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Clinical Pathology Laboratories employees gather samples during a UNLV Medicine drive-through testing clinic in Las Vegas on March 24, 2020. (Lonnie Timmons III/UNLV Photo Services/Courtesy)

Welcome to the 27th installment of “Coronavirus Contextualized,” a recurring feature in which we explore some of the numbers swirling around in the time of coronavirus.

Through these stories, we hope to parse the numbers, including confirmed cases of COVID-19, people tested, number of hospitalizations and deaths, and provide some context to them. You can view the prior editions of “Coronavirus Contextualized” here on our coronavirus page.

These pieces serve as a written roundup of the COVID-19 trends we kept our eyes on this week, with all graphs and charts living permanently on our COVID-19 data page, where they are updated multiple times a day with the latest numbers. 

We’re continuing to take suggestions for what kind of data, graphs and trends you would like to see analyzed in future versions of this story or included in a future update of our data page. Reach out to [email protected] with any feedback.

Below, we take a look at some of the latest COVID-19 trends in Nevada as COVID-19 cases continue to increase statewide, including a surge in Washoe County, which has the highest rate of new cases being identified per capita of any county in the state.

Cases and test positivity

COVID-19 cases are still on the rise in Nevada.

On average, 706 new COVID-19 cases were reported each day over the last seven days, up from 588 last week and 494 the week before that. Before cases started to rise last month, the state reached a low of 267 cases reported on average each day on Sept. 14. At the peak this summer, an average of 1,176 new cases were reported each day.

There have now been 93,029 COVID-19 cases confirmed statewide since the beginning of the pandemic in March, including 4,944 over the last seven days. That’s up from 4,119 new cases reported in the prior seven days and the 3,457 new cases reported in the seven days before that. At the peak in mid-July, 8,184 new cases were reported in a seven-day period, including 1,451 in a single day.

One in 33 Nevadans has tested positive for the virus since the beginning of the pandemic, or about 3 percent of the state’s population. Nevada ranks 17th in the nation for COVID-19 cases per capita, down from 14th last week.

Nevada’s test positivity rate — which looks at the percentage of tests or people coming back positive out of the total tested — has also continued to steadily increase. Below, we’ll look at two different methods of calculating test positivity, using both individual people and what are known as testing encounters.

Starting with the number of new reported people who tested positive for COVID-19 out of the total number of new reported people tested each day, the state’s seven-day average test positivity rate was about 18.5 percent as of Thursday, up from a recent low of 9.2 percent on Sept. 17. 

There are, however, some drawbacks to looking at test positivity using individual people because some people are tested repeatedly. That means that someone who tested negative four times but tested positive on their fifth time would be counted as a new positive person but not a new person tested. (In other words, they would be counted in the numerator but not the denominator.)

Another way of looking at test positivity is to examine test encounters, or the number of individual people tested each day. This method of looking at test positivity excludes duplicate samples collected the same day — such as when someone has a rapid antigen test and a molecular PCR sample collected at the same time — but accounts for people who are tested repeatedly on different days.

It is not possible to independently calculate the test positivity rate based on test encounters because the state only reports the number of positive cases, not the number of positive test encounters . However, the state does provide the test positivity rate based on test encounters, calculated as an average over a 14-day period with a seven-day lag. As of Wednesday, that number was 9.6 percent, up from a recent low of 6.5 percent on Sept. 19.

Whichever calculation you use to look at test positivity, the trend is the same: Test positivity is generally increasing in Nevada and has been since the middle of September.

“The overall story here is … we are experiencing an increase in cases. I don't think there's any way around that whether we're looking at cases or test positivity or other factors,” Caleb Cage, Nevada’s COVID-19 response director, said at a meeting of the COVID-19 Mitigation and Management Task Force on Thursday.

A total of 774,095 people — or about one in four Nevadans have been tested for COVID-19 and there have been 1,175,414 individual testing encounters since March. 

Deaths

COVID-19 deaths, however, have not increased in the same way as cases have. As of Thursday, the average number of new deaths each day was 5.1, significantly down from a high of 20.7 on Aug. 20. The previous low point before cases started to increase this summer was 1.9 deaths per day, reported on June 28.

Over the last seven days, 36 people have died of COVID-19 across the state, including 27 in Clark County, seven in Washoe County and two in Lyon County.

State officials say that trends in deaths typically lag trends in cases by about five weeks. If the low point of cases was on Sept. 14 — and if that five-week trend holds — the low point of deaths would be on or around Oct. 19.

A total of 1,736 COVID-19 deaths have been reported statewide since March. Nevada ranks 22nd in the nation for deaths per capita, down from 21st last week.

Hospitalizations

While COVID-19 hospitalizations are slightly up since September, they have not increased steadily week over week as cases have.

