The Montana Department of Public Health and Human Services Wednesday afternoon published its latest interim analysis of COVID-19 cases in the state.
The report, put together by the DPHHS Communicable Disease Epidemiology program, uses data current as of Friday, Oct. 2., at which point the state had confirmed a total of 14,337 COVID-19 cases.
By Thursday that number had risen to 16,667.
The report provides some greater detail about COVID-19 case growth in the state, the extent to which COVID-19 is resulting in deaths or hospitalizations of Montanans among different age groups, and the ways in which disease transmission is most commonly occurring.
It also describes an 8% positive test rate in the state through the month of September, up from between 4% and 5% across the months of July and August. From Sept. 26 to Oct. 2, the statewide positivity rate for COVID-19 tests was at 10%. The state's positivity rate for any given month has dropped as low as .4%, which was the positivity rate for the month of May.
The increased positivity rate in the state is being seen despite an increase in testing. About 24,000 tests were completed weekly in Montana for the month of September, which the report notes is an increase of 50% from weekly tests in August.
The Johns Hopkins University Coronavirus Resource Center explains that a higher positivity rate typically means not enough testing is being done and that also infection rates are high in a community. Based on World Health Organization recommendations they consider as a rule of thumb a 5% positivity rate as too high.
Jim Murphy, the head of the DPHHS communicable disease control and prevention bureau, was asked during a press call Wednesday about the state's increasing positivity rate and if it means the state is not doing enough testing. He noted that it's a snapshot in time, but still not something to disregard.
"We are concerned that it's at that 10% mark," Murphy said. "One thing we have to notice is that because of our spike in that we've been experiencing we have highly targeted testing efforts going on. As we focus on close contacts and symptomatic individuals."
He continued, saying "I think part of this reflects targeted testing that has been very effective identifying positive folks. Could we do more testing? We are looking at expanding some testing into some areas that are considered hot spots and doing some folks that are not close contacts and who are not symptomatic. That's going to affect positivity rates as well, but we want that to be focused."
Dr. Greg Holzman, the state's medical officer added that "from a clinical standpoint, again, it's working with denominators and numerators, so another aspect of the higher positivity rates are that we have higher disease in the community."
The report also shows the state has had one person in their 20s die as a result of COVID-19 out of 3,212 reported cases among that age group. That death was not included in the last such report, which relied on data current through Sept. 18.
Later in the report the age range for deaths in the state is put at between 24 and 97 years of age, indicating the person in their 20s who died was 24.
The report also details outcomes broken down by age for 14,337 people who have had COVID-19 in Montana.
For 628 people younger than the age of ten who have had COVID-19 in Montana, 415 had recovered and none had died by Oct. 2.
For 1,624 people between the ages of 10 and 19 who have had COVID-19 in Montana, 1,045 had recovered and none had died by Oct. 2.
For 3,212 people in their 20s who have had COVID-19 in Montana, 2,236 had recovered and one had died by Oct. 2.
For 2,399 people in their 30s who have had COVID-19 in Montana, 1,678 had recovered and three had died by Oct. 2.
For 1,867 people in their 40s who have had COVID-19 in Montana, 1,283 had recovered and seven had died by Oct. 2.
For 1,783 people in their 50s who have had COVID-19 in Montana, 1,175 had recovered and 13 had died by Oct. 2.
For 1,473 people in their 60s who have had COVID-19 in Montana, 980 people had recovered and 38 had died by Oct. 2.
For 850 people in their 70s who have had COVID-19 in Montana, 535 had recovered and 48 had died by Oct. 2.
For 397 people in their 80s who have had COVID-19 in Montana, 205 had recovered and 51 had died by Oct. 2.
For 104 people in their 90s who have had COVID-19 in Montana, 45 had recovered and 25 had died by Oct. 2.
For people who have died in the state whose race is known, 63% identified as white and 36% as Native American, according to the report.
There were some slight changes in common routes of transmission, for which 5,302 cases were analyzed. For another 9,035 cases or, 63% of cases at the time of the analysis, data was unavailable and under investigation, per the report.
Cluster transmission, in which a case comes from a known cluster of cases, remains the leading known cause of transmission in the state, accounting for 30% of cases, which is down slightly from 31% in the last report which was based on data through Sept. 18.
Household contact was the route of transmission for 22% of cases reviewed, compared to 20% in the previous report.
Community acquired, meaning the case was unable to be linked to other known cases, is believed to be the route of transmission for 20% of cases reviewed, compared to 18% in the previous report.
