2022 | Coronavirus

As cases rise, county changes COVID-19 metrics to match what CDC did

New focus is on hospitalizations, severe illness over case numbers

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Centers for Disease Control and Prevention

The number of coronavirus cases has risen again in Montgomery County in recent weeks, but the newest standards for measuring the spread of the virus are hospitalization and severe illness, which remain at low levels.

So far, the rebound in cases has not prompted any public discussion of any new restrictions.

Sean O’Donnell, the county’s public health emergency manager, said in an interview that it’s likely that hospitalizations and severe illness will play more of a role if the county considered future potential restrictions, such as indoor mask mandates and business capacity limitations.

Any decisions would depend on how contagious and virulent a new variant is, he said.

County officials have updated their COVID-19 dashboard to reflect changes the Centers for Disease Control and Prevention made for calculating community transmission levels.

O’Donnell said the CDC changes were first implemented for the county dashboard on April 5.

Previously, the CDC and the county were using the same metrics based on the spread of the coronavirus, including case counts and related data. For instance, last fall, whether the indoor mask mandate was in effect depended on the number of cases of COVID-19 per 100,000 people, over a seven-day average.

Other metrics included hospitalizations, hospital capacity, and intensive care unit beds.

The CDC used various terms to describe the level and severity of spread in the community. For case counts, the categories for levels were low, moderate, substantial and high, depending on how many cases were recorded.

In recent weeks, the CDC adapted new metrics for identifying the level of transmission, labeled as low, medium and high. 

Those metrics, called “Community Levels,” focus more on COVID-19 hospital admissions, running over a seven-day total.

It still relies on case counts. Jurisdictions are, by default, in the medium or high level if they’ve had 200 or more cases per 100,000 people over a seven-day period. 

But if there are fewer than 200 cases per 100,000 people over a seven-day period, then hospital beds occupied by COVID-19 patients determine whether a jurisdiction is low, medium or high. 

Montgomery County, given its current hospitalization rates and case counts, is in the low category.

The number of new cases per day in Montgomery County has fluctuated widely in 2022. It was in the thousands in early and mid-January, then dropped to the hundreds through late February, then double digits for much of March.

In April, the number is back in the hundreds. From April 4 to 8, there were 881 new cases reported in Montgomery County, a daily average of about 176. One month earlier, from March 4 to 8, there were 324 new cases, a daily average of about 65.

O’Donnell said it took the county time to update its dashboard to reflect the CDC’s Community Levels because county health officials wanted to make sure the data feeds that populate the dashboard were accurate, when comparing CDC, state and local data.

The county’s current dashboard shows cases are starting to increase, but also shows that two hospitalization metrics under the CDC model are low. Those are:

  • Percent of staffed in-patient beds occupied by COVID-19 patients, over a seven-day average. As of Monday, this was at 1.9%. The threshold for medium is 10% or more, and high is 15% or more, according to CDC guidance
  • New COVID-19 admissions per 100,000 population, over a seven-day total. As of Monday, this was 1.5 admissions. The threshold for medium is 10 admissions or more, and for high is 20 admissions or more, according to CDC guidance 

O’Donnell said these new metrics will guide health officials on what actions to take, if cases continue to rise in the county in the local weeks and months.

Officials would likely look at congregate facilities or taking actions in isolated areas before broader actions like a universal indoor mask mandate or other mitigation measures, he added.

A universal masking would pre-empt a complete closure in essential settings like public schools, he said. The new metrics from the CDC will be one factor in what determines future decisions, O’Donnell said.

“I understand the advantage of being clear on what you’re tied to and what you consider to be a significant measure of disease,” O’Donnell said. “But the previous versions of COVID were very different than what we experienced with omicron.”

Health officials would need to see how severe any new strains are, O’Donnell said. Tying decisions to any one data point wouldn’t leave much flexibility to county officials, he said.

“Hospitalizations will be one of the key metrics going forward. I just don’t know if it will be one of the only metrics we use,” O’Donnell said.

Steve Bohnel can be reached at steve.bohnel@bethesdamagazine.com