Carson City health officials fight two battles: one against COVID-19, another against misinformation

In our region, as well as in many areas across the country, there have been massive spikes in COVID-19 transmissions over the past few months. Even as restaurants and bars were reopened, daily positive cases were generally staying within single digits inside the Quad-County region.

However, between October and December, both test positivity rates as well as overall cases — and deaths — have seen a massive increase. Local health organizations are now not only fighting against the disease, but against misinformation campaigns as well.

What is causing these spikes in our community, and how can we regain control of it before our local hospitals reach capacity? That’s what our local health experts are attempting to tackle.

Test positivity rates have skyrocketed. Between Oct. 5 and Dec. 7 in Carson City alone, test positivity rates have increased by 1,244 percent, from 1.8 percent to 24.2 percent. That means that while in October, only 1.8 percent of all tests taken in the capital city were returned as positive, now nearly a quarter of all tests are returning positive in December, a mere two months’ difference, according to Nevada Health Response.

Douglas County has had a 340 percent increase in test positivity between Oct. 5 and Dec. 7, from 6.2 percent to 27.3 percent, while Lyon County has a similar increase of 249 percent, from 6.3 percent on Oct. 5 to 22 percent on Dec. 7.

Contrary to some misinformation campaigns around test positivity, this is not due to there being more testing available, or only testing those who are symptomatic. Carson City Health and Human Services has continued to host “community testing,” in which people without symptoms are encouraged to take free COVID-19 tests at designated times and locations throughout the Quad-County region. This is done in order to gauge how many asymptomatic cases there are within the community.

According to Carson City Health and Human Services' Jessica Rapp, the real culprit behind the increase in numbers is simple: People are ignoring quarantine orders. Specifically, people are gathering from multiple households, and those who are infected are going to work.

"We know that there are positive cases that are ignoring quarantine orders," said Rapp. "When we have this information, we have a very serious discussion with the individual. The increase is contributed to people going to work sick and then finding out they are sick with COVID-19. Keep in mind that individuals are contagious 2 days prior to feeling sick."

A major reason for this, said Rapp, is that in our society people are used to going to work while feeling ill.

"The population is used to going to work with symptoms of illness long before COVID-19 and this mindset needs to change," said Rapp.

Another problem is that there are family gatherings that involve many different households, according to Rapp.

"We have had people report that they participated in Halloween activities and we will start to see positive cases of individuals that attended Thanksgiving celebrations," said Rapp. "We will see number increase more as more people get together for Christmas and New Year’s celebrations."

Rapp says people should look into other options for get-togethers this holiday season, including virtual options.

Statewide, we are currently seeing a daily case average of 1,872, measured over a 14-day rolling average. We’ve reached a total of 176,334 cumulative cases, with a 15 death per day average over the past two weeks, according to Nevada Health Response.

A total of 2,384 Nevadans have lost their lives to COVID-19 as of Dec. 7.

Of those deaths, 28 have occurred in Carson City, 22 in Lyon County, and 7 in Douglas County.

FIGHTING MISINFORMATION

One misinformation campaign currently spreading is that doctors and health organizations are listing deaths as COVID-19 deaths in order to receive more funding from the government, when there is actually a different cause of death.

Diane Rush, Director of Communications for Carson Tahoe Health in Carson City, explained how COVID-19 deaths are listed, and exactly where those extra funds are going.

“When a patient dies, the hospitalist physician who was caring for a patient is responsible for completing the death certificate,” said Rush. “When certifying the death, the physician records the immediate cause of death, as well as the chain of events that led to that final disease or incident. Physicians also record contributing factors to the death. For a patient who expires with COVID-19, the immediate cause of death might be listed as respiratory distress or failure, with the second line reading ‘due to COVID-19.’ Contributing factors such as heart disease, diabetes or high blood pressure would then be listed later in the record.  Physicians use their clinical expertise, education and training to most accurately reflect the patient’s condition and clinical course that caused death, and in many cases COVID-19 is the final common pathway.”

A major factor of misinformation campaigns is to accuse hospitals of billing patients as COVID-19 deaths in order to receive more money, when the patient died of something like cancer.

“There has been speculation and suggestions of an incentive to code and bill patients as COVID-19 because they get paid a higher amount,” said Rush. “While it is true that inpatients (not outpatients) with COVID-19 are eligible to receive a 20 percent add-on payment from Medicare, there must be a documented positive laboratory test in the patient’s medical record in order to be eligible for that add-on payment. When COVID-19 is suspected (not confirmed), healthcare workers take all the precautions (enhanced PPE, safety protocols, etc.) to ensure patient safety. These precautions come with additional costs.”

Rush said that in many circumstances, the hospital is delaying billing in order to make sure their coding and billing is correct in order to hold onto public trust.

