Wisconsin And Local Pandemic Data

Data current as of 2:16 PM 08/12/2020

KEY METRICS

Consistent with Johns Hopkins recommendations, “key metrics for understanding the reach and severity of COVID-19 in a given area” are being followed here. These are: number of new daily cases, percent of tests that are positive (“positivity”), and testing rate, shown here as tests per 1,000 people. In addition, I am closely watching the total number of tests being reported.

Harvard Global Health group and others have recently reported that sufficient testing should be done in a community so that positivity is 3% or lower in order to “suppress” (not just “mitigate”) infections, meaning “greatly reducing new infections and keeping them low enough to safely open public life again” (see
https://www.wpr.org/coronavirus-surges-how-much-testing-does-your-state-need-subdue-virus). Wisconsin experienced 3% or below 14-day positivity from June 13 to June 23. Dane County had 3% or below 14-day positivity from April 24 to June 25.

ADDITIONAL METRICS

Additional information I’m watching includes the relationship between the number of tests being performed and the percent of tests that are positive (“positivity”). It had be reported that “the number positive cases that are being found is because there is more testing.” To some extend that may occur, but these charts show that the relationship is far from direct, and indeed at times these move in different directions.

3:42 PM 6/3/2020 UPDATE LOCAL INFORMATION — In doing research related to telehealth coverage policies by local insurance companies during the pandemic, I have received information that Group Health Cooperative of South Central Wisconsin (“GHC”) has made no changes to their policy regarding waivers of co-insurance or deductibles for telehealth provision of mental health services. This would be quite different from policies of most major insurance companies locally and nationally during the pandemic. I would be most interested in reliable confirming or disconfirming information from consumers, health care professionals, representatives of GHC and others. Please contact me directly at Gordon@DrHerz.us if you have related information to share. DO NOT include personally identifiable health information. To provide potentially identifiable information securely, you may submit this to me through the link at
http://drherz.us/secure-email-contact-for-dr-herz/ .

June 7 UPDATE TO LOCAL INFORMATION – The day after I posted the above information, I received a member “update” message from GHC Marketing/<corporatecommunications@ghcscw.com> which included the following information. I will let the reader decide whether the timing was a fluke or not. The bottom line is, GHC is advising its members that, as of June 8, whatever cost-sharing policy may have been in effect up to then, “both telephone-only and Video Visits will have cost-sharing applied in the same way as for in-person office visits, wherever applicable per CMS guidance. “

That statement in itself is confusing, as CMS (Medicare) is allowing psychologists and other health professionals to waive co-insurance and deductible amounts during the public health emergency. So will GHC allow mental health providers to waive your copay? Does your therapist have a clear understanding of what the policy is? Call GHC directly and see what they tell you. When you do, take the name of the person you are talking to, and ask for what they tell you in writing.

Here is GHC’s statement on mental health cost-sharing in their 6/4/2020 update to members:

“MENTAL HEALTH VISITS AND COST SHARING: Since the beginning of the COVID public health emergency in March, GHC-SCW Mental Health (MH) and Primary Care Behavioral Health (PCBH) services have been providing care to Members primarily through the use of Telephone Calls and Video Visits. Providing behavioral health care “virtually” reduces the number of people in our clinics and helps to ensure the health and safety of all of our members and our staff.
In March and April, mental health appointments completed by GHC-SCW clinical staff by telephone-only were charted using visit codes that did not result in patient cost sharing (i.e., co-pays, deductibles, co-insurance). Appointments completed through Video Visits continued to result in the application of patient cost sharing.  In early May, the federal Centers for Medicare & Medicaid Services (CMS) provided new guidance regarding the coding of telephone-only mental health visits. The new coding guidance applies new codes that do trigger cost-sharing for telephone-only visits.
While the CMS guidance is effective retroactively to March 1, 2020, GHC-SCW’s Medical Billing is waiving collection copays, deductibles and co-insurance for telephone-only mental health visits provided by GHC-SCW clinicians through June 7, 2020. Starting June 8, 2020, both telephone-only and Video Visits will have cost-sharing applied in the same way as for in-person office visits, wherever applicable per CMS guidance.
In an effort to provide the best care possible, GHC-SCW Mental Health (MH) and Primary Care Behavioral Health (PCBH) providers are increasingly offering video visits to our members. Members receiving MH or PCBH care in a GHC-SCW clinic may receive a GHC MyChart message or phone call from a provider or a member of the reception team to discuss the use of a video visit. Please check your GHC MyChart account and voicemail in advance of any upcoming MH/PCBH appointment, for messages and information about how your appointment will be completed.
GHC-SCW will resume charging no show fees for mental health visits starting June 8th.
If you have questions about your plan’s cost sharing details, please contact GHC-SCW Member Services at (608) 828-4853.”

June 3 Update — Dane County has now continued for the third day in a row with a 7-day average of positive test results relative to number of tests administered at or above 2%, the first time that has happened since April 27.

Wisconsin is continuing with its long decline in percent of positive tests relative to number of tests reported, just at 4% today, down from a high of 10.2% April 25-26, and May 7. Wisconsin does continue to show twice as many positive test results relative to Dane County. Today Wisconsin shows 31.93 positive tests per 10,000 population, Dane County shows 15.55 positive tests per 10,000 population. Wisconsin has had twice as many positive tests results per 10K population as Dane County since May 22.

