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Monday, September 14, 2020

Officials ask for more localized data, positivity rates

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By Robin Gee

Some days with COVID-19, it seems it’s all about the numbers.

How many have been tested? How many test positive? How many are sick? How many have died? What percentage of population? What demographic data is relevant? What is the information we need? How do we plan our lives to keep safe?


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These are the questions we all have.

According to some state and local decision makers, navigating through the data to make relevant decisions has been difficult and frustrating. In some cases, information from the federal government conflicts with state data, and it is hard to get clear regional or local information.

Before the fall semester began, officials at Fort Thomas Independent Schools gave families the option to choose between remote learning or returning to classroom learning. Those coming back to school buildings in person could also periodically be asked to work from home if the health and safety situation required it, utilizing NTI (non-traditional instruction) days.

Then the Fort Thomas Independent Schools board, following recommendations from the governor, announced in-person learning would be delayed until the end of September.

School leaders had been tracking data and watching the reports and noticed discrepancies between the information provided by the federal government and what they were hearing from the Northern Kentucky regional health department.

Upon further exploration and data mining by the school district itself, they met with public health officials and were cleared to change their plans, getting the green light to bring students back to school buildings sooner.


The Fort Thomas Independent Schools District Data Dashboard, part of its Healthy at School website.

Fort Thomas Independent Schools digs into data


During the first week in September, District Superintendent Dr. Karen Cheser and the school board held a public meeting to announce the decision to bring students who opted to be on campus back to school buildings on September 17. At that meeting, Dr. Cheser also shared her concerns and frustrations with the lack of clear and complete data with which to make decisions.

She has not been alone in this frustration.

Other school district leaders have expressed similar concerns, as well as some local governments and agencies. The concern prompted district leaders to dig into the data themselves and work with local health officials to try to figure out a way to cut through the confusion and find relevant local and regional data.

"We have been tracking data since March and especially considering the data from the last three weeks as schools have opened in the region and around the state. In addition, we have been in conversation with these districts to learn from their experiences, which have been overwhelmingly positive” Dr. Cheser said.



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Tracking the data has been no easy task.

The school district has been working with the Deputy Commissioner of the Kentucky Department of Public Health, Dr. Connie White, who advised keeping an eye on incidence rates on two resources – the Harvard Global Health Institute Global Epidemics website and the Kentucky Department of Public Health website, rather than the federal report, as that report only includes a portion of overall tests.

Fort Thomas schools has a team of people who are now keeping careful track of a number of data sources to try to determine what exactly is happening in Fort Thomas, Campbell County and Northern Kentucky. They share their data and a host of COVID-related information for the schools on a district data dashboard on their Healthy at School website.

The good news so far is that for a seven-day average, the area has not gone above 2.5 cases per day. At the time of the school board meeting, Dr. Cheser noted there were 11 cases in the community, two were at a nursing home, seven were college students from here who are away at school and two were people with no children in school or any connection with the school system.

The plan for the schools is to return to off-campus instruction if the positivity rate moves above five percent locally, if the total number of Campbell County cases grows to 25 or more daily, if extensive quarantining is needed or if there is a directive from the Department of Public Health.

Yet, as noted, positivity data is incomplete and unclear at this time. In the meantime, Dr. Cheser and other officials are keeping a careful eye daily and have reached out to the business community, St. Elizabeth Healthcare and other districts to push for better centralization of data going forward.


RELATED: Fort Thomas Schools Return to In-person Learning September 17

Regional data gathering helps NKU decision makers 

 

Regional case data, available on the Northern Kentucky University COVID-19 Regional Statistics Dashboard may be useful for all residents of Northern Kentucky, as well as their targeted audience of students and NKU staff.

Dr. Valerie Hardcastle is the executive director for the St. Elizabeth Healthcare Institute for Health Innovation and vice president of NKU’s Institute of Health Innovation (IHI). Last month the IHI, with help from the university’s IT team, launched the COVID-19 Regional Statistics Dashboard to share the data it is using to make decisions on when and how to open campus to in-person learning.

