C29 D-19 - wate.com

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COVID-19 Critical Indicators July 8, 2021 Introduction As Tennessee (TN) monitors reopening across the state, the Tennessee Department of Health (TDH) will maintain vigilance of criƟcal COVID-19 indicators at the state and county levels to idenƟfy ‘problemareas’ across the state and provide early indicaƟon of sustained increases in community transmission. These metrics were developed in line with the White House proposed State GaƟng Criteria and help officials monitor trends in four key areas: • Trends in COVID-19 Cases (see on page 2) • Trends in COVID-19 Symptoms (see on page 7) • Trends in COVID-19 TesƟng CapabiliƟes (see on page 8) • Trends in Healthcare SystemCapacity (see on page 9) Beginning June 12th, 2020, case trends (beginning on page 2) include both confirmed and probable cases. COVID-9 inTNat a Glance 869,752 Total Number of COVID-19 Cases 561 NewCOVID-19 Cases Today 3,214 Active COVID-19 Cases Today 12,596 Total Number of COVID-19 Deaths Key Definitions Beloware definiƟons important to understanding this report. In addiƟon to these definiƟons, each visuaizaƟon in this report will be explained in further detail in the technical notes (see page 11 ): • In TN, a COVID-19 case is counted in the daily case count, demographics, and outcomes, if it classified as a confirmed or probable case. Please see the COVID-19 case definiƟon here . • A confirmed case is someone who tested posiƟve (via PCR test) for the virus that casues COVID-19 (SARS-Cov-2). • A probable case is someone who may have tested negaƟve by PCR, tested posiƟve by another type of test or may not have been tested at all, but has an illness consistent with COVID-19, and may have other risk factors. For example: • If a person is a close contact of a COVID-19 case and has a clinically-compaƟble illness, this person meets the criteria to be a probable case • The specimen collecƟon date is the date someone's COVID-19 lab sample was collected. Due to lab turnaround Ɵme there may be delays between when a specimen is collected and a confirmed case is reported to the public. Unless otherwise stated, visualizaƟons in this report use specimen collecƟon date as it more accurately indicates when a paƟent was sick (and not when their case was reported to the public). This report was producedby the Tennessee Department of HealthonJuly 9, 2021.

Transcript of C29 D-19 - wate.com

Page 1: C29 D-19 - wate.com

COVID-19Critical IndicatorsJuly 8, 2021

IntroductionAs Tennessee (TN) monitors reopening across the state, the Tennessee Department of Health (TDH) will maintainvigilance of crical COVID-19 indicators at the state and county levels to idenfy ‘problem areas’ across the stateand provide early indicaon of sustained increases in community transmission.These metrics were developed in line with the White House proposed State Gang Criteria and help officialsmonitor trends in four key areas: • Trends in COVID-19 Cases (see on page 2) • Trends in COVID-19 Symptoms (see on page 7) • Trends in COVID-19 Tesng Capabilies (see on page 8) • Trends in Healthcare System Capacity (see on page 9)

Beginning June 12th, 2020, case trends (beginning on page 2) include both confirmed and probable cases.

COVID-9 in TN at a Glance

869,752Total Number ofCOVID-19 Cases

561New COVID-19Cases Today

3,214Active COVID-19Cases Today

12,596Total Number ofCOVID-19 Deaths

Key DefinitionsBelow are definions important to understanding this report. In addion to these definions, each visuaizaon in thisreport will be explained in further detail in the technical notes (see page 11): • In TN, a COVID-19 case is counted in the daily case count, demographics, and outcomes, if it classified as a confirmed or probable case. Please see the COVID-19 case definion here. • A confirmed case is someone who tested posive (via PCR test) for the virus that casues COVID-19 (SARS-Cov-2). • A probable case is someone who may have tested negave by PCR, tested posive by another type of test or may not have been tested at all, but has an illness consistent with COVID-19, and may have other risk factors. For example: • If a person is a close contact of a COVID-19 case and has a clinically-compable illness, this person meets the criteria to be a probable case

• The specimen collecon date is the date someone's COVID-19 lab sample was collected. Due to lab turnaround me there may be delays between when a specimen is collected and a confirmed case is reported to the public. Unless otherwise stated, visualizaons in this report use specimen collecon date as it more accurately indicates when a paent was sick (and not when their case was reported to the public).

