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By Dr. Peter J. Plantes

September 28, 2020

COVID-19 Hotspots

Numerous counties in this week’s Top 10 list are vacillating rapidly in their rise, decline, and variability in Local Risk Index (LRI) over short 1 to 2-week time periods. The ratio of the current 7-day period average LRI to the previous 7-day average LRI (7vs7) fluctuates quickly upward and then rapidly downward recently in the majority of the 3007 counties in the U.S.  This universal theme likely represents bursts of school-age children recently exposed in live classroom activities. The “burst and rapidly suppress” CV19 activity is a positive sign of early containment. Most schools must be rapidly identifying and isolating the CV19 viral test (+) child and containing the exposure within separated small groups of children (pods.)  Apart from University communities highlighted in last week’s Top 10 report, most counties reviewed in the Top 10 this week are not seeing huge, sustained surges in percent positivity [%(+)] in cv19 Viral tests. This suggests primary and secondary school outbreaks are NOT translating into broad community spread from children to other household members.

Unfortunately, two of the spotlight counties are dealing with sustained rapid rises in %(+) testing. Genesee County Michigan (Flint) is an old auto manufacturing town that has had the loss of much of its industrial manufacturing base. You might remember the crisis Flint is still handling from the lead that leached into the public water system from old metal pipe systems. It is home to no less than 15 smaller university programs.  And this may be the cause for their sustained LRI rise over the past 30 days since both universities reopened and Labor Day celebrations occurred. The highest %(+) rates are occurring in the 20-29 age group consistent with the university population.  

Genesee County Michigan

Genesee County Michigan (Flint, MI) – Distribution of testing and %(+) by Age Group

Genesee County Michigan Age Group

Another new “hot spot” has emerged in East Texas in Smith County (home of Tyler, TX).  This county has two major medical centers in the town of Tyler that serve what is a largely rural region with numerous lakeside retirement populations. The LRI has risen into the range of 15, but the daily escalation of 7vs7 to 2.0 is a bad omen going into the flu season. 

The age distribution is very interesting as well. There is a high %(+) rate in viral genome testing performed in all ages ranges 30 to 80. And, at the same time, a surge in testing is occurring in the 0-9 and 10-19 age ranges reflecting concern for children in the newly opened primary and secondary schools of Texas. Other sources reveal the ICU Occupancy Rate for this county is 78% currently.  With the large elderly demographic of the county, large %(+) in the elderly age bands, and the expected onset of the flu season, Smith County is a place to watch closely in the weeks and months to come. 

Smith County Texas

Smith County Texas (Tyler, TX) – Distribution of testing and %(+) by Age Group

Smith County Texas Age Group


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.

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