MOUNT VERNON – For most of January, February and March, COVID-19 cases and hospitalizations dropped precipitously in Knox County.
But over the last two weeks, that trend has reversed.
The county's per-capita infection rate has doubled since March 18, according to data from the Ohio Department of Health. There were 69 active COVID-19 cases in Knox County as of Thursday, according to Knox Public Health, up from 40 two weeks ago. Current hospitalizations have jumped from two to seven during that time.
“We need to continue to follow all the guidance that we know," Knox County Health Commissioner Julie Miller said in a Facebook Live briefing Tuesday.
"We’re all tired of masking up, we’re all tired of social distancing and limiting our gatherings. But until we do those (things) and we do them well, and we get more people vaccinated, we’re not gonna see a decrease in the numbers of COVID (cases)."
Knox County triggered three indicators in the state's Public Health Advisory System this week, up from two the week before:
New cases per capita: This indicator is flagged if a county records 50 or more cases per 100,000 residents over the last two weeks. Knox County recorded 189.34 cases per 100,000 residents over the last two weeks – up from 118.74 last Thursday – with 118 new cases during that time. This is the county's highest per-capita infection rate since Feb. 11.
Non-congregate cases: This indicator is flagged if the proportion of a county's cases occurring in non-congregate settings goes over 50 percent in at least one of the last three weeks. Knox County reached this indicator each of the last three weeks, as roughly 95 percent of the county's confirmed COVID-19 cases occurred in non-congregate settings during that time.
New cases increase (NEW): This indicator is flagged if a county sees its rolling daily new-case average increase for five consecutive days over a three-week span. Knox County's new-case average increased every day from March 16 to March 23 – seven consecutive days.
Knox County remained "orange" in the OPHAS this week. It did not meet the state's indicators for: emergency department visits; outpatient visits; hospital admissions; or regional ICU bed occupancy. The county also recorded no coronavirus-related deaths this week (the last came Feb. 19).
Knox County is currently experiencing "high-incidence" COVID-19 spread, according to the CDC's definition, as it recorded more than 100 cases per 100,000 residents over the last two weeks. Nearly three-quarters of the state's 88 counties currently bear this distinction.
According to the ODH, "orange" counties are experiencing "increased exposure and COVID-19 spread." Residents are encouraged to "exercise a high degree of caution."
If Knox County triggers four or five indicators, it will return to "red," where it stayed for four months during the wintertime surge. If the county triggers one indicator or fewer, it will drop to "yellow" for the first time since Oct. 1, 2020.
The former may be more likely than the latter, if recent trends continue.
Just two weeks ago, Knox County boasted the 18th-lowest per-capita infection rate in the state, recording 86.65 new cases per 100,000 residents over the two weeks prior. The county now finds itself on the opposite end of the spectrum, carrying the 17th-highest infection rate in the state this week at 189.34.
Knox County had a higher per-capita infection rate than six of its seven neighbors this week (only Delaware County was higher at 218.95 cases per 100,000 residents).
"We really want to go yellow, folks. Knox County, I know we can do it," Miller said Tuesday. "Let’s get back to getting vaccinated if you so choose, and then let’s please start to use the guidance again, if you’ve gotten away from it. Mask up and social distance and limit your gatherings.”
Knox County's recent uptick in COVID-19 cases and hospitalizations is mirrored at the state level. Gov. Mike DeWine and his chief medical officer, Dr. Bruce Vanderhoff, implored residents this week to remain vigilant against the virus as Ohio's vaccination program ramps up.
"For the past two Thursdays, our statewide averages were just under 150 cases per 100,000 population. The two-week case rate has risen to 167.1 cases per 100,000 as of today ..." DeWine said in a press conference Thursday.
"New cases have been relatively flat through the month of March, but we are seeing the numbers go back up."
Vanderhoff said Ohio's uptick mirrors a national COVID-19 rise, though the state's increases are below hot spots like Michigan and the New York City/New Jersey area.