June 1 Evening Update — Dane County has indeed exceeded 2% of positive tests out of tests reported (2.15%) for the first time since April 27. There has been a clearly increasing trend in the 7-day average for the number of positive tests relative to the number of tests reported since May 27, when the 7-day average for percent positive tests was 1.1%. Dane County appears to have been heading in the wrong direction in terms of number of positive test results for the past 6 days.


June 1 Update —  Dane County has had an increase in the 7-day average of percent of tests positive for the past five days in a row, increasing from 1.2% on May 27 to 2.0% June 1. If the 7 day average exceeds 2% tomorrow or in the near future, this would be the first time more than 2% of test results have been positive for a seven day span since April 27, when 3.5% of tests were positive in the preceding week. A change to greater than 2% would suggest a relatively sustained increase in the number of positive tests, a worsening from the 1-2% stability seen since April 27.

The rest of Wisconsin continues to show twice as many positive test results per tests administered as Dane County, a ratio seen consistently since May 22.

May 30 Update — As you read information about the number of people found be infected, it is important to keep in mind the way the information is being reported.

For example, many sites seem to show “the number of cases is increasing” in Wisconsin or other locations. While this may be true, it is also true that more tests are being performed. An apparently increasing number of cases being reported could be occurring because more people are being tested, not necessarily because the infection rate is increasing. So, the number of people being tested — and whether this is increasing, stable, or decreasing — should be kept in mind when looking at a chart or information that shows the “direction” the number of cases is going.

The following chart is an effort to demonstrate this. It shows the number of cases being detected in Wisconsin, which clearly is increasing from week to week. It also shows the number of positive test results relative to the number of tests results being reported. That is decreasing, and is around 5%.

A report or chart that shows whether new cases are increasing or decreasing does not give a full picture of whether the rate of infection is increasing or decreasing, unless you know how many tests are being done. And even that does not fully show what is happening in terms of the overall infection rate, since it may be unknown who is or is not being tested: generally concerned citizens, those who may be at higher risk, or people at home clearly with symptoms who have not gone for testing.

May 28 Update — Wisconsin appears to be continuing a downward trend in the number of positive tests relative to the number of tests over the last week. at 5.1% as of 5/27. Dane County appears to be remaining stable in the number of positive tests relative to the number of tests given during the past week, at 1.1% as of 5/27.

Wisconsin had the highest number of positive tests on any single date on 5/27, at 599 (prior highest number of positive tests was on 5/20, at 528). 5.8% of all tests given on 5/27 were positive statewide.

The number of positive tests per 10,000 population remains about twice as high in the rest of Wisconsin relative to Dane County. 27.8 positive tests per 10K population were reported in the rest of Wisconsin on 5/27, and 13.36 positive tests per 10K were reported in Dane County on that date.

Source: Wisconsin Department Of Health Services website and databases at https://www.dhs.wisconsin.gov/covid-19/data.htm.

May 21 Update — Updated impression from the data: Dane County appears to have stabilized in the percent of positive tests reported. The pattern has remained very consistent for the last three weeks. The positive test percent has continued between 1-2% since 4/28, based on a 7-day average (specifically 0.9% at the lowest to 1.8% at the most). During that time period the number of tests reported ranged from a low of 233 per day (on May 2) up to 1425, which just occurred today (also the greatest number of tests reported in Dane County on any single date thus far).

Data suggest that the rate of positive test results could have stabilized and may well remain within this 1-2% range for the foreseeable future. A weeklong increase to 2% or more of positive test results might be considered a potential signal of an increasing infection rate in Dane County. Other factors might also contribute to such a change, but the 2% threshold could well be a useful metric.

This shows the total number of cases (positive test results) that have been reported in Wisconsin and in Dane County. This also shows the differing patterns of increased cases between WI and Dane County. WI seems to have begun more slowly, with an increasing rate up until the present. Dane County appears to have begun more quickly, with a possibly slowing rate of increase at this time.

However the total number of cases and number of new cases each day may be misleading, simply because more tests are being done. So, the proportion of positive cases relative to the number of tests being done may be a more meaningful measure. That is what the chart below shows, taking into account the 7 days up to and including the date shown.

It appears that, about 4/27 to 4/28, Dane County showed a substantial reduction in the number of positive cases relative to the number of tests done, from 3.5% to 1.5% (which would have begun during the preceding week). Since that time, Dane County has remained below 2% in terms of detected cases relative to number of tests administered, dipping just below 1% (0.9%) at best on May 7, with what appears to be a somewhat increasing trend, up to 1.8%, on 5/13, since that time. Dane County continues to remain below 2% positive test results of people tested, on average per week, since April 28.

A reduction in the number of detected cases in Wisconsin overall appears to have begun to be detectable about May 7, with a reduction that would have started to occur the week before, from a weeklong average over 10% (10.2%) on May 6, dipping below 10% (9.5%) on May 7. Since that time, WI seems to be showing a decreasing number of positive cases relative to the number of people being tested, to a low point up to this time of 5.7% for the week up to and including May 18.

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