Welcome to the 32nd 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 megan@thenvindy.com with any feedback.

Below, we take a look at some of the latest COVID-19 trends with 11 days left in the three-week “statewide pause” that lowered occupancy limits and once again limited the size of gatherings.

Cases and test positivity

COVID-19 cases in Nevada are down this week, though public health officials say it’s too soon to say whether the decreases are the result of decreased transmission of the virus or the result of fewer testing sites open and lab delays over the Thanksgiving holiday.

Experts have been expecting to see a spike in cases associated with gatherings over the holiday period, though they note that it will take some time for any Thanksgiving-related transmission to appear in the data because of the time it takes for people to develop symptoms, get tested and for those test results to come back.

“We're continuing to watch that and continuing to be quite concerned about what we may be seeing coming out of Thanksgiving gatherings that may have occurred,” Washoe County District Health Officer Kevin Dick said on a press call on Wednesday.

An average of 2,233 new COVID-19 cases were reported each day over the last seven days as of Thursday, the first day to see an increase after four days of decreases. Still, that number is down from last week, when the seven-day average was 2,362.

Nevada hit a record seven-day average of 2,441 on Saturday, more than double the previous record, 1,176, from the summer, the last time coronavirus cases surged.

Two weeks ago the seven-day average was 1,835 and it was 1,380 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 160,427 COVID-19 cases reported statewide. More than a third of those cases, 57,109, have been diagnosed in the last month.

“If we do not begin to see a change in our trajectory and if this crisis continues to get worse, we will be left in the unfortunate position of having to take stronger actions, something I've been desperately trying to avoid in order to balance the economic impacts,” Gov. Steve Sisolak said during a press conference Wednesday afternoon. “But I've been clear since the start, we cannot overwhelm our healthcare system and put countless lives in danger.”

One in 19 Nevadans has tested positive for the virus since the beginning of the pandemic. Nevada ranks 21st in the nation for COVID-19 cases per capita, up from 22nd two weeks ago. State officials say Nevada is still outpacing both California and Arizona in its COVID-19 trends. California ranks 41st in the nation for COVID-19 cases per capita while Arizona ranks 24th.

While cases have slightly decreased, Nevada’s test positivity rate — which looks at the percentage of tests or people coming back positive out of the total tested — 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 39.4 percent as of Thursday, up from a recent low of 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 18.1 percent, continuing to climb from a recent low of 6.2 percent on Sept. 22.

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

A total of 999,188 people — or about one in 3.1 Nevadans — have been tested for COVID-19 and there have been 1,682,758 individual testing encounters since March.

Testing turnaround times, meanwhile, are starting to lag. It now takes approximately three days after specimen collection for results to be reported, up from two days two weeks ago. The situation is worse in some counties, including Pershing and White Pine counties where the median test turnaround time is six days.

Julia Peek, deputy administrator of the Division of Public and Behavioral Health, said during the state’s COVID-19 Mitigation and Management Task Force meeting on Thursday that those turnaround times mean that Nevadans will likely not be able to take advantage of the new Centers for Disease Control and Prevention guidance for discontinuing quarantine after exposure. The new guidelines allow people to end their quarantine after seven days after testing negative on the fifth day after exposure or 10 days after exposure with no test, down from a 14-day quarantine period.

“With our turnaround times, that's highly unlikely,” Peek said, referring to the chance that someone would get their results back quickly enough after testing on their fifth day to discontinue quarantine on the seventh. “Probably most people will go from a 14-day to a 10-day, with no test, no symptoms, just realistically.”

Deaths

Nevada surpassed its previous peak in deaths from over the summer on Thursday.

The average number of new deaths each day over the last seven days was 23.6 on Thursday, up from a recent low of 4.1 on Oct. 27. The previous record was 20.7 new deaths each day on average, which the state set on Aug. 20 and tied on Wednesday.

Officials had expected the number of COVID-19-related deaths in Nevada to climb but trends in deaths typically lag cases by about five weeks. Nevada beat its summer seven-day average case record on Nov. 7, which was a little less than four weeks ago.

Over the last seven days, 165 new COVID-19 deaths have been reported across the state, about 7 percent of the 2,249 COVID-19 deaths reported since the beginning of the pandemic. The deaths this week included 82 in Clark County, 46 in Washoe County, 12 in Carson City, nine in Churchill County, five in Lyon County, three in Mineral County, two each in Douglas, Elko, Storey counties, and one each in Humboldt and Nye counties.

Mineral County now has the highest number of deaths per capita in Nevada, with 8.9 deaths per 10,000 residents, followed by Churchill County at 8.4, Clark County at 8 and Lander County at 7.2.

Nevada ranks 26th in the nation for deaths per capita, down from 25th two weeks ago.

Hospitalizations

COVID-19 hospitalizations remain high across the state though Wednesday saw slightly fewer people hospitalized than Tuesday.

There were 1,645 people hospitalized with COVID-19 as of Wednesday, the last day for which data is available, up significantly from a recent low of 417 on Sept. 12 and down slightly from the record 1,652 hospitalizations reported Tuesday. At the peak over the summer, 1,165 people were hospitalized with COVID-19.

Nevada has the second highest number of people hospitalized per capita, 53.6 people per 100,000 residents, only behind South Dakota, which has 60 people hospitalized per 100,000 residents.

The hospitals statewide are currently staffing 6,852 beds when only 6,660 are normally licensed to operate — something hospitals can do to keep up with demand. As of Wednesday, 82 percent of staffed hospital beds and 69 percent of ICU beds statewide were occupied. Those numbers were 81 percent and 72 percent, respectively, in Southern Nevada and 91 percent and 61 percent, respectively, in Northern Nevada.

Christopher Lake, executive director of community resilience for the Nevada Hospital Association, said during the COVID-19 Mitigation and Management Task Force meeting that staffing remains a “constant concern.”

“We had a nursing shortage prior to COVID — I just want to put that out there — so we started from a deficit, and then we have the increase in patients right now, and we also have, as this disease becomes relatively endemic in the community, staff are also people, their family gets exposed, they're required to have the stay at home order or they’re waiting for tests, etc. and that diminishes some of the staff out of the hospitals, further compounding that issue,” Lake said.

The hospital association, in a report this week, noted that 30 percent of hospital patients statewide have COVID-19 compared to only 9 percent on Sept. 12. In the ICU, 49 percent of patients currently have confirmed or suspected COVID-19.

Lake told the task force that some hospitals have individually elected to postpone medically necessary surgeries and outpatient procedures for a couple of weeks while other hospitals are continuing to do them following review with the hospital CEO and chief medical officer to determine the urgency of the procedure and the resources available.

“They are managing their calendar literally daily for those scheduled surgeries that are medically necessary,” he said.

County by county

Almost every single county in Nevada is being hit hard by COVID-19. Sixteen of the state’s 17 counties meet the state’s criteria to be flagged as at risk of elevated spread of COVID-19 as of Thursday. The only exception is Storey County.

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.

Carson City continues to have the highest case rate per capita, at 3,155 cases per 100,000 over the last 30 days as of Wednesday, largely because of an outbreak at Warm Springs Correctional Center. Once the inmate population is removed, Humboldt County has the highest case rate per capita, 2,306 per 100,000, followed by Mineral County at 2,250 and Washoe County at 2,233.

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