Welcome to the 65th installment of “Coronavirus Contextualized.”

Since the beginning of the pandemic, we have brought you the latest COVID-19 numbers in Nevada, including cases, hospitalizations and deaths, and provided context to them on a near-weekly basis through this series. (Prior editions of “Coronavirus Contextualized” live here.)

“Coronavirus Contextualized” publishes on a semi-regular basis, meaning that if cases are increasing or decreasing, you can expect to see a new story every week or every other week, and if cases are stable, you might not see a new story for a few weeks.

As a programming note, “Coronavirus Contextualized” will be on hiatus for the month of November. It will return on Friday. Dec. 3.

Don’t fear, though: You can find the latest data daily on our COVID-19 data page and on Twitter. As always, you can reach out to megan@thenvindy.com with any questions.

Below, we take a look at the latest inflection point in the pandemic with case numbers appearing to level out in Clark County while starting to climb again in Washoe County.

Cases

COVID-19 cases have been fluctuating statewide over the last week, largely the result of a fluctuating case trend in Clark County and an increasing trend in Washoe County.

As of Thursday, 638 new cases were reported on average each day over the previous seven days, up slightly from 622 last week but still significantly down from the highest point of the current wave, 1,226, which the state hit on Sept. 13. Cases have been fluctuating between a low of 622 and a high of 689 over the past seven days.

Clark County, which was hit early and hard by the latest wave of the virus, has also seen some fluctuations in recent days, hitting a seven-day average of 382 on Thursday. That’s slightly up from 363 last week but significantly down from 917 on Aug. 1, the highest point of the current wave. 

Cases, however, are up in Washoe County. After hitting a low point of 88 on Oct. 6, the seven-day average was back up to 118 as of Thursday. That’s up from 108 last week, but still significantly less than Washoe’s most recent high point, 304 on Sept. 15.

“Last week I reported that we were seeing COVID-19 cases and transmission plateauing. We had been coming down significantly from the high that we had experienced previously of around 300 new cases per day, but that had flattened out, and now we're actually seeing increases in new cases occurring,” Washoe County District Health Officer Kevin Dick said during a press call this week. “So we've reversed that trend and are moving in the wrong direction.”

Dick urged people to get the COVID-19 vaccine to stem the rising tide of cases and suggested that people get the booster shot if they are eligible for it. He also urged people to exercise caution with upcoming celebrations for Nevada Day, Halloween and Día de los Muertos.

“We're concerned with the potential for gatherings and a repeat of what we saw last year at this time with large gatherings that were occurring and transmission that occurred at those gatherings and spreading of COVID-19,” Dick said. “People need to remember that we are still at high levels of transmission in Washoe County.”

Washoe County’s case rate, which was about equal to Clark County’s two weeks ago, is now significantly higher than Clark’s. As of Thursday, Clark County was seeing 17 cases reported per 100,000 residents each day over the previous seven days, while Washoe County’s case rate was 25. The case rate in the other 15 counties continues to be significantly higher than both urban counties at 40.

Since the beginning of the pandemic, there have been 449,322 COVID-19 cases confirmed statewide, meaning 1 in 7 Nevadans has tested positive for the virus. About 7 percent of those cases, 29,943, have been diagnosed in the last month, and a little less than 1 percent, or 4,467 cases, have been reported in the last week.

Test positivity

While cases plateau or begin to increase in some parts of the state, the statewide test positivity rate, which looks at the percentage of tests coming back positive out of the total tested, continues to decrease.

It is not possible to independently calculate the test positivity rate based on test encounters because the state only publicly reports the number of positive cases, not the number of positive test encounters. However, the state does provide this number, calculated as an average over a 14-day period with a seven-day lag. (It’s worth noting that 14-day lag may be responsible for differing trends between cases and test positivity.)

As of Tuesday, that number was 6.8 percent, down from the 7.3 percent last week and significantly down from 14.9 percent at the peak of the current wave on Aug. 13. Still, the state’s test positivity rate remains above the World Health Organization’s recommended 5 percent threshold.

