Welcome to the 58th installment of “Coronavirus Contextualized.”

Since the beginning of the pandemic, we have brought you the latest COVID-19 numbers in Nevada, including cases, hospitalizations and deaths, and provided context to them on a near-weekly basis through this series. (Prior editions of “Coronavirus Contextualized” live here.)

“Coronavirus Contextualized” publishes on a semi-regular basis, meaning that if cases are increasing or decreasing, you can expect to see a new story every week or every other week, and if cases are stable, you might not see a new story for a few weeks.

Don’t fear, though: You can find the latest data daily on our COVID-19 data page and on Twitter. As always, you can reach out to [email protected] with any questions.

Below, we take a look at how the northern and rural portions of the state continue to be hit hard by COVID-19 as the federal government announced new measures on Thursday aimed at curbing the virus’s spread, including a new employee vaccine mandate that is expected to affect as many as 100 million Americans.

Cases

Statewide case numbers remain high, though both Clark and Washoe counties have seen drops in recent days. 

As of Thursday, 1,023 new cases were reported on average each day over the previous seven days, down from the highest point of the current wave so far, 1,160, which the state hit Aug. 24. That peak is just below the highest point of last summer’s wave, 1,176 on July 20, 2020, but a little less than half of the fall and winter wave case record, 2,736 on Dec. 10, 2020.

In Clark County, which was hit early and hard by the latest wave of the virus, cases have been fairly steadily decreasing for more than two weeks, hitting 539 on Thursday. The highest point of the current wave, which the state hit on Aug. 1, was 917. That peak is below both the high point of the 2020 summer wave — 1,072 on July 20, 2020 — and the fall and winter wave, when Clark County hit its highest seven-day case average ever of 2,092 on Jan. 12.

Washoe County, where cases were steadily rising for nearly two months, started to see some decreases this week, hitting 274 on Thursday, down from the highest point of the current wave, 295, last Thursday. That number is significantly higher than the peak of last summer’s small wave, 98 on July 30, 2020, and a little less than half of its record high point of 532 on Nov. 27 during the fall and winter wave.

Adjusted for population size, Washoe County’s case rate remains more than double Clark County’s. As of Thursday, Clark County was seeing 24 cases reported per 100,000 residents each day over the previous seven days, compared to 54 in Washoe County. The case rate in the other 15 counties, meanwhile, was 61.

Across the rest of the state, almost every other county continues to see elevated or increasing case numbers as well.

According to the Nevada State Public Health Lab’s weekly lineage report, the Delta variant was responsible for 93.7 percent of sequenced COVID-19 cases over the last five days.

Since the beginning of the pandemic, there have been 400,349 COVID-19 cases confirmed statewide, meaning 1 in 8 Nevadans has tested positive for the virus. More than 8 percent of those cases, 33,765, have been diagnosed in the last month, and nearly 2 percent, or 7,161 cases, have been reported in the last week.

Test positivity

The statewide test positivity rate, which looks at the percentage of tests coming back positive out of the total tested, has been fluctuating in recent days following a couple of weeks of steady decreases.

It is not possible to independently calculate the test positivity rate based on test encounters because the state only publicly 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 Tuesday, that number was 12.2 percent, down from a recent high of 16.4 percent on Aug. 13 but even with last week’s rate of 12.2 percent.

The test positivity rate remains more than double the World Health Organization’s recommended 5 percent threshold but less than the peak test positivity rate of 21.3 percent the state saw in mid-January.

Since the beginning of the pandemic, more than 1.9 million people — 62 percent of Nevadans — have been tested for COVID-19, and there have been more than 4 million individual testing encounters.

Vaccinations

The pace of vaccine distribution in Nevada is slightly down after several weeks of increases as the state worked to boost its vaccination rate.

As of Wednesday, about 6,100 vaccines were reported administered each day over the last seven days, down from 7,900 last week but still up from a low point of 5,200 on July 13.

Nearly 59 percent of Nevadans have now been either partially or fully vaccinated against COVID-19 — including nearly 49 percent fully vaccinated — and about 28 percent of Nevadans eligible for the vaccine have yet to receive it.

Since vaccinations started in December, more than 1.8 million people have received at least one dose of the COVID-19 vaccine and more than 1.5 million Nevadans have been fully vaccinated.

Among the counties, Carson City continues to have the highest percentage of residents fully vaccinated against COVID-19 at 55.7 percent, followed by Washoe County at 52.7 percent, Douglas County at 48.1 percent and Clark County at 44.2 percent. Tiny Storey County has still vaccinated the least, with only 16.4 percent of its residents partially or fully vaccinated.

