SUMMARY • • • • • • • • • MISSOURI STATE REPORT 11.01.2020 Issue 20 Missouri is in the red zone for cases, indicating 101 or more new cases per 100,000 population, with the 19th highest rate in the country. Missouri is in the red zone for test positivity, indicating a rate at or above 10.1%, with the 10th highest rate in the country. Missouri has seen an increase in new cases and an increase in test positivity. 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. St. Charles County. These counties represent 28.9% of new cases in Missouri. 91% of all counties in Missouri have moderate or high levels of community transmission (yellow, orange, or red zones), with 76% having high levels of community transmission (red zone). During the week of Oct 19 - Oct 25, 23% of nursing homes had at least one new resident COVID-19 case, 38% had at least one new staff COVID-19 case, and 6% had at least one new resident COVID-19 death. Missouri had 257 new cases per 100,000 population, compared to a national average of 165 per 100,000. Current staff deployed from the federal government as assets to support the state response are: 67 to support operations activities from FEMA; 5 to support operations activities from ASPR; 17 to support medical activities from VA; and 3 to support operations activities from VA. The federal government has supported surge testing in Columbia, Cape Giradeau, Branson, and Lee's Summit. Between Oct 24 - Oct 30, on average, 182 patients with confirmed COVID-19 and 217 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 • • • • • • • • • • • As you can see from the time sequence of maps at the back of your packet, there is a continued increase in cases, hospitalizations, and fatalities nationally, spreading southward from the coldest climates as the population moves indoors and cases increase exponentially. These maps demonstrate the previous impact of comprehensive mitigation efforts when implemented effectively in many areas and that partial or incomplete mitigation leads to prolonged community spread, hospitalizations, and increased fatalities. With unrelenting spread and increasing new hospital admissions, refocus efforts on finding asymptomatic sources of spread. Prioritize the use of Abbot BinaxNOW: • Implement weekly sentinel surveillance among specific populations to provide detailed trend data on where the virus is and direct mitigation efforts. Target populations should include healthcare workers, K-12 teachers, prison staff, and first responders. • Find asymptomatic cases to stop the source of spread; primarily test those younger than 40 years old. In areas with low positivity, confirm positives with RT-PCR testing. Realign contact tracing staff to support new testing approaches. Visualize integrated surveillance data on dashboard so community can see local virus changes. Effective practices to decrease transmission in public spaces include limiting restaurant indoor capacity to less than 50% and restricting hours until cases and test positivity decrease. Review testing at universities; if universities have not been testing all students (on and off campus) weekly, then work with them to implement weekly testing protocols. Investigate if there is ongoing transmission in university towns; mitigation behaviors may be eroding in university towns. Messages to community for basic actions that they should take now: • Do not gather without a mask with individuals living outside of your household. • Always wear a mask in public places. • Stop gatherings beyond immediate household until cases and test positivity decrease significantly. In accordance with CDC guidelines, masks must be worn by students and teachers in K-12 schools. Work with hospitals, chambers of commerce, and others to create and communicate PSAs on taking smart actions to stay open, including targeted messages to rural communities. Ensure all hospitals, including rural hospitals, have access to antivirals, antibodies, PPE, and ventilators. 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 Issue 20 MISSOURI STATE REPORT 11.01.2020 STATE STATE, % CHANGE FROM PREVIOUS WEEK FEMA/HHS REGION UNITED STATES NEW COVID-19 CASES (RATE PER 100,000) 15,754 (257) +29% 43,731 (309) 542,805 (165) VIRAL (RT-PCR) LAB TEST POSITIVITY RATE 13.3% +2.4%* 13.9% 6.7% 66,867** (1,089**) -3%** 234,460** (1,658**) 7,430,977** (2,264**) COVID-19 DEATHS (RATE PER 100,000) 232 (3.8) +4% 429 (3.0) 5,623 (1.7) SNFs WITH ≥1 NEW RESIDENT COVID-19 CASE 23% +1%* 17% 13% SNFs WITH ≥1 NEW STAFF COVID-19 CASE 38% -1%* 35% 26% SNFs WITH ≥1 NEW RESIDENT COVID-19 DEATH 6% -1%* 6% 4% TOTAL VIRAL (RT-PCR) LAB TESTS (TESTS PER 100,000) * 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 10/30/2020; previous week is 10/17 - 10/23. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/28/2020. Previous week is 10/15 - 10/21. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Data is through 10/25/2020, previous week is 10/12-10/18. Facilities that are undergoing reporting quality review are not included in the table, but may be included in other NHSN analyses. COVID-19 Issue 20 MISSOURI TESTING NEW CASES STATE REPORT 11.01.2020 TOP COUNTIES Top counties based on greatest number of new cases in last three weeks (10/10 - 10/30) 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 10/30/2020. Testing: HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) through 10/28/2020. COVID-19 Issue 20 MISSOURI STATE REPORT 11.01.2020 HOSPITAL PPE SUPPLIES HOSPITAL ADMISSIONS 115 hospitals are expected to report in Missouri DATA SOURCES – Additional data details available under METHODS Hospitalizations: Unified hospitalization dataset in HHS Protect. 