SUMMARY • • • • • • • • MISSOURI STATE REPORT 09.27.2020 Missouri is in the red zone for cases, indicating 101 or more new cases per 100,000 population last week, with the 8th highest rate in the country. Missouri is in the orange zone for test positivity, indicating a rate between 8.0% and 10.0%, with the 8th highest rate in the country. Missouri has seen stability 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. Jackson County, 2. St. Louis County, and 3. Greene County. These counties represent 27.8% of new cases in Missouri. 71% of all counties in Missouri have moderate or high levels of community transmission (yellow, orange, or red zones), with 42% having high levels of community transmission (red zone). During the week of Sep 14 - Sep 20, 18% of nursing homes had at least one new resident COVID-19 case, 35% had at least one new staff COVID-19 case, and 5% had at least one new resident COVID-19 death. Missouri had 166 new cases per 100,000 population in the last week, compared to a national average of 93 per 100,000. Current staff deployed from the federal government as assets to support the state response are: 68 to support operations activities from FEMA; 7 to support operations activities from ASPR; 2 to support epidemiology activities from CDC; 1 to support operations activities from CDC; 25 to support medical activities from VA; and 1 to support operations activities from VA. Between Sep 19 - Sep 25, on average, 114 patients with confirmed COVID-19 and 206 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in Missouri. An average of greater than 95% of hospitals reported either new confirmed or new suspected COVID patients each day during this period. RECOMMENDATIONS • • • • • • • • • Rapidly scale up testing to identify individuals with COVID-19 with support for isolation to reduce community transmission. Target testing in areas with persistent high levels of transmission and rapidly increasing incidence from east to northwestern parts of the state. Develop age-segmented and geographic relevant messaging to keep Missourians compliant with mitigation efforts, including wearing face masks. On the Missouri COVID-19 public dashboard, provide county trends in test positivity and case rates with numerators and denominators so the community can follow local transmission status and adhere to mitigation efforts to decrease spread. Decrease introduction of COVID-19 in correctional facilities through on-site inspection of infection control practices in congregate settings. Decrease introduction of COVID-19 in nursing homes through on-site inspection of infection control practices at skilled nursing facilities. COVID-19 continues to be introduced in nursing homes through community transmission. Abbott BinaxNOW supplies will be distributed in the coming weeks; develop a plan for weekly surveillance in critical populations to monitor the degree of community spread among K-12 teachers; staff working at nursing homes, assisted living, senior living facilities, and other congregate living settings including correctional facilities; and first responders. Tribal Colleges will be receiving testing supplies this week. In university settings, use wastewater surveillance on and off campus to identify areas with high viral load for targeted testing. Establish routine testing of student body to find cases early, prevent spread, and keep students on campus. Provide these data to students, faculty, parents, and community on public dashboard. Test positivity and case rates have been sustained at the highest levels during the past four weeks, putting Nebraska in a vulnerable position going into the fall and winter. Transmission is statewide and new hospital admissions are increasing. Institute mask requirements in counties with ongoing transmission; reduce capacity for indoor dining and bars while expanding outdoor dining options. Use metrics like West Virginia to determine school learning and extracurricular activity 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 09.27.2020 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) 10,178 (166) -7% 23,969 (170) 305,449 (93) VIRAL (RT-PCR) LAB TEST POSITIVITY RATE 9.2% +1.2%* 8.7% 4.3% 69,675** (1,135) -24%** 236,699** (1,674) 6,381,570** (1,944) COVID-19 DEATHS (RATE PER 100,000) 214 (3.5) +171% 315 (2.2) 5,143 (1.6) SNFs WITH ≥1 NEW RESIDENT COVID-19 CASE (≥1 NEW STAFF CASE) 18% (35%) +2%* (+5%*) 11% (29%) 9% (20%) 5% +0%* 3% 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 9/25/2020; last week is 9/19 - 9/25, previous week is 9/12 - 9/18. