SUMMARY • • • • • • • • MISSOURI STATE REPORT 09.06.2020 Missouri is in the red zone for cases, indicating more than 100 new cases per 100,000 population last week, with the 7th highest rate in the country. Missouri is in the yellow zone for test positivity, indicating a rate between 5% and 10%, with the 9th highest rate in the country. Missouri has seen an increase in new cases and stability in test positivity over the last week. The following three counties had the highest number of new cases over the last 3 weeks: 1. St. Louis County, 2. Jackson County, and 3. Greene County. These counties represent 36.4% of new cases in Missouri. 67% of all counties in Missouri have moderate or high levels of community transmission (yellow or red zone), with 33% having high levels of community transmission (red zone). During the week of Aug 24 – Aug 30, 9% of nursing homes had at least one new resident COVID-19 case, 16% of nursing homes had at least one new staff COVID-19, and 6% of nursing homes had at least one new resident COVID-19 death. Missouri had 150 new cases per 100,000 population in the last week, compared to a national average of 88 per 100,000. Current staff deployed from the federal government as assets to support the state response are: 65 to support operations activities from FEMA; 7 to support operations activities from ASPR; 4 to support epidemiology activities from CDC; 2 to support operations activities from CDC; and 1 to support operations activities from VA. Between Aug 29 - Sep 04, on average, 92 patients with confirmed COVID-19 and 229 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in Missouri. 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 • • • • • Require masks in metro areas and counties with COVID-19 cases among students or teachers in K-12 schools. In university settings: • Increase testing capacity by expanding public-private partnerships; increasing the budget and capacity of public health labs; pooling specimens where appropriate; and utilizing all university, veterinary and research platforms for surveillance and testing of students and, if needed, the surrounding communities. • Require all universities and colleges to have a plan for both rapid testing and contact tracing of symptomatic students and periodic surveillance testing of students. Ensure quick turnaround times for results and the rapid isolation of cases and quarantine of contacts. Residential cases and contacts should not be sent home to isolate or quarantine. • Recruit college and university students to expand public health messaging and contact tracing capacity and ensure protection of local communities by strict mask wearing and social distancing off campus. • Universities and colleges should work with various student leaders and campus media to support compliance with recommendations. • Consider utilizing focused wastewater surveillance to detect cases early and to direct diagnostic testing and public health interventions. Using the Abbott BinaxNOW, establish weekly surveillance in critical populations to monitor degree of community spread among K-12 teachers; staff working at nursing homes, assisted living, and other congregate living settings; and first responders. Bars must be closed, and indoor dining must be restricted to 50% of normal capacity in yellow zone and 25% of normal capacity in red zone counties and metro areas. Expand outdoor dining options. 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 discrepancies and improving data completeness and sharing across systems. We look forward to your feedback. COVID-19 COVID-19 MISSOURI STATE REPORT 09.06.2020 STATE, LAST WEEK STATE, % CHANGE FROM PREVIOUS WEEK FEMA/HHS REGION, LAST WEEK UNITED STATES, LAST WEEK NEW COVID-19 CASES (RATE PER 100,000) 9,227 (150) +15.0% 21,819 (154) 290,363 (88) VIRAL (RT-PCR) LAB TEST POSITIVITY RATE 9.7% +0.2%* 10.0% 5.2% 53,359** (869) +6.5%** 190,085** (1,344) 5,652,360** (1,722) 98 (2) +113.0% 204 (1) 5,963 (2) 9% (16%) -2%* (-2%*) 7% (15%) 10% (17%) 6% +2%* 4% 5% TOTAL VIRAL (RT-PCR) LAB TESTS (TESTS PER 100,000) COVID-19 DEATHS (RATE PER 100,000) SNFs WITH ≥1 NEW RESIDENT COVID-19 CASE (≥1 NEW STAFF CASE) MOBILITY SNFs WITH ≥1 NEW RESIDENT COVID-19 DEATH * 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 9/4/2020; last week is 8/29 - 9/4, previous week is 8/22 - 8/28. