SUMMARY • • • • • • • • WISCONSIN STATE REPORT 10.11.2020 Wisconsin has seen a sustained peak of epidemic activity in the last week with an ongoing health emergency. Wisconsin is in the red zone for cases, indicating 101 or more new cases per 100,000 population last week, with the 4th highest rate in the country. Wisconsin is in the red zone for test positivity, indicating a rate at or above 10.1%, with the 7th highest rate in the country. Wisconsin has seen stability in new cases and stability in test positivity over the last week. The state averaged 2,500 cases a day; hospitalizations have tripled over the past three weeks and deaths continued to increase last week. Low adherence to mitigation measures has been reported with wide variation between localities. Intense community virus transmission is seen throughout the state with only two of 72 counties reporting less than 100 cases per 100,000 population (and those two exceeded 90 per 100,000); six counties exceeded incidence rates of 700 per 100,000. The following three counties had the highest number of new cases over the last 3 weeks: 1. Milwaukee County, 2. Brown County, and 3. Winnebago County. These counties represent 27.1% of new cases in Wisconsin. 92% of all counties in Wisconsin have moderate or high levels of community transmission (yellow, orange, or red zones), with 50% having high levels of community transmission (red zone). During the week of Sep 28 - Oct 4, 10% of nursing homes had at least one new resident COVID-19 case, 36% had at least one new staff COVID19 case, and 2% had at least one new resident COVID-19 death. Wisconsin had 304 new cases per 100,000 population in the last week, compared to a national average of 100 per 100,000. Current staff deployed from the federal government as assets to support the state response are: 6 to support operations activities from FEMA; 1 to support testing activities from CDC; 8 to support epidemiology activities from CDC; 2 to support operations activities from CDC; 1 to support operations activities from USCG; and 8 to support medical activities from VA. Between Oct 3 - Oct 9, on average, 180 patients with confirmed COVID-19 and 106 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in Wisconsin. An average of 94% 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 Wisconsin 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 health officials that the current situation can continue to worsen. Wisconsin’s ability to limit further and avoid increases in hospitalizations and deaths will depend on increased observation of social distancing mitigation measures by the community until cases decline. Lack of compliance with these measures will lead to preventable deaths. State leaders should work intensely with communities to ensure a clear and shared message. 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, as well as tailored business and public venue measures especially for counties with increasing incidence. There is extreme concern for continued 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 where masking and social distancing recommendations are not followed. 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.” Localized, more intense mitigation measures in high incidence jurisdictions are recommended, including limiting indoor gathering sizes, both in public and especially private spaces (gatherings of friends and families), to help limit the super-spreader events that disproportionately contribute to increased or maintained epidemic spread. This is especially important in the next few weeks given the recent increased transmission with larger numbers of infectious individuals. Public education and enforcement measures to increase compliance with gathering restrictions should be enhanced. Continue to use testing and case investigations strategically to identify and mitigate these areas of increasing disease activity and the transmission venues. Use of rapid tests can be extremely helpful in doing this. Continue testing programs in long-term care facilities, 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 long-term care facility workers indicates significant transmission in their communities and those transmission settings must be identified and mitigated. 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. Ensure all hospitals are aware that COVID-19 antivirals and antibodies, when available, work best when used early in the course of infection. 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 WISCONSIN STATE REPORT 10.11.2020 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) 17,683 (304) +0% 67,586 (129) 327,190 (100) VIRAL (RT-PCR) LAB TEST POSITIVITY RATE 10.1% -0.1%* 5.4% 5.8% 221,332** (3,801) -3%** 1,414,080** (2,691) 6,936,223** (2,113) COVID-19 DEATHS (RATE PER 100,000) 87 (1.5) +10% 638 (1.2) 4,908 (1.5) SNFs WITH ≥1 NEW RESIDENT COVID-19 CASE (≥1 NEW STAFF CASE) 10% (36%) +5%* (+6%*) 10% (23%) 10% (21%) 2% +1%* 4% 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 10/9/2020; last week is 10/3 - 10/9, previous week is 9/26 - 10/2. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/7/2020. Last week is 10/1 - 10/7, previous week is 9/24 9/30. 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 10/7/2020. