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Home , November 20

Date: 20, 2020 To: Acting Mayor Austin Quinn-Davidson Thru: Heather Harris, Anchorage Health Department Director From: Janet Johnston, Anchorage Health Department Epidemiologist Subject: November 20, 2020, COVID-19 Risk Assessment Update for the Municipality of Anchorage This weekly report shares data available on the State of Alaska and Municipality of Anchorage (MOA) websites for the period of – , 2020, with some more recent data. This will be reviewed and discussed on November 20, 2020, at 10:30 a.m. Unless otherwise indicated, this data is for cases reported in the MOA.

Key Findings Municipality of Anchorage COVID-19 metric status for the past week: • RED LIGHT for epidemiology • YELLOW LIGHT for health care capacity • RED LIGHT for public health capacity The number of new cases continues to increase in Anchorage. A new peak was set on November 13th and 16th, with 491 new cases each day. The current 14-day rolling daily average of 109.72 cases per 100,000 population is the highest since the epidemic began, and 11 times the State's high alert level of 10 new cases per day per 100,000 population. The increase in the last week in average new cases was 30% over last week. Test positivity remains high at 11%.

Epidemiology These metrics consider case counts and COVID-19-related hospitalizations and deaths.

Case Count Trends and Deaths Key Findings: This measure is RED. New cases in Anchorage increased by 30 percent to 364 new cases per day on average during the last week. A new peak was set on November 13th and 16th, with 491 new cases each day. This exceeds the new peak from last week by 150 cases. • Cumulative cases. As of , there are 13,811 confirmed cases in the MOA. This includes 13,542 Anchorage residents in- and out-of-state and 269 nonresidents testing positive in Anchorage. • Deaths. There have been 62 deaths among Anchorage residents, an increase of four over last week’s report.

825 L Street, Anchorage, AK, 99501 | (907) 343-6718 | www.muni.org/health | @ancpublichealth

November 20, 2020 Report, Page 2 of 11

Table 1: Case Count Measures

November 5 - November 12 – Cases by Date Reported November 18 Change Notes

New cases in the last week 1,959 2,551 592

New non-resident cases Reason for visit unknown.

10 10 0

Average new cases per day, last 7 days 280 364 85 +30%

Average new cases per day SOA high alert level is per 100,000, last 14 days 10+; continues to 76.76 109.72 33 increase to new highs

Infectious Period – – (Previous 10 days) November 11 November 18 Change

Number of cases still Decrease due to change presumed to be infections in how SOA is estimating (New cases in last 10 days) onset date. Previously, if onset date was missing, it was approximated by report date. Now missing onset dates are approximated by 3268 1989 -1279 specimen collection date.

COVID/PUI Hospitalization Trends Key Findings: This measure is RED. Hospitalizations are at an all-time high and are increasing. The fewest hospitalizations in one day for the last week (69) exceeded the previous week’s high (65). With increasing case counts, particularly in older people, we remain concerned about increasing hospitalizations and the ensuing need for ICU beds. • Current hospitalizations. As of November 19, there were 78 hospitalized COVID-19 cases. The number of hospitalized cases ranged from a low of 69 to a high of 83 last week. As of November 19, there were 18 hospitalized Persons Under Investigation (PUI). The number of hospitalized PUIs ranged from 11 to 18. • Age risk. The age distribution of cases in the last three weeks has held relatively steady. People age 20 to 29 and 30 to 39, each comprise approximately 20% of the cases respectively, but only 16% of the population. People age 40 to 49 are also overrepresented in the case count with 14%

825 L Street, Anchorage, AK, 99501 | (907) 343-6718 | www.muni.org/health | @ancpublichealth November 20, 2020 Report, Page 3 of 11

of cases, but only 12% of the population. Table 2 shows the age distribution for new cases reported in the previous three weeks as well as for cumulative cases, hospitalizations, and deaths. Older age groups are overrepresented in hospitalizations and deaths since the start of the pandemic. • Risk by racial category. Table 3 shows the prevalence of COVID-19 cases, hospitalizations, and deaths by race. People of color, particularly Alaska Natives and Native Hawaiian/Other Pacific Islanders continue to be overrepresented in cases, hospitalizations, and deaths. In the last week, white people increased in their proportion of cases (45% compared to 30% the week before), but that proportion remains below their proportion of the population (62%). Alaska Natives decreased in their proportional number of COVID-19 cases in the last week (14% compared to 25% the week before) of all cases, compared to 24% and 25% the previous weeks. Race data is missing for a larger proportion of cases than for hospitalizations and deaths, due in part to our limited capacity to interview all cases. Cases that do not have race data available are excluded from this analysis.