“CTH takes the public trust seriously,” said Rush. “We have implemented a rigorous coding compliance program to ensure every medical record is complete and accurate. Each medical record is scrubbed by numerous coders, clinical documentation specialists, physicians, billers, and others to ensure our coding and billing is accurate.  We even wait for a positive laboratory test to ensure our coding is accurate before a bill goes out the door because we want to ensure each bill is correct (and are willing to delay cash flow to ensure it is correct). “

And as for the allegation that there are people profiting from the additional funding, Rush says this simply is not the case.

“As a reminder, CTH is a nonprofit organization,” said Rush. “All monies we make are invested into expanding and improving healthcare or promoting health and wellbeing in our community. We have no stock investors who profit from our results.”

Campaigns of misinformation is causing hardship for health officials, but they don't have the ability to save lives and fight against misinformation at the same time, according to Rapp.

"We are not actively fighting against misinformation campaigns since we are so busy trying to fight our daily fight of identifying positive cases and getting them in isolation," said Rapp.

When asked about how certain misinformation campaigns, such as the allegation that tests are being contaminated or individuals are intentionally being infected with COVID-19, Rush stated the hospital is undertaking measures that are burdensome to protect lives, not infect people.

"CTH is disappointed that misinformation campaigns persist," said Rush. "The thought that people are being intentionally exposed to the virus is unthinkable to us. First, this is a dangerous and deadly virus that has the potential to devastate lives. Secondly, the measures CTH must take to protect staff, physicians, and the public from transmission is burdensome. CTH has not operated 'normally' since February 2020. We are hopeful that the burden and stress of this pandemic, the toll it takes on each of us, will end soon."

SPREADING WITHIN THE COMMUNITY

Some people who are spreading the disease are doing so knowingly, but unfortunately, there's not much anyone can do.

When asked what the Health Department is doing about individuals who are knowingly contagious but continue to go to restaurants, bars, and stores without wearing masks, Rapp said that while a legal route is possible, they haven't undertaken these measures yet.

"When the health department finds out about these individuals, we attempt to contact them and reinforce the necessity and requirement for that person to stay at home," said Rapp. "Other than that, there is not a lot the health department can do besides taking the legal route. We have not done this yet because of the time it takes to go through the legal system and the time in which an individual is contagious."

Rapp says that what the Health Department needs most is cooperation from the public.

"We need the public to help us fight this fight and take the necessary preventive measures to protect their family, neighbors, co-worker, and community members," said Rapp.

Every county in Nevada is currently flagged for too high of test positivity rates with the exception of Storey and Eureka. Lincoln County currently holds the highest at 62 percent, and Eureka County the lowest with 5.5 percent, according to Nevada Health Response.

The 20-29 age group constitutes the highest amount of positive cases with 36,008. The 30-39 age group is second highest at 32,447; individuals under the age of ten still make up the lowest group at only 6,598 total cases.

The most common exposures among Carson City County cases from November 1 – 14, 2020 (the most up to date analysis at this time) were:

• contact with a known COVID-19 case (65 percent)
• working or residing in a correctional facility (39 percent)
• going to a grocery or retail store (24 percent)
• working in a healthcare setting (19 percent)
• attending or working at a school (14 percent)

In addition, thirty-three percent of those Carson City residents reported being employed or employed within the previous month, and of those who were employed, sixty-three percent stated they went to work while symptomatic. Thirty-nine cases were enrolled students, at the time of the report.

Of confirmed cases, those who identify as Hispanic are the highest race/ethnicity group with 39 percent, followed by White at 35 percent. Women are slightly higher at 51 percent with males at 49 percent.

According to Rapp, the Health Department has been dedicated toward Hispanic and Latino community outreach since the beginning of the pandemic.

"We have worked with community partners in the Hispanic/Latino community since the start of this pandemic to ensure we were reaching our entire community," said Rapp. "Although according to the data, 39 percent of cases reported their ethnicity as Hispanic, safety and educational outreach and the actions to prevent the spread of the virus are the same across all ethnicities. We are aware of various cultural celebrations and holidays and we provide education and guidance surrounding those holidays. All of our educational materials are also available in Spanish and we have Spanish speakers in the call center."

DEFENDING AGAINST THE VIRUS

Both Rapp and Rush agree that wearing masks, staying home while sick, hand-washing and social distancing are still the best defenses against COVID-19, and the uptick in cases is not a response to their effectiveness but rather because people aren't utilizing them.

"Combined with social distancing and frequent hand washing, masks do protect against the transmission of COVID-19," said Rush. "The type and quality of the mask does change the effectiveness but all are still recommended for transmission reduction."

Rapp agrees with the sentiment. "There are multiple tools that work to fight against the virus — it is the combination of mask wearing, limiting family gatherings, staying home when sick, social distancing, and practicing other good prevention practices."

Rapp also encourages community members to get not only the COVID-19 vaccine when available, but the flu vaccine as well.

"In the future, get the vaccine," said Rapp. "People should also get the flu vaccine so we are not inundating our healthcare system (i.e. our hospitals) with individuals that may be hospitalized for flu complications."

Updated Dec 7th, references from the CDC regarding mask effectiveness can be found here.

For a full list of statistics with up-to-date information, visit https://nvhealthresponse.nv.gov/