Yellowstone County health officials define COVID-19 stats that would prompt school closures

A series of metrics to help guide decisions about COVID-19-related school closures in Yellowstone County was released by RiverStone Health at a media conference Sunday after the county saw it's largest weekly increase in cases to date.

“As we all recognize, the situation has changed substantially over just the last several days," said John Felton, Yellowstone County health officer.

From Aug. 16 - 22, Yellowstone County added 269 new COVID-19 cases for an average of 38 new cases per day, Felton said.

In the previous week, the county added 240 new cases for an average of 34 new cases per day, Felton said.

"So we increased our weekly total by 12 percent over the prior week,” Felton said.

Of the 1523 active cases in Montana, Yellowstone County has just over half at 777 cases, Felton said.

Yellowstone County also has 43 percent of the state's hospitalized patients. 48 patients are hospitalized in Billings with an even split of people from inside and outside the county, Felton said. Of those hospitalized in Billings 16 are in intensive care and 12 are on ventilators in intensive care.

To view bar graphs of various county COVID-19 case counts from June to present provided by RiverStone Health, click here.

Billings School District 2 Superintendent Greg Upham said in-person classes are still a go for students and teachers starting Monday. As classrooms begin to fill up, Felton named four data points or measures that health officials will watch to decide whether to close schools or relax restrictions in the future.

"The clinical metrics we developed are designed to help us understand if things are getting better or if the direction is getting worse in our community and how much of that direction is being affected by the schools being open," said Dr. Megan Littlefield, RiverStone Health medical director and chief medical officer.

Of the four measures, two are data-based, the other two require interpretation by doctors and public health officials.

On the interpretive side, officials will watch the trends of COVID-19 cases in children and youth, Felton said. The other is the capacity of the local health care and public health systems.

“As you can imagine, a cluster outbreak that would maybe add 10 to 15 people turning positive in a long-term care facility has very different implications in that same number if that cluster outbreak is occurring in schools or on a sports team," Littlefield said.

On the data-driven measures, officials will look to the seven day average of new cases per 100,000 people and the weekly test positivity rate calculated by the Montana Department of Public Health and Human Services.

“The medical/technical team which is composed of physicians, infection preventionists and public health nurses will monitor these situations and assign a green, yellow or red status to them based on status and changes over time," Felton said.

At least three of the four measures would need to be in a red status before Felton would recommend that districts suspend in-person classes, Felton said. As of the weekend, the four measures are in yellow status.

See a list of the data-driven metrics and their corresponding status color below:

7-day average of new cases per 100,000 population

• Less than 10 new cases per 100,000 = Green

• 0 – 25 new cases per 100,000 = Yellow

• More than 25 new cases per 100,000 = Red

Weekly COVID-19 test positivity rate

• Less than 5% = Green

• 5 – 10% = Yellow

• More than 15% = Red

Public health officials will look at the whole picture of COVID-19 spread in the county before making decisions about whether to close schools. Felton said they will be looking for weekly trends to base their decisions about a metric's color status.

“A single day will go up or down pretty dramatically depending on what happens, it’s the trend that we’re concerned about," Felton said.

The metrics can be viewed on RiverStone Health's web site by clicking here. Note that the page is dated Aug. 17, but does reflect current statuses.

Littlefield said there is no set minimum or maximum time frame that county public health may close a particular school due to an outbreak. If the decision to close would be made, it won't necessarily hold until the end of the school year, Littlefield said.

"What we might see happen and what has been seen in some other countries is they have had to do temporary shutdowns of the school and then reopen when the metrics are going in a direction that look like it would be safe to do that,” Littlefield said.

There was a last-minute change announced to the block schedule for the three Billings high schools at the request of the county health department, Upham said.

The high schools will now have class periods 1 - 3 for five days, then switch to have periods 4 - 6 for the next five days and so on.

This is a change from early last week when high school students would have spent two weeks in their first three class periods before making the switch to the later three periods.

Schedules remain the same for Billings elementary and middle schools.

Upham urged flexibility to students, parents and teachers at the start of an unprecedentedly challenging school year. The community needs to be ready for a shift to an all-remote school day again, Upham said.

“What I want to communicate to our parents and our teachers, our staff is that we need to be flexible. Are we approaching numbers that could place us into remote? Possibly. I want us to be ready to change at a moments notice and be ready to move to the direction we need to move, when we need to move. I know it’s challenging for all of us. I know there’s concern and we will address those. But i feel comfortable, I feel confident that RiverStone Health, our medical professionals are guiding us in this," Upham said.