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Ohio Coronavirus Update: Nursing home visitation to expand indoors beginning Oct. 12

DeWine issued recommendations Thursday calling on all residential colleges and universities to regularly test a sample population of asymptomatic students

COLUMBUS, Ohio — Ohio Gov. Mike DeWine held another coronavirus press conference Thursday afternoon, providing new information on his administration's response to the ongoing pandemic.

Here is a breakdown of what was discussed.

THURSDAY

KEY METRICS

Here were the daily trends on Thursday as reported by the Ohio Dept. of Health:

  • 991 new cases reported compared to 21-day average of 982
  • 28 new coronavirus-related deaths compared to 21-day average of 23
  • 74 new hospitalizations compared to 21-day average of 66
  • 10 new ICU admissions compared to 21-day average of 11

DeWine said the state is slowly headed in the right direction, as the 21-day average for new cases is now back below 1,000.

CASES PER 100,000

Putnam stayed in the second spot on Thursday, after finally dropping out of the top spot on Tuesday on the governor's list ranking counties in order of those with the most cases per 100,000 people to the least.

Putnam was reported to have 239.2 cases per 100,000 in the last 14 days.

Local health dept. officials said they have continued to see significant spread among members of the same family. However, schools are still doing well. DeWine said that a number of schools in the county have modified homecoming plans, including only a court and excluding parades and dances.

Wood County entered the top 10 on Thursday after slowly creeping up the list in previous weeks. On Tuesday, the county held the 11th spot. However, on Thursday, Wood came in at nine.

The county was reported to have 136.8 cases per 100,000 people.

The only other northwest Ohio counties in the top 20 on Thursday were Seneca and Henry, with 105.1 and 103.7 cases per 100,000 respectively.

PUBLIC HEALTH ADVISORY MAP

On Thursday, there were nine counties at Level 3 (Red) in the state's Public Health Advisory System, jumping up by four from last week.

In northwest Ohio, Putnam was the only county in that category.

DeWine noted that the biggest movement Thursday, was nine counties moving up from Level 1 (Yellow) to Level 2 (Orange).

Sixty-seven counties stayed at the same level.

For more information on the risk levels of all 88 Ohio counties, click here.

NURSING HOME VISITATION

Ohio Dept. of Aging Director Ursel McElroy joined in on Thursday's conference with an update on nursing facility visitation guidelines allowing limited indoor visitation on Oct. 12.

In the beginning of the pandemic, nursing homes and long-term care facilities were closed for visitors in an effort to thwart the spread of COVID-19.

On June 8, outdoor visitation was permitted at assisted living facilities as long as health and safety guidelines were met. This same allowance was granted to nursing homes on July 20.

As winter months approach, outdoor visits will become less of a possibility. But, McElroy said that the transition into indoor visitation does not indicate that people can be less cautious. What it means, she said, is that residents, staff and visitors need to be even more vigilant: wear masks, wash hands, keep your distance and stay home when you are sick. 

"When you enter one of these facilities, you are entering someone's home," McElroy said.

McElroy also said people should be keeping track of the status of the virus in your community and keep that in mind before entering a facility.

Here is a look at some of the new guidelines for indoor visitation at nursing home facilities:

  • Facility leaders need to determine level of readiness: Look at community spread, cases within the facility, staffing levels, access to testing, supply of PPE and local hospital capacity
  • Limit entry to personnel who are necessary to the operations of the facility: This includes health care providers, governmental representatives, regulators, Hospice personnel, clergy and hairstylists, among others
  • Screen staff and visitors upon entering the facility
  • Maintain a daily log of individuals who enter the building
  • Visits must be scheduled in advance and occur in designated visitation areas
  • Visits will be 30 minutes maximum: This allows for meaningful visits, but time for staff to sanitize spaces between use
  • Two visitors are permitted: This is per resident and per visit
  • No limit on age of visitor: However, the visitor must be able to wear a mask and maintain six feet of social distance

All visitors will be required to wear a mask supplied by the facility, McElroy said.

In addition to regular visits, visitation will also be permitted in compassionate care situations. A few examples of "compassionate care" situations would be: when a resident is grieving, needs encouragement in eating or drinking, experiencing weight loss or dehydration or maybe goes from being social to isolating themselves.

Communal activities will be able to occur with social distancing in place and in a safe environment. 

McElroy said facilities will have to develop a written and transparent plan so families are aware and know what to expect on arrival.

