SUMMARY • • • • • • • • • MONTANA STATE REPORT 09.20.2020 Montana is in the red zone for cases, indicating 101 or more new cases per 100,000 population last week, with the 18th highest rate in the country. Montana is in the orange zone for test positivity, indicating a rate between 8.0% and 10.0%, with the 7th highest rate in the country. Montana 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. Yellowstone County, 2. Rosebud County, and 3. Cascade County. These counties represent 46.9% of new cases in Montana. Bozeman (Montana State University) and Missoula (University of Montana) have had increases in cases and test positivity, suggesting increasing transmission. 27% of all counties in Montana have moderate or high levels of community transmission (yellow, orange, or red zones), with 9% having high levels of community transmission (red zone). During the week of Sep 7 - Sep 13, 5% 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. Montana had 105 new cases per 100,000 population in the last week, compared to a national average of 86 per 100,000. Current staff deployed from the federal government as assets to support the state response are: 3 to support operations activities from FEMA; 13 to support medical activities from ASPR; 1 to support operations activities from ASPR; 6 to support epidemiology activities from CDC; and 3 to support operations activities from CDC. Between Sep 12 - Sep 18, on average, 16 patients with confirmed COVID-19 and 20 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in Montana. An average of 82% 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 • • • • • • • • • • • • • Testing is critical to epidemic control and recent increases in testing will help guide efforts; areas with increasing test positivity in context of increased testing suggest increasing transmission. Consider fines for violation of face mask mandates in high transmission communities. Monitor hospitalizations and ensure hospital and EMS capacity remain sufficient and clinical staff are trained on latest care strategies. Intensify public health messaging, promoting personal and social responsibility for social distancing and face coverings, targeting young adult populations; counsel young adults to avoid close contact with elderly or vulnerable people/family in efforts to reduce transmission. Feature testing, hospitalization, and mortality data on state website. Continue all efforts to expand testing capacity, utilizing every PCR platform in the state and conducting pooled testing to expand surveillance efforts. Recruit and train college and university students to expand contact tracing capacity. At colleges and universities, ensure capacity to conduct surge testing of 50-100% of the student body over 14 days and ensure adequate isolation so that students do not return home and transmit to their families. Conduct surveillance testing thereafter to identify resurgence; consider using focused wastewater surveillance to detect outbreaks early and to direct diagnostic testing and public health interventions. Require strong mitigation efforts on campus, including masks and social distancing; de-densification of residences and classrooms; maximum ventilation adjustments in all buildings; creation of sheltered outside study and dining areas, if reasonable; and proactive and adaptive limits on bar patronage and student gatherings on and off campus. Ensure long-term care facilities (LTCFs) follow CMS testing requirements. For LTCFs in Billings, Bozeman, or Missoula, increase testing even further to prevent spread. Immediately ensure that inspection surveys have been conducted in all LTCFs with an initial case or 3 or more cases in the last week and ensure prompt corrective actions were taken. Conduct routine surveillance at all crowded indoor work environments (e.g., meat packing plants) to identify outbreaks early. Implement a plan for increased surveillance using the Abbott BinaxNOW or other antigen tests. Develop weekly surveillance among critical populations to monitor degree of community spread among: K-12 teachers, staff working at LTCFs, prison staff, public transportation workers, and first responders, as capacity allows. Intensify focus on Tribal Nations: As inter-tribal community events resume and epidemic fatigue sets in, develop specific messaging with tribal communities to promote social distancing and mask recommendations. Ensure widely available testing with quick turnaround of results (48 hours), provide immediate housing and food for quarantine and isolation while results are pending, and conduct contact interviews within 48 hours of test results. Recruit and train contact tracers from within the community. 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 MONTANA STATE REPORT 09.20.2020 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) 1,118 (105) +47% 14,427 (118) 283,590 (86) VIRAL (RT-PCR) LAB TEST POSITIVITY RATE 8.9% +0.1%* 7.2% 4.4% 19,026** (1,780) +36%** 208,129** (1,698) 5,881,734** (1,792) COVID-19 DEATHS (RATE PER 100,000) 15 (1.4) -12% 93 (0.8) 5,580 (1.7) SNFs WITH ≥1 NEW RESIDENT COVID-19 CASE (≥1 NEW STAFF CASE) 5% (14%) +1%* (+2%*) 4% (16%) 9% (19%) 2% +1%* 2% 4% TOTAL VIRAL (RT-PCR) LAB TESTS (TESTS PER 100,000) 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 9/18/2020; last week is 9/12 - 9/18, previous week is 9/5 - 9/11. