I think in Excel sheets. For whatever reasons of neural wiring, my mind doesn’t mind a floor covered with litter, but I can’t understand something until I can put it in a spreadsheet. Rather than fighting this strangeness, I’ve learned to embrace it 😉
And so I’ve been following the rise of cases in the novel coronavirus / COVID-19. Like many people, I tried to take a crash course in all things exponential. It is helpful to remember that a little information can sometimes be more dangerous than none. As Yogi Berra said, “It’s tough to make predictions, especially about the future.”
So, humility is in order. Experts and officials continue to be surprised by the unfolding of events. We are dealing with an ecological-viral-social-economic storm of global proportions. But all this is not to say that we know nothing. We have no choice but to lay the facts bare, discern the best path forward, consider our values, and act (then repeat).
Statewide, things have been slowly improving. New cases have been slowly declining, and medical infrastructure has not been overwhelmed. We are one of 18 states who are still not testing enough people, but our positivity rate (the % of tests that come back positive) has been steadily declining. If this gets too high, we risk not tracking how fast the virus is truly spreading through the community. For Indiana stands at 6.3%, just above the World Health Organization goal of <5%.
Hard to say it like this, but for a state that consistently ranks near the bottom of the U.S. for most environmental and health metrics, it could be worse.
As you’ve probably read, the virus is hitting non-white and Hispanic/Latino populations in Indiana harder (and nationally). Black Hoosiers represent 10% of the population, but 13% of the cases; for Hispanic/Latino Hoosiers it is 7% and 12%, respectively.
There is so much that could be said about this, especially in light of the last few weeks, but all I can do today is mourn.
So, what about Marshall County and District 2 (Marshall + the surrounding 6 counties)? From Indiana’s experience with HIV, there remains concern that rural communities are vulnerable to public health threats.
Unfortunately, the trends are in the opposite direction as the state.
Note that there are two different Y-axis, necessarily so you can see the relative movement of the two variables: total tests vs. daily new cases (positive tests). Dividing the later into the former, you compute the positivity rate. We need to do this because it is not just enough to know that there are more official cases; that could be explained by increased testing. “A high positivity rate can be a sign that a state is only testing its sickest patients and failing to cast a net wide enough to accurately capture community transmission, according to Johns Hopkins University.” That appears to be the situation we are in.
The population centers of St. Joseph and Elkhart comprise the bulk of this 7-county area. The common explanation is that factories have been reopening and bringing more people together. The availability and use of personal protective equipment (PPE) is… spotty. I know from second-hand accounts that people are being asked to perform unsafe work, and they don’t have the economic or political clout to push back.
What about Marshall County? Unfortunately, the numbers appear even worse.
Testing had increased through the end of May. The big surge in cases came from June 3rd, when 31 new cases were logged. The positivity rate has jumped to alarming levels during the last few 7-day-averages (confirmed also by this county-by-county snapshot by the New York Times)
For reference, our positivity rate is over 3 times higher than the state and 4 times higher than the WHO guideline. The state with the highest positivity rate currently is Arizona at 14%.
Those are the best data we have available to us. It suggests that the risk locally is higher than it has been yet, and we would need to increase testing in order to capture the extent of the spread.
Remember also that in late April, we found through a randomized study that the true rate of infection in Indiana was 11 times the official count. That multiple is too old to be relevant now, but we will see more updated results from Phase 2 of the study in a few weeks.
According to ISDH, we have three testing sites in the county: a corporate contractor (OptumServe) at Menominee Elementary (Plymouth) who is contracted with the State of Indiana; a site run by Saint Joseph Health System at the Lifeplex (Plymouth); and the Bremen Hospital.
I have been staying in touch with local Latino/a leaders around the issue of COVID-19. I hesitate to comment on the issue, because I have been hearing anti-immigrant and racist comments regarding disease transmission in non-white populations (U.S. history shows that this attitude has always been thus). But the truth is that our Hispanic neighbors are getting hit harder than the rest. Anecdotally, at one testing site a worker told me recently that around 75% of those getting tested were Latino/a.
