Hello Thurston County! This week I have a brief update about schools, and then I will answer some more of your questions. I always look forward to reading all of your questions and seeing what has captured the attention of our community!
Update to a question from last week: How are positive cases from college students counted?
Last week, I mentioned we were using permanent addresses to identify where a college student who has COVID–19 would be counted. The answer going forward is a bit more complicated. The county where a person is counted is important for two reasons. First, knowing where people are getting sick helps advise targeted interventions and direct resources. In addition, it connects the person who has COVID-19 with local resources to support them. The State Department of Health has clarified this formula and we are now counting students in the county where they reside more than 50 percent of the year, and additional considerations are made for intermittent and part time students.
When will schools reopen for in-person instruction?
I have been getting a lot of questions about when schools are going to reopen for in-person instruction. I know this is a very sensitive issue, and I want to make sure when we move to in-person instruction, the timing is right, and our community is ready. I am watching the numbers from the Labor Day weekend as we saw a significant rise in transmission rates after the Fourth of July weekend. I am hoping this won’t be the case but am waiting for a full incubation period, 14 days, to see what our trajectory is going into fall. I will dedicate my letter to this topic next week.
To what extent do our daily and weekly positive test numbers reflect a true picture of the pandemic in Thurston County?
Great question! When looking at cases, I look at our daily case counts, and if there is a spike in cases I take a closer look to see if there is an event or location associated with multiple cases. I am always looking for potential outbreaks. There can be a significant amount of variability in our day-to-day case counts, so for long-term planning and insight into how our county is doing, I look at the case rates per 100,000 over 14 days. Because 14 days is the incubation period for the virus, or the time people can be infected without symptoms, I look for case clusters or where cases emerge 14 days prior to the individual having symptoms or seeking testing.
Because some people have few symptoms or are asymptomatic, there are likely untested people who are COVID-19 positive in our community. When we get population data identifying past infections, we will have a better estimate of how large this group is. Testing people who have a high likelihood of having COVID-19 as identified by being a close contact, spending more than 15 minutes within 6 feet of someone who was diagnosed with COVID-19 is one way we approach this problem of asymptomatic and presymptomatic cases. This then gives us a better idea of disease spread in our county.
Do we have access to enough tests? Can anyone who wants a test get one?
Right now, there is an ample supply of tests. People who meet criteria of having at least one symptom of COVID-19 or who have been contacted by Public Health and Social Services and told they were a close contact should consult their primary care provider. Testing locations can be found on our website here: https://www.thurstoncountywa.gov/phss/phssdocuments/COVID-19%20Testing%20Locations%20FINAL.pdf.
What kind of tests are mostly given in Thurston County — antigen or PCR?
Some of the rapid tests being completed in Thurston County are antigen tests, meaning they test for viral proteins, but most tests are PCR tests which test for viral genetic material. The original tests for COVID-19 were PCR tests and people with positive results are considered confirmed cases. People with positive antigen test results are considered probable cases. At this time in Thurston County, we investigate positive test results of both PCR and antigen tests the same way.
To what extent does our percent positives reflect the true picture?
Percent positive tests tell us about access to testing and if we are doing enough tests. Our goal is to continue using our current testing criteria, which is having at least one COVID-19 symptom or being notified of being a close contact by Public Health and Social Services. We intend to have tests be accessible enough to meet the goal of having fewer than 2 percent of those tested be positive.
Should we mainly be looking at hospitalizations for an accurate picture?
When looking at hospitalization data we are looking predominantly at two elements: the number of people who are hospitalized and the ability of our health care infrastructure to be able to respond if we had a surge in cases and people needed additional medical support. There are many facets to the pandemic in our county, and each of these indicators show us specific areas where we can intervene to stop the spread of COVID-19.
Can the number of COVID-19 positive cases be reported by neighborhood locations?
At this time, we report case data by ZIP code to give additional information as to how different communities within the county are faring in the pandemic. We will not be breaking this information out into neighborhoods. I take my responsibility to protect the health of everyone in the county seriously. This includes protecting the confidentiality of people who have tested positive, and their close contacts, as well as making sure everyone knows how to keep themselves safe no matter where they are or what they are doing. Breaking down the data further may have negative impacts through the potential of identifying cases in small communities or giving people a false sense of security due to a small number of cases in their neighborhood. Staying vigilant, wearing face coverings in public spaces, maintaining 6 feet of distance between yourself and non-household members, staying home when sick, covering your cough, and continuing handwashing are essential for everyone everywhere in the county.
Thank you so much for your questions! Please send additional questions to firstname.lastname@example.org.
Wishing you the best of health.
Dimyana Abdelmalek, MD, MPH, is the health officer for Thurston County.