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From The Print Last Week

New cases of COVID-19 are rising in Greene County, Gov. Mike DeWine said at his June 18 press briefing. He highlighted Greene County as one of five southwest Ohio counties that have seen case increases in June. The graph above shows an approximately four-fold rise in new cases from the end of May to early June, based on seven-day case averages in Greene County. Cases continue to rise past the dates on the chart. (Chart from Ohio Department of Health)

COVID-19 update— ‘Worrisome’ trend? More new cases

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NOTE: This story originally ran in the June 25 issue of the News. Since the story appeared in print, new cases of COVID-19 have continued to climb across Ohio, with Hamilton and Montgomery counties among the areas of top concern. Gov. Mike DeWine has addressed rising cases in Ohio in recent press briefings. A new “public health advisory system” was announced on July 2 to help individuals and communities assess the level of risk in their area. Greene County is currently at level 2 of a 4-level system, indicating “increased exposure and spread.” The News will continue to report regularly on COVID-19 developments affecting our area.

COVID-19 cases are on the rise in Greene County. Since early June, the county has seen at least a fourfold increase in new cases of the virus. Numbers remain relatively low, but Greene County is now seeing, on average, about four new cases each day, rather than around one, as was true through much of April and May, according to state data presented at Gov. Mike DeWine’s press briefing last Thursday, June 18.

At that briefing, DeWine identified Greene County as one of five southwest Ohio counties whose COVID-19 cases are rising as cases statewide are trending downward. The other counties are Montgomery, Clark, Warren and Hamilton. DeWine called the trend troubling.

“The trendlines that we’re seeing in these five counties are worrisome,” he said.

For each of the five counties, DeWine singled out specific zip codes that have had the highest number of cumulative cases — both probable and confirmed. In Greene County, the identified zip codes are 45324 and 45385, which correspond to Fairborn and Xenia.

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Fairborn has had 47 cases since the start of the pandemic, and Xenia has had 21, a map prepared by the state shows. By contrast, Yellow Springs’ zip code, 45387, has had five cases, which include two confirmed and three probable cases.

Greene County Public Health, or GCPH, previously had noted the countywide rise, though without highlighting specific locations. In a press release issued June 12, local health officials acknowledged an overall case increase, and offered a brief explanation.

“The increased number of cases is a reflection of increased testing and people getting out to enjoy places where restrictions have been eased. The increase in hospitalizations may indicate an upward trend,” GCPH Medical Director Kevin Sharrett is quoted as saying.

At that time, Greene County had 129 total cases, with 20 hospitalizations and six deaths. As of June 22, the county figures had risen to 175 total cases, 28 hospitalizations and eight deaths. The county population is around 169,000, so those cases represent about 0.1% of county residents. Clark County’s per capita case rate, by contrast, is around 0.5%.

Following DeWine’s June 18 briefing, county health officials from the five counties identified by DeWine held their own press conference. Greene County’s deputy health commissioner, Noah Stuby, acknowledged the case increase, but emphasized that the county had a handle on the new cases.

“Our focus continues to be on case identification, contact tracing and distributing PPEs,” he said.

Greene County at that time had 58 active cases, with 44 new cases since June 1. According to Stuby, county residents who had tested positive for COVID-19 were being monitored by the county health department and were self-isolating at home to avoid infecting others.

“Those persons that are currently positive cases are no threat to the community. They’re isolated, they’re not out,” he said.

The News this week sought greater clarity and context about the case rise in Greene County. We interviewed Greene County Health Commissioner Melissa Howell about the increase, including case counts in the identified zip codes and the modest number of cases in Yellow Springs.

Is the county seeing a spike? Are the cases concentrated in certain communities, as has been reported in recent days? What other information do county residents need to know?

Context for county case rise

In response to these and other questions, Howell confirmed that the county has been seeing a case rise. But she cautioned local residents not to draw conclusions that the county was less safe as a result, and she denied that the municipalities singled out by DeWine were areas of greater concern.

Howell said Greene County health officials began noticing a case increase during the first week in June. That led to the June 12 press release. The rising numbers are likely due to a combination of increased testing, community spread and transmission within families, according to Howell.

“By and large our cases get classified as community spread,” she said.

Community spread means that health authorities aren’t able to identify a place or point in time that led to the infection. This is in contrast to outbreaks associated with specific settings such as workplaces, nursing homes or medical centers, as has been seen in neighboring Clark County. For example, about 300 workers at the Dole vegetable plant in Springfield have tested positive for COVID-19, making the factory one of the hotspots in the area.

Greene County has not seen a group of cases tied to a single workplace, according to Howell. And its congregate living facilities have so far avoided outbreaks. The county’s 21 nursing homes have reported a total of eight staff cases and one resident case, according to the latest state data. The county jail has not reported any cases among inmates.

One location that has seen multiple cases is Gates of Praise Church in Fairborn. A worship service on May 31 led to multiple members of the congregation testing positive for the virus. At least 14 cases in Greene County are associated with that worship service, according to Don Brannen, GCPH epidemiologist, in response to a News question this week.

Howell declined to describe the church as a “hotspot,” however. While cases occurred there, it is “improper to characterize the church as the source of an outbreak” pending a full epidemiological investigation, she said.

Nationwide, churches have emerged as having clusters of cases, national media has reported in recent days.

Family transmission is another factor in the recent case rise, according to Howell. Spread within families accounts for as much as 30% of new cases in Xenia and Fairborn, she added. Families should continue to be cautious about adding extended family to their inner group, and if an individual family member gets sick, that person should isolate away from other family members, Howell advised.

Expanded testing also accounts for some of the recent case rise countywide. Initial state restrictions on testing began to loosen here in late May, with a further loosening after June 11, when DeWine announced that anyone in the state who wanted a test would be able to get one. Since then, many more people with and without symptoms have gotten tests at testing locations throughout the county, Howell said.

