This month’s resurgence in COVID-19 cases is beginning to scramble Clark County’s outbreak response.
At Wednesday’s Clark County Board of Health meeting, Clark County Public Health Officer Dr. Alan Melnick outlined problem areas that have manifested with contact notification and testing.
The county has averaged around 33 cases per day this month, more than triple the county’s target of nine or fewer cases per day.
Melnick said the influx of cases is hampering contact notification, which is dealing with a backlog of work.
The recent rise in cases in Clark County, and the U.S., is also negatively impacting testing, with test supply shortages cropping up and a backlog of pending tests at large commercial laboratories.
Melnick said some large commercial labs are taking up to a week to return results. Last week, the county sent out a medical provider advisory, asking providers to send specimens to state labs, which are returning tests quicker.
“It’s unacceptable having to wait a week to get test results,” Melnick said. “We really need test results quickly.”
Increased spread
When Clark County turned in its Phase 3 application on June 26, the county firmly met most of the state’s metrics for entering Phase 3. In the weeks since, Clark County has backslid significantly.
For the week of June 14, the county was averaging 417 COVID-19 tests per day with a 1.85 percent positive test rate, according to Melnick. For July 5 through July 11, the county averaged 696 tests per day, with a 5.3 percent positive rate. Melnick said he wants the positive test rate to be at 2 percent or below.
“We’re seeing more cases because there are more cases, not because we are doing more testing,” Melnick said. “There is more disease activity in the community.”
The county is also falling short of its testing goals. Clark County would like to be at 2 percent positivity or lower, and test 50 times the number of confirmed cases per week.
For the week of June 20, Clark County had 56 positive tests, which gave it a target of 2,800 tests. There were 4,079 tests conducted that week with 1.37 percent positivity.
The numbers slid the week of June 27, when the county accumulated 148 positive tests, but only ran 5,670 tests, short of the 7,400 target. Percent positivity was 2.61 that week, also above the threshold.
That meant the county had a 39 percent increase in testing and 91 percent increase in positivity between those weeks.
For the week of July 4, the county saw a 9 percent decrease in testing and a 22 percent increase in positivity. That week the county tallied 165 positive tests and 5,186 total tests with 3.18 percent of tests returning positive. The target for tests that week was 8,250 tests.
The week of July 11, the county recorded 260 positive results out of 4,874 tests, which fell short of the 13,000 tests the county aimed for. The percent positive rate that week was 5.33. Those numbers add up to a 6 percent decrease in testing and a 68 percent increase in positives from the prior week.
Melnick said test supply shortages have also played a role in the lag in testing.
“The issue around these machines and testing is going to be around adequate supplies,” he said.
Slowed contact notification
Clark County Public Health has continued to struggle with contact notification, although Melnick said Public Health is making alterations to its approach and adding staff to improve results.
Melnick said issues have arisen as new nurses started training just as the number of cases surged. A recent spate of outbreaks that take more time to investigate also slowed the overall response down, as did the launching of a new COVID-19 database that Public Health is using.
When the county turned in its Phase 3 application last month, the county was contacting 63 percent of cases within 24 hours of receipt of a positive test. Melnick said that between July 5 and July 18, the county only reached 7 percent of cases.
When Melnick briefed the board of health two weeks ago, the number was 8 percent.
“We’re still having difficulty,” Melnick said Wednesday.
Public Health is doing better in other areas, but still generally falling short of the state’s targets. For July 4 through July 17, Clark County was reaching 68 percent of close contacts of confirmed cases within 48 hours of receipt of a positive test, up from 61 percent last month, but still below the 80 percent target.
Clark County is meeting or exceeding the 80 percent target in two other areas. Public Health is contacting 82 percent of cases during their isolation period and is reaching 80 percent of close contacts daily during their quarantine period. But both of those metrics have dropped from an 88 percent mark recorded last month.
Melnick said Public Health is hiring a new team of nurses to conduct case investigation. He also said Public Health has streamlined the questions nurses ask on their investigation calls, so they can move on to the next call more quickly.
Public Health was previously working through a backlog of cases, and contacting older cases first, then working its way to newer cases. Public Health will now be contacting newer cases first and working its way to older cases.
Clark County Councilor Gary Medvigy said he’s concerned about the problem areas, and wants to see improvements.
“I’m worried … especially with the number of cases we are now seeing, that ultimately, we are going to be chasing our tail, and will never be able to meet the standard that we hope to attain,” Medvigy said.