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. PPE: Unified hospitalization dataset in HHS Protect. 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. Values presented show the latest reports from hospitals in the week ending 10/28/2020. COVID-19 Issue 20 MISSOURI STATE REPORT 11.01.2020 COVID-19 COUNTY AND METRO ALERTS* Top 12 shown in table (full lists below) METRO AREA (CBSA) LOCALITIES IN RED ZONE LOCALITIES IN ORANGE ZONE LOCALITIES IN YELLOW ZONE 23 ▲ (+5) 3 ▼ (-5) 0 COUNTIES St. Louis Kansas City Springfield Jefferson City Joplin Columbia St. Joseph Cape Girardeau Poplar Bluff Warrensburg Sikeston West Plains 87 ▲ (+9) 12 Farmington Sedalia Rolla ▼ (-4) 6 N/A ■ (+0) ▼ (-1) Change from previous week’s alerts: ▲ Increase St. Louis Jackson St. Charles Greene Boone Cole Jefferson Jasper Franklin Cape Girardeau Buchanan Newton St. Louis City Clay St. Francois Pettis Phelps Barry Polk Platte Clinton Bates Wayne Dade Barton Warren Gasconade Cedar St. Clair Linn ■ Stable ▼ Decrease All Red CBSAs: St. Louis, Kansas City, Springfield, Jefferson City, Joplin, Columbia, St. Joseph, Cape Girardeau, Poplar Bluff, Warrensburg, Sikeston, West Plains, Branson, Lebanon, Maryville, Hannibal, Fort Leonard Wood, Moberly, Kennett, Kirksville, Marshall, Quincy, Fort Madison-Keokuk All Red Counties: St. Louis, Jackson, St. Charles, Greene, Boone, Cole, Jefferson, Jasper, Franklin, Cape Girardeau, Buchanan, Newton, Christian, Callaway, Johnson, Butler, Cass, Scott, Camden, Howell, Taney, Lawrence, Laclede, Lincoln, Webster, Miller, Nodaway, Osage, Stoddard, Moniteau, Pulaski, Randolph, Lafayette, Dunklin, Morgan, Marion, Crawford, Ste. Genevieve, Texas, Madison, Stone, Washington, New Madrid, Adair, Dallas, Bollinger, Saline, Perry, Cooper, Henry, Pemiscot, Andrew, Wright, DeKalb, McDonald, Sullivan, Ripley, Mississippi, Vernon, Hickory, Maries, Pike, Dent, Shannon, Livingston, Montgomery, Monroe, Lewis, Oregon, Carter, Ozark, Daviess, Carroll, Macon, Howard, Douglas, Caldwell, Ralls, Harrison, Reynolds, Iron, Gentry, Clark, Scotland, Holt, Shelby, Chariton * 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 10/30/2020. Testing: HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) through 10/28/2020. COVID-19 Issue 20 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 10/30/2020. Last 3 weeks is 10/10 - 10/30. COVID-19 Issue 20 MISSOURI STATE REPORT 11.01.2020 CASE RATES AND VIRAL LAB TEST POSITIVITY NEW CASES PER 100,000 VIRAL (RT-PCR) LABORATORY TEST POSITIVITY 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 10/30/2020. Previous week is 10/17 - 10/23. Testing: HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) through 10/28/2020. Previous week is 10/15 - 10/21. COVID-19 Issue 20 National Picture NEW CASES PER 100,000 NATIONAL RANKING OF NEW CASES PER 100,000 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 WI MT WY IA AK NE UT ID KS IL MN NM IN TN RI KY MO AR CO MI NV OK MS OH 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 NC TX WV CT SC FL AL MA NJ PA AZ DE GA VA MD DC CA LA OR NY WA NH HI 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 10/30/2020. The week one month before is 9/26 - 10/2; the week two months before is 8/29 - 9/4; the week three months before is 8/1 - 8/7. COVID-19 Issue 20 National Picture VIRAL (RT-PCR) LAB TEST POSITIVITY NATIONAL RANKING OF TEST POSITIVITY 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 MT SD ID UT IA KS NE WI ND MO OK NV NM TN TX IN MN AL KY MS IL WY AK VA AR 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 SC MI CO NC OR AZ FL PA OH NJ CT LA MD WV WA CA DE RI NH HI MA NY DC 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 10/28/2020. Tthe week one month before is 9/24 - 9/30; the week two months before is 8/27 - 9/2; the week three months before is 7/30 - 8/5. COVID-19 Issue 20 National Picture NEW DEATHS PER 100,000 NATIONAL RANKING OF NEW DEATHS PER 100,000 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 MT SD WI TN AR MO ID WY MS IN NE IA DE SC IL OK RI NM MN MA NC LA TX GA KS 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 MI KY AK FL WV AL NV PA VA CO CT UT MD AZ WA OH NH CA NJ NY HI OR DC ME VT 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 10/30/2020. The week one month before is 9/26 - 10/2; the week two months before is 8/29 - 9/4; the week three months before is 8/1 - 8/7. COVID-19 Issue 20 METHODS STATE REPORT 11.01.2020 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% 0.1 – 1.0 1.1 – 2.0 ≥2.1 -10% – 0% 1% – 10% ≥11% Metric New cases per 100,000 population per week 0.0 COVID-19 deaths per 100,000 population per week Percent change in deaths per 100,000 population ≤-26% -25% – -11% 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 18:13 EST on 11/01/2020. 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 10/24 to 10/30; previous week data are from 10/17 to 10/23; the week one month before data are from 9/26 to 10/2. 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 10/22 to 10/28; previous week data are from 10/15 to 10/21; the week one month before data are from 9/24 to 9/30. HHS Protect data is recent as of 10:22 EST on 11/01/2020. Testing data are inclusive of everything received and processed by the CELR system as of 19:00 EDT on 10/31/2020. 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 18:40 EST on 11/01/2020. Hospital PPE: 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. Data is recent as of 18:58 EDT on 10/31/2020. 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 10/19-10/25, previous week is 10/12-10/18. Facilities that are undergoing reporting quality review are not included in the table, but may be included in other NHSN analyses. 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.”