As optimism falls, virus scorecard altered to focus on high-risk clusters, week-to-week comparisons
photo by: Kevin Anderson/Journal-World File Photo
Douglas County’s health department has altered its metrics and goals for its weekly “Smart and Safe” community scorecard — a change its leaders say is a better reflection of the current situation — but the new metrics also include less information than before.
The new version of the scorecard alters the way outbreaks are reported and has gotten rid of some statistics about types of transmission, among other changes. For instance, the scorecard previously listed the average number of cases due to local transmission, as opposed to cases contracted outside of the county. Now, the scorecard instead states whether the average number of new COVID-19 cases per week has increased or decreased compared to the last and links to the health department’s 14-day rolling average graph.
Sonia Jordan, informatics director for Lawrence-Douglas County Public Health, said the decision to stop publishing the average number of cases due to local transmission was because “we felt like COVID is endemic here.”
“We have community transmission occurring,” she said. “It’s likely not going away unless something radically changes.”
Jordan said the overall decision to change some of the metrics came after a discussion with community leaders and infectious disease doctors. A news release about the changes said they went into effect after a discussion with the county’s Education Unified Command.
“When we first developed the metrics … we developed them in a more optimistic time,” Jordan said to the Journal-World. As the pandemic progressed, Jordan said the team recognized that the goals on the “Smart and Safe” scorecard were “not reflective of where we are as a community anymore.”
The team also recognized that it no longer knew what kinds of case numbers would be appropriate goals, Jordan said. Now, instead of listing specific numerical goals as it did in the past, the scorecard says the goal for the “average number of new COVID-19 cases per week” and “number of active COVID-19 cases per week” is simply a decrease from the prior week.
photo by: Lawrence-Douglas County Public Health
“What we’re trying to do here is be reflective of a situation that’s fluid and be responsive to the context of the current situation,” Jordan said in the news release about the changes.
In a phone conversation with the Journal-World, Jordan said the changes will help bring “a more dynamic understanding of the current context of the situation.”
Another change to the scorecard involves the reporting of outbreaks. Instead of listing the number of new outbreaks reported each week, the health department is now only listing the number of “high-risk” outbreaks. The department defines “high-risk” outbreaks as “those that are — by setting or by population — considered potentially detrimental in their effects on our healthcare system.” As examples, the scorecard lists long-term care facilities, jails, community shelters, hospitals or events that resulted in high levels of transmission.
Jordan said this change was made because a high-risk outbreak is more of a concern for LMH Health, Lawrence’s hospital.
“Not all outbreaks are created equal,” Jordan said. She said the health department was trying to be responsive to what information LMH Health needs to be as prepared as possible.
When asked why LMH Health is the targeted audience for the scorecard and not community members, Jordan said that when thinking about how COVID-19 is negatively affecting the population, ultimately what the county wants to avoid is a situation where the local hospital is “run ragged.” But Jordan added that the department hopes community members also look at the metrics.
Not all of the scorecard has changed. The information about medical surge capacity still states the exact percentage of beds and ventilators in use at LMH Health.
Friday’s changes were the first such alterations to the scorecard since it had been created.
More information about outbreaks
This week, the Journal-World also asked Lawrence-Douglas County Public Health and the Kansas Department of Health and Environment about outbreaks and how they are reported publicly.
As the Journal-World has reported, KDHE has begun announcing the locations of COVID-19 clusters across Kansas. Just this week, the state health department altered its specifications on how it announces clusters publicly. The department will now only list locations with five or more cases with onset dates within the last 14 days.
KDHE specifically uses the word “cluster” instead of “outbreak,” because outbreaks are defined as two or more cases connected to one known source where a case has occurred within the last 28 days.
This week, KDHE reported no active clusters in Douglas County. But last week, on the reopening scorecard, Lawrence-Douglas County Public Health listed that it had identified seven outbreaks in the community that week. There are a couple of reasons why those outbreaks might not be announced publicly by KDHE.
First, the location might not have had five or more cases. To reiterate, the local health department defines an outbreak as two or more cases with the same identified source of exposure. KDHE is only listing clusters with five or more cases.
Second, the location of the outbreak may not have been named because of privacy concerns.
Lastly, Jordan explained that though Lawrence-Douglas County Public Health announced seven outbreaks last week, that doesn’t mean all of the outbreaks had five or more symptom onset dates in the last 14 days. Because the disease investigation process can take a long time, by the time the outbreak is identified, it might no longer fall within KDHE’s guidelines.