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 9/2/2020. Last week is 8/27 - 9/2, previous week is 8/20 8/26. Mobility: Descartes Labs. This data depicts the median distance moved across a collection of mobile devices to estimate the level of human mobility within a county. The 100% represents the baseline mobility level prior to the pandemic; lower percent mobility indicates less population movement. Data is anonymized and provided at the county level. Data through 9/4/2020. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Last week is 8/24-8/30, previous week is 8/17-8/23. COVID-19 MISSOURI STATE REPORT 09.06.2020 COVID-19 COUNTY AND METRO ALERTS* Top 12 shown in table (full lists below) LOCALITIES IN RED ZONE METRO AREA (CBSA) LAST WEEK COUNTY LAST WEEK 12 38 Springfield Columbia Joplin Farmington Jefferson City Cape Girardeau St. Joseph Hannibal Sikeston Kennett West Plains Fort Madison-Keokuk Greene Boone Jefferson St. Francois Jasper Cole Franklin Christian Cape Girardeau Marion Buchanan Scott LOCALITIES IN YELLOW ZONE 12 St. Louis Kansas City Branson Sedalia Fort Leonard Wood Poplar Bluff Rolla Warrensburg Lebanon Marshall Mexico Moberly 39 St. Louis Jackson St. Charles St. Louis City Clay Cass Taney Callaway Pettis Pulaski Stone Lawrence All Red Counties: Greene, Boone, Jefferson, St. Francois, Jasper, Cole, Franklin, Christian, Cape Girardeau, Marion, Buchanan, Scott, Newton, Camden, Lincoln, Dunklin, Perry, Madison, New Madrid, Miller, Washington, Howell, Webster, Crawford, Pemiscot, Polk, Bollinger, Texas, Grundy, Barton, Oregon, DeKalb, Wayne, Holt, Ozark, Harrison, Daviess, Chariton All Yellow Counties: St. Louis, Jackson, St. Charles, St. Louis City, Clay, Cass, Taney, Callaway, Pettis, Pulaski, Stone, Lawrence, Phelps, Warren, Johnson, Platte, Butler, Laclede, Saline, Audrain, Barry, Mississippi, Stoddard, Ralls, Howard, Lafayette, Randolph, Ste. Genevieve, Clinton, Andrew, Morgan, Dallas, Ripley, Moniteau, Vernon, Osage, Douglas, Dent, Bates * Localities with fewer than 10 cases last week have been excluded from these alerts. Red Zone: Those core-based statistical areas (CBSAs) and counties that during the last week reported both new cases above 100 per 100,000 population, and lab test positivity result above 10%. Yellow Zone: Those CBSAs and counties that during the last week reported both new cases between 10-100 per 100,000 population, and a lab test positivity result between 5-10%, or one of those two conditions and one condition qualifying as being in the “Red Zone.” Note: Lists of red 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 9/4/2020; last week is 8/29 - 9/4, three weeks is 8/15 - 9/4. Testing: HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) through 9/2/2020. Last week is 8/27 - 9/2. COVID-19 MISSOURI TESTING NEW CASES STATE REPORT 09.06.2020 TOP COUNTIES Top counties based on greatest number of new cases in last three weeks (8/15 - 9/4) 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 9/4/2020. Testing: HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) through 9/2/2020. COVID-19 TOTAL DAILY CASES Top 12 counties based on number of new cases in the last 3 weeks 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 9/4/2020. Last 3 weeks is 8/15 - 9/4. COVID-19 MISSOURI STATE REPORT 09.06.2020 CASE RATES AND VIRAL LAB TEST POSITIVITY DURING THE LAST WEEK NEW CASES PER 100,000 DURING THE LAST WEEK VIRAL (RT-PCR) LABORATORY TEST POSITIVITY DURING THE LAST WEEK WEEKLY CHANGE IN NEW CASES PER 100K WEEKLY CHANGE IN VIRAL (RT-PCR) 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 9/4/2020. Last week is 8/29 - 9/4, previous week is 8/22 - 8/28. Testing: HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) through 9/2/2020. Last week is 8/27 - 9/2, previous week is 8/20 - 8/26. COVID-19 National Picture NEW CASES PER 100,000 LAST WEEK NEW CASES PER 100,000 IN THE WEEK ONE MONTH BEFORE DATA SOURCES 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: County-level data from USAFacts through 9/4/2020. Last week is 8/29 - 9/4; the week one month before is 8/1 - 8/7. COVID-19 National Picture VIRAL (RT-PCR) LAB TEST POSITIVITY LAST WEEK VIRAL (RT-PCR) LAB TEST POSITIVITY IN THE WEEK ONE MONTH BEFORE DATA SOURCES Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Testing: Combination of CELR (COVID-19 Electronic Lab Reporting) state health department-reported data and HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) through 9/2/2020. Last week is 8/27 - 9/2; the week one month before is 7/30 - 8/5. COVID-19 METHODS STATE REPORT 09.06.2020 COLOR