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 9/16/2020. Last week is 9/10 - 9/16, previous week is 9/3 9/9. 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 9/18/2020. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Last week is 9/7-9/13, previous week is 8/31-9/6. COVID-19 MONTANA STATE REPORT 09.20.2020 COVID-19 COUNTY AND METRO ALERTS* Top 12 shown in table (full lists below) METRO AREA (CBSA) LAST WEEK LOCALITIES IN RED ZONE 0 N/A LOCALITIES IN ORANGE ZONE 4 Billings Great Falls Kalispell Butte-Silver Bow LOCALITIES IN YELLOW ZONE 1 Missoula COUNTY LAST WEEK 5 Rosebud Big Horn Roosevelt Glacier Meagher 5 Yellowstone Cascade Flathead Silver Bow Custer 5 Missoula Lake Hill Park Carbon * 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 9/18/2020; last week is 9/12 - 9/18, three weeks is 8/29 - 9/18. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 9/16/2020. Last week is 9/10 - 9/16. COVID-19 MONTANA TESTING NEW CASES STATE REPORT 09.20.2020 TOP COUNTIES Top counties based on greatest number of new cases in last three weeks (8/29 - 9/18) 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 9/18/2020. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 9/16/2020. 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 9/18/2020. Last 3 weeks is 8/29 - 9/18. COVID-19 MONTANA STATE REPORT 09.20.2020 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 100,000 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 9/18/2020. Last week is 9/12 - 9/18, previous week is 9/5 - 9/11. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 9/16/2020. Last week is 9/10 - 9/16, previous week is 9/3 - 9/9. 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 9/18/2020. Last week is 9/12 - 9/18; the week one month before is 8/15 - 8/21. 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 9/16/2020. Last week is 9/10 - 9/16; the week one month before is 8/13 - 8/19. COVID-19 METHODS STATE REPORT 09.20.2020 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). Values are rounded before color classification. Metric Dark Green Light Green Yellow Orange Red ≤4 5–9 10 – 50 51 – 100 ≥101 Percent change in new cases per 100,000 population ≤-26% -25% – -11% -10% – 0% 1% – 10% ≥11% Diagnostic test result positivity rate ≤2.9% 3.0% – 4.9% 5.0% – 7.9% 8.0% – 10.0% ≥10.1% Change in test positivity ≤-2.1% -2.0% – -0.6% -0.5% – 0.0% 0.1% – 0.5% ≥0.6% Total diagnostic tests resulted per 100,000 population per week ≥2001 1001 – 2000 750 – 1000 500 – 749 ≤499 Percent change in tests per 100,000 population ≥26% 11% – 25% 1% – 10% -10% – 0% ≤-11% COVID-19 deaths per 100,000 population per week ≤0.1 0.2 – 0.4 0.5 – 1.0 1.1 – 2.0 ≥2.1 Percent change in deaths per 100,000 population ≤-26% -25% – -11% -10% – 0% 1% – 10% ≥11% New cases per 100,000 population per week Skilled Nursing Facilities with at least one resident COVID-19 case, death 0% 1% – 5% ≥6% Change in SNFs with at least one resident COVID-19 case, death ≤-2% -1% – 1% ≥2% 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 16:14 EDT on 09/20/2020. 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 9/12 to 9/18; previous week data are from 9/5 to 9/11; the week one month before data are from 8/15 to 8/21. 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, unless stated otherwise. 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 test-related 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 9/10 to 9/16; previous week data are from 9/3 to 9/9; the week one month before data are from 8/13 to 8/19. HHS Protect data is recent as of 11:37 EDT on 09/20/2020. Testing data are inclusive of everything received and processed by the CELR system as of 19:00 EDT on 09/19/2020. 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 09/20/2020 and is through 9/18/2020. 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 17:01 EDT on 09/20/2020. 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 9/7-9/13, previous week is 8/31-9/6. County and Metro Area Color Categorizations • Red Zone: Those core-based statistical areas (CBSAs) and counties that during the last week reported both new cases at or above 101 per 100,000 population, and a lab test positivity result at or above 10.1%. • Orange Zone: Those CBSAs and counties that during the last week reported both new cases between 51–100 per 100,000 population, and a lab test positivity result between 8.0–10.0%, or one of those two conditions and one condition qualifying as being in the “Red Zone.” • Yellow Zone: Those CBSAs and counties that during the last week reported both new cases between 10–50 per 100,000 population, and a lab test positivity result between 5.0–7.9%, or one of those two conditions and one condition qualifying as being in the “Orange Zone” or “Red Zone.”