/2020-6/14/2020 (n=2) and 6/15/2020-6/21/2020 (n=10). Age Distribution of Cases in Washington County Between 6/8/2020-6/21/2020 2 Week Period Total <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 5 10 15 20 25 30 35 40 45 50 Percentage of Total Cases 0% Outbreak Related (6/8-6/21) The cases reported in Washington County between 6/8/20206/21/2020 associated with an outbreak account for 0% (n=0) of the total cases reported during that time county-wide. The other 100% of cases reported during that timeframe in Washington County have not been attributed to a single area of concern and represent community level spread within the county. Since March 2020, 23% (n=21) of cases reported in Washington County have been linked to an outbreak. There are no active investigations regarding congregate setting outbreaks within Washington County at this time. Wilkinson County - Low/Insufficient Data Emergency Department Visits captured in syndromic surveillance for residents of Wilkinson County with either a COVID-19 Syndrome or ILI Syndrome were less than 3 visits between 6/8/2020-6/21/2020. NA 14-Day Incidence Rate (6/8 - 6/21) 100% The incidence rate of COVID-19 for Twiggs County residents between 6/8/2020-6/21/2020 can not be calculated due to insufficient data (n=3; population=9,036). The prior 14-Day Incidence Rate (6/1-6/14) was 66 per 100,000 population. 100% decrease in newly Confirmed COVID-19 Cases amongst Wilkinson County residents between the week of 6/8/2020-6/14/2020 (n=3) and 6/15/2020-6/21/2020 (n=0). Age Distribution of Cases in Wilkinson County Between 6/8/2020-6/21/2020 2 Week Period Total <1 1-4 5-9 10-17 18-24 25-34 35-49 50-64 65-79 80 and older 0 10 20 30 40 50 60 Percentage of Total Cases 0% Outbreak Related (6/8-6/21) The cases reported in Wilkinson County between 6/8/20206/21/2020 associated with an outbreak account for 0% (n=0) of the total cases reported during that time county-wide. The other 100% of cases reported during that timeframe in Washington County have not been attributed to a single area of concern and represent community level spread within the county. Since March 2020, 42% (n=32) of cases reported in Wilkinson County have been linked to an outbreak. 70