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 9/23/2020. Last week is 9/17 - 9/23, previous week is 9/10 9/16. 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 9/24/2020. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Last week is 9/14-9/20, previous week is 9/7-9/13. COVID-19 MISSOURI STATE REPORT 09.27.2020 COVID-19 COUNTY AND METRO ALERTS* Top 12 shown in table (full lists below) METRO AREA (CBSA) LAST WEEK LOCALITIES IN RED ZONE LOCALITIES IN ORANGE ZONE LOCALITIES IN YELLOW ZONE 12 6 7 Springfield Joplin Jefferson City St. Joseph Warrensburg West Plains Poplar Bluff Lebanon Sedalia Branson Fort Leonard Wood Marshall Kansas City Cape Girardeau Kennett Sikeston Mexico Moberly St. Louis Columbia Farmington Rolla Kirksville Quincy Fort Madison-Keokuk COUNTY LAST WEEK 48 Greene Jefferson Jasper Christian Cole Franklin Buchanan Johnson Camden Webster Newton Howell 15 Jackson St. Charles Cape Girardeau Dunklin Polk Scott Platte Crawford Audrain Randolph McDonald Oregon 19 St. Louis Boone St. Francois St. Louis City Cass Clay Callaway Phelps Morgan Warren Barry Adair All Red Counties: Greene, Jefferson, Jasper, Christian, Cole, Franklin, Buchanan, Johnson, Camden, Webster, Newton, Howell, Laclede, Pettis, Taney, Butler, Lafayette, Pulaski, Lawrence, Wright, Miller, Bollinger, Perry, Texas, Stoddard, Cooper, Pemiscot, Benton, Stone, Saline, Washington, Livingston, Wayne, Moniteau, Grundy, Andrew, Dent, Ozark, Daviess, Douglas, Barton, Ripley, Carter, Cedar, Caldwell, St. Clair, Shannon, Dade All Orange Counties: Jackson, St. Charles, Cape Girardeau, Dunklin, Polk, Scott, Platte, Crawford, Audrain, Randolph, McDonald, Oregon, DeKalb, Howard, Lewis All Yellow Counties: St. Louis, Boone, St. Francois, St. Louis City, Cass, Clay, Callaway, Phelps, Morgan, Warren, Barry, Adair, Clinton, Vernon, Ste. Genevieve, Henry, Mississippi, Bates, Maries * 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 9/25/2020; last week is 9/19 - 9/25, three weeks is 9/5 - 9/25. Testing: HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) through 9/23/2020. Last week is 9/17 - 9/23. COVID-19 MISSOURI TESTING NEW CASES STATE REPORT 09.27.2020 TOP COUNTIES Top counties based on greatest number of new cases in last three weeks (9/5 - 9/25) 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 9/25/2020. Testing: HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) through 9/23/2020. 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 9/25/2020. Last 3 weeks is 9/5 - 9/25. COVID-19 MISSOURI STATE REPORT 09.27.2020 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 9/25/2020. Last week is 9/19 - 9/25, previous week is 9/12 - 9/18. Testing: HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) through 9/23/2020. Last week is 9/17 - 9/23, previous week is 9/10 - 9/16. 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 9/25/2020. Last week is 9/19 - 9/25; the week one month before is 8/22 - 8/28. 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 9/23/2020. Last week is 9/17 - 9/23; the week one month before is 8/20 - 8/26. COVID-19 METHODS STATE REPORT 09.27.2020 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 17:12 EDT on 09/27/2020. 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 9/19 to 9/25; previous week data are from 9/12 to 9/18; the week one month before data are from 8/22 to 8/28. 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 9/17 to 9/23; previous week data are from 9/10 to 9/16; the week one month before data are from 8/20 to 8/26. HHS Protect data is recent as of 12:34 EDT on 09/27/2020. Testing data are inclusive of everything received and processed by the CELR system as of 19:00 EDT on 09/26/2020. 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 09/27/2020 and is through 9/24/2020. 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 17:28 EDT on 09/27/2020. 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 9/14-9/20, previous week is 9/7-9/13. 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.”