July 15, 2020
The CV19 Lab Testing Dashboard™ powered by hc1 scans all 3,007 counties in the United States for several index factors that indicate a rapid increase in the percent positivity [% (+)] of SARS-CoV-2 viral tests is occurring. hc1 has been keeping an eye on the counties facing the most rapidly expanding challenge from the spread of COVID-19. These “top 10” counties all have a population >100,000, more than 100 COVID-19 viral tests performed in the past week, an hc1 Local Risk Index™ (LRI) >7, and an acceleration factor of LRI equal to or greater than 1.5 (see my earlier post for a full explanation of LRI).
For a community of 100,000, a rapid rise in the presence of positive COVID-19 viral testing is the earliest indicator that ER, hospital, ICU, ventilators, and other medical resources (clinical providers, PPE, facilities, etc.) will be heavily taxed in the next 10 to 21 days. The community that has the largest acceleration in positive tests week-over-week will see the fastest rise in the magnitude of COVID-19 cases.
The first week of COVID-19 symptoms are typically milder. It is in the second week that sicker patients seek acute care and hospitalization for advancing symptoms. A larger portion of the healthy population will get tested when a potential contact with another COVID-19 positive individual is suspected. This expansion of testing will begin to capture the 30–45% asymptomatic and presymptomatic cases. The more widespread the testing, the earlier the warning will be of the future strain on medical resources from an increasing percent positive [% (+)] trend.
Top 10 Counties with the Largest Magnitude of Change
determined by LRI x ‘7vs7’ rate
#1 Stark County, Ohio
South of Cleveland, Canton, Ohio is the seat of Stark County and home to the Pro Football Hall of Fame. This area has seen an intense acceleration of percent positivity in COVID-19 viral PCR tests since the beginning of the July 4 holiday week. On June 30, the county had a very low LRI of 2.2 that rapidly peaked July 6 at 17.6 and remains high at 13.8. This spike in COVID-19 prevalence is typical after super-spreader events of multiple folks who escape from being locked inside for “fun in the sun” together. Hardly anyone had previously been sick in their community with that low 2.2 LRI. Likely, everyone thought it just wasn’t going to hit their community. They were wrong.
#2 Parker County, Texas
Texas is hot! One of the earliest states to lift mitigation measures, Texas as a whole now has an LRI of 23. The Dallas-Fort Worth metroplex has been one of the hardest-hit regions in the steady increase of COVID-19 prevalence since Memorial Day.
Parker County is rural with a county seat of Weatherford and some suburban outcropping just west of Fort Worth. Its pattern is concerning because of the steady rise in the LRI for almost the whole of last month. Now with a LRI near 23 and a weekly increase between 1.5 to 2 times, one could expect this county and many others in Texas to be approaching an LRI of 40 within 7 to 10 days. Governor Abbott has been pleading each evening on the television news for citizens to wear masks as the effect of opening up the state too soon and too fast is now apparent in the numbers.
#7 Boulder County, Colorado
Boulder, Colorado was making good progress in steadily lowering its LRI from May 23 (the week before Memorial Day weekend) to less than 1 (0.93) by July 4. But the July 4 celebrations launched a rapid acceleration in the rate of viral testing and the percent positivity increased by 6 times during the subsequent week. It is unfortunate to see an area that positioned itself well for summer activities in the weeks leading up to the July 4th holiday to ruin it all in one weekend. The 20–29-year-old cohort is driving the higher LRI with its own 9.8% (+) rate.
About the Author
Peter J. Plantes, M.D. has three decades of experience creating service and delivery solutions that enhance marketplace success and clinical performance for clinical practice groups, academic faculty group practices, hospitals, health systems, and health care organizations. His success stems from his ability to blend and synergize clinical knowledge, operational expertise, financial performance, and collaborative methodology with his deep commitment to serve patients and improve the health of the community. Dr. Plantes has served in CEO & Physician Executive roles for a number of large healthcare clinical delivery networks including regional community networks, academic practices, national hospital networks, international health systems (Chile, Colombia), and corporate managed care/HMO networks.