These facilities should not restrict visitation without a reasonable clinical or safety cause.

Additionally, facilities will be reporting visitation information to the state. That information will be available on the state's coronavirus website when indoor visitation begins on Oct. 12.

DEPT. OF DEVELOPMENTAL DISABILITIES

During the pandemic, there has also been limited visitation allowed in the state's intermediate care facilities.

These facilities have been allowing outdoor visitation only, but as winter months approach, a plan has been put together to create safe opportunities for indoor visitation in these beginning Sept. 28.

Ohio Dept. of Developmental Disabilities Director Jeff Davis joined in on Thursday, he explained that many of the guidelines these facilities are expected to follow will mirror those put forth in the state's nursing homes and long-term care facilities.

We will keep you updated when that official guidance is released.

SPORTS ORDER UPDATE

Lt. Gov. Jon Husted announced Thursday that the one-game-per-day limit for Ohio athletics will be removed. 

"We have been successful with the protocols put in place," he said.

However, something that will be added in the upcoming new sports order, is a provision that will require each sports venue to cooperate with local inspectors who are put in charge of ensuring compliance with state health orders.

These inspectors have the authority to end gameplay if they find people violating guidelines.

"We are adding opportunity, but we are also going to make sure we follow the rules so that we can continue to maintain these events in a healthy and successful manner," he said.

NATIONAL GUARD IN CLEVELAND

DeWine issued a proclamation Thursday, activating roughly 300 members of the Ohio National Guard to help Cleveland police ensure a safe environment for those attending the first presidential debate in Cleveland on Tuesday.

The move comes after the governor received a formal request from Cleveland officials Wednesday night. 

RESIDENTIAL COLLEGE TESTING

DeWine issued recommendations on Thursday requiring all residential colleges and universities to regularly test a sample population of their asymptomatic students, noting that some schools are already doing this. 

"Screening asymptomatic students really gives college presidents and their staff an idea of the spread on their campuses," DeWine said in a tweet.

School leaders on each campus should plan to screen at least 3% of their at-risk population. 

Formal guidance is expected to be released in the coming days.

ANTIBODIES

Since June, the American Red Cross has been testing blood, plasma, and platelet donors for COVID-19 antibodies. DeWine showed a chart at Thursday's conference, demonstrating the weekly percentage of donors that had COVID-19 antibodies in their blood and comparing Ohio’s levels with the country as a whole.

The antibody positivity for Ohio blood donors has increased from 1.2% in June, to 3.3% on September 14. DeWine said this movement is consistent with national trends. The current rate for the entire US is at 3.5%.

TUESDAY

KEY METRICS

DeWine updated Ohioans on the latest trends on Tuesday. While the case numbers were the lowest they have been since Sept. 8, DeWine cautioned that these numbers may still be low due to a lag in reporting from over the weekend. State health leaders should get a more clear picture of the status of the virus on Wednesday. With that in mind, here were the trends on Tuesday as reported by the Ohio Dept. of Health:

  • 685 new cases of coronavirus, compared to 21-day average 1,111
  • 12 new coronavirus-related deaths reported, compared to 21-day average of 22
  • 70 new hospitalizations, compared to 21-day average of 68
  • 11 new ICU admissions, which is the same as the 21-day average

In terms of confirmed coronavirus cases, the state reported just 579 in last 24 hours. That's the lowest number in a month, and second-lowest total in three months.

Credit: Andrew Asmus

The state's positivity rate has also dropped to 2.9%, DeWine said. 

CASES PER 100,000

Putnam County dropped out of the top spot on the list of counties with the most cases per 100,000 people on Tuesday, for the first time in weeks. Putnam came in second on Tuesday, just after Mercer County. Putnam was reported to have 236.2 cases per 100,000, which is still well above the Centers for Disease Control and Prevention's threshold for high incidence, which is 100 per 100,000.

Henry County dropped way down the list, out of the top 10. Last week, the county came in seventh, but on Tuesday they held the 18th spot with 114.8 cases per 100,000 people. 

Wood County, while still not in the top 10, has continued to creep up the list. On Tuesday, they took the 11th spot, with 139.9 cases per 100,000.

COVID-19 AND AEROSOLS

Environmental Engineer with The Ohio State University, Dr. Mark Weir, joined in on Tuesday's presser to discuss aerosolized particles and droplets and how COVID-19 spreads.

"Every time that you cough... if you're coughing or you're sneezing, you're obviously expelling out droplets and other particles and those finer smaller particles that don't drop out within that three to six feet range that we've heard about so much are the aerosols," Weir said.