Dr. Hardcastle said the university ran into the same issues that challenged decision makers at Fort Thomas schools and others across the state. While some students do live on campus, NKU is primarily a commuter school pulling from all over the region, so it was important for officials to have relevant information from throughout the region.

“With students coming from Ohio, Indiana and Kentucky, we don’t have this kind of education bubble that some other universities have, especially the smaller private ones,” she explained. Smaller college communities whose students mostly live on campus are more contained and easier to track.

Right now NKU is only holding about 18 percent of classes face-to-face, and they have cut the number of students who do live on campus by 50 percent.

To help their entire campus community, students and staff, she said, "We thought, if we could provide what is going on where they spend most of their time, we could give them the best idea of what is going on."

NKU pulls and shares data on the number of active cases in each state, the number of regional active cases for people in the 20- to 29-year-old age range, the rolling seven-day average of new cases by county and state, and the transmission rates by state.

RELATED: NKU Develops COVID-19 Dashboard to Help Track Region's Health

Problems with positivity rates


At NKU, as well as Fort Thomas schools, staff has discovered “positivity rates” shared by the federal government and in the governor’s briefings may not be very useful in determining what is happening on the ground.

Ideally, positivity rates are determined by dividing the number of people who have tested positive for COVID, by the number of tests performed. The rates are given as a rolling seven-day average.

Dr. Hardcastle outlined one of the main problems with positivity data in Kentucky. There is no central repository of information. Several labs outside of Kentucky, throughout the region and beyond are doing the tests for Kentucky residents. Some of these labs do not report how many tests were done or how many people tested negative.

"Many of these labs are private entities, and that’s another complication," said Dr. Hardcastle. "They may feel they have privacy obligations to their clients who get tested. These labs see themselves as the middle man. The data, to them, belongs to the person who got tested."

In fact, another challenge is that data for our region may come from different health departments as well. NKU takes into consideration information coming from the Northern Kentucky Health Department but also the health department in Cincinnati and even from the Three Rivers Health Department to the south in Pendleton County.



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Another issue, she said, is testing is not universal. "In an ideal world, we would test all the people all at the same time and then could use that information to know what percent of the population has it [COVID]...But, right now we have no capacity to test everyone. We are dependent on how many people take the test at a particular time – which is not as meaningful because we are testing against a random collection of people who got the test. They might have gotten it because they feel sick or some particular reason."

If large numbers of people test positive in this pool, it would indicate a problem, but the current positivity data is not as useful for slower, smaller movements or trends.

Another challenge, said Dr. Hardcastle, is how COVID exposure unfolds. If a person is exposed, it takes about two days for their body to replicate the virus and, therefore, two days before beginning to shed the virus. Symptoms, if they are going to happen, don’t tend to show up until day three. If the person got tested before day three, the virus might not show up. Even if they are tested after day three, it is taking five or six days at get results back, so positivity rates are considered a "lagging indicator," never keeping up with what is happening on the ground in real time.

"It’s hard to make a decision as an organization – that six days can be very significant...When you find out about a spike, it’s been happening for up to a week by the time you know about it," she said.

Finding meaningful data and what we can do going forward


"To me, more important than positivity rates, is the rate of transmission," said Dr. Hardcastle. An R1 rate of transmission means each infected person has infected one other person. This is a plateau, and it is currently where most of Kentucky has been, she explained.

If there is a rate of transmission less than 1, it means the virus is dying out, and more than one is very dangerous. Rates higher than R1 indicate what has become known as super spreader events, where the virus can take off exponentially.

With all the uncertainty and challenges with the data, she says the one thing we do know is that following the health guidelines does work.

"We know that the wearing of masks prevents the spread of the virus, as well as social distancing and other measures...As long as we can follow the safety guidelines, we can prevent the spread of the disease. We cannot let our guard down even one time, thinking 'oh, it won’t matter,' because it does...Yes, it’s annoying, but the cost of not wearing them is too high."

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