Frustratingly, OptumServe did not have translation services at the testing center. When I visited the site, I found no posted information translated into Spanish. As you might expect, every additional point of friction in the provision of healthcare adds confusion and decreases health outcomes. There are some truly great community members who are trying to fill these gaps, translating documents on the fly and accompanying people to test sites.
Additionally, we’ve seen that test results are getting delayed because of lack of in-state lab capacity. This further hampers the ability of individuals to quarantine, contact trace, and reduce the spread. The contractors were from out of state and from my experience did not appear to be coordinating well with the local community. On the plus side, the site was open 12 hours a day, 5 days a week, critical for those who don’t have the privilege of flexible work arrangements. Scheduling was done easily online, in English and Spanish.
Given the increasing positivity rate, I decided today to go get tested. I was not knowingly in contact with anyone who tested positive; I’ve worn masks indoors, tried to maintain physical distancing, etc. But I have been running some errands and meeting with people (almost always outside).
The testing process was fast, efficient, and with some very strict safety protocols on-site. Unfortunately, I learned that today was the last day of testing and that the site would be demobilized. The contract with the State of Indiana is up. Right as we are seeing a surge in the positivity rate, this site is being shut down. Maybe there is some greater plan that I’m not aware of, but this gives me great concern for our situation locally.
There is a headline today – “Indiana Aims To Double COVID-19 Testing Capacity Through New Lab Network” – that requires a closer look. If I’m understanding it correction, this is referencing lab capacity (which could help turn-around times) but not testing sites that actually administer tests. Reading further, it appears this won’t be operational until early July at the earliest.
The coronavirus pandemic has again underscored the importance of local resiliency, a topic of frequent interested by our co-conspirators over at AIRE. Some state and federal systems are simply not responding to the needs of the time. Local leaders often have to work on a shoestring, bootstrapping and improvising. Sadly, local public servants are even becoming targets of enraged citizens. So those playing official (and unofficial) roles in serving the public should have all our support in this time.
So… what will be affecting local spread? Distancing, masks, and social activity.
The evidence keeps accumulating that masks work to reduce the spread (including this recent study from Germany). However, masks are not mandated locally or statewide, and anecdotally we are seeing much less mask wearing in Marshall County than we did weeks ago when the risk was lower. As I’ve talked with folks in town, I get the sense that people have become so worn down that we’ve just given up trying, having accepted that increased spread will be the price we have to pay.
Cancellations of events and programs continue as we move through summer. No 4-H fair, no public pool or summer programs. However, the State of Indiana is today (two days early) moving into Stage 4 of the “Back on Track” reopening, pushing forward toward the full re-opening on July 4th. Gatherings of 250 people are permitted, and retail shops have no restrictions.
To conclude, I will try to strip away opinions or predictions and look directly at our situation locally, based on the best available information:
*the prevalence of virus locally has been increasing and is higher than is has been so far; it is also increasing regionally
*the virus is disproportionately hitting people of color, locally, statewide, and nationally
*masks reduce the spread, but are being worn less
*we will lose a testing site after today (and probably testing capability, unless other sites scale up), as well as reduced hours
*the State of Indiana is moving to stage 4 of re-opening today; all things equal, increased interactions increase the opportunities for spread
Hoping everyone can find time to get outside, enjoy the sunshine and cool temps, birdsong and wildflowers. Stay safe and take care of each other.
I’ll end the post and head into the weekend with the only way I know how: photos of things lively and crawling. First, of my friend Michael, who helped catch a swarm of bees that landed on my grapevine. If it turns out that we successfully captured the queen, we’ll have a new hive.
Second, of an Ichneumonid wasp, a parasitic wasp with a big long wood drill on her rear end. She landed on this cut wood stump within 2 minutes after I struck it with an axe. Somehow she located an insect larva deep inside the wood, drilled in, and laid an egg on that larva. Smarter than me! (Don’t fear, it can’t physically sting you).
Thank you for educating us, Adam.