Missoula County set a record for the number of new COVID-19 cases in a single day when it reported 89 new infections on Thursday, the same day the state hit a new daily high of 932 cases.
Additional restrictions may be on the horizon for Missoula County, Ellen Leahy, director and health officer of the Missoula City-County Health Department, said in a Thursday press conference.
Leahy said the Board of Health's COVID-19 committee is formulating proposals for additional local restrictions based on current trends, and will have announcements next week. Leahy did not provide details as to what type of restrictions the board may propose.
There are currently 634 total active cases in Missoula County with more than 1,500 close contacts. Twenty-three people are hospitalized with COVID-related complications in Missoula County facilities, 12 of which are county residents, according to county reports.
Local health officials said Thursday they expect the number of COVID-19 cases, hospitalizations and deaths in Missoula County to continue to increase, especially with upcoming holidays.
"Not only are these popular times for gatherings and travel, but they also occur during this colder weather we're starting to experience so they're going to be indoor gatherings," said Ethan Walker, an epidemiological researcher at the University of Montana, on Thursday. "And when gatherings occur indoors, there's going to be a higher possibility of transmission because there's less ventilation and there's more close contacts."
With Halloween a week away, health officials are asking anyone going out and about to wear face coverings. The health department did not prohibit trick-or-treating, but encouraged people to maintain small social circles and take festivities outside if the weather permits. Young adults, specifically, are asked not to have parties, especially in crammed indoor spaces.
"We are at a precarious point of being able to slow the numbers, and this next week, we're going to know a lot more about whether we're going to be able to do that or not," Leahy said.
Epidemiologists said Thursday that Missoula County has had a "rapid, concerning uptick" of cases since the first week of October, with the current daily new average at 44 cases per 100,000 people, in comparison to an average of 12 cases per 100,000 residents for the month of September.
Health officials also expressed concern over the increase of cases in people age 60 and older.
Three weeks ago, over half of Missoula County's total cases were among the 20- to 29-year-old age group, and only 5% of cases were among people age 60 and older. Today, 20% of all cases fall in the 60 and older age group — a 300% increase from three weeks ago — while the total cases in the 20- to 29-year-old age group have dropped to 29%.
"This is obviously a really concerning trend as older age groups are more at risk for COVID-related complications," said Kristie Scheel, COVID-19 situation unit leader for the county. "As a result, this increase in the 60 and older age group, we're seeing more COVID-related hospitalizations... Unfortunately, with increasing hospitalizations, we also may see an increase in COVID-related deaths."
Scheel noted that six of the county's nine total deaths related to COVID-19 have occurred in the last 16 days. On Wednesday, the county announced the ninth death in the county from COVID-19 infection and related complications.
"We wish to extend our deepest sympathies to the family and friends impacted by this loss," the county said in a press release Wednesday. "The individual was middle-aged or older."
The 80-plus age group has had the highest incidence rate (the rate of cases per 100,000 population) in Missoula County over the past couple of weeks. Walker said looking at incidence rates gives a much better picture of what's going on by age group because it gives the number of cases that could be expected if all age groups had the same population.
"This will be an important trend, particularly because the 80-plus age group is more risk for hospitalization and subsequent death from infection," he said.
Senior living and retirement homes are also experiencing an increase in cases despite additional local restrictions put into place about a week ago that don't allow for visitation or new admissions, Leahy said.
Leahy said she didn't know the exact proportion of cases in senior living facilities during the press conference, but said it's is a "significant slice of active cases."
"It's not as high as half or a third, it could be a fifth, but they are continuing to add cases unfortunately because regardless of the restrictions...it's just a very difficult environment in which to control spread," she said.
The health department is encouraging anyone with even mild symptoms to get tested, and Cindy Farr, Missoula County COVID-19 incident commander, said they have some expanded testing capacity. Test results are usually coming in at about two days, although that can fluctuate depending on lab capacity, Farr said.
With cases on the rise, the county is experiencing increased demand, so it's taking health department staff longer to perform contact tracing, but Farr doesn't want that to discourage anyone from getting tested.
Missoula County serves as a regional healthcare hub and Farr said that local hospitals currently have the capacity to be able to continue to take additional hospitalizations, and will continue to serve out-of-county residents.
The state Department of Health and Human Services is maintaining a report of hospital capacity on its website, dphhs.mt.gov. According to the most recent update on Wednesday, Community Medical Center had 17 of 42 Intensive Care Unit (ICU) beds open, with COVID patients occupying four of those beds. That hospital has 16 total ventilators with two in use for COVID-19 patients and seven in use for non-COVID issues, leaving seven still available for use.
St. Patrick Hospital had six of 24 ICU beds open as of Wednesday, with COVID patients occupying four of those beds. That hospital has 42 total ventilators with two in use for COVID-19 patients and four in use for non-COVID issues, leaving 36 still available for use.
To date, Missoula County has had a total of 1,871 total COVID-19 cases with 1,228 recoveries and nine deaths in the county.
Fifty-six of the 634 active cases are associated with University of Montana staff, faculty, and students. Leahy said UM is likely experiencing a decrease in its cases due to limiting extracurricular activities and other measures that were imposed after the health department realized transmission and exposure was happening in areas outside of the classroom.
The health department is not yet breaking out numbers specific to Missoula County Public Schools, but the district is self-reporting data weekly. MCPS' most recent update on Sunday reports 59 total cases since the start of school, with 18 active.
Reporter Laura Scheer contributed to this story.
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