Ohio’s case spike can’t be explained away by increased testing, data shows

Updated: Jun. 25, 2020 at 5:06 PM EDT
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CINCINNATI (FOX19) - Ohio’s COVID-19 case numbers are surging, with 858 new lab-confirmed cases reported Thursday.

That represents a marked increase from the state’s 21-day reporting average of 494 new daily cases, which itself is also steadily climbing.

Relying on newly reported cases alone, though, can paint an incomplete picture of the pandemic. Case numbers are a function of tests performed, as some number of carriers are asymptomatic, are pre-symptomatic or have very mild symptoms.

More testing does not always lead to more cases, and more cases can’t always be attributed to more testing, but the relationship between the two — between tests performed and tests returned positive — is perhaps the most important measure of how well a state is faring.

This is called the positivity rate. Ohio’s Department of Health began reporting its positivity rate this week, but the data is several days behind.

Johns Hopkins University reports 7-day positivity rate averages for U.S. states (link). Its reports are up-to-date and published several times daily:

“The rate of positivity is an important indicator because it can provide insights into whether a community is conducting enough testing to find cases. If a community’s positivity is high, it suggests that that community may largely be testing the sickest patients and possibly missing milder or asymptomatic cases. A lower positivity may indicate that a community is including in its testing patients with milder or no symptoms. The WHO has said that in countries that have conducted extensive testing for COVID-19, should remain at 5% or lower for at least 14 days.”

Ohio’s Thursday report of 858 lab-confirmed cases comes as the Health Department reports 15,513 new tests. That puts Thursday’s positivity rate — positive tests as a percentage of total tests — at 5.5 percent.

It’s still a spike, and it falls above the WHO’s recommended threshold, but it’s not quite as large a spike as raw case numbers suggest.

Thursday’s report of 858 new cases is 75 percent higher than Ohio’s 21-day average of 494, but Thursday’s positivity rate of 5.5 percent is just 22 percent higher than the state’s 7-day positivity rate average of 4.5 percent.

As for Ohio’s neighbors, Kentucky’s 7-day positivity rate average stands at 3 percent and Indiana’s stands at 3.5 percent.

Meanwhile, the U.S.‘s 7-day average is currently 5.9 percent, and Arizona’s 7-day average comes in at 23 percent, the highest in the country.

So, Ohio seems to be faring comparatively well.

But it might not last. Ohio’s positivity rate, like its 21-day case number averages, is beginning to creep up, according to Johns Hopkins.

After more than two weeks spent hovering around 3.5 percent, Ohio’s positivity rate average has risen one percent in just six days, a 28 percent increase.

Gov. Mike DeWine said in his Thursday press briefing experts do not yet know the cause of the increase, whether it’s the result of more testing in congregate facilities like nursing homes and prisons or more community-spread cases of the virus — or some combination of both.

But DeWine did rule out ascribing the increase wholly to an increase in raw tests performed.

Even more sobering are Ohio’s hospitalization numbers, which creeped above 600 for the first time in two weeks.

A concurrent rise in hospitalizations and case numbers such as that would seem to support DeWine’s claim that rising case numbers aren’t just due to rising testing numbers, as a hospitalization implies a symptomatic case.

Ohio's hospitalizations number is above 600 for the first time in weeks.
Ohio's hospitalizations number is above 600 for the first time in weeks.(Ohio Department of Health)

ICU visits and deaths in Ohio remain steady, but they also naturally lag hospital admission dates, as admission dates lag testing dates, meaning a case spike in late June might not show up as a death spike until early July.

DeWine has said several times this week that Greater Cincinnati’s case numbers are cause for concern. Thursday he teleconferenced with Richard Lofgren, MD, President and CEO of UC Health, to give some idea of what’s happening on the ground here.

Lofgren reported the positivity rate among those aged 20-30 is 14 percent, while the rate among those aged 60-70 stands at 5 percent.

Many of the younger group are asymptomatic or have mild symptoms, Lofgren said, perhaps contributing to an attitude among them that the pandemic is no longer serious. The concern, he explained, is widespread transmission among that age group leading to infection of other vulnerable populations.

Lofgren also reported hospitalizations and ICU admissions are up in the region over the last 10 days.

Lastly, he put the region’s reproduction rate (how many other people are infected by one confirmed positive case) at 1.49, a figure that indicates the virus is actively spreading and, according to Johns Hopkins, places the region at risk of a critical outbreak.

The region’s reproduction rate has doubled over the last 10 days.

Lofgren explained the increase in cases is not only due to the tests being performed, but shows there is a greater presence of COVID-19 in the area, and that it is spreading in the community.

He also said it serves as a reminder about the importance of wearing a mask in public, washing your hands, sanitizing frequently touched surfaces and keeping social distance.

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