This report was produced by the Tennessee Department of Health on July 9, 2021.

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COVID-19Critical IndicatorsJuly 8, 2021

Trends in COVID-19 Cases in TN

Epidemic Curve of COVID-19 Cases by Specimen Collection Date1

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 2|

The following secon will visualize the COVID-19 case trends (both confirmed and probable) in TN, including newlyreported cases, the acve number of cases, and the number of COVID-19 confirmed deaths.

The epidemic curve is based on the day the specimen was collected. Therefore, the most recent day’s data may not be complete as test results takean average of 2-5 days to be reflected in the visualizaon. To learn more about this visualizaon, please reference the technical notes.

Mar 1, 20 May 1, 20 Jul 1, 20 Sep 1, 20 Nov 1, 20 Jan 1, 21 Mar 1, 21 May 1, 21 Jul 1, 21

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Moving Average of COVID-19 Cases

Illness thatbeganduring thistime maynot yet bereported.

Illness thatbeganduring thistime maynot yet bereported.

The curve below visualizes the number of new cases each day since the beginning of the COVID-19 outbreak. Since mid-April2020, the moving 7-day average for new cases has increased over me with higher averages seen in June and July compared toApril. On December 20th, 2020, the moving 7-day average was the highest of the pandemic averaging 6,946 new cases/day.

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COVID-19Critical IndicatorsJuly 8, 2021

Statewide Number and Rate of Active Cases2

Daily Percent of Positive COVID-19 Tests3

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 3|

Mar 1, 20 May 1, 20 Jul 1, 20 Sep 1, 20 Nov 1, 20 Jan 1, 21 Mar 1, 21 May 1, 21 Jul 1, 21

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Rate of Active Cases (per 100,000 Persons)

TDH updated its definition of an active case on 9/3/2020TDH updated its definition of an active case on 9/3/2020

The chart below visualizes the number and rate of acve COVID-19 cases in TN. On September 3rd, 2020 (orange line) TDHupdated its definion of an acve case significantly lowering the number of acve cases on that day and moving forward. SinceTDH updated its definion of an acve case, the number and rate of acve cases hit a peak on December 21st, 2020 with 85,406cases.

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Daily % pos

Positivity Rates 5%

Positivity Rate 10%

On 5/3/2021, TDH shied to a more reliable system-generated date, the date the COVID-19 case was added to the surveillance system. Because of thischange, this visualizaon has had a minor shi in the number of new cases reported for each day and therefore, the daily percent of posive COVID-19 tests.

On July 8, 2021, there were3,214 active COVID-19 cases inTN. The rate of active cases was47.1 per 100,000 persons.

5.3%

The chart below visualizes the daily percent of posive COVID-19 tests. While the daily percent of posive COVID-19 tests fluctuates, inSeptember the daily posivity rate was more consistently between 5 and 10%, a downward trend from the higher daily posivity ratesseen through much of July. In October, the daily posivity rate has started to rise again. For today, July 8, 2021, the daily posivity ratewas 5.3 %and the posivity rate for the last 7 days was 4.7%.

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COVID-19Critical IndicatorsJuly 8, 2021

Positive Tests per 100,000 Person by Public Health Region (over last 7 days)4

TN SARS-CoV-2 Variant Case Summary5

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 4|

14.1▲

5.6▼

18.3▼

16.2▲

11.6▼

14.7▼

28.7▲

50.9▲

22.0▲ 11.7

▼6.1▼

11.2▲

37.0▲

The map below shows the number of new posive tests in the last 7 days per 100,000 persons. The arrow indicators representthe trend (up or down) as compared to the week prior. For the week of July 8, 2021, the highest rate of posive tests was seenin the Memphis-Shelby Metro. Addionally, 7 of the 13 public health regions saw an increase in the number of posive casescompared to the week prior.