Contact with someone not in a cluster and not in a household is believed to be the cause of transmission for 20% of cases reviewed, compared to 24% in the previous report.
Travel-associated transmission, meaning a person traveled out of state during the virus incubation period, accounts for 5% of cases reviewed, compared to 6% in the previous report.
Health care-associated infection remained the cause of transmission for less than 1% of cases reviewed.
The route of transmission is also broken down by county for Big Horn, Cascade, Flathead, Gallatin, Missoula, Rosebud, Yellowstone and other counties.
Clusters were the cause of nearly two-thirds of new cases in Cascade and more than 40% of cases in Big Horn and Flathead, according to the report.
The report also notes that contact and household contact investigations "significantly impact case counts in Rosebud County."
Contact with someone who has COVID-19 was the cause of more than 40% of new cases in Big Horn, Missoula and Yellowstone County, the report says.
Gallatin, Yellowstone and Missoula Counties had the most cases connected to community transmission, with 27%, 26% and 18%.
Travel was associated with 13% of new cases in Flathead County and 12% of cases in Missoula County, the report says.
For all other counties that have less than 600 total cases, the report estimates that nearly half are from contacts or household contacts and one third are from clusters. In those counties about 15% of cases were acquired in the community and 6% were travel related.
For hospitalizations, the review found that people as young as their teens had been hospitalized but that generally people requiring hospitalization are older than those who do not require hospitalization. The analysis reports 9% of Native Americans and 13% of Black people infected in the state have required hospitalization, compared to 6% of those infected who identify as white.
The report also shows an increased number of cases associated with congregate settings and an increased number of different congregate settings reporting cases. Those increases appear to be driven in part by cases in schools.
Congregate settings are broken down in the analysis into categories including schools, assisted living facilities, long-term care facilities, correctional facilities, group homes, mental health facilities and senior independent living facilities.
The state had 220 active outbreaks in congregate settings, based on data up to Oct. 2 included in the new report. The previous report relying on data through Sept. 18 put the number of active congregate setting outbreaks at 98.
A total of 28 counties have reported at least one congregate setting outbreak. Of the total congregate setting outbreaks in the state, 31% have happened in Yellowstone County, followed by Flathead with 12%, Gallatin with 9% and Cascade with 8%.
According to the report the total number of congregate settings to have COVID-19 cases is 297, which is an increase of 143 since the previous report. Schools account for 100 of the additional places with cases.
The number of assisted living facilities with outbreaks increased by 24 from the previous report for 61 total. The number of long term care facilities with outbreaks increased by 10 from the previous report for a total of 43.
Ten different universities in the state have had outbreaks resulting in 345 cases, according to the report.
Congregate settings through Oct. 2 had led to 1,839 total cases, according to the report. That's an increase of 788 cases compared to the previous report which relied on data current as of Sept. 18.
Schools account for 433 cases in the recent report, more than doubling the 209 cases associated with them in the previous report.
The report attributes 368 cases to long term care facilities, which is an increase of 143 from the previous report.
Assisted living facilities have had 322 cases, according to the report, which is an increase of 66 cases from the previous DPHHS report.
The state has had a total of 58 deaths associated with congregate settings. Of those deaths, the review finds 93% occurred at assisted living facilities and long-term care facilities.
People in their 20s account for 22% of cases in the state, more than any other group. That's followed by people in their 30s (17%) and people in their 40s (13%), people in their 50s (12%). People 19 years or younger account for about 15.7% of cases, according the report. That breaks down people age 10 through 19 accounting for about 11.3% of known cases, and people younger than 10 accounting for about 4.4% of known cases. People in their 60s account for 10% of cases, people in their 70s about 6% of cases, people in their 80s about 2.7% of cases and people in their 90s about .7% of cases.
About 50% of cases in the state are among people between the ages of 23 and 55 years of age, according to the report.
For the 9,120 cases with known race at the time they were reported, people identifying as white account for 72% of cases in the state. People identifying as American Indian, Alaska Native, Native Hawaiian or Pacific Islander make up about 25% of cases despite making up about 7% of the state's population.
People identifying as Black or African American make up .8% of cases. People identifying as Asian make up .5% of cases reviewed. People identifying with the "Other" category make up 1.7% of cases.
Of cases where ethnicity information is available, 5% of people identify as Hispanic.
Between males and females, the case distribution is at 51% and 49%, according to the review.