Welcome to the 33rd 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 stories 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 as Nevada now has the most people currently hospitalized with COVID-19 per capita of any state in the nation and four days remain under the current three-week “statewide pause” period.

Cases and test positivity

COVID-19 cases across Nevada continued to climb this week after a brief blip of decreases last week following the Thanksgiving holiday. State health officials have attributed those decreases to fewer people seeking testing over the holiday weekend and a slowdown in lab processing capabilities as staff took time off.

An average of 2,723 new COVID-19 cases were reported each day over the last seven days as of Thursday, a new record and more than double the previous record, 1,176, from the summer, the last time coronavirus cases surged. Last week’s seven-day average was 2,229.

“The daily case rate is consistently double that of our summer peak,” state biostatistician Kyra Morgan told the COVID-19 Mitigation and Management Task Force on Thursday. “There’s not any indication that we’re approaching a plateau.”

Two weeks ago the seven-day average was 2,362 and it was 1,835 the week before that. Cases have been rising since mid-September, when a low of 267 cases on average were reported each day.

Since the beginning of the pandemic in March, there have been 179,454 COVID-19 cases reported statewide. More than a third of those cases, 66,821, have been diagnosed in the last month, and more than 10 percent, or 19,058 cases, have been reported in the last week.

One in 17 Nevadans has tested positive for the virus since the beginning of the pandemic. Nevada ranks 18th in the nation for COVID-19 cases per capita, up from 21st last week.

Nevada’s test positivity rate — which looks at the percentage of tests or people coming back positive out of the total tested — also continues to increase. As usual, we’ll look at two different methods of calculating test positivity below, using both individual people and a metric 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 42.2 percent as of Thursday, up from 39.4 percent last week. The recent low was 9.2 percent on Sept. 17. 

However, there are some drawbacks to looking at test positivity using individual people since some people are tested repeatedly. For instance, 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.)

Additionally, someone may receive a rapid antigen test that comes back negative the same day, only to have a positive molecular PCR test, which is more accurate in determining whether someone is negative for COVID-19, come back positive several days later. In that instance, the individual would be counted as a new person tested the day of their first, negative test but a positive several days later.

Another way of looking at test positivity, as we have noted each week, 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 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 this number, calculated as an average over a 14-day period with a seven-day lag. As of Wednesday, that number was 22.1 percent, up from 20 percent last week and continuing to climb from a recent low of 6.2 percent on Sept. 17.

Whichever calculation you use to look at test positivity, the trend is the same and shows that test positivity continues to increase across Nevada.

Since the beginning of the pandemic, 1,045,846 people — or about one in 2.9 Nevadans — have been tested for COVID-19, and there have been 1,787,862 individual testing encounters.

Testing turnaround times, meanwhile, continue to lag. It typically takes about three days for lab results to be reported, though Pershing and White Pine counties continue to report that lab result turnaround time is typically around six days.

Deaths

Nevada continues to see high, if not record, numbers of deaths being reported each day.

The average number of new deaths each day over the last seven days was 27.3 on Thursday, a new record, up from a recent low of 4.1 on Oct. 27. The previous record over the summer was 20.7, which the state set on Aug. 20.

Over the last seven days, 191 new COVID-19 deaths have been reported across the state, including 118 in Clark County, 41 in Washoe County, nine in Elko County, six in Carson City, five in Douglas County, three each in Nye and Lyon counties, two each in Churchill and White Pine counties and one each in Humboldt and Pershing counties. The death in Pershing, reported Thursday, was the county’s first.

In the last month, 587 deaths from COVID-19 have been reported statewide, about a quarter of the 2,450 total COVID-19 deaths reported statewide since the beginning of the pandemic.

Churchill County now has the highest number of deaths per capita in Nevada, with 9.2 deaths per 1,000 residents, followed by Mineral County at 8.9, Clark County at 8.5 and Washoe County at 7.3.

Nevada ranks 26th in the nation for deaths per capita, the same as last week.

Hospitalizations

Nevada continues to set new records for COVID-19 hospitalizations day over day.

There were 1,824 people hospitalized with COVID-19 as of Wednesday, the last day for which data is available, up from 1,645 last week and significantly up from the recent low of 417 on Sept. 12. At the peak over the summer, 1,165 people were hospitalized with COVID-19.

Nevada now has the highest number of people hospitalized per capita of any state, 58.8 people per 100,000 residents, now ahead of South Dakota, which has 56.6 people hospitalized per 100,000 residents and had the highest rate of COVID-19 hospitalizations per capita last week.

To keep up with that demand, hospitals statewide are currently staffing 6,813 beds, more than the 6,660 they are normally licensed to operate. As of Wednesday, 82 percent of staffed hospital beds and 73 percent of ICU beds were occupied. Those numbers were 81 percent and 78 percent, respectively, in Southern Nevada and 92 percent and 62 percent, respectively, in Northern Nevada. 

In rural Nevada, those numbers are 49 percent and 52 percent, though the percentages vary wildly by county. Churchill County, for instance, is operating beyond its capacity with 144 percent of staffed beds and 125 percent of ICU beds occupied.

Dr. Marjorie Bessel, chief clinical officer of Banner Health, which operates Banner Churchill Community Hospital in Fallon, said that the hospital continues to be “very capacity constrained” during a press conference on Wednesday. Bessel said the hospital has had a “fairly large number of COVID patients, some of whom have been very, very ill.”

“In addition to that, at times, we have had to transfer outside of the state to some of our other Banner facilities. We've transferred into Colorado from Banner Churchill and we've even transferred all the way down into Tucson here in the state of Arizona to accommodate,” Bessel said. “We continue to provide a lot of support to that facility and that community to help them manage as best as we can.”

Jason Bleak, CEO of Battle Mountain General Hospital in Lander County, told the COVID-19 task force that rural hospitals are facing the same stresses that urban hospitals are facing, including an increased volume of patients and decreased staffing available as more positives are identified. 

Bleak said rural facilities are also running out of space in which to put patients, noting that they don’t have parking garages in which to set up alternate care sites like Renown Regional Medical Center in Reno has.

“Many of our little hospitals, we don't have a parking garage that we can convert into extra space,” Bleak said. “We’re falling back to tents outdoors, things like that.”

County by county

Fifteen of the state’s 17 counties met the state’s criteria to be flagged as at risk of elevated spread of COVID-19 as of Thursday. Storey and Eureka counties are the only exceptions.

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.

Excluding the prison population, Pershing County had the highest case rate, 3,813, as of Wednesday, followed by Mineral County at 3,154 and Humboldt at 3,143.