5.6 50.9

Positive Tests by Region

Covid-19 Variant WHO Label Cases in TN

B.1.1.7 Alpha

B.1.351 Beta

B.1.427 Epsilon

B.1.429 Epsilon

B.1.617.2 Delta

P.1 Gamma

4,133

20

54

48

125

124

Below is a table summarizing the COVID-19 variant cases idenfied in TN. To learn more about COVID-19 variants, please seethe SARS-CoV-2 Variant Classificaons and Definions published by the CDC:hps://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-surveillance/variant-info.html

Covid-19 Variant WHO Label Cases in TN

B.1.525 Eta

B.1.526 Iota

B.1.526.1

B.1.617

B.1.617.1 Kappa

P.2 Zeta

5

1

22

1

2

16

Variants of Concern Variants of Interest

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COVID-19Critical IndicatorsJuly 8, 2021

Vaccine Breakthrough Cases in TN6

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 5|

Below is a table summarizing the COVID-19 vaccine breakthrough cases idenfied in TN. The CDC defines COVID-19 BreakthroughCases as a U.S. resident with SARS-CoV-2 RNA or angen detected on a respiratory specimen collected ≥14 days aer complengthe primary series of an FDA-authorized COVID-19 vaccine. All cases meeng this definion through April 30th are reported. Asof May 1st, CDC asked that only cases with severe outcomes (hospitalizaon or death) be reported. Data are currently reportedas such:

- Prior to May 1st: All people that meet case definion - May 1st and aer: People that meet case definion and had an outcome of hospitalized or deceased from COVID-19

To learn more about breakthrough cases across the US and how they are being reported to the CDC:hps://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html

Total Number of VaccineBreakthrough InfectionsReported to CDC

Total Cases inTN = 994

Deaths 24(2%)

Hospitalizations 164(16%)

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COVID-19Critical IndicatorsJuly 8, 2021

7 Day Running Average of New Cases in Metropolitan Public Health Regions7

7 Day Running Average of New Cases in Rural Public Health Regions7

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 6|

The plot above illustrates the 7 day running average of new COVID-19 cases (based on the date of public report) for the sixmetropolitan public health regions. The Nashville/Davidson and Memphis/Shelby metropolitan areas have consistently reportedhigher counts of COVID-19 cases compared to the other four metropolitan areas since the outbreak began.

The plot above illustrates the 7 day running average of new COVID-19 cases (based on the date of public report) for the sevenrural public health regions.

Mar 1, 20 Jun 1, 20 Sep 1, 20 Dec 1, 20 Mar 1, 21 Jun 1, 21

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Blountville/Sullivan CountyChattanooga/Hamilton CountyJackson/Madison CountyKnoxville/Knox CountyMemphis/Shelby CountyNashville/Davidson County

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East Tennessee RegionMid-Cumberland RegionNortheast RegionSouth Central RegionSoutheast RegionUpper Cumberland RegionWest Region

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COVID-19Critical IndicatorsJuly 8, 2021

Number of Deaths per Day (by date of death)8

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 7|

On July 8, 2021, the total number of confirmed COVID-19 deaths was 12,596 (10,148 confirmed and 2,448 probable). Below arethe number of COVID-19 deaths by the date of death. The red line represents the 4 day running average number of deaths.

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Deaths thatoccurredduring thistime maynot yet bereported toTDH.

Deaths thatoccurredduring thistime maynot yet bereported toTDH.

Case Fatality Rate:1.4%

(12,596/869,752)

30-Day Case Fatality Rate:1.5%(86/5,920)

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COVID-19Critical IndicatorsJuly 8, 2021

COVID-19 Active Cluster Monitoring Table9

COVID-19 Confirmed Clusters by Week10

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 8|

The table below shows the number acve COVID-19 clusters that are currently being monitored by region and cluster type. Tolearn more cluster and cluster types, please reference the endnotes on page 14.

For more informaon on the metro and regional health departments, please click here or see page 15.

Facility Type CHR ETR KKR MCR MSR NDR NER SER SUL UCR WTR Total

Assisted Care Living Facility

Community

Correctional

Homeless Shelter

Industrial

Nursing Home

Other facility

Other Healthcare

Restaurant

Total 80

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The visualizaon below shows the number of new clusters idenfied in Tennessee each week.

Jun 21, 20 Aug 16, 20 Oct 11, 20 Dec 6, 20 Jan 31, 21 Mar 28, 21 May 23, 21 Jul 18, 21

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COVID-19Critical IndicatorsJuly 8, 2021

Trends in COVID-19 Symptoms in TN

Syndromic Surveillance (Emergency Room) Data11

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 9|

The following secon will visualize the trends in COVID-19 symptoms based on data collected through TN’s syndromicsurveillance system, ESSENCE. ESSENCE tracks paent chief complaints and discharge diagnoses from 95 emergencydepartments across the state. The data are typically received from parcipang EDs within 24 hours of a paentencounter. These data are used to get pre-diagnosc esmates of health condions (like COVID-19) being reportedfrom emergency departments.

