Increasing coronavirus infections in health care workers could stall Idaho’s reopening
Idaho has plowed through Gov. Brad Little’s coronavirus reopening plan on schedule since Stage 1 began May 1.
That might end at noon Thursday when Little holds a press conference that will air on Idaho Public Television.
Stage 4 — the final stage — is scheduled to end Friday, but there are signs that Idaho might not meet the criteria to advance out of the Idaho Rebounds plan and into whatever plan comes next.
Idaho seems likely to fall short on one of the state’s six criteria for advancement through the stages of Idaho Rebounds, and another one likely will be a close call. The state is expected to meet the other four criteria.
“We just barely made it over our criteria last time, and things aren’t great right now,” Little said Wednesday on an AARP telephone town hall, according to Idaho Education News.
According to the Idaho Rebounds plan, all criteria must be met to advance. If Idaho falls short, Little could extend Stage 4 — joining neighbor states Nevada, Oregon and Utah in pausing reopening. Many of the coronavirus-related restrictions were eased by Stage 4 but it still required physical distancing for large events and recommended against events that draw people from other communities with “substantial community spread.”
“If the criteria indicates trends are beginning to move the wrong direction, or there is evidence that a stage has adversely impacted rates, stages may have to be extended or reversed,” the Rebounds plan says.
Already, Central District Health has moved Ada County back to Stage 3 to address an outbreak that has brought record COVID-19 case counts to the Boise area — 464 confirmed cases in nine days. That change took effect Wednesday, closing bars and nightclubs, and limiting gatherings to 50 people.
But it’s not just Ada County that’s seeing an uptick.
All other counties reported 76 new confirmed cases Tuesday, 83 Monday (includes Sunday), 49 Saturday, 65 Friday and 51 Thursday — an average of 54 per day.
The entire state was averaging just 21 cases per day the first two weeks of May, when the Rebounds plan began.
Health care workers hold the key
Idaho barely made it out of Stage 3 because of this metric, and it’s the most significant danger to exiting Stage 4.
The Rebounds plan requires that Idaho have fewer than two health care workers per day reported as COVID-19 positive over the 14-day evaluation period leading to a decision, or that there’s a downward trend in reported cases among health care workers.
Idaho added 79 health care workers with COVID-19 to its database from June 10 through June 23, the 14 days immediately following the Stage 3 evaluation window. That’s 5.6 per day.
It’s likely that the Idaho Department of Health and Welfare won’t count all of those, though. During the last 14-day window, IDHW added 48 health care workers to its database but only 28 were included in those 14 days. It’s unclear why — but it’s possible the others were backdated to prior dates.
Still, it seems certain that the per-day average during Stage 4 will be more than two per day. That leaves the question of whether there’s a downward trend, which is based on the daily number added for each of the 14 days. Those numbers aren’t publicly available. However, since IDHW added 11 to its total Tuesday, 10 on Monday and nine on Saturday (it doesn’t report on Sundays), a downward trends seems unlikely.
At the end of Stage 3, IDHW reported exactly two COVID-19-positive health care workers per day, but the state advanced because of a downward trend. That was created when the state didn’t report any ill health care workers two of the last three days.
What about rising case counts?
The criteria give Idaho a get-out-of-stage-free card that trumps rising case counts: positive testing percentage.
As long as the positive testing percentage is below 5% during the 14-day evaluation window, or the daily positive percentage trends downward, Idaho can advance regardless of even-soaring case counts.
So even though Idaho’s average daily confirmed and probable cases has spiked from 36.5 during Stage 3 to 85.9 during Stage 4, this part of the criteria might be met.
However, IDHW doesn’t post positive percentage on a daily basis — so it’s unknown what that percentage is until the gating criteria is released in conjunction with Little’s decision. On the state’s data dashboard, positive testing percentage is reported by week on Thursdays — making that data always at least five days behind. And the most recent week usually doesn’t have complete data.
Idaho has been below 5% for each of the past 10 reported weeks, so it seems unlikely that will change for Stage 4.
Idaho does report its total number of tests completed since the start of the pandemic each day, but IDHW has described that number as “raw” and indicated that it isn’t an accurate way to determine positivity percentage. If you used that number, Idaho reported 18,630 tests and 1,049 confirmed cases during the 14-day window — for a positive percentage of 5.6%. And the trend in that number has definitely been upward.
But calculations with the daily tests number have consistently produced a higher positivity percentage than the “verified” percentages the state puts out.
What about the other criteria?
Idaho has performed well against the criteria for COVID-19-like illnesses reported at hospital emergency departments throughout Idaho Rebounds, maintained sufficient health care capacity and equipment, and avoided the need for a crisis standards of care order from Little.
Emergency departments reported 10.9 ER visits per day with COVID-19-like symptoms and 1.14 emergency admits per day with those symptoms during Stage 4, well below the thresholds of 20 and two.
This story was originally published June 24, 2020 at 4:29 PM.
