What Montgomery County’s ‘level 3’ alert means

Montgomery County remains on a high level of alert levels under a new monitoring system for coronavirus risk.

The Ohio Public Health Advisory Alert System has four levels of alerts, based on seven different indicators of how prolific coronavirus spread is a community. A level four alert is the highest alert level and means that people in that county are advised to only go out in public for essentials.

Every Thursday afternoon, the DeWine administration will update the alert levels for each county based on the most recent data available. Alerts are posted on coronavirus.ohio.gov.

When determining whether a county is a level one, two, three or four alert, alert system measures how many of the following seven indicators that counties meet:

New cases per capita: This measure considers how many new cases have occurred in the last 14 days relative to the population of a county, the DeWine administration stated in an explanation of the seven alert indicators. More cases mean a greater potential for spread among individuals living in that county, and contributes to a county's overall risk level. The threshold for concern is set at 50 cases per 100,000 residents over the last two weeks, which follows CDC guidance for categorizing incidence.

Sustained increase in new COVID-19 hospital admissions: If the number of daily new cases continually increases day over day, then that means the virus is spreading more in a county. However, The DeWine administration stated that it didn't want to flag a county that may have experienced just a one-day increase so the alert system looks at the increase using smoothed analysis (or 7-day moving average) of new cases and see if there is at least a 5-day period of sustained growth. The CDC and Resolve to Save Lives both use 5 days as the minimum for determining a trajectory.

High proportion of cases that aren't congregate cases: Congregate settings for this indicator are defined as long-term care facilities (including nursing homes) and prisons. Individuals who reside in congregate settings or are incarcerated are generally not viewed as a transmission risk to the broader community. "As such, people with COVID-19 not residing in a congregate setting should carry greater weight in a county's risk analysis since they are more likely to interact with others in the broader community," the DeWine administration stated. A county is flagged on this measure if at least one week of the last three weeks, sees more than 50% of new cases in non-congregate settings.

Sustained increase in ER visits: The administration stated it looks at those going to emergency departments for COVID-19 symptoms as an early warning sign of COVID activity that may impact hospitals down the road.

This measures the trend in the number of people with symptoms consistent with COVID-19 that visit the emergency department (e.g., fever, cough, shortness of breath, difficulty breathing) and not diagnosed with another respiratory illness. In addition, patients with a COVID-19 diagnosis code are included in this metric. A county is flagged when there is an increase over a 5-day period using a 7-day moving average, which follows CDC criteria for assessing increases or rebounds of COVID-like illness.

Sustained increase in outpatient visits: The number of people visiting outpatient settings with suspected and confirmed COVID-19 diagnosis codes is important to understand how many people are sick enough to go to the doctor's office. Like with emergency visits, this can be an early warning indicator. A county is flagged when the there is an increase over a 5-day period using a smoothed analysis (7-day moving average), per CDC criteria for assessing increases or rebound.

Sustained increase in new COVID-19 hospital admissions: The number of county residents who are admitted to hospitals with COVID is an indicator of the burden of illness in the community.

This measure looks at the county of residence (rather than the county of hospitalization) since residents of rural counties may seek care at hospitals in neighboring counties. In addition, CDC recommends looking at hospital admissions in addition to COVID-like illness for a more complete picture of disease activity in an area. A county is flagged when there is at least a 5-day period of sustained growth with a 7-day moving average of new hospital admissions.

ICU bed occupancy: "One of the challenges of treating COVID patients is the long period of hospital or ICU care required per patient," the DeWine administration stated. "While new hospital admissions tell us the new burden of illness on individuals in a county, it does not tell us the resource burden on the hospitals in the broader region."

This measure considers both COVID and non-COVID use of intensive care unit beds, as COVID cases are just one portion of what hospitals must handle in their communities. A county is flagged on this measure when the regional ICU occupancy goes above 80% for at least three of the last seven days. The CDC has set ICU occupancy at 80% as an indicator of hospital capacity to treat all patients without resorting to crisis standards of care.

Based on this alert, Montgomery County is considered one of the Ohio counties on a “level three” alert as of Thursday. The indicators that Montgomery County meets are: new cases per capita, increases in new cases, non-congregate cases, ER visits and outpatient visits.

People in counties like Montgomery considered “level three” are advised to decrease in-person interactions with others, consider necessary travel only, and limit attending gatherings of any number.

As of July 7, Montgomery County had 600 cases during the past 14 days, which is considered “high incidence” by the CDC definition. Cases increased from an average of 41 cases on June 16 to 50 cases on June 30. The county is continuing to see early signs that people are seeking medical care for COVID-19 symptoms, from June 16 to July 2, visits for COVID-19 to the ER increased from an average of 9 per day to 16.

From June 16 to July 3, outpatient visits went from an average of 14 to 48 per day. More than 63% of the cases in the county are not in congregate settings, signalling transmission in the broader community.

And lastly, the number of COVID-19 positive patients in the west central region’s hospital beds and ICUs and on ventilators have tripled since the beginning of June.

Recent community outbreaks have been in workplaces, restaurants and nursing homes.

No county has become a level four emergency yet in Ohio though as of Thursday Franklin County was on that trajectory, according to the DeWine adminstration.

Free Montgomery County COVID-19 testing

July 16: 9 a.m. to 4 p.m., Rose Music Center, 6800 Executive Blvd., Huber Heights

July 17: 9 a.m. to 4 p.m., Trotwood Madison High School, 4440 N. Union Road, Trotwood

July 20: 9 a.m. to 4 p.m. at Montgomery County Fairgrounds, 645 Infirmary Road, Dayton

Public Health - Dayton & Montgomery County is providing free pop-up COVID-19 testing for the public.

No appointment or doctor recommendation needed. For questions call the COVID-19 Information Line at 937-225-6217.

About the Author