Nov 10, 19 Jan 19, 20 Mar 29, 20 Jun 7, 20 Aug 16, 20 Oct 25, 20 Jan 3, 21 Mar 14, 21May 23, 21

Week Starting Date

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Percentage of All Emergency Department Visits

Coronavirus-like Illness

Influenza-like Illness

Cornavirus like illness (CLI) is defined as symptom terms, free text, or discharge diagnoses specified by CDC that are likely to be related to illness caused bythe 2019 novel Coronavirus. The visits counted within these criteria will contain a percentage illnesses caused by condions other than novel coronavirusinfecon. The visits counted within these criteria will contain a percentage illnesses caused by condions other than novel corona virus infecon. Theseresults should be considered preliminary in nature and are not all confirmed diagnoses of disease.

Influenza like illness (ILI) is defined by terms, free text, or discharge diagnoses that are likely to be related to illness caused by seasonal influenza. The visitscounted within these criteria will contain a percentage illnesses caused by condions other than influenza infecon. These results should be consideredpreliminary in nature and are not all confirmed diagnoses of disease.

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COVID-19Critical IndicatorsJuly 8, 2021

Trends in COVID-19 Testing Capabilities

Laboratory Testing & Turnaround Time12

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 10|

The following secon will visualize the COVID-19 tesng trends in TN, including laboratory tesng turnaround meand the rates of tesng across the state.

Below is the number of COVID-19 laboratory tests conducted in TN from March to July with the average turnaround me (fromspecimen collecon to me of result). The number of tests conducted each month has increased in TN from ~42,000 tests inMarch to >894,000 tests in July. Lab turnaround me improved from March (3.57 Days) to June (1.85), but increased again inJuly (3.43 days). Overall, lab TAT has improved since mid-2020.

0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0 2.2 2.4 2.6

Average Turnaround Time in Days (# of Labs)

AUGUST 2020

SEPTEMBER 2020

OCTOBER 2020

NOVEMBER 2020

DECEMBER 2020

JANUARY 2021

FEBRUARY 2021

MARCH 2021

APRIL 2021

MAY 2021

JUNE 2021

JULY 2021

1.37 Days (1,096,549 Labs)

1.66 Days (691,178 Labs)

1.41 Days (737,227 Labs)

1.27 Days (858,899 Labs)

1.82 Days (980,603 Labs)

1.18 Days (828,454 Labs)

1.03 Days (503,169 Labs)

0.89 Days (492,438 Labs)

0.83 Days (433,880 Labs)

0.79 Days (308,120 Labs)

0.78 Days (199,089 Labs)

0.81 Days (42,318 Labs)

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COVID-19Critical IndicatorsJuly 8, 2021

Trends in COVID-19 Hospital Capacity

Number/Rate of COVID-19 Hospitalized Patients13

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 11|

The following secon will visualize trends in hospital capacity, including the number of COVID-19 posive paentscurrently admied, hospital bed ulizaon, and bed/venlator availability. All of the visualizaons below werecreated using data from the TN Healthcare Resource Tracking System (HRTS), a tool developed by TDH that manageshealthcare facility bed, service and asset availability. These data are reported by hospitals across TN daily.

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Below is the number of COVID-19 paents currently hospitalized (dark blue), and of those hospitalized who are in the ICU (green) andare using venlators (light blue). The grey bar represents the number of paents per reporng hospital, a rate that can help us beerinterpret changes in COVID-19 hospitalizaons (as not all hospitals report each day).

The trends in both the number of COVID-19 inpaents and the number of paents per reporng hospital have increased since May.The total number of COVID-19 posive paents hospitalized across TN on July 08, 2021 was 271. There are 95 COVID-19 paentscurrently in the ICU and 47 ulizing venlators. The number of admied paents per hospital reporng was 2.15 (with 114 hospitalsreporng).

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COVID-19Critical IndicatorsJuly 8, 2021

Hospital Utilization and Confirmed COVID Hospitalizations in TN13

Quick Glance at Hospital Bed & Ventilator Availability13

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 12|

Below is a brief snapshot of the currently available floor beds, ICU beds and venlators across TN.