Data Note: From the beginning of the pandemic, through 21, 2020, hospitals reported their data through the Alaska State Hospital and Nursing Home Association (ASHNHA) to the CDC. As of , 2020, hospitals report directly to the US Department of Health and Human Services (HHS) TeleTracking System using a template provided by HHS. With this change, ASHNA no longer provides hospital data; therefore, some of the current data not be directly comparable to previously reported data.

825 L Street, Anchorage, AK, 99501 | (907) 343-6718 | www.muni.org/health | @ancpublichealth

Table 2 Cases, Hospitalization, and Deaths by Age Category

825 L Street, Anchorage, AK, 99501 | (907) 343-6718 | www.muni.org/health | @ancpublichealth

November 20, 2020 Report, Page 5 of 11

Table 3 Cases, Hospitalization, and Deaths by Race Category

October 29 - - 11 November 12 - 18 All Cases Last Three Weeks Race Cases Percent Rate* Cases Percent Rate* Cases Percent Rate* Cases Percent Rate* American Indian or Alaska Native 196 24% 890 303 25% 1,376 234 14% 1,063 733 20% 3,328 Asian 42 5% 149 54 4% 191 104 6% 368 200 5% 707 Black or African American 38 5% 228 45 4% 270 83 5% 498 166 5% 995 Native Hawaiian or Other Pacific Islander 34 4% 557 41 3% 672 81 5% 1,327 156 4% 2,555 White 240 30% 132 393 32% 217 732 45% 403 1,365 37% 752 Other Race 154 19% 2,884 218 18% 4,082 231 14% 4,326 603 17% 11,292 Two or More Races 99 12% 313 172 14% 544 157 10% 496 428 12% 1,353 All Cases 803 100% 275 1,226 100% 421 1,622 100% 556 3,651 100% 1,252 * Per 100,000

All Cases, All Time Hospitalizations Deaths Anchorage Population Race Cases Percent Rate* Cases Percent Rate* Cases Percent Rate* Cases Percent Rate* American Indian or Alaska Native 2,141 23% 9,722 76 24% 345 14 25% 64 22,022 8% Asian 691 7% 2,444 27 8% 95 6 11% 21 28,273 10% Black or African American 521 6% 3,124 24 7% 144 4 7% 24 16,679 6% Native Hawaiian or Other Pacific Islander 602 6% 9,861 61 19% 999 9 16% 147 6,105 2% White 3,458 37% 1,905 97 30% 53 19 33% 10 181,491 62% Other Race 1,024 11% 19,176 19 6% 356 2 4% 37 5,340 2% Two or More Races 825 9% 2,608 19 6% 60 3 5% 9 31,628 11% All Cases 9,262 100% 3,177 323 1 111 57 100% 20 291,538 100% * Per 100,000 Anchorage population source: 2018 5-Year American Community Survey Estimates

825 L Street, Anchorage, AK, 99501 | (907) 343-6718 | www.muni.org/health | @ancpublichealth

Health Care Capacity These metrics measure our ability to provide hospital care in the case of a surge in people sick with COVID-19.

Ability and Capacity to Meet Anticipated Case Surge Key Findings: This measure is YELLOW. The number of available adult ICU beds decreased to 13 as of