Related to the identified case rise, DeWine announced a free pop-up testing site in Xenia June 24, aided by members of the Ohio National Guard. Other free pop-up sites are being set up across the state.

Yet if expanded testing plays a role in case increases, health officials don’t know how big a role. GCPH doesn’t know how many tests are performed in Greene County, as the health department only receives reports of positive cases, not negative results, according to Howell. And in response to a question from the News, Ohio Department of Health spokesperson Melanie Amato said the state doesn’t track testing on a county level.

“ODH does not know how many tests have been performed in Greene County since the start of the pandemic. We don’t break down all tests done by county level,” she wrote in an email.

Without knowing overall testing numbers, it’s also impossible to know the county’s “positivity” rate, which refers to the percent of COVID-19 tests that come back positive. Positivity rates help health officials determine if “enough” tests are being performed, and where to channel resources, Howell said.

“It’s one of our frustrations that we don’t know how many people are tested, and we don’t know our own positivity rate,” she said.

Testing has expanded in Ohio overall, though not as rapidly as the state projected. According to a recent article in the Cleveland Plain Dealer, however, Ohio is currently at a positivity rate of 3.5%, in line with the WHO’s recommended rate of less than 5%. That implies that testing in the state is adequate to identify and contain the spread of the virus.

Situation in specific communities

DeWine identified Xenia and Fairborn as communities of particular concern within Greene County based on case numbers. But Howell believes that the singling out of these municipalities is misleading.

“It was a surprise to us that those two were singled out,” she said, adding that her office had not received word of the presentation prior to the governor’s briefing.

In her view, the county as a whole is seeing an increase, with the rise not concentrated in any particular area.

“We don’t necessarily see it in those zip codes,” she said.

While it’s true that Xenia and Fairborn have greater numbers of cases, those zip codes are also population centers within the county, she pointed out. In addition, Beavercreek, which is spread among four zip codes on the governor’s map, could arguably also be a location of concern if the zip codes were grouped together, Howell said.

Based on a 2019 population estimate for the Fairborn zip code, the case rate is 0.1%, comparable to Greene County as a whole. The case rate for Xenia is actually under 0.1%, again based on a 2019 population estimate for that zip code.

As a point of reference, the five cases in the 45387 zip code, which includes areas beyond Yellow Springs, represents a per capita rate of just under 0.1%.

Based on that per capita analysis, the differences among various communities seem slight.

Howell said she “feels bad” for the communities singled out by the governor.

“When you put a zip code out like that it implies there is a threat in the community. But that’s not necessarily true,” she said.

People in those areas are not out in public spreading cases, she argued. They’re self-isolating and being monitored by local health authorities.

“People self-isolate; they don’t want to spread it. We’re in contact with them twice a day, so we know they’re home,” she explained.

And Howell emphasized that where businesses and residents were following precautions, people are not getting sick. She singled out Yellow Springs for praise. Echoing an email she wrote in response to questions from Village Manager Josué Salmerón on June 12, Howell said Yellow Springs has seen two confirmed cases and three probable cases since the start of the pandemic in March. Probable cases are those determined by positive antibody tests, which indicate that a person previously had the virus, or cases in which a person has symptoms and a known exposure to the virus, but hasn’t been tested, according to a definition from epidemiologist Brannen.

Importantly, there have been no confirmed cases since May 9 in Yellow Springs, an outcome Howell attributed in part to villagers’ compliance with masking and social distancing.

“The health district doesn’t mandate the use of masks but this success story in Yellow Springs is one example to support our recommendation to mask,” she wrote to Salmerón.

The News asked Howell about widespread anecdotal observations that while many residents are masking, far fewer visitors to the village appear to be doing so. Howell emphasized that despite these observations, Yellow Springs has not seen a COVID-19 case in well over a month.

In Howell’s view, the county overall is seeing a “manageable bump,” not a spike. She believes area hospitals and county contact tracers are prepared to handle new cases, and she encourages people to continue to social distance, wear cloth masks, avoid large gatherings and stay home if they feel sick. Local residents shouldn’t panic, however.

“People aren’t in jeopardy” as a result of the new cases, she said.

Broader trends

The same day DeWine identified case increases in Greene and other southwest Ohio counties, Ohio’s overall daily case count rose from a 21-day average of 438 to 700 new cases over the prior 24 hours. The governor noted the uptick in passing, emphasizing that other indicators were flat or down.

But the next day’s case number was also well above the 21-day average, as was Monday’s count. In fact, these three days, not including the weekend, were among the highest series of daily case rises Ohio has seen. As of Tuesday, June 23, there were over 46,000 confirmed and probable cases in the state.

It’s probably too early to tell what the statewide case rises mean. Experts around the country have singled out Ohio for its successful handling of the COVID-19 crisis, according to a recent report in the Cleveland Plain Dealer.

The state “may have potentially truly flattened the curve and changed the trajectory of cases in Ohio, versus some of the states in the south who were late to shut down and then early to reopen,” one expert, Dr. Tom Tsai of Harvard T.H. Chan School of Public Health, is quoted as saying.

By contrast, new cases are surging in 22 states nationwide, primarily in the West and South, following last month’s reopenings, according to the New York Times. Missouri and Oklahoma reported their largest single-day increases yet on Sunday, the Times reported.

The local increases are modest by these lights. Still, DeWine last Thursday sounded a note of caution about the wider significance of regional trends. The rise of COVID-19 cases in southwest Ohio, he said, is a “stark reminder that the virus is very much still with us.”

Read the June 18 web post covering DeWine’s briefing regarding the Greene County and southwest Ohio case increases.

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