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COVID Hospitalizations

Non-COVID Hospitalizations

This visual illustrates the total number ofhospital beds (adult floor beds) occupied bynon-COVID-19 (light blue) and confirmedCOVID-19 paents (darker blue) since July 15th,2020.

Addionally, please note the following:• On December 18, 2020 this visualizaon waschanged to compare the number of hospitalbeds (adult floor beds) occupied bynon-COVID-19 paents and confirmed COVID-19paents (excluding COVID-19 paents using ICUbeds) across TN.

• Hospital ulizaon dipped significantly in TNfrom mid-March, through April. Through themonth of May hospital ulizaon increasedstatewide, but primarily due to theresumpon of elecve procedures, not anincrease in COVID posive hospitalizaons. Thenumber of COVID-19 hospitalizaons inTennessee was roughly the same on June 1st(296) as it was on May 1st (295). Recently, anincrease in admied COVID-19 posive paentshas been seen across the state.

• On July 8, 2021, 2.0% (176/9,016) of allhospitalizaed paents in Tennessee areCOVID-19 paents.

Available Adult Ventilators Available Floor Beds Available ICU Beds

14%1,763/12,540

73%1,338/1,842

16%346/2,210

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COVID-19Critical IndicatorsJuly 8, 2021

Technical Notes

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 13|

1. Epidemic Curve for COVID-19 Cases by Specimen Collecon Date (page 2)

The visualizaon on page 2 shows the daily new COVID-19 cases (blue bars) and 4-day moving average of new cases (red line). A fourday moving average is the average of one data point and the three preceding data points. Looking at the moving average helps tounderstand trends and account for fluctuaons in the data.

Are probable cases included in the Epidemic Curve?Probable cases are included in the epidemic curve in this report. For the probable cases where specimen collecon date is not available,the date the paent's illness or symptoms began is used.

Can I recreate this with TDH publicly available data?Not exactly. The public downloadable datasets (Daily Case Informaon) present COVID-19 case counts based on the day they werepublicly reported, not specimen collecon date. However, using the column New_Cases one can create a similar visualizaon. Theprimary difference between the visualizaon using the public dataset method and the one in this report would be that the trends seenin this report should align with trends seen roughly 2-5 days later in the public dataset visualizaon. Again, this would be because of the2-5 day lag between specimen collecon date and public report date.

2. Statewide Number and Rate of Acve Cases (page 3)

The visualizaon on page 3 shows the number (light blue bars) and rate (dark blue line) of acve cases each day in TN.

How does TDH count recovered COVID-19 Cases?The number of acve COVID-19 cases are determined by: total number of cases - inacve/recovered cases. TDH considers a case“inacve/recovered” when: 1) they are at least 14 days beyond their symptom onset date, or are at least 14 days beyond the first testconfirming illness if asymptomac, and 2) are not deceased.

How is the rate of acve cases calculated?The acve rate is the total number of individuals who acvely have COVID-19 in TN divided by the state populaon, see examplecalculaon and interpretaon below. The populaon of the state is from the 2018 projected populaon esmate for Tennessee.

Can I recreate this with TDH publicly available data?Yes. Using the public downloadable datasets (Daily Case Informaon) you can use the column Total_Acve to get the daily number ofacve cases and the instrucons above to calculate the rate. If you want to understand how TDH calculates "Total Acve" you cancalculate it yourself by subtracng the number of recovered cases (Total_Recovered) and the number of cases who have died(Total_Deaths) from the total number of cases (Total_Cases).

3. Daily Percent of Posive COVID-19 tests (page 3)

The visualizaon on page 3 shows the daily posivity rate (blue line) as well as two thresholds that indicate if the posivity rate wasabove either 5% or 10%.

How is the daily percent of posive tests calculated?The daily percent of posive tests is calculated by taking the number of new posive tests for that day divided by the total number ofnew tests for that day. These numbers are publicly available in the downloadable data- Daily Case Info. While the number of new testsconducted that day can be found in the column New_Tests, the new posive number of tests can be calculated by subtracngyesterdays total Pos_Tests from today's total Pos_Test.

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COVID-19Critical IndicatorsJuly 8, 2021

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 14|

Daily Percent of Posive COVID-19 tests (page 3) connued

Can I recreate this with TDH publicly available data?Yes. Using the public downloadable datasets (Daily Case Informaon) and the instrucons above one is able to recreate thevisualizaon.

