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Weekly update to Ohio Public Health Advisory System shows good and bad news

Ohio weekly Public Health Advisory System
Posted at 2:58 PM, Jul 16, 2020
and last updated 2020-07-16 14:58:04-04

COLUMBUS, Ohio — During Thursday’s press conference, Gov. Mike DeWine announced the weekly changes to the state's color-coded Public Health Advisory System and while there was good news, there was also bad news. More counties in Northeast Ohio have increased in their threat level but others who were on a watch list at risk to moving into the highest level have been taken off that list.

Cuyahoga County has been listed at red Level 3 since the advisory system was created, but was added to a watch list after it was deemed at risk into crossing over into the purple Level 4. DeWine announced that it has been taken off that watch list and remains at a regular Level 3.

Hamilton County was also removed from the watch list, according to DeWine.

Trumbull County was moved from a Level 3 down to a Level 2, DeWine said. While they are no longer required to wear face masks when in public, the governor said he hopes they continue to.

Richland County was alerted Thursday afternoon that it has been moved from orange Level 2 into red Level 3 and there have been more cases over the last two weeks than have been reported across the entire nation of Jamaica. Citizens of the county will now be mandated to wear masks when in public. The mandate will begin at 6 p.m. Friday, the county said.

In Athens County, more COVID-19 cases have been reported in the last two weeks than the county has seen over the entire pandemic, DeWine said. Local health officials traced at least three outbreaks at bars in the county, which have since temporarily closed.

Similarly in Delaware County, a surge of COVID-19 cases has been reported. DeWine said that a number of people are believed to have contracted the virus while traveling in Florida and developed symptoms when they returned to Ohio.
DeWine said that due to the increase in Level 3 counties, around 60% of the state will be under a mask mandate as of Friday at 6 p.m.

Dr. Andrew Thomas, Chief Clinical Officer at The Ohio State University Wexner Medical Center, explained the importance of the health advisory system and the precautions counties take in relation to their alert level.

There are four levels with seven indicators involved in the advisory system.

The four levels include:

  • Level 1 - Yellow: Zero or one indicator have been flagged active spread exposure, All current health guidelines to be followed as ordered. 53 counties are currently listed at Level
  • Level 2 - Orange: Two or three indicators have been flagged, there is an increased risk for exposure and spread. There are 28 counties currently listed at Level 2.
  • Level 3 - Red: Four or five indicators have been flagged, there is a very high risk for exposure and spread. Ohioans should limit activities when possible and wear a mask in public. As of Thursday, counties that are Level 3 include: Cuyahoga County, Trumbull County, Huron County, Butler County, Montgomery County, Hamilton County, Franklin County
  • Level 4 - Purple: Six to seven indicators have been flagged, there is severe exposure and spread. Residents in these counties should stay home as much as possible. No counties are currently listed at Level 4, but Franklin County has been flagged as approaching this level.

The seven data indicators are:

  1. New cases per capita - When the data shows that a county has had an average of 50 cases per 100,000 people over a two-week period, that will trigger a flag for increasing case rate.
  2. Sustained new case growth - If the data shows at least a five-day period of sustained new case growth, that will trigger a flag.
  3. Proportion of cases that are non-congregate cases - When there are a large number of positive cases from those living in the broader community, more than 50% of new cases originating from non-congregate settings during at least one of the past three weeks, that will trigger a flag on this indicator.
  4. Sustained increase in emergency room visits - When there is an increase in the number of people who visit an emergency department with COVID-19 symptoms or COVID diagnoses over a five day period, that will trigger a flag on this indicator.
  5. Sustained increase in outpatient visits - When there is an increase over a five-day period in the number of people in outpatient settings, including telehealth appointments, with suspected or confirmed COVID-19 symptoms, that will trigger a flag on this indicator.
  6. Sustained increase in new COVID-19 hospital admissions - When the numbers show at least a five-day period of sustained growth in the number of county residents with COVID-19 who are admitted to a hospital, the county will be flagged for meeting this indicator.
  7. Intensive Care Unit (ICU) bed occupancy- A county will be flagged for the indicator when the regional ICU occupancy goes above 80% for at least three of the last seven days.

Thomas said that the system is similar to that of a storm warning, it monitors trends and allows counties in Ohio to prepare and hopefully intervene before a surge in COVID-19 cases, and subsequent hospitalizations and deaths, occur.

He said that no matter how severe the impact of COVID-19 in a single county, until a vaccine or medication is readily available, everyone is at risk for contracting the virus and therefore no counties can be listed as green or no risk.

As it’s been suggested throughout the pandemic, Thomas said the best way to keep a county at a lower level is to follow best practices such as washing hands regularly, wearing a mask or facial covering when in public, keeping six feet of distance with people not in the same household and disinfecting high-touch surfaces.

Thomas said wearing a mask outdoors isn’t necessary unless you are going to stop and talk to neighbors or if you plan on stopping in a business. He also reminded people that wearing a mask is not intended to particularly prevent an individual from contracting the virus, but rather preventing them from spreading it, even when they aren’t showing symptoms but may have the virus.

“There’s a reason why surgeons have worn masks in the operating room for over 100 years. It’s not really particularly to keep the surgeon from being infected by whatever they’re doing with the patient—it’s because we know that when the surgeon breathes or the anesthesiologist breathes or the nurse breathes, they’re breathing out bacteria that can cause a wound infection,” Thomas said. “So, the source control of a mask is really important if you’re one of those asymptomatic positives. It keeps you from having others be at risk of spreading the disease. It’s the primary use of the face mask.

“At the same time, if someone else either doesn’t have a face mask on or even if they do but maybe they’re not wearing it perfectly—they’re wearing their blow their nose or whatever it might be—you wearing a mask also can protect you for those droplets that are in the air, because that person's either not wearing the mask correctly or not wearing one at all so mainly the mask is to protect others but it also provides protection for yourself,” Thomas said.

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