What does Purple Level 4 on Ohio's Public Health Advisory Alert System mean?

Posted at 12:36 PM, Oct 22, 2020
and last updated 2020-10-23 07:01:20-04

COLUMBUS, Ohio — Since Ohio Gov. Mike DeWine announced in July that the Ohio Department of Health had created a Public Health Advisory Alert System, which is the color-coded system used to assess the level of spread of the coronavirus in the state, he’s repeatedly used the map as a snapshot of areas of concern.

Over the first few months since that announcement, counties across the state moved in and out of the first three levels.

Level 4 (Purple) is the highest on the advisory alert, and it's for counties where residents have the highest risk of exposure to the coronavirus.

  • Level 4 - Purple: Six to seven indicators have been flagged, there is severe exposure and spread. Residents should only leave home for supplies and services. If six to seven indicators are met for two consecutive weeks, the county remains at Level 3 and must be on a watch list the first week.

"It is serious now. It is getting worse by the minute," Governor Mike DeWine said. "Collectively, we have the power. We have the power to turn this thing around. And we can do it and we need and we need to do it."

DeWine said 92.8% of Ohioans are living in a county that is red or high incidence. He posted a tweet urging Ohioans to step up saying, "we can turn this around. COVID-19 is multiplying very quickly - and it will continue unless we do something different. More of us need to wear masks, and more of us need to be careful. We've done it before, and we can do it again."

The ODH said that when residents fall are under a Level 4, and they are asked to only leave home only for supplies and services, it's a recommendation and is not enforceable by law. There is no health order attached.

The other levels are:

  • Level 1 - Yellow: Zero or one indicator have been flagged for active spread exposure, all current health guidelines to be followed as ordered.
  • Level 2 - Orange: Two or three indicators have been flagged, there is an increased risk for exposure and spread.
  • 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.

The 10 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.
  8. Rate of new cases from contacts of known cases (still under development): Portion of cases that can be linked to known transmission chains. Indicates the extent of community transmission and containment.
  9. Tests per capita (still under development): The number of COVID-19 tests performed per 100,000 people per day. Provides an indication as to whether there is enough testing to detect most of cases in the population.
  10. Percent positivity (still under development): The percentage of COVID-19 tests performed for residents of a county that are positive. Important indicator for determining whether the trajectory is cases is related to changes in testing patterns.

*Data not yet available.

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Click here for a page with resources including a COVID-19 overview from the CDC, details on cases in Ohio, a timeline of Governor Mike DeWine's orders since the outbreak, coronavirus' impact on Northeast Ohio, and link to more information from the Ohio Department of Health, the Cuyahoga County Board of Health, the CDC and the WHO.

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