THRESHOLDS: Results for each indicator should be taken in context of the findings for related indicators (e.g., changes in case incidence and testing volume) Metric Green Yellow Red <10 10-100 >100 <-10% -10% - 10% >10% <5% 5%-10% >10% Change in test positivity <-0.5% -0.5%-0.5% >0.5% Total diagnostic tests resulted per 100,000 population per week >1000 500-1000 <500 Percent change in tests per 100,000 population >10% -10% - 10% <-10% COVID-19 deaths per 100,000 population per week <1 1-2 >2 Percent change in deaths per 100,000 population <-10% -10% - 10% >10% Skilled Nursing Facilities with at least one resident COVID-19 case, death <1% 1%-5% >5% Change in SNFs with at least one resident COVID-19 case, death <-1% -1%-1% >1% New cases per 100,000 population per week Percent change in new cases per 100,000 population Diagnostic test result positivity rate DATA NOTES • • • • • • Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. It is critical that states provide as up-to-date data as possible. Cases and deaths: County-level data from USAFacts as of 22:00 EDT on 09/06/2020. State values are calculated by aggregating county-level data from USAFacts; therefore, values may not match those reported directly by the state. Data are reviewed on a daily basis against internal and verified external sources and, if needed, adjusted. Last week data are from 8/29 to 9/4; previous week data are from 8/22 to 8/28; the week one month before data are from 8/1 to 8/7. Testing: The data presented represent viral COVID-19 laboratory diagnostic and screening test (reverse transcription polymerase chain reaction, RT-PCR) results—not individual people—and exclude antibody and antigen tests. CELR (COVID-19 Electronic Lab Reporting) state health department-reported data are used to describe county-level viral COVID-19 laboratory test (RT-PCR) result totals when information is available on patients’ county of residence or healthcare providers’ practice location. HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) are used otherwise. Some states did not report on certain days, which may affect the total number of tests resulted and positivity rate values. Because the data are deidentified, total viral (RT-PCR) laboratory tests are the number of tests performed, not the number of individuals tested. Viral (RT-PCR) laboratory test positivity rate is the number of positive tests divided by the number of tests performed and resulted. Resulted tests are assigned to a timeframe based on this hierarchy of test-related dates: 1. test date; 2. result date; 3. specimen received date; 4. specimen collection date. Resulted tests are assigned to a county based on a hierarchy of testrelated locations: 1. patient residency; 2. provider facility location; 3. ordering facility location; 4. performing organization location. States may calculate test positivity other using other methods. Last week data are from 8/27 to 9/2; previous week data are from 8/20 to 8/26; the week one month before data are from 7/30 to 8/5. HHS Protect data is recent as of 11:30 EDT on 09/06/2020. Testing data are inclusive of everything received and processed by the CELR system as of 19:00 EDT on 09/05/2020. Mobility: Descartes Labs. These data depict the median distance moved across a collection of mobile devices to estimate the level of human mobility within a locality. The 100% represents the baseline mobility level prior to the pandemic; lower percent mobility indicates less population movement. Data is anonymized and provided at the locality level. Data is recent as of 13:00 EDT on 09/06/2020 and is through 9/4/2020. Hospitalizations: Unified hospitalization dataset in HHS Protect. This figure may differ from state data due to differences in hospital lists and reporting between federal and state systems. 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. The data presented represents raw data provided; we are working diligently with state liaisons to improve reporting consistency. Data is recent as of 15:00 EDT on 09/06/2020. Skilled Nursing Facilities: National Healthcare Safety Network (NHSN). Data report resident and staff cases independently. Quality checks are performed on data submitted to the NHSN. Data that fail these quality checks or appear inconsistent with surveillance protocols may be excluded from analyses. Data presented in this report are more recent than data publicly posted by CMS. Last week is 8/17-8/23, previous week is 8/24-8/30.