A weekly report by Karen A. Chapman, MD, MPH, Director
The information in this report is collected and monitored daily and updated weekly to the community. As of August 23, 2020, 3,965 COVID-19 cases are reported for Okaloosa County, an increase of 223 cases since August 16, 2020.
New Confirmed or Probable COVID-19+ Resident Cases over past 14 days: Reports daily number and 7-day moving average of confirmed (PCR+) or probable (Antigen+) cases.
RATIONALE: Daily new cases reflect the proportion of the outbreak captured by surveillance systems. Number of new cases gives a sense of the size of the epidemic/outbreak in Okaloosa County.
TARGET: Decreasing case count over 14 days or at a low level (as defined by CDC* as below 10 cases per 100,000 population over 2 weeks).
*CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening Up America Again. May 2020. Low incidence plateau defined as a very low number of new cases (below 10 cases per 100,000 population over 2 weeks with only minimal change in daily cases.
New resident cases had been increasing at a rate of about 1,000 new cases every 12-14 days. As of August 23, 2020, Okaloosa has 3,965 cases of COVID-19 and it has been 21 days since we hit 3,000 cases.
However, cases are not <10/100,000 population over a two-week period but are the rate is significantly improving.
- Total Cases in 2 weeks (August 10 – 23) = 435 (down 286 cases in a two-week period)
- Rate: 207 cases/100,000 population 2-week period
- Okaloosa Population = 210,000
Based on the rate of cases per 100,000 population disease burden in Okaloosa remains high over the past two-week period. However, the declining daily and moving case count, which then leveled off before we hit a sustained two-week decline, remains an encouraging trend.
COVID-19 Diagnostic (PCR) and Screening (Antigen) Testing Per Capita Reports daily and 7-day moving average total test results received / 1,000 population / day.
RATIONALE: The number of cases and percent of positive tests can be interpreted only with comprehensive surveillance and testing of suspect cases in the order of 1.5 /1,000 population/day.
TARGET: 1.5 tests / 1,000 population / day*
*Resolve to Save Lives. Tracking COVID-19 in the United States. Essential Indicators. July 21, 2020.
Okaloosa County remains above the target of 1.5 COVID-19 diagnostic tests (positive and negative results) per 1,000 population per day. However, there has been a marked decline in returning test results over the past two-week period.
While there is still adequate testing of the population to be able to interpret the burden of disease in the County based on the case count and the percentage of positive COVID-19 diagnostic or screening tests received, the decline in testing is concerning.
Percent Positive COVID-19 Tests:
Reports daily and 7-day moving average percentage of all positive COVID-19 diagnostic and screening tests (regardless of provider) for Okaloosa County residents.
RATIONALE: Test positivity is an important indicator of the burden of disease in the area (county). The percent of positive tests can be interpreted only with comprehensive surveillance and testing of suspect cases in the order of 1.5 /1,000 population/day, which Okaloosa County achieves (see above metric).
TARGET: 5% or less of tests for COVID-19 are positive for at least 2 weeks.
*WHO. Public Health criteria to adjust public health and social measures in the context of COVID-19. May 2020.
The decline in 7-day moving average of percent positive tests seen over the previous two-week period has ended. The 7-day moving average percent positive tests has stabilized over the past week at 8.66%. Okaloosa remains above the <5% target. Okaloosa can continue to push this curve downward through adherence to physical distancing and the wearing of cloth face masks.
Influenza-Like Illness
Activity levels are based on the percent of emergency department visits due to influenza-like illness (ILI) compared with past year activity at the same time of the year.
RATIONALE: This type of syndromic surveillance* is used to monitor trends in emergency department visits and can be used to potentially detect a rise in COVID-19 cases before a rise in confirmed cases occurs. ILI is defined as fever (temperature of 100o F or greater with cough and/or sore throat without a known cause other than influenza).
TARGET: At or below baseline for the time of year based on past year trends for percent of ILI visits to emergency departments.
*Resolve to Save Lives. Tracking COVID-19 in the United States. Essential Indicators. July 21, 2020. White House Coronavirus Task Force. Guidelines for Opening Up American Again. Gating Criteria. May 2020.
As of Week 34, percentage of emergency department visits for ILI is at baseline for this time of year.
| WEEK | VISITS ILI/Total | % ILI of Total ED Visits | WEEK | VISITS ILI/Total | % ILI of Total ED visits |
| Week 25 | 22/2075 | 1.06% | Week 30 | 48/2117 | 2.27% |
| Week 26 | 38/2208 | 1.72% | Week 31 | 32/2117 | 1.51% |
| Week 27 | 57/2184 | 2.61% | Week 32 | 32/2107 | 1.52% |
| Week 28 | 71/2274 | 3.12% | Week 33 | 21/2015 | 1.04% |
| Week 29 | 59/2194 | 2.69% | Week 34 | 19/1918 | 0.99% |
COVID-19 Hospital Admits
Number of COVID+ Hospitalized; Number of COVID+ in ICU; and percentage of ICU beds occupied by COVID+ patients.
RATIONALE*: Declining hospitalization and use of ICU beds indicates a decline in the number of cases in community, with an approximately ~1week lag and providing that the criteria for hospitalization has not changed.
