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Novel Coronavirus (COVID-19) Activity
Issue 29 - June 19, 2020
The Marin County Department of Health and Human Services is conducting on-going surveillance of respiratory illness in Marin County to increase sensitivity in detecting potential COVID-19 activity. We will provide timely surveillance updates at marinhhs.org/coronavirus/data.
There are two main indicators of potential COVID-19 virus transmission locally — the number of confirmed cases and the number of people experiencing severe respiratory illness. Tracking this will help our healthcare providers and partners know when COVID-19 activity may be increasing in Marin. Marin County Public Health receives regular updates on respiratory illness cases from all Marin County emergency departments (ED) and from Emergency Medical Services (EMS), our countywide 911 ambulance response system. We track these over time and evaluate these trends by age because older adults infected with COVID-19 experience more severe disease. Knowing there's always ups and downs in our usual activity, we're looking for significant changes.

We've recently launched a web page detailing our progress towards indicators Bay Area Health Officers are tracking to assess progress in ensuring we have the strategies and infrastructure in place to contain and treat COVID-19.  In addition, we are now including a map in our surveillance page that shows the cumulative number of confirmed COVID-19 cases and the rate of COVID-19 cases per 100,000 residents by city and community in Marin County as of March 2020.  
As of June 19th, 837 cases of Coronavirus Disease 2019 (COVID-19) have been identified in the community and 80 cases of COVID-19 have been identified in San Quentin State Prison. 592 individuals are estimated to have recovered. During the past several weeks, the number of COVID-19 cases has continued to increase significantly. While this corresponds with an increase in testing rates, it is not likely to be attributable to testing alone. For additional information on current activity and Marin County's response visit marinhhs.org/coronavirus. Respiratory illness and COVID-19 surveillance updates are available at marinhhs.org/coronavirus/data, including clinical, demographic, and testing information.
Confirmed COVID-19 Cases:  As of June 19th, there have been 837 cases of COVID-19 diagnosed in the community, 536 of whom are estimated to have recovered*, 56 reported cumulative hospitalizations, and 18 reported deaths in Marin County. Figure 1 presents positive COVID-19 tests by date of specimen collection and Figure 2 presents the number of individuals with confirmed COVID-19 who are hospitalized or in the ICU by day.
*Recovered is currently defined as 14 days post-diagnosis with COVID-19 excluding deaths and those currently hospitalized.
Figure 1.  Positive COVID-19 Tests by Collection Date in the Community*
*This epidemic curve does not include cases diagnosed in San Quentin State Prison.

Decisions to test individuals for COVID-19 are made by medical providers based on assessment of symptoms and evaluation of other possible conditions (e.g., influenza). Many providers are now performing these assessments over the telephone. Providers who determine an individual should be tested are aware that they can refer patients to Marin County Public Health to obtain testing in our drive through testing site.

Percent Positive Summary

The 7-day rolling average of percent positive tests for Marin residents between 6/06/2020 - 6/12/2020 is 4.0%. This time period is the most recent reporting period that has updated testing results in the state reporting system, CalREDIE.  
Figure 2.  Number of People in a Marin Hospital or ICU with Confirmed COVID-19 by Day
Source: California Department of Health daily hospital inventory
Demographics of Confirmed Cases: To date, the majority of confirmed cases have been older than 35 years of age, male, and of Hispanic/Latinx race/ethnicity. The majority of hospitalizations have occurred among those greater than 50 years of age and of non-Hispanic, white or Hispanic/Latinx race/ethnicity. The majority of deaths have occurred among those 80 years of age or greater and of non-Hispanic white race/ethnicity. The average age of confirmed COVID-19 cases is 42 years (range: 0-101 years). The figures below present information about confirmed COVID-19 cases, hospitalizations, and deaths by age, gender, and race/ethnicity as compared to the distribution of each countywide.
Respiratory illness activity: Common symptoms of COVID-19 include fever, cough, and difficulty breathing. Respiratory illness activity will capture visits that may be due to COVID-19 and influenza-like illnesses. The majority of individuals with COVID-19 will experience mild to moderate symptoms. However, some individuals may experience more severe symptoms and require a higher level of medical care through EMS or the ED. Tracking the total number of visits and those due to respiratory illnesses provides a situational awareness of current resource needs in our community. Each daily count below reflects 3-day rolling averages. Figures 3-5 display information on current trends in EMS calls and ED visits due to respiratory illnesses total and by age.
Utilization Trends: Over the past week, the number of ED and EMS visits and those due to respiratory illnesses have continued to be lower than or similar to daily averages seen in March-June, 2019. All daily counts below reflect 3-day rolling averages. Marin County Public Health will continue to monitor trends to identify any significant changes (Figures 3A-B).
Figures 3A-B.  Number of Total Visits and Visits due to Respiratory Illnesses
THROUGH JUNE 18TH: Marin County Emergency Medical Services Calls (3A
THROUGH JUNE 18TH: Kaiser San Rafael, MarinHealth Medical Center and Novato Community Hospital Emergency Department Visits* (3B
*Data from Kaiser San Rafael, MarinHealth and Novato Community Hospital Emergency Departments are updated as soon as data are available.
Percentage of visits due to respiratory illnesses: Approximately 5.2% of Emergency Medical Services (EMS) calls and 4.6% of Emergency Department (ED) visits were due to respiratory illnesses (Figures 4A-B). 
Figures 4A-B.  Proportion of Visits due to Respiratory Illnesses
THROUGH JUNE 18TH: Marin County Emergency Medical Services Calls (4A
THROUGH JUNE 18TH: Kaiser San Rafael, MarinHealth Medical Center and Novato Community Hospital Emergency Department Visits* (4B
*Data from Kaiser San Rafael, MarinHealth and Novato Community Hospital Emergency Departments are updated as soon as data are available.
Age Distribution of Respiratory Illness Visits: In the past week, the majority of respiratory illness-related EMS calls and ED visits occurred among those 65 years and older.  (Figures 5A-B). 
Figures 5A-B. Daily Age Distribution of Visits due to Respiratory Illness
THROUGH JUNE 18TH: Marin County Emergency Medical Services Calls (5A)
THROUGH JUNE 18TH: Kaiser San Rafael, MarinHealth Medical Center and Novato Community Hospital Emergency Department Visits.* (5B
*Data from Kaiser San Rafael, MarinHealth and Novato Community Hospital Emergency Departments are updated as soon as data are available. Data from Kaiser San Rafael are not available at this time.

California

As of June 18th, there are 165,416 confirmed cases and 5,360 deaths in California. View full updates at the California Department of Public Health's COVID-19 website.

United States

National COVID-19 activity is continuing to increase, with 2,178,710 confirmed cases and 118,365 deaths across 55 states and territories (50 states, District of Columbia, Puerto Rico, Guam, the Northern Mariana Islands, and US Virgin Islands) as of June 19th. View more detailed information at the Centers for Disease Control and Prevention's COVID-19 website.
Copyright ©  2020
Marin County Department of Health and Human Services.
All rights reserved.


Lisa Santora, MD, MPH
Deputy Health Officer
(415) 473-4163

This publication is provided to you by the Office of the Public Health Officer, County of Marin Department of Health and Human Services.

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