513 cases in Cuyahoga County, 10 deaths. ‘We’re not gonna get on the other side of this curve unless you stay home’

The Cuyahoga County Board of Health holds press conference updating citizens on the coronavirus pandemic on Monday, Wednesday and Friday mornings.

Cuyahoga County Board of Health (CCBH) commissioner Terry Allan opened his Friday, April 3 briefing by talking about ManorCare in Parma, a long-term care facility which was identified as the location of a COVID-19 cluster.

“They’ve been very cooperative with us we’ve I think have an ongoing relationship with them and we feel that they’re taking all the necessary steps they can in a situation where you have a facility with a lot of at-risk individuals,” said Allan. CCBH medical director Dr. Heidi Gullett echoed that sentiment about MarnorCare.

Things like social distancing, cleaning surfaces and covering coughs are crucial he said.

He went on to reiterate that a collection of steps are needed in order to fight COVID-19. Things like social distancing, cleaning surfaces and covering coughs are crucial he said.

COVID-19 is everywhere. We’ve given that guidance to our first responders that in every call that they make, in every response that they make, that they need to be approaching the situation as if any individual that they transport is COVID-19 positive and that’s the way that we need to move forward in the community,” said Allan.

He touched on the governor’s new dispute resolution panel businesses can use if there is a disagreement between authorities and businesses as to whether a business is deemed essential.

Gullett then proceeded to give a medical and epidemiological update on COVID-19 in Cuyahoga County.

For the jurisdiction of Cuyahoga County, not including the City of Cleveland, there are 513 cases, with an age range of 11 months to 101 years old. Ten people, ages 63 to 91 years old, have died as a result of COVID-19.

Ten people, ages 63 to 91 years old, have died as a result of COVID-19.

I don’t give these data as simply numbers but these are 10 families in our community who are grieving who’ve lost a loved one and with whom we stand with our deepest sympathies,” said Gullett.

Gullett said that CCBH has also issued 598 isolation orders, 831 quarantine orders and 60 people have been cleared – meaning they have recovered from the infection but are still following the stay-at-home order. There are more isolation orders than lab-confirmed cases, Gullett said, because there aren’t enough tests to confirm all of the cases.

“They haven’t had a lab test in a perfect situation we would be able to deploy testing to every single one of those individuals but we are not able to do that at this time,” said Gullett.

Gullett shared the epidemiological curve for both Cuyahoga County and the City of Cleveland. She said it shows that we are not yet on the other side of the curve.

We’re not gonna get on the other side of this curve unless you stay home, and you socially distance when you’re not at home and you also do the other things we’re asking — which is making sure you’re cleaning spaces making sure you’re washing hands those are the things that are going to help us get on the other side of this curve,” said Gullett.

She highlighted the increase in red was when testing became more prevalent locally. She also said they have started including cleared cases in the chart – and as those cases increase she said the county will be closer to the other side of the curve.

Gullett then moved on to a heat map of the cases of coronavirus by ZIP code.

You’ll see that we have cases across the entire county, there is really nowhere in the county that’s unaffected.

You’ll see that we have cases across the entire county there is really nowhere in the county that’s unaffected,” said Gullett. The areas with larger numbers of cases are darker green. “So our goal is to get ahead of the transmission so that the entire map doesn’t end up dark green but we do know that the green will continue to darken over the coming weeks.”

The cases are reported by their home addresses, not the address of where someone currently is.

Gullett then presented data about the percent of COVID-19 tests that are being done and how many of those are actually positive. Gullett said about 10 to 15 percent of COVID-19 tests are positive but cautioned that this data is hard to collect due to the fact there are few tests that are used for sicker people or those who work in hospitals/are first responders.

Thirty-two percent of Cuyahoga County COVID-19 cases result in hospitalization, 10 percent in intensive care admissions, and 33 percent of those who test positive are health care workers. Gullett then briefly touched upon the capacities in hospitals – 62 percent of hospital beds are in use, 31 percent of pediatric bed, 69 percent of ICU bed are full and 55 percent of ventilators are currently in use. The number of ventilators in use has gone up significantly, last week 36 percent of county ventilators were in use.

The goal is that we never get to a hundred percent utilization where we don’t have enough beds for the sickest people and we don’t have enough ventilators for the sickest people,” said Gullett.

Allan then answered a question about the governor designating the state into regions.

We recognize that thinking about it in regions about care is not dissimilar to what’s happening here in Greater Cleveland,” said Allan. He described a similar system in Northeast Ohio for trauma services called the Northeast Ohio Trauma System or NOTS. Allan said the NOTS system is “a way to assure that care is provided at the right place at the right time and by the right folks to deliberate and so that model now I think has been extended statewide and I think it’s a welcome development.”

When asked if the county was where it wanted to be at this point in the curve in terms of hospital capacity, Gullett said that it’s important to realize that with things like ventilators it’s not just the equipment itself it’s also making sure there’s someone who can run them.

“I wish I could give you a clearer answer to that but I think it’s not an easy question to answer we are very fortunate in this community to have a considerable amount of resources from a medical standpoint for high level care we in if you are sick anywhere there’s probably not a better place to be than in Cleveland,” said Gullett. “So what I can say is that I’m watching this closely as I see our numbers climb but I’m also trying to work really hard with our team here to understand where we are on that curve.”

She said that models are only as good as the information they’re based on and it really depends on how many people get really sick.

If more transmission continues to happen and more people continue to get this virus more people will need to be admitted to the hospital. More people will need to be on ventilators and more people will die. So that’s why it’s important to understand that you’ve got to do your part to keep us from getting up to 100 percent utilization,” said Gullett.

Gullett said that the percentage of health care workers and first responders represent a higher percentage of positive cases in the county because there is more testing in Cuyahoga County, the hospitals and employers are being more aggressive in testing those folks, and the guidelines have changed to include health care workers as a top priority to be tested.

Gullett answered a question about if there are other facilities that can be used for health care in a surge in addition to hospital space by saying it’s not just the space it’s also the trained professionals who are needed. She mentioned that Dr. Amy Acton reached out to people licensed in the State of Ohio from many different sectors who may be able to help in the effort. She said hospitals can think about the space they have – and potentially how it can be repurposed – and she mentioned some of the field hospitals and ships in places like New York and California but said those are only physical spaces and it’s important to think about the trained professionals who will need to serve in those physical spaces. Gullett also said that the CCBH is thinking about capacity and care for more than just Cuyahoga County because, “we have to think about the needs to provide high-level care for community members across our region because they frequently need to come here for a ventilator support or for ICU care.”

Allan added, “these plans have been in place with hospital systems — and in the clinical settings — for a long time and so what they’re doing now is looking at those plans and perhaps looking at novel ways to implement portions of these plans around non-traditional settings for care in the context of available staff to be there to support those care settings.”