TARGET: Continuous decline in the number of hospitalized and ICU admissions of confirmed (PCR test) or probable (Antigen) COVID-19 cases for at least the past two weeks.
*WHO. Public Health criteria to adjust public health and social measures in the context of COVID-19. May 2020.
Okaloosa continues to see admissions to area hospitals for COVID-19. In Week 33, COVID-19 admissions accounted for 12.2% of all staffed acute care hospital beds admissions. However, as of Week 34, COVID-19 admissions have declined to 8.9% of all staffed acute care hospital beds. This is an encouraging trend.
Indeed, COVID-19 admissions averaged 49 per day between August 4-10 and as of August 18-24, COVID-19 admissions have declined to an average of 35 per day. Patients in hospital needing an ICU bed for COVID has also declined. For the period August 4-10, 19 individuals needed an ICU bed per day for COVID-19. For August 18-24, this has dropped to an average of 10 patients per day.
Percent of ICU beds occupied has steadily declined over the past two weeks. Utilization of ICU beds has been below 85% for the past 10 days. Again, more encouraging signs of progress in the war on COVID-19.
Deaths
On August 24, 2020 Okaloosa County has 71 COVID-19 deaths. This is an increase of 21 deaths reported since Week 33. Not all deaths occurred in the last seven days but were only reported within the last seven days.
AGE GROUP DEATHS PERCENT CHANGE FROM
8/16
| 25-34 YEARS | 3 | 4% | +0 |
| 45-54 YEARS | 5 | 7% | +2 |
| 55-64 YEARS | 9 | 13% | +3 |
| 65-74 YEARS | 7 | 10% | +3 |
| 75-84 YEARS | 22 | 31% | +5 |
| 85+ YEARS | 25 | 35% | +8 |
| TOTAL | 50 | +21 |
Long-Term Care Facilities
As of August 23, 2020, Okaloosa has seven long-term care facilities which have 56 COVID-19+ residents under their care. This is down 32 cases from last week. Sadly, some of these residents died. An additional 29 COVID-19+ residents have been transferred to other facilities for ongoing care. There are four long-term care facilities with 5 or more resident COVID-19+ cases (range 5 – 21). Of the seven facilities there are 21 COVID-19+ positive employees, down by 25 from last week.
Children
DOH modified the pediatric report this past week. There have been 2,597 children birth – 17 years that have received testing for COVID-19 to date. Of those tested, 288 children were positive for a total positivity rate of 11.1%.
SUMMARY
After an almost two-week decline in COVID-19 cases, Okaloosa has once again reached a plateau of about 32 cases per day over the past week. Disease burden is decreasing as evidenced by two weeks in a row of a decline in the rate of new cases per 100,000 population. However, disease burden remains high.
Our positivity rate among those tested has also plateaued at about 8.66%. This is below 10%, showing progress, but we need to continue to wash our hands properly, practice physical distancing of at least 6 feet and wear a cloth face mask.
Other encouraging news is a decline in percentage of hospital beds occupied by COVID-19 patients and a reduction below 85% in the usage of ICU beds.
With school starting in a week, I thought a review of available testing options for COVID-19 diagnosis would be helpful. Coronavirus testing basics can be found at the FDA.
It has come to my attention that some clinics are using antibody testing to make a diagnosis of COVID-19. Antibody testing is not recognized in the United States for COVID-19 diagnosis. Antibody test results will not be accepted by the health department for confirming or ruling out an infection with the virus that causes COVID-19. One can tell if someone got an antibody test for COVID-19 since it is a blood test.
There are two types of tests that are recognized for diagnosis of COVID-19, molecular tests, such as PCR tests, and antigen tests. How does one tell the difference?
- Molecular test or PCR tests o Sample is collected with a nasal or throat swab.
- Results can be obtained same day (in areas that have access to rapid molecular testing) up to 5 days.
- Test is highly accurate whether the result is positive or negative. o Test can be used in asymptomatic individuals.
- Diagnoses active coronavirus infection.
- Antigen Tests o Sample is collected with a nasal or throat swab. o Results can be obtained within 1 hour or less.
- Positive results are highly accurate when the test is done on a person who has symptoms consistent with COVID-19 and is within the first 5 days of illness. o Negative results need to be confirmed in a symptomatic person with a PCR test. o This test is not recommended for persons with no symptoms at this time. o Diagnoses active coronavirus infection in symptomatic people.
Currently, antigen tests are in very short supply in the United States. The federal government has committed to making antigen testing available in nursing homes throughout the country and priority has been given to getting the equipment and test kits to those facilities.
PCR testing is available at the health department and through community drive thru events 5-days a week. Community drive-thru events are held on Tuesdays and Thursdays and dates and times are posted on the health department web site. Every Monday, Wednesday, and Friday, testing is available at one of our two health department locations (Fort Walton Beach and Crestview). These are drive-thru events too but are by appointment to cut down on wait time. Call 850-344-0566 for appointments, location days, and times.
A very high percentage of test results for the PCR test are returned to the health department within 48 hours of testing. The health department commits that 100% of people who have a test done at the CHD will get notified of the result within 24 hours or less of when we receive the result.