"Cases are also up in Ohio for the first week in a long time," Vanderhoff said. "Our seven-day average of new cases per day was 1,842 this week compared with 1,570 last week, and (Wednesday) we saw almost 2,500 new cases.
"Not surprisingly, this has been accompanied by a rise in concurrent hospitalizations, up from 851 a week ago to 978 (Wednesday). And our seven-day rate of positive test results is up to 4 percent from 3 percent in mid-March."
While numbers increased this week locally, current totals still pale in comparison to the height of the wintertime surge, when Knox County was reporting dozens of new cases each day.
The peak came Dec. 3, according to KPH, when Knox County recorded 67 new cases in a 24-hour span (the county's per-capita infection rate was 619.36 at the time). The county saw 66 new cases on Jan. 7, before the surge began to subside.
More than 4,000 Knox County residents have tested positive for COVID-19 since the pandemic began last March, according to Knox Public Health. Over 300 residents have been hospitalized by the virus, according to the Ohio Department of Health, and 82 have died from it.
NEW INFECTIONS SKEWING YOUNGER: While residents of all ages have tested positive for COVID-19 over the last two weeks, Knox County's recent caseload skews young.
Residents in their teens and 20s made up roughly 40 percent of Knox County's COVID-19 caseload over the last two weeks, according to KPH. Residents younger than 50 years old comprised nearly 75 percent of the caseload.
This may be because Ohio's vaccination rollout prioritized older, more vulnerable citizens, Miller said, meaning most of Knox County's young-adult population has yet to be inoculated.
Nearly 70 percent of Knox County's senior-citizen population had been vaccinated as of Friday, according to the ODH, compared to 23 percent of those age 40-49. An even smaller fraction of those 39 and younger have received a shot.
"Half of (the county's current active cases) are at least college-aged students ..." Miller said. "We’ll have to follow that and continue to watch that as we go.”
Of the seven county residents currently hospitalized with COVID-19, none are younger than 64. Miller said it's unclear if any of those individuals have been vaccinated against the virus.
"We’ll try to start gathering that information and be able to give you an update on that," she said.
Approximately 25 percent of Knox County (15,785 residents) has received at least one dose of the COVID-19 vaccine, according to the ODH. Seventeen percent of the population (10,596 residents) is fully vaccinated.
“Our rates are really good," Miller said. Roughly 31 percent of Ohio is at least partially inoculated, which matches the national average, according to the CDC.
Miller was particularly pleased with the county's efforts to vaccinate its most vulnerable population: senior citizens. All 82 of Knox County's COVID-19 fatalities (and the vast majority of its hospitalizations) have involved residents age 50 or older. Now, well over half of that population is at least partially immune from the virus.
“That’s really exciting ..." Miller said. “Overall, we’ve done a really good job of vaccinating our most at-risk residents ... We’re pretty pleased with that and proud of the fact that we’ve been able to do that.”
After prioritizing vulnerable populations and essential workers early in the distribution effort, Ohio has now opened its vaccine eligibility to anyone age 16 or older.
Knox Public Health offered an additional evening vaccination clinic last week to better serve the younger population, and Miller said Tuesday it will likely do so again in the future, depending on the number of doses it receives from the state.
“We will probably have more of those evening clinics. We’ve tossed around the idea of a Saturday (clinic)," Miller said. "But we will try to continue to accommodate the younger age group who’s working, with all your family schedules, and do those evening clinics as often as we can. Stay tuned for that.”
Infectious disease experts predict 70 to 80 percent of the population will need to obtain COVID-19 antibodies (whether through vaccination or infection) to achieve "herd immunity," where the virus runs out of viable hosts. Until that happens, continuing mitigation efforts will be crucial to preventing another surge, Miller said.
“The reason (restrictions) are still in-place is because we’re still trying to contain this virus, and we’re starting to see increases in some areas. So please still be mindful of the guidance – masking, hand-washing, (social distancing). I repeat it over and over again ..." Miller said.
“We’re so close – and that’s my frustration. We’re so close. If we can continue to vaccinate, and we can be kind and conscientious about wearing a mask and washing our hands, we can make this happen where we can have these restrictions lessened."