SUMMARY • • • • • • • • • • COLORADO STATE REPORT 11.01.2020 Issue 20 Colorado has seen a persistent rise in cases and test positivity over the last two months that will continue to lead to increasing hospitalizations and deaths; a more comprehensive mitigation strategy is needed. The rise in test positivity, hospitalizations, and deaths confirm increasing disease activity, while testing has increased in response. Colorado is in the red zone for cases, indicating 101 or more new cases per 100,000 population, with the 21st highest rate in the country. Colorado is in the yellow zone for test positivity, indicating a rate between 5.0% and 7.9%, with the 29th highest rate in the country. Colorado has seen an increase in new cases and an increase in test positivity last week. Current hospitalizations continue to increase rapidly and are now four times higher than in late September. State models indicate that within two weeks, the number of hospitalizations could exceed the maximum reached in the initial pandemic peak. The increase in cases involves counties throughout the state with high percentage increases in multiple counties outside of Front Range population centers. The following three counties had the highest number of new cases over the last 3 weeks: 1. Denver County, 2. Adams County, and 3. Arapahoe County. These counties represent 43.6% of new cases in Colorado. In Pueblo County, in addition to smaller personal gatherings, recent outbreak growth has been driven by childcare centers, offices workspaces, K-12 schools, sit-down restaurants, and retailers. Institutions of higher education (IHE): While IHEs continue to report active outbreaks, mitigation measures have limited ongoing transmission. The contact tracing app introduced by the state has been downloaded by more than 500,000 Coloradans. 42% of all counties in Colorado have moderate or high levels of community transmission (yellow, orange, or red zones), with 14% having high levels of community transmission (red zone). During the week of Oct 19 - Oct 25, 10% of nursing homes had at least one new resident COVID-19 case, 28% had at least one new staff COVID-19 case, and 4% had at least one new resident COVID-19 death. Colorado had 223 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: 65 to support operations activities from FEMA; 4 to support operations activities from ASPR; 2 to support epidemiology activities from CDC; and 1 to support operations activities from USCG. Between Oct 24 - Oct 30, on average, 98 patients with confirmed COVID-19 and 114 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in Colorado. An average of 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. We share the strong concern of Colorado leaders that the current situation is worsening and that there is a limited time window to limit further cases and avoid increases in hospitalizations and deaths. The Governor’s continued personal guidance on these measures is critical and is commended. Colorado has had considerable success in limiting morbidity and mortality using the adaptive adjustment of mitigation measures in response to changes in incidence. At this point, the rapid increase in cases and test positivity throughout the state indicates that additional measures should be taken, in addition to expeditious upward adjustment of mitigation to avoid falling behind the rapid spread. As called for in the state plan, intensification in mitigation measures by local authorities in response to disease activity, such as those being taken in El Paso County, should be encouraged and accelerated. Given the trajectory of disease activity, efforts to be keep less intense mitigation levels are unlikely to succeed. Initiating appropriate levels of mitigation now will allow for earlier control of disease and earlier resumption of business activity than a lagging upward adjustment. Communication from state, local, and community leaders is needed for a clear and shared message asking Coloradans to wear masks, physically distance, and avoid gatherings in both public and private spaces. The Step Up Colorado media campaign is commended, especially its use of community influencers. Hospital personnel are frequently trusted in the community and have been successfully recruited to amplify these messages locally. Continue to use testing and case investigations strategically to identify and mitigate areas of increasing disease activity and transmission venues. In addition to testing symptomatic individuals and their contacts, devote resources to rapidly increase surveillance for silent community spread. Given their ease of use at sites, the Abbott BinaxNOW or other antigen tests should be used to augment nucleic acid testing (NAT) and allow for implementation of weekly repeat surveillance in critical populations to monitor degree of asymptomatic community spread. Information from the cases identified and available wastewater surveillance data should be used to identify high transmission zip codes or venues for additional testing. In these high transmission localities, work with local communities and businesses to maximize testing for asymptomatic spread, especially among 18-35 year-olds, potentially including incentives. Community spread continues at social and family gatherings where observance of social distancing and mask wearing is not followed due to people assuming that “healthy” family members and friends are not infected with COVID since they do not have symptoms. Highly infectious asymptomatic COVID individuals then cause ongoing transmission, frequently infecting multiple people in a single gathering. Increase efforts to address these venues through communication and pivot to surveillance for asymptomatic infections. Ensure all K-12 schools are following CDC guidelines, including mask wearing, and utilizing the Abbott BinaxNOW tests to routinely test all teachers as another indicator of the degree of community spread to further increase mitigation efforts. Ensure university students continue their mitigation behaviors to ensure no further outbreaks on or off campus as cases decline. Encourage institutions of higher education to test their student body before they leave campus for Thanksgiving break to mitigate exposure to family and 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 Issue 20 COLORADO STATE REPORT 11.01.2020 STATE STATE, % CHANGE FROM PREVIOUS WEEK FEMA/HHS REGION UNITED STATES NEW COVID-19 CASES (RATE PER 100,000) 12,855 (223) +54% 46,019 (375) 542,805 (165) VIRAL (RT-PCR) LAB TEST POSITIVITY RATE 7.2% +1.3%* 12.8% 6.7% 153,145** (2,659**) +27%** 366,427** (2,989**) 7,430,977** (2,264**) COVID-19 DEATHS (RATE PER 100,000) 67 (1.2) +68% 332 (2.7) 5,623 (1.7) SNFs WITH ≥1 NEW RESIDENT COVID-19 CASE 10% +2%* 15% 13% SNFs WITH ≥1 NEW STAFF COVID-19 CASE 28% +2%* 40% 26% SNFs WITH ≥1 NEW RESIDENT COVID-19 DEATH 4% +2%* 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 COLORADO 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: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/28/2020. COVID-19 Issue 20 COLORADO STATE REPORT 11.01.2020 HOSPITAL PPE SUPPLIES HOSPITAL ADMISSIONS 89 hospitals are expected to report in Colorado 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 COLORADO 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 3 ▲ (+3) 1 COUNTIES 9 Greeley Pueblo Breckenridge ▲ (+6) 4 Montrose ■ (+0) 6 ■ (+0) ▲ (+2) 14 Denver-Aurora-Lakewood Colorado Springs Fort Collins Grand Junction Glenwood Springs Fort Morgan Change from previous week’s alerts: ▲ (+2) ▲ Increase Adams Weld Pueblo Summit Prowers Montrose Elbert Washington Crowley Teller Pitkin Grand Lake Denver Arapahoe El Paso Jefferson Larimer Douglas Mesa Broomfield Garfield Morgan Alamosa Yuma ■ Stable ▼ Decrease All Yellow Counties: Denver, Arapahoe, El Paso, Jefferson, Larimer, Douglas, Mesa, Broomfield, Garfield, Morgan, Alamosa, Yuma, Otero, Park * 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: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data 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 COLORADO 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: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data 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. 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% 0.1 – 1.0 1.1 – 2.0 ≥2.1 -10% – 0% 1% – 10% ≥11% 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.”