November 19, which is ten fewer than last week. The transmission rate (Ro) has reached 1.2 in Anchorage, according to the COVID ActNow model. Overall, the health care system's ability is sufficient to meet the current demand in hospitalizations; however, increasing case counts and a reproductive rate of 1.2 keep us in a watchful and guarded position. As of November 19, 14.2% of people hospitalized in Anchorage are COVID-19 positive. • ICU beds. As of November 19, there were 13 available adult ICU beds out of 74 total staffed adult ICU beds. Available adult ICU beds during the past week ranged from a low of eleven to a high of 27. The number of possible staffed adult ICU beds ranged from a low of 66 to a high of 79. • Non-ICU beds. As of November 19, there were 83 available adult non-ICU beds out of 514 total staffed adult non-ICU beds. • Ventilators. As of November 19, there were 12 COVID-19 patients on ventilators in Anchorage, twice that of last week. • Hospital Impact: As of November 19, 14.2% of all COVID-19 hospitalizations and 18.3% of Emergency Department visits at the three acute care hospitals in Anchorage were related to COVID-19. • Reproductive number estimates. See Table 4 below. These data were pulled on November 19. These numbers are reported using a seven-day lag to be consistent with COVID ActNow’s policy of reporting the most recent seven days as preliminary due to fluctuations in data for several days after reporting from states. • Projected cases. Projected daily new cases with no mitigation measures and the estimated doubling time for new daily COVID-19 cases per day in Anchorage with no mitigation measures are based on models reported on the State of Alaska COVID-19 Data Hub. These measures are not currently available because the model is undergoing revision. We expect to resume reporting these measures next week. • CDC COVID-19 Surge model: Using current case and hospitalization data for Anchorage and the most recent transmission estimate, the CDC COVID-19 Surge model predicts that Anchorage hospitals could exceed demand for available staffed adult ICU beds by the beginning of next year. If transmission increases just slightly (from Ro = 1.2 to Ro = 1.3), demand for adult in- patient (non-ICU) beds could exceed demand by late .

825 L Street, Anchorage, AK, 99501 | (907) 343-6718 | www.muni.org/health | @ancpublichealth

November 20, 2020 Report, Page 7 of 11

Table 4: Reproductive Number Estimates

Nov 4 (from last Nov 4 (updated Geography, Source week’s report) since last week) November 11

Anchorage, COVID ActNow 1.18 1.20 1.22

Anchorage, SOA model (in-state residents only) 1.12 not available not available

Alaska, COVID ActNow 1.15 1.15 1.15

Alaska, SOA model (in-state residents only) 1.09 not available not available

Testing Activity Key Findings: This measure is RED. This measure remains above 11% for tests conducted as of November 12 and may be stabilizing at this higher level. Test positivity has been consistently above 7.0% since 28 and above 10% since . This measure reports a seven-day average of tests through November 12, 2020. The State reports test results according to the date when the sample was collected. Therefore, testing numbers for the more recent days are low and increase over time until all test results have been reported. We are changing the time lag for reporting test positivity from four days to seven days to allow for inclusion of more test results, which will provide a more stable estimate.

Table 5: Percent Positive Measure

November 5 November 12 November 9 Indicator (One week prior to (Current Benchmark (Last week's report) current estimate) estimate)

Percent 11.38% 7.96% 11.00% <5%: GREEN positive 5%-10%: YELLOW >10%: RED

Ability and Capacity to Test Widely Key Findings: This measure is YELLOW. Test volumes appear to have recovered from the lower volumes that we saw in early September. However, as both daily case counts and percent positivity increase, we need to watch the test volume. Test turnaround times increased for the Alaska State Public Health Lab (ASPHL) to 3.2 days and while turnaround times for commercial labs and facility labs have decreased to 1.0 days or lower.

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Each week's average daily counts are calculated using a five-day lag to allow for sample processing time. Because some tests take more than five days to process, the average daily counts for more recent weeks will increase as more test results are received.

Table 6: Average Daily Test Count Measures

White House Target Average Daily Tests - 31 - 7 - 14 (>2,000 per 100,000 population per week)

Per Total Population >814 27,770 26,507 23,249

Per 100,000 3,967 3,787 3,321 >285

Table 7: Average Turnaround Time Measures

Lab November 12, 2020 November 19, 2020 Change

Commercial 1.5 0.8 decrease

Alaska State Public Health Lab 2.2 3.2 increase

Facility 1.2 1.0 decrease

Personal Protective Equipment Availability Key Findings: This measure remains YELLOW. The supply chain remains disrupted, with a relatively small number of providers requiring PPE from the EOC. The EOC encourages providers to stay in contact with their normal PPE suppliers as more items become available through the normal supply chain. This light will turn green when supply chain access to PPE returns to normal. • Access to PPE. Most health care and first responders can achieve sufficient PPE, but not through normal channels. • Requests. The EOC continues to receive and fill requests from health care providers within the Municipality. The EOC issued 7,871 PPE items to nine agencies during the week ending , 2020. This is similar to the 8,774 PPE items issued the week before and but less than the average of 10,786 PPE items issued per week since the start of the pandemic. The items most in demand this week were masks, including non-medical grade, N95, and surgical.

