Date: November 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 November 12 – November 18, 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 November 19, 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 11 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 November 2 – November 9 – (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 September 21, 2020, hospitals reported their data through the Alaska State Hospital and Nursing Home Association (ASHNHA) to the CDC. As of September 22, 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 may 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 - November 4 November 5 - 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.