By Dr. Peter Plantes
The extreme challenges presented by the COVID-19 pandemic have forced extraordinary responses at multiple levels. However, as micro-communities like workplaces and schools are reopening, it is imperative that their highly granular data needs be met in ways that are useful to leaders that are not statisticians. Individuals spend their days moving between multiple micro-communities, raising the risk for infection in each. In fact, research suggests that one-third of viral respiratory infectious disease transmission occurs in schools and workplaces.¹ As such, significant precautions are required to prevent rapid spread of infection among and between micro-community populations.
Foundationally, the ability to sustain a safe micro-community environment necessitates an understanding of and ability to gauge the risk associated with an infected, yet asymptomatic, employee or student in the workplace or school who endangers anyone with whom they interact on a given day. When COVID-19 made its way into the U.S., many business executives, school leaders, and public health officials found themselves accountable to react without an effective strategy for tracking the local risk rates of infection and then managing measures to ensure the highest level of employee and student safety.
The Foundation For Optimal Response
In spring 2020, as the nation faced the growing threat of COVID-19, a coalition of commercial and health system laboratories and technology partners began collaborating on ways to provide public health agencies and healthcare organizations with detailed lab testing insights. The result was a powerful dashboard — The CV19 Lab Testing Dashboard — that produces granular insights derived from COVID-19 test results from more than 20,000 lab ordering sites across 3,007 U.S. counties and numerous sub-county areas known as PUMAs (Public Use Microdata Areas).
A key element of the complimentary dashboard is the Local Risk Index™ (LRI), which is calculated from the percent of those tested by nasal swab for the COVID-19 virus who have a positive result. The LRI is a ratio of the current week average of the daily percent positive divided by the baseline percent positive where epidemiological control can be secured in a region by containment efforts alone.
The power of the LRI is its ability to serve as the earliest indicator of change in COVID-19 exposure RISK at the county and sub-county levels. Business executives, school leaders, and public health officials can track risk level trends and the rate at which risk is rising or falling over time. Geographical risk metric insights based on the current week detected rates for viral testing help users identify and understand the current level of active viral infection in an area and how the level of active infection has changed over time.
The most effective measures to keep employees and students safe are routine lab testing, physical infrastructure reconfiguration, workplace/classroom social distancing, and remaining vigilant for symptoms of—and potential exposure to—COVID-19. The challenge is that these safety measures can leave decision-makers grappling with how best to deal with the massive amount of confusing and often conflicting guidance they generate while juggling data security, privacy, and compliance requirements.
Resolving this dilemma has given rise to LRI-driven, COVID-19 return-to-work solutions that enable critical information to be delivered in a meaningful, actionable way via an integrated view of employee data, test results tracking, symptom data, and other insights on the local level—as well as real-time identification of building, floor, and/or wing where an infected individual is located or has visited.²
With their permission, an individual’s test results are immediately transmitted from the lab to the solution. Management is alerted when action is required, allowing immediate intervention, including isolation, to minimize potential spread.
Daily PUMA or sub-county LRI also helps inform actions. For example, if someone lives in an area with an elevated LRI, actions may include close symptom monitoring, bi-weekly testing, requiring masks and social distancing, and/or remote work or school.
The use of local LRI data trends is analogous to how we use weather data to predict the chance of getting wet in a rainstorm. If the weather data indicates a higher RISK of rain, we enhance our REALITY of staying warm, dry, and healthy by smartly REACTING to grab for the protection of our raincoat and umbrella. If the LRI-data trends indicate a higher RISK environment of contracting COVID-19, we enhance the REALITY of staying healthy and cv19-free by smartly REACTING to protect employees and students with enhanced focal testing, mask-orders and safe spacing.
Finally, effective communication is a critical aspect of return-to-work solutions, as they set the stage for contact tracing should it become necessary.
Here is an example:
COVID-19 started out under control and then the state became a hotspot. Why? Los Angeles (LA) County, CA was early in the spring 2020 and summer supporting safe practices (limiting crowds, masks, public closures). The early cycle of COVID19 prevalence was lower as a result. But, as the end of year holidays arrived in late 2020, LA, like most of the rest of the country, dropped their guard and socialized for the holidays. And if they were with family, perhaps they ignored wearing masks, gave a hug, and a kiss.
Graph 1 below shows the Trend in LRI (Local Risk Index) in Los Angeles, CA County representing the percent positive COVID-19 PCR testing across the community. The rise of LRI is demonstrated after the 4th of July celebration, and then again during the last two months of the 2020 into January 2021 based on holiday celebrations at Thanksgiving, Christmas and New Years.
And Graph 2 below demonstrates the rapid rise in the Local Risk Index (LRI) for LA County through November and December in 2020, as end-of-year holidays occurred during minimal community ordered restrictions on public meetings and public places (restaurants, etc.)
Keeping Micro-Communities Safe
While valuable at the state and national levels, the true power of the LRI is its ability to inform actionable insights that can enhance micro-community decision-making. By enabling rapid access to the right information, the LRI has become the foundation of a comprehensive, holistic approach that drives faster public health response, better outcomes, and the ability to safely open work and school sites—and keep them open.
1 Mossong J, Hens N, Jit M, et al. Social contacts and mixing patterns relevant to the spread of infectious diseases. PLoS Med 2008;5(3):0381–91.
2 Plantes, P. A case for hc1 Workforce Advisor. hc1. (https://www.hc1.com/blog/a-case-for-hc1-workforce-advisor/)
Plantes, M.D. is a Physician Executive with hc1, a bioinformatics leader in precision testing and prescribing. He has three decades of experience creating service and delivery solutions that enhance marketplace success and clinical performance for clinical practice groups, academic faculty group practices, hospitals, health systems, and health care organizations. Dr. Plantes has served in CEO & Physician Executive roles for a number of large healthcare clinical delivery networks including regional community networks, academic practices, national hospital networks, international health systems (Chile, Colombia), and corporate managed care/HMO networks. He is a top-performing national physician executive providing innovative and strategic leadership in the growth and expansion of entrepreneurial, domestic and international health services environments.
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