4.TN SARS-CoV-2 Variant Case Summary (page 4)

The table on page 4 summarizes the COVID-19 variant cases idenfied in TN (learn more about variants here).

Can I recreate this with TDH publicly available data?No. The count of variant cases is not currently available in the TDH provided public data sets.

5. Posive Tests per 100,000 Persons by Public Health Region (Over the last 7 Days) (page 4)

The regional level map shows the number of new posive tests per 100,000 persons by public health region in the last 7 days. Thearrows indicate trends (up or down) of the new posive tests rate compared to the week prior.

How is the number of posive tests per 100,000 persons calculated in the map?These rates are calculated by the taking the number of new posive tests for the region divided by the region's populaon. This is thenmulplied by 100,000 to have the number per 100,000 persons.

Are the number of cases the same as the number of posive tests?No, not necessarily. The number of posive tests is the total number of PCR-posive laboratory results that have been reported to TDH,while the number of cases are individual people who are either confirmed or probable COVID-19 cases. Individuals are only countedonce in this number, no maer how many posive tests they might have had. Therefore, if an individual tested posive mulple mes ina given week in the same area they would be counted mulple mes in this map (but would only be counted once in the case counts)

Can I recreate this with TDH publicly available data?Yes. The numbers required to create the calculaon explained above are publicly available in the County New dataset but only at thecounty level. In order to recreate this visualizaon one will need to group the counes (and county populaons) by their public healthregion (can be found here).

6. Vaccine Breakthrough Cases in TN (page 5)

The table on page 5 shows some demographic, hospitalizaon, and death metrics for the COVID-19 vaccine brekthrough casesidenfied in TN. To learn more about breakthrough cases and how they are reported see here.

What is a breakthrough case?CDC defines COVID-19 Breakthrough Cases as a U.S. resident with SARS-CoV-2 RNA or angen detected on a respiratory specimencollected ≥14 days aer compleng the primary series of an FDA-authorized COVID-19 vaccine. All cases meeng this definion throughApril 30th are reported. As of May 1st, CDC asked that only cases with severe outcomes (hospitalizaon or death) be reported.

Can I recreate this with TDH publicly available data?No, vaccine breakthrough informaon is not publicly available.

7.7 Day Running Average of New Cases in Metropolitan and Rural Public Health Regions (see page 6)

The visualizaons on page 6 show the 7 day running average of new COVID-19 cases for all of the metropolitan and rural public healthregions. These new case counts are based on their public report date and not specimen collecon date. A 7 day moving average is theaverage of one data point and the six preceding data points. Looking at the moving average helps to understand trends and account forfluctuaons in the data.

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COVID-19Critical IndicatorsJuly 8, 2021

This report was produced by the Tennessee Department of Health on July 9, 2021. PAGE 15|

7 Day Running Average of New Cases (page 6 & 7) connued

Can I recreate this with TDH publicly available data?Yes, using the downloadable dataset- County New and the column New_Case, one is able to see the daily counts at the county level.These counts can added together to create the daily new case counts for each public health region. The 7 day average of new cases canbe then calculated by totaling the daily new case counts (by region) for today and the previous 6 days and then dividing by 7.

8. Number of Deaths per Day (by date of death) (page 7)

The visualizaons on page 7 show the number of COVID-19 deaths by date of death (blue bars) and the 4-day moving average of thenumber of deaths. A four day moving average is the average of one data point and the three preceding data points. Looking at themoving average helps to understand trends and account for fluctuaons in the data.

What is a probable death?A probable COVID-19 death is if a person dies and the health care provider that signed their death cerficate determined that COVID-19disease was their cause of death or a significant condion contribung to death, then the person meets the probable case criteria andwould be considered a probable death.

Is date of the death the same day it is publicly reported?No, similarly to specimen collecon date, the date of death frequently occurs 2-5 days before the death is reported to the public due tolag me in reporng. Therefore, the most recent day's data may not be complete.

How can I calculate the Case Fatality Rate? What about the 30-Day Case Fatality Rate?A case fatality rate is calculated by taking the total number of COVID-19 deaths divided by the total number of COVID-19 cases. A 30-daycase fatality rate would only look at the total number of deaths and number of cases for the last 30 days. Both of these rates can beproduced using the publicly downloadable datasets (Daily Case Informaon).