Hospitalizations have generally been fluctuating between 450 and 540 over the last two weeks, up from a recent low of 417 on Sept. 12. As of Wednesday, the last day for which data is available, 520 people were hospitalized with confirmed or suspected COVID-19 statewide. At the peak over the summer, 1,165 people were hospitalized with COVID-19 on July 31.

“The other thing that we’re seeing with this virus is it’s just not driving as many people percentage-wise to the hospital,” Christopher Lake, executive director of community resilience with the Nevada Hospital Association, told the task force on Thursday. “Even though the positivity rates are increasing, those that require hospitalization are staying relatively stable with only about 10 percent of the people in the hospital at this time being there with COVID.”

The hospital association, in a report this week, noted that while the number of COVID-19 hospitalizations are “very manageable” for the state’s health care infrastructure, this is also the time of year “when hospital all-cause occupancy rates generally reach their highest points.”

“These all-cause hospitalizations will soon begin to compete with COVID-19 for available hospital capacity,” the association wrote in its report.

In fact, Washoe County is already starting to experience some of that strain in its hospitals, District Health Officer Kevin Dick told the task force on Thursday.

“We had hospitals that had filled up ICU units earlier this week with their emergency departments going on divert as a result of that,” Dick said. “That’s not driven specifically by COVID. The COVID-19 cases in the hospital are a fairly low burden on overall hospital capacity, but it’s just the other activities that are normal activities with elective surgeries and people becoming sick or injured, etc., that are impacting that.”

As of Wednesday, 76 percent of licensed hospital beds and 64 percent of ICU beds statewide were occupied. Those numbers were 80 percent and 67 percent, respectively, in Clark County and 68 percent and 58 percent, respectively, in Washoe County.

However, the counties have asked the hospital association to once again start reporting figures of staffed beds in addition to licensed beds — noting that even though the hospital may have the physical space for additional patients, it may not have the staffing to do so.

County by county

The state has flagged eight counties, including hard-hit Washoe County, as at risk of elevated transmission of the spread of COVID-19 as of Thursday.

Counties are considered at risk for elevated spread of COVID-19 if they meet two of the following three metrics:

  • The average number of tests per day per 100,000, calculated over a 14-day period. If this number is less than 100, a county could be considered at risk.
  • The case rate per 100,000, calculated by taking the number of cases diagnosed and reported over a 30-day period. If this number is greater than 200, a county could be considered at risk.
  • The case rate per 100,000 and the test positivity rate, calculated over a 14-day period with a seven-day lag. If the case rate is greater than 50 and the test positivity rate is greater than 8.0 percent, a county could be considered at risk.

Washoe County continues to have the highest case rate in the state by far, 600 cases per 100,000 over the last 30 days, coupled with an 8.8 percent test positivity rate. Clark County, by comparison, has a case rate of 463 and a test positivity rate of 9.1 percent

Of the six rural counties at elevated risk, Carson City has the highest case rate per 100,000 at 481, followed by Elko at 442, Lincoln at 404, White Pine at 387, Lyon at 260 and Humboldt at 205. However, Lincoln has the highest test positivity at 14.2 percent, followed by Lyon at 12 percent, Elko at 9.7 percent, Humboldt at 9.5 percent, Carson City at 8.6 percent and White Pine at 8.3 percent.

Counties, however, are only flagged as at risk by the state on Mondays, for purposes of determining whether the county needs to come before the COVID-19 Mitigation and Management Task Force. If a county makes the list two weeks in a row, they are required to present the task force with an action plan.

Clark, Elko, Lincoln, Lyon and Washoe counties made that list this week — and Washoe was the only county on the list for the second week in a row. For now, Washoe County’s action plan includes additional community outreach and continuing to bar gatherings of more than 250 people, but the task force has asked the county to discuss possible numerical thresholds that could serve as triggers for further mitigation measures.

Dick, the county health officer, said the highest number of cases, 70, over the last week came from K-12 students and staff at the Washoe County School District, which has students participating in both in-person and hybrid learning in addition to distance education. The county also saw an outbreak of 35 cases associated with the Salvation Army Adult Rehabilitation Program, and another 34 cases tied to the University of Nevada, Reno, though Dick noted that represents a decrease in the number of cases tied to the university.

Dick said that the county has been struggling to keep up with the “surge” in cases across the county. The county has fallen from being able to investigate 53 percent of new COVID-19 cases over the course of a week to 37 percent, he said.

“We're working hard to try to catch up with the surging case numbers that we have. We're being overwhelmed with the disease investigation efforts,” Dick said. “We really need to have people being careful to protect themselves and others when they're out and about trying to drive down the spread that we have occurring.”

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