Montana became the state with the highest number of COVID-19 cases per 100,000 people in the country Tuesday morning. The New York Times COVID tracker moved Montana into the top slot as the state hit 97 cases per 100,000 people per day.

Idaho and Wyoming follow with 78 cases and 75 cases per 100,000 people respectively. Alaska, which had been number one over the weekend, has moved down to fourth in the country with 71 cases per 100,000 people.

“We are the hottest spot and Yellowstone County is leading with the number of cases in the state,” said Public Health Officer John Felton during a Tuesday meeting of the County Commissioners.

Last year, COVID peaked in Nov. 2020 and worked its way back down to settle at a manageable level during the summer months. During this stable period, the state averaged about 10 cases per 100,000 people per day. That’s about 107 cases per day in the state and 16 cases per day in Yellowstone County. In a year, that’s about 39,000 cases in the state and about 5,800 cases in Yellowstone County.

“This looks a lot like influenza, but influenza goes back to zero. We haven’t hit a zero point for COVID,” Felton said.

In Yellowstone County, October case numbers have exceeded that of September. And the seven day average of new cases in the county has far exceeded that of the Nov. 2020 peak. The same is true for Missoula County.

In 20 months, 383 Yellowstone County residents have died from COVID-19. In the entire pandemic, September 2021 saw the highest number of deaths from COVID-19, Felton said.

Other respiratory viruses are starting to circulate as well with only 25% of symptomatic testers showing a positive test for COVID. Other viruses include rhinovirus and respiratory syncytial virus (RSV) that is common in children during winter months.

An unusual uptick in RSV cases was recorded over the summer in Montana. Usually, the virus doesn’t start circulating until December. A co-infection of COVID-19 and RSV is possible and could potentially overwhelm an immune system.

During the 2020-2021 school year, about 9% of COVID cases were in school-aged kids, Felton said. This school year, about 20% of cases are in school-aged kids.

About two-thirds of COVID cases are in people aged 20 to 59 years old. This population makes up the adult workforce in Yellowstone County and is not sufficiently vaccinated to minimize the spread, Felton added.

Kelly Gardner, RN with RiverStone Health and Unified Health Command, added that four to seven employees work on COVID-19 data entry every day for public health and nine case investigators work on hundreds of cases per day. In Yellowstone County alone, about 72 hours per day is devoted to COVID-19.

Gardner said that as of 10:15 a.m. on Oct. 19, the time spent on COVID-19 in public health was equivalent to 25 years worth of work.

On Tuesday morning, about 13,500 people in Yellowstone County were removed from the workforce due to COVID-19. Of those, 2,691 people were in isolation and about 11,000 were close contacts expected to quarantine until they receive a negative COVID test.

On top of that, massive numbers of resignations are coming in from health care and education sectors, mostly due to to frustration and burnout, Gardner said.

“That’s a huge loss of years of investment in those sectors,” Gardner said. “All these hours are spent on COVID and huge economic impacts are being felt in the county … we continue to set records we do not want to set.”

As of Tuesday morning, Billings Clinic had 75 COVID positive inpatients with 32 in the intensive care unit and 23 on ventilators. Of those, 61 are unvaccinated.

St. Vincent Healthcare had 63 COVID positive patients with 10 in the ICU and 10 intubated. Out of the COVID inpatients, 52 were unvaccinated. 

At the commissioner meeting, Dr. David Graham, infectious disease doctor with St. Vincent Healthcare, encouraged all to get a third dose or booster shot when it is approved by the FDA.

Third doses are available for those who have received the Pfizer vaccine and are immunocompromised and 65 years old and older. Adults 50 to 64 years with underlying medical conditions should also receive a third shot if they have received the Pfizer vaccine.

Those who received Pfizer and are 18 to 64 years old in essential worker positions may get a booster, as their risk of exposure to COVID-19 is increased.

Moderna recipients can receive a booster if they have a moderately to severely compromised immune system.

Later this week, the FDA will make recommendations for J&J recipients in regards to booster shots.