Open letter from health commissioner: Something has to change

(Posted on Nov. 30, 2020)

Editor’s note: Chris Cook, Madison County health commissioner, issued the following open letter to the Madison County community on Nov. 28, 2020.


Our county has been at Level 3 (red) and experiencing high incidence of COVID-19 spread on the Ohio Public Health Advisory System (OPHAS) for two months. Over the last two weeks, 322 Madison County residents have been newly diagnosed with COVID-19. This is more than 14 times the “high incidence” level that would be expected for a county of our size.

On Nov. 25, Madison County triggered five of the seven indicators on the OPHAS. Had the OPHAS been published on Nov. 26, Madison County would have triggered six of the seven indicators. Outpatient offices, emergency departments, hospitals and intensive care units in our region are being taxed like never before during this pandemic.

Nearly every way that we measure the spread of COVID-19 and the corresponding risk to residents, is significantly increasing. During the last two weeks, cases in Madison County schools have increased by nearly 400 percent. Also in the last two weeks, the number of students who are quarantined has increased by 300 percent, going from 149 to 589. Multiple entire sports teams and entire classrooms have been quarantined due to exposure to cases of COVID-19.

The role schools play in the overall community spread of COVID-19, particularly from students, is just now being realized. Current studies estimate that between 40 percent and 80 percent of students are asymptomatic (those with no symptoms) carriers and spreaders of COVID-19. One such study found that asymptomatic children had detectable virus for two to three weeks after testing positive and were of unknown potential infectivity.

Additionally, younger children with COVID-19 have been shown to carry greater amounts of the virus in their upper respiratory tract than adults, indicating they could be important drivers of viral spread.

While masks and physical distancing are some of the best tools we have to limit the spread of the virus, these protective actions are not always consistently followed and are most effective in communities where transmission is not high. School studies suggest that in-person learning can be safe in communities with low COVID-19 transmission rates. These same studies indicate that schools may increase overall transmission risk in communities where transmission is already high. Transmission in Madison County is extremely high, and there are no indications that it will slow without other interventions.

Nearly half of all new cases recorded in Madison County since October have been students, school staff, or people who have reported contact with students in the two weeks prior to the onset of illness. Only one-fifth of all new cases recorded in Madison County in this same timeframe reported attending a social gathering in the two weeks prior to the onset of illness. There are multiple contributing factors to cases and exposures.

While none of this is independently conclusive, it does indicate that schools have an impact on the number of cases beyond their four walls. Schools and athletics impact overall community health and are one of the drivers of the pandemic. Interventions such as closing school buildings slowed overall community spread in the early stages of the pandemic. However, closing schools often accompanies other interventions, such as limiting public gatherings. These concurrent interventions make it difficult to attribute a decrease in cases solely to the closure of schools. This is why the move to temporarily close schools is not standing alone in Madison County. Sports and community events are suspended and businesses, government offices, and churches have been advised to work remotely and not meet in person. We are calling upon many sectors of our community, not individual silos, to simultaneously make temporary changes in order to achieve the greatest possible impact at this stage of the pandemic.

The growth in the number of cases across the state has far outpaced public health’s ability to investigate cases and quarantine contacts. Delays in receiving test results from labs due to high demand and a significant decrease in individual compliance with isolation and quarantine has caused case investigation and contact tracing to become minimally effective in slowing the spread in our community. In essence, this tool has been taken away.

The healthcare system as a whole is being pushed to the limit. Public health staff and healthcare workers are working around the clock to manage the overwhelming impact of COVID-19 on our community. We must reduce new case growth or the healthcare system will begin to fracture and the reality of rationed care may hit very close to home.

The directives and advisories from Madison County Public Health are “population health” decisions. What we are currently doing is not working. Something must change, or we can expect the same trends to continue or worsen. These decisions are equally based on responding to current conditions and on prevention–which is the core of our mission. The winter holidays will be collective super spreader events with exponential growth of cases. At no other time during this pandemic have we so clearly been able to see where we are headed. Now is the time to act.

We are stumbling and struggling to reach the next intervention–vaccine–that will make a significant impact on this pandemic. We are in a highly vulnerable position in Madison County. I do not believe Level 4 (purple) on the OPHAS is an unavoidable destination for all of Ohio. I do not believe it is an acceptable outcome for Madison County. I want students in the classroom, playing sports, and having every childhood experience they deserve. I want communities to return to hosting festivals and events. But we must make population health decisions now. With your help, and only with your help, we can reduce the rapid increase of cases, preserve our healthcare system, return our students to classrooms and gyms, and restore a sense of community that makes Madison County so great.

Chris Cook, MPH, RS
Madison County Health Commissioner

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