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Last week is 9/28-10/4, previous week is 9/21-9/27. COVID-19 WISCONSIN STATE REPORT 10.11.2020 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 13 ▼ (-1) 6 ▲ (+3) 6 ▼ (-2) Green Bay Appleton Oshkosh-Neenah Wausau-Weston Fond du Lac Shawano Sheboygan Manitowoc Beaver Dam Stevens Point Watertown-Fort Atkinson Platteville 36 ▼ (-1) 10 Milwaukee-Waukesha Racine Eau Claire Janesville-Beloit Wisconsin Rapids-Marshfield Iron Mountain ▼ (-2) 20 La Crosse-Onalaska Chicago-Naperville-Elgin Minneapolis-St. Paul-Bloomington Whitewater Menomonie Baraboo Change from previous week’s alerts: COUNTY LAST WEEK ▲ (+6) ▲ Increase Brown Winnebago Outagamie Marathon Fond du Lac Sheboygan Washington Shawano Calumet Manitowoc Dodge Oconto Milwaukee Waukesha Racine Rock Eau Claire Wood Trempealeau Clark Richland Crawford La Crosse Kenosha Walworth Dunn Ozaukee St. Croix Sauk Chippewa Door Green Pierce Douglas ■ Stable ▼ Decrease All Red CBSAs: Green Bay, Appleton, Oshkosh-Neenah, Wausau-Weston, Fond du Lac, Shawano, Sheboygan, Manitowoc, Beaver Dam, Stevens Point, Watertown-Fort Atkinson, Platteville, Marinette All Red Counties: Brown, Winnebago, Outagamie, Marathon, Fond du Lac, Sheboygan, Washington, Shawano, Calumet, Manitowoc, Dodge, Oconto, Portage, Waupaca, Jefferson, Grant, Columbia, Marinette, Kewaunee, Oneida, Monroe, Waushara, Langlade, Green Lake, Lincoln, Marquette, Juneau, Lafayette, Vilas, Price, Vernon, Forest, Taylor, Menominee, Sawyer, Washburn All Yellow Counties: La Crosse, Kenosha, Walworth, Dunn, Ozaukee, St. Croix, Sauk, Chippewa, Door, Green, Pierce, Douglas, Burnett, Ashland, Iowa, Adams, Jackson, Polk, Florence, Buffalo * 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 10/9/2020; last week is 10/3 - 10/9, three weeks is 9/19 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/7/2020. Last week is 10/1 - 10/7. COVID-19 WISCONSIN TESTING NEW CASES STATE REPORT 10.11.2020 TOP COUNTIES Top counties based on greatest number of new cases in last three weeks (9/19 - 10/9) 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 10/9/2020. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/7/2020. 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 10/9/2020. Last 3 weeks is 9/19 - 10/9. COVID-19 WISCONSIN STATE REPORT 10.11.2020 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 10/9/2020. Last week is 10/3 - 10/9, previous week is 9/26 - 10/2. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/7/2020. Last week is 10/1 - 10/7, previous week is 9/24 - 9/30. COVID-19 National Picture NEW CASES PER 100,000 LAST WEEK NATIONAL RANKING OF NEW CASES PER 100,000 LAST WEEK National Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 State ND SD MT WI UT ID IA WY OK TN AR KY KS NE MO AK MN MS AL IN SC IL NC RI NV NM National Rank 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 State TX DE CO VA FL OH GA MI WV LA MD PA NJ MA DC AZ CA OR NY WA HI CT NH ME VT NEW CASES PER 100,000 IN THE WEEK: ONE MONTH BEFORE TWO MONTHS BEFORE THREE MONTHS 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 10/9/2020. Last week is 10/3 - 10/9; the week one month before is 9/5 - 9/11; the week two months before is 8/8 - 8/14; the week three months before is 7/11 - 7/17. COVID-19 National Picture VIRAL (RT-PCR) LAB TEST POSITIVITY LAST WEEK NATIONAL RANKING OF TEST POSITIVITY LAST WEEK National Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 State NE MT ID UT CA SD WI OK OR MO IA KY KS SC NV ND MS TN AL AR TX IN NC AK VA GA National Rank 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 State MN FL IL NM LA AZ WY WV PA MD CO MI HI OH WA NJ DE CT NH RI NY DC MA ME VT VIRAL (RT-PCR) LAB TEST POSITIVITY IN THE WEEK: ONE MONTH BEFORE TWO MONTHS BEFORE THREE MONTHS 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 10/7/2020. Last week is 10/1 - 10/7; the week one month before is 9/3 - 9/9; the week two months before is 8/6 - 8/12; the week three months before is 7/9 - 7/15. COVID-19 National Picture NEW DEATHS PER 100,000 LAST WEEK NATIONAL RANKING OF NEW DEATHS PER 100,000 LAST WEEK National Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 State ND AR SD MO TN FL MS SC GA KS AL IA TX LA MT ID HI IL IN NV WI NC MA OK WV VA National Rank 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 State RI MN CA UT PA NE KY MI DE OR CO OH AZ NM DC NH WA MD CT NY AK NJ ME VT WY NEW DEATHS PER 100,000 IN THE WEEK: ONE MONTH BEFORE TWO MONTHS BEFORE THREE MONTHS 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. Deaths: County-level data from USAFacts through 10/9/2020. Last week is 10/3 - 10/9; the week one month before is 9/5 - 9/11; the week two months before is 8/8 - 8/14; the week three months before is 7/11 - 7/17. COVID-19 METHODS STATE REPORT 10.11.2020 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. 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% Metric 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 17:35 EDT on 10/11/2020. 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 10/3 to 10/9; previous week data are from 9/26 to 10/2; the week one month before data are from 9/5 to 9/11. 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 10/1 to 10/7; previous week data are from 9/24 to 9/30; the week one month before data are from 9/3 to 9/9. HHS Protect data is recent as of 13:41 EDT on 10/11/2020. Testing data are inclusive of everything received and processed by the CELR system as of 19:00 EDT on 10/10/2020. 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 17:33 EDT on 10/11/2020 and is through 10/7/2020. 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 18:19 EDT on 10/11/2020. 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 9/28-10/4, previous week is 9/21-9/27. 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.”