Nationally, Nevada ranks 31st among the 50 states for percentage of its population fully vaccinated, at 48.7 percent, behind all of its neighbors except Idaho, at 48th.

Breakthrough cases

There have been 7,634 breakthrough cases — fully vaccinated individuals who have tested positive for COVID-19 — in Clark County as of Sept. 2, meaning that 0.75 percent of fully vaccinated individuals have contracted the virus. In Washoe County, there have been 1,701 breakthrough cases as of Thursday, representing 0.67 percent of fully vaccinated people in the county.

As of Sept. 2, there were 362 breakthrough hospitalizations in Clark County and 112 breakthrough deaths, meaning that 0.04 percent of vaccinated individuals in Clark County have been hospitalized and 0.01 percent have died.

Of the people hospitalized with breakthrough infections, 66 percent had underlying conditions, 74 percent were those 65 years or older and 60 percent were men.

Data from the Southern Nevada Health District released last week show that breakthrough cases represent just a small, but increasing, percentage of the total number of cases identified in Clark County each month. In August, fully vaccinated people represented 17.4 percent of overall cases, compared to 15.7 percent in July and 11.6 percent in June.

Deaths

The number of new COVID-19 deaths reported on average each day dropped this week, though it isn’t uncommon to see a drop in reported cases or deaths following holidays.

As of Thursday, 17 COVID-19 deaths were being reported on average each day over the prior seven days, down from 24 last week and a high point during the current wave of 25 on Aug. 30. Last summer’s surge peaked at an average of 21 daily deaths, while the fall and winter surge peaked at 45 daily deaths.

Over the last seven days, 116 new COVID-19 deaths have been reported across the state — down from 167 last week — including:

• 70 in Clark County
• 27 in Washoe County
• 5 in Lander County
• 4 in Churchill County
• 3 each in Lyon and Nye counties
• 2 in Elko County
• 1 each in Carson City and Douglas County

Since the beginning of the pandemic, there have been 6,681 deaths from COVID-19. In the last month, 641 deaths from COVID-19 were reported statewide, nearly 10 percent of the deaths reported statewide since the beginning of the pandemic.

Hospitalizations

The number of people hospitalized with COVID-19 statewide has been fluctuating in recent days, though statewide numbers are still down from where they were last month. That’s largely a result of decreasing hospitalizations in Clark County and increases in Washoe County and rural portions of the state.

As of Tuesday, there were 1,115 people hospitalized with confirmed or suspected cases of COVID-19 across the state, down slightly from 1,126 last week and significantly down from this wave’s peak of 1,317 on Aug. 10. The peak of last summer’s wave was 1,165, which the state hit on July 31, 2020, and the peak of the fall and winter wave was 2,025, on Dec. 13, 2020.

“COVID-19 hospitalizations represent upwards of 20-25% of all patients hospitalized in the northern and rural areas with some variation by the facilities,” the Nevada Hospital Association wrote in its weekly report. “The overwhelming majority of these patients are unvaccinated, driving some hospitals to publish pleas within their neighborhoods and communities to get vaccinated.”

The hospital association wrote that continued staffing shortages are affecting patient care, “including ambulances delayed at hospitals, difficulties discharging or placing patients in a skilled nursing facility, and delayed or canceled procedures.”

County by county

Fourteen counties are considered by the state to be at elevated risk for the spread of COVID-19 as of Thursday. That’s all except Pershing, White Pine and Lincoln.

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.

The state continues to align its mask mandate with federal guidance, however, meaning it is using the CDC’s community transmission tracker to determine which counties are at substantial or high risk for the spread of COVID-19 and therefore required to abide by indoor mask mandates for vaccinated and unvaccinated individuals alike.

Under the CDC’s metrics, counties are considered at risk for “high” transmission if they have more than 100 cases per 100,000 residents in the last seven days, “substantial” if they have between 50 and 100, “moderate” if they have between 10 and 50 and “low” if they have fewer than 10.

As of Wednesday, all Nevada counties were considered at “high” or “substantial” risk of transmission. As of Friday, all counties will be required to follow universal indoor masking precautions for both vaccinated and unvaccinated individuals.

Counties can have mask mandates put in place if they have two weeks of “substantial” or “high” transmission; those mask mandates will automatically be removed after two weeks of “low” transmission.

Read more of our pandemic coverage here. You can also find the latest COVID-19 data on our data page.