Can I recreate this with TDH publicly available data?Not exactly. The public downloadable datasets-Daily Case Informaon presents COVID-19 deaths based on the day they were publiclyreported, not the date of death. However, using the New_Deaths column one can create a similar visualizaon. The primary differencebetween the visualizaon using the public dataset method and the one in this report would be the trends seen in this report shouldalign with trends seen roughly 2-5 days later with the public dataset visualizaon. Again, this would be because of the 2-5 day lagbetween date of death and public report date.

9. COVID-19 Acve Cluster Monitoring Table (page 8)

The table on page 8 displays the number of acve COVID-19 clusters that are currently being monitored by region and cluster type.

What the definion of a COVID-19 Cluster?A COVID-19 cluster is two (2) or more confirmed cases (with posive lab results) of COVID-19 that are linked by the same locaon ofexposure (for example a hospital, nursing home, grocery store, correcons facility, etc.) or exposure event (for example a work party,vacaon, etc.) that is not a household exposure. In TN, the most commonly reported clusters have been in correcons facilies andnursing homes.

Cluster Types Quick Definions-Community clusters include those associated with: First RespondersReligious/spiritual organizaonsDaycares, educaonal se ngsApartment complexes

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COVID-19 Acve Cluster Monitoring Table (page 8) connued

BusinessesShopping faciliesSports/fitness faciliesOther facilies clusters include facilies such as camps.Other Healthcare clusters include provider types such as:Mental health instuonsPharmaciesHome health agenciesDenst offices

Metro/Regional Health Department Abbreviaons:

CHRETRJMRKKRMCRMSRNDRNERSCRSERSULUCRWTR West Tennessee Regional Health Department

Upper Cumberland Regional Health DepartmentSullivan County Health DepartmentSoutheast Regional Health DepartmentSouth Central Regional Health DepartmentNortheast Regional Health DepartmentNashville Davidson County Health Department

Mid Cumberland Regional Health DepartmentMemphis Shelby County Health Department

Knoxville Knox County Health DepartmentJackson Madison County Health DepartmentEast Tennessee Regional Health DepartmentChaanooga Hamilton County Health Department

Can I recreate this with TDH publicly available data?No, cluster informaon is not publicly available.

10. COVID-19 Confirmed Clusters by Week (page 8)

The visualizaon on page 8 shows the new clusters idenfied in Tennessee each week.

What the definion of a COVID-19 Cluster?A COVID-19 cluster is two (2) or more confirmed cases (with posive lab results) of COVID-19 that are linked by the same locaon ofexposure (for example a hospital, nursing home, grocery store, correcons facility, etc.) or exposure event (for example a work party,vacaon, etc.) that is not a household exposure. In TN, the most commonly reported clusters have been in correcons facilies andnursing homes.

Can I recreate this with TDH publicly available data?No, cluster informaon is not publicly available.

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11. Syndromic Surveillance (Emergency Room) Data (page 9)

The visualizaons on page 9 shows the percent of all emergency room visits in that are reporng both Cornavirus like Illness (CLI) andInfluenza like Illness (ILI) in TN. This dashboard can also be found online here.

Can I recreate this with TDH publicly available data?Yes and no. While ESSENCE data is not included in the publicly available datasets, the dashboard above does provide the weekly percentof ILI and CLI symptoms in the tool ps. Therefore, one could recreate the visualizaon if desired.

Can I recreate this with TDH publicly available data?Yes and no, while lab turnaround me is not publicly reported, the lab tesng volume can determined using the New_Tests column ofthe Daily Case Informaon public dataset.

12. Lab Tesng & Turnaround Time (page 10)

The visualizaon on page 10 shows the volume of COVID-19 lab tesng and average turnaround me for the months of March throughOctober (so far) in 2020.

Can I recreate this with TDH publicly available data?Yes and no, while lab turnaround me is not publicly reported, the lab tesng volume can be determined using the New_Tests columnof the Daily Case Informaon public dataset.

13. HRTS-Reported Hospitalizaons & Bed Capacity (page 11 and 12)

The visualizaons see on pages 11 and 12 shows TN's hospital capacity through acve hospitalizaons, current bed ulizaon, and bedavailability.

Can I recreate this with TDH publicly available data?No, HRTS data is not publically available.

To access all the downloadable datasets menoned in the technical notes, please see:hps://www.tn.gov/health/cedep/ncov/data/downloadable-datasets.html