There are a number of factors that play into how far these aerosols spread, he said, including the shape of your mouth when you're talking, the force in which you are talking, how quietly you're talking, if you're coughing, among a number of others.

Weir said his team has been looking at different variables and overall "room risks" when you are speaking, coughing, singing, etc. with COVID-19 or other illnesses as we head toward colder months and begin to spend more time indoors. 

Weir explained that aerosols do spread far, but not all of them are viruses. They move around us all the time, without us being aware. However, we do have means to control them.

Between the virus and you, there are a series of walls you can put in place, he said. We know the obvious: handwashing, masks and social distancing. But, Weir said there's some engineering we can do to provide more barriers, like indoor ventilation.

First and foremost, Weir said, people should find out what control they have over ventilation systems in their home or workplace. He made clear that air conditioning and heating is not the same as ventilation, ventilation means moving the air around. 

Weir said circulation is a great way to think about it. There are three big pieces that work together:

  • Air exchange rates - How often can you take all the air in the room, remove it and make it fresh?
  • Makeup air - How much outdoor air can you bring in?
  • Filtration - Remove allergens, etc.

WHAT STEPS TO TAKE

Business owners should talk to whoever they work with as their licensed HVAC technician or engineer. Have them come out, survey their equipment and figure out what they can operate Weir said. 

Ask them: How high of an air change rate can I have? Through what size filter? How much outdoor air can I bring in and still be profitable?

Weir said a great way to start is to go to the EPA website and look at the indoor air quality page for a crash course on the topic. You can find that information here.

WHAT WE KNOW IN TERMS OF COVID-19 AND AEROSOLS

The virus has to get to the back of your throat, depositing in the upper respiratory tract, and infect cells for it to cause an infection. How that gets delivered, is the question.

At first, surface spread was the focus; you touch a surface, you touch your nose and face, getting into your mucus system and make its way to where it needs to be. 

This was downgraded the more experts learned about droplet spread. Droplet spread is where the three to six-foot spread comes in, where larger particles hit your face or there will be a larger contaminated area in front of you, drawing surface risks.

Now, when experts talk about aerosols, those are spread further than six feet, and people can still inhale them. However, when people speak, they expel mostly droplets, so there are fewer aerosols and it takes a good amount of them to make someone sick. 

The question for experts remains: how important are aerosols when it comes to the spread of COVID-19? 

CONTACT TRACING

Lorain County Health Dept. Epidemiologist Mitch Dandurand also joined in Tuesday to discuss the importance of contact tracing and what you can expect if you get a call from a tracer. 

Dandurand said that the process is pretty straightforward. Once he gets a notification of a confirmed lab result, he identifies how to reach that person and makes a phone call.

Once they make that call, they have to evaluate whether or not that person is medically fit to participate in an interview, as the severity of symptoms varies from person to person. 

From there, he said contact tracers are straightforward with their intentions so people are aware of why they are being asked certain questions.

Next, they work to figure out when this person may have been infected. To do this, they ask when the infected person first started to feel ill. Once tracers establish symptom onset, they can establish the infectious period. 

When the infectious period is established, they work to figure out who they may have exposed within that time frame, including family members, workplace contacts, and potential community exposures.

The interview is then followed up with a two-week history, helping them to establish any links to potential outbreaks.

There is a second team that then reaches out to the people who were exposed to inform them that they were exposed while maintaining patient confidentiality.

CRITERIA FOR EXPOSURE

Dandurand said contact tracers look three days before symptom onset, as people can spread the virus before they develop symptoms.

He said some of the things they ask in terms of figuring out "close contacts" are:

  • Was anyone within 6 ft. of you for 15 minutes or more?
  • Where you there all day?
  • Did you make direct contact?
  • Did you wear a mask

Dandurand explained that those who spent the day together, but kept their distance, may not be a high-risk situation. However, if you spent the day inside someone's house, there may be more risk factors.

"It's all about the details," he said.

CASE DEMOGRAPHICS DASHBOARD

DeWine unveiled a new dashboard on the state's coronavirus website on Tuesday. The new Case Demographics Dashboard will break down case data by race or ethnicity as well as by age and county and comparing it to the overall Ohio population. 

This dashboard was made following recommendations by the COVID-19 Minority Health Strikeforce is aimed to better track health inequities and disparities. It will also help put critical decisions into context for policymakers, DeWine said.