Health department: Risk level on the rise

By 
Robert Cox

After six weeks of what was considered a “moderate” risk level for COVID-19 infection, the Perry County Health Department on Tuesday announced that it had upgraded the risk to “moderately high.”
The move came after a 14-day increase in positive cases that put Perry County at No. 8 on the top 10 list of cases per capita, ahead of both St. Louis City and St. Louis County.
Through Monday, the health department has reported an increase of 90 cases in the previous seven days, culminating in 102 active cases, including four hospitalizations.
All told, the number of cases in Perry County more than doubled from 204 on July 31 to a reported 426 in 30 days.
Most troubling, at least for educators and parents, is that the number of positive tests for people under 20 years old — a group that included the smallest amount of cases for months — grew from one case in early June to 20 by the end of the month. That number remained steady through July, but August saw it increase nearly 80 percent, as the youngest age group rapidly became the leading demographic in terms of infection, nearly twice as high as the next highest group, 20-29 year-olds.
“Many of our new cases are school-aged children,” said health department director Sylvia Forester. “At first, we were able to identify potential correlations such as specific after-school activities. However, as more and more cases came in and the information we were receiving from investigations were leading us to nothing specific, we were unable to identify precise correlations and could only associate individuals based on where they attended school and sometimes, some of their after-school activities.”
Forester said that another large portion of the new cases have been household close contacts of the original positive cases.
“Now, we are seeing increasing numbers of individuals who have no known contact to a positive case or that are not associated with a school,” she said.
While not directly related, Tuesday’s increase in assessed risk also triggered a shift in educational strategy at Perry County School District, which announced Tuesday that it would shift to 100 percent virtual learning for at least 14 days.
“So far, our investigations have not indicated the majority of spread occurring in the actual classroom setting, as we have not seen an increase in cases associated with a specific classroom,” Forester said, adding that contact tracing can sometime be a little difficult when children and young people are involved. “Our investigations rely on the memory of the positive case and hopefully a truthful recollection of events.”
In addition, because the positive case is a minor, investigators are speaking with parents rather than directly to the subject of the investigation.
“We are relying on the children to tell accurate stories to their parents or guardians and then the parents to communicate that to our investigators,” Forester said. “We also rely on schools to help us determine where the child was during the school day to help us determine school close contacts and possible exposures.”
St. Vincent de Paul in Perryville has been the hardest hit among local schools, with Jennifer Streiler, the interim head of schools, reporting that nearly two dozen students and five teachers have tested positive for the virus.
Away from school, Forester said other concerns include public gatherings and social events.
“Events where there is no social distancing, no mask usage, and gatherings of large amounts of people in and of themselves create a high-risk scenario,” Forester said. “When you have numbers and spread like we currently do, it has the potential to add fuel to the fire and increases risk during those events more so. I would suggest that organizations analyze their activities, develop a risk assessment, and if they are willing to accept the risks involved — I would ask that they develop and enforce provisions to reduce possible spread of the disease to help us get through another unfortunate rise in cases, not make it worse.”
The upgraded risk assessment, Forester said, is based on data analysis of cases in Perry County, but not solely on total cases, new cases or active cases for any given day.
“They are a part of the information we look at, but no one number is a threshold for change,” Forester said. “There is no magical number. I wish there were. It would be a lot easier. Instead, we calculate indicators to monitor trends. We also use indicators from the Missouri Department of Health and Senior Services and [the Centers for Disease Control and Prevention].”
Among the indicators that warranted the change, Forester said, were a new record number of active cases, new record numbers of new cases reported, a three-week sustained increase in number of new cases, and a three-day rolling average, which has been more than 10 for the past week.
“For our population, the CDC recommends this number not be over two for any sustained length of time,” Forester said. “We have not met this goal since the beginning of August.”
According to the Missouri Department of Health and Senior Services, Perry County’s seven-day percent increase in new cases was 24 percent – which is comparatively high to other Missouri counties. Also, according to the DHSS’s COVID-19 dashboard, Perry County has been notable for posting comparably high numbers in daily percent increase reports and reports of new cases over the past 14 days.
“All of this data we are seeing coming down from other sources only confirms what we are recognizing here through our analysis on the local level,” Forester said.
All this number crunching allows the health department to better monitor outbreaks and potential outbreaks in the county.
“An outbreak does not necessarily impact the risk for an entire county,” Forester said. “Instead we monitor and watch for data that indicates the outbreak is no longer contained. Information that indicates an outbreak is no longer contained includes investigations that lead to dead ends and assumptions and no clear epidemiological correlation between individuals associated with the affected outbreak. Another key piece of this data are increases in cases in which there is no known contact and new cases not associated with an outbreak.
Forester said that if her department did not account for these outbreaks and just looked at the numbers, the risk assessment for the community would have increased sooner based on data analysis of overall numbers alone.
“We are fortunate to still be able to identify and respond to outbreaks,” Forester said, “and we are also fortunate to have been able to effectively stem many outbreaks within our county before they translated into greater community spread.”

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