825 L Street, Anchorage, AK, 99501 | (907) 343-6718 | www.muni.org/health | @ancpublichealth November 20, 2020 Report, Page 9 of 11

Public Health Capacity These metrics measure AHD’s capacity to track and follow the positive cases and their contacts, ensuring as many people as possible self-isolate or quarantine depending on the situation, and testing symptomatic contacts. AHD is fully transitioned to using the CommCare system for case interviews and contact tracing.

Track and Follow New Cases and Contacts Key Findings: This measure is RED. With increasing case counts, the capacity to interview cases promptly and monitor high-risk contacts continues to be stretched thin. • Positive case outreach. The MOA Public Health Professional’s goal is to interview or leave a message for each new case within 24 hours of receiving the case assignment. However, with increasing cases and processing times, many cases are being closed without an interview because they cannot be reached before the end of their infectious period. • Interview completion. Of the 2,090 Anchorage cases opened in CommCare between November 11 and , 1127 (53.9%) have completed an interview. Most interviews (82.8%) were completed within one day of the case being opened in CommCare, and another 10.6% were completed within two days. The remaining 74 cases were completed between three and seven days after the case was opened. • New contacts. There were 150 contacts newly registered into CommCare between November 11 and November 17 who were still awaiting investigation as of the close of business on November 19.

Transmission Trends This section summarizes trends in infection and transmission found in CommCare or through feedback from the AHD COVID-19 response team. • Exposure source. We continue to see cases in congregate residential settings and among employees at a variety of businesses. The most commonly reported exposure types are household, employment, and social events. Of the 2,090 cases opened in CommCare between November 11 and November 17, 950 (45.5%) provided information about occupation, as shown in Table 8. Given the high level of community spread, this does not mean that these cases acquired COVID-19 at work. With the large number of cases in the community and limited capacity for conducting case interviews, it is difficult to identify where exactly transmission is occurring.

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Table 8: Occupation Among Interviewed Cases

Occupation Count Percent Child Care 11 1.2% City 7 0.7% Correctional Worker 1 0.1% Food Service 31 3.3% Health Care Worker 103 10.8% Other 446 46.9% Retired 92 9.7% Self Employed 29 3.1% Student 104 10.9% Unemployed 126 13.3% Total 950 100.0%

• At-risk populations. We continue to see sporadic cases associated with the outbreak within homeless shelters, supportive housing locations in proximity to shelters, and unsheltered homeless individuals. As of Thursday, November 17, 2020, 341 cases have been identified within this population. Eight of these cases were identified in the past ten days and are therefore considered infectious. Twenty-two cases have been hospitalized since the beginning of the outbreak, and three have died. This outbreak began approximately three months ago. Reinfection with COVID-19, while infrequent, has been known to occur. Infections that occur more than 90 days after the original infection are considered new infections, requiring a new isolation period.

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Public Health Advisory To prevent unneeded serious illness and deaths, AHD urges everyone to do the following: • Stay home except to get food, to go to work, or to recreate outdoors. o Where possible, use delivery options and work from home. o Trails and parks are ideal for exercise while distanced from others. • If you feel sick, stay home except to get tested. • Wear a mask and stay at least 6 feet from others in public. o Masks are recommended for anyone over the age of two. o Masks are recommended during all indoor exercise or sports. • Protect your friends and family by avoiding gatherings, especially indoors. Gatherings are not safe. o Incorporate CDC holiday gathering recommendations into your planning. o Reconsider any travel plans for the upcoming holiday season. • Protect the vulnerable by avoiding contact with those at higher risk of severe illness, such as older adults or those with certain medical conditions. o Check-in on older and medically fragile family members and ensure they can get food and other essentials without leaving the house. o If you work among older or medically fragile individuals, keep your number of contacts small and get tested regularly. o Stores are encouraged to add more curbside pick-up options or special hours for older and medically fragile patrons.

Policy Recommendations • Emergency Orders (EO). AHD is supportive of the administration’s actions to implement EO 13 v3, strengthening and clarifying the mask requirements, and EO 14 v3, reducing gathering limitation sizes and minimizing exceptions. Given test turnaround time and delays in case entry, it is still too soon to tell from the case counts whether these measures are helping to decrease transmission within the community. If we do not see a reduction in infection rates, more restrictive measures may be required to protect health care capacity and staffing for first responders and other critical infrastructure positions.

825 L Street, Anchorage, AK, 99501 | (907) 343-6718 | www.muni.org/health | @ancpublichealth