Since the beginning of the pandemic, nearly 2.2 million people — more than 71 percent of Nevadans — have been tested for COVID-19, and there have been more than 5.2 million individual testing encounters.

Vaccinations

The pace of vaccine distribution in Nevada remains fairly level, though it has seen some increases in recent days.

As of Thursday, about 9,000 vaccines were reported administered each day over the last seven days, up from 6,700 reported last week.

More than 63 percent of Nevadans now have been either partially or fully vaccinated against COVID-19, with nearly 53 percent fully vaccinated.

An additional 277,000 Nevadans will become eligible for the vaccine if and when the Centers for Disease Control and Prevention signs off on a plan to administer the Pfizer vaccine to 5- to 11-year-olds. That includes about 209,000 5- to 11-year-olds in Clark County and nearly 41,000 in Washoe County.

Karissa Loper, the state's health bureau chief, said on a press call this week that the state has been in contact with many Nevada pediatricians to find out whether they plan to offer the vaccine to kids and is “working to enroll more vaccinators every day.”

Loper said about 95,000 doses of the vaccine will be initially available to the age group and will be “equitably distributed statewide.” That means that about a third of kids in that age group will be able to get the vaccine as soon as it is approved.

“This is an important next step in our efforts to protect our communities from COVID-19,” Loper said.

Since vaccinations started in December, more than 1.9 million people have received at least one dose of the COVID-19 vaccine and more than 1.6 million Nevadans have been fully vaccinated.

Among the counties, Carson City continues to have the highest percentage of residents fully vaccinated against COVID-19 at 58.1 percent, followed by Washoe County at 55.9 percent, Douglas County at 49.9 percent and Clark County at 48 percent. Tiny Storey County has still vaccinated the least, with only 17.5 percent of its residents fully vaccinated. (Storey County’s percentage of residents fully vaccinated has not changed in four weeks.)

Nationally, Nevada continues to rank 31st among the 50 states for percentage of its population fully vaccinated, still behind all of its neighbors except Idaho, which ranks 49th.

Breakthrough cases

There have been 11,104 breakthrough cases — fully vaccinated individuals who have tested positive for COVID-19 — in Clark County as of Thursday, meaning that 1 percent of fully vaccinated individuals have contracted the virus.

In Washoe County, there have been 4,412 breakthrough cases as of Thursday, representing 1.65 percent of fully vaccinated people in the county.

There have been 566 breakthrough hospitalizations and 183 breakthrough deaths in Clark County as of Oct. 21, meaning that 0.05 percent of vaccinated individuals in Clark County have been hospitalized and 0.02 percent have died. Of the people hospitalized with breakthrough infections, 65 percent had underlying conditions, 75 percent were 65 years or older and 58 percent were men.

Southern Nevada Health District data show that breakthrough cases have made up about 23 percent of all cases in October so far. Non-breakthrough cases make up the remaining 77 percent.

Deaths

The number of new COVID-19 deaths continues to fluctuate, though deaths are slightly up from last week.

As of Thursday, 17 COVID-19 deaths were being reported on average each day over the prior seven days, up from 14 last week but down from 19 two weeks ago. The 2020 summer surge peaked at an average of 21 daily deaths, while the fall and winter surge peaked at 45 daily deaths. This surge peaked at 25 average daily deaths on Aug. 30.

Over the last seven days, 118 new COVID-19 deaths have been reported across the state — up from 101 last week — including:

• 69 in Clark County
• 13 in Washoe County
• 6 each in Humboldt and Nye counties
• 5 in Lyon County
• 4 each in Carson City, Churchill and Douglas
• 2 each in Elko and Lander counties
• 1 in Pershing, Storey and White Pine counties

Since the beginning of the pandemic, there have been 7,631 deaths in Nevada from COVID-19. In the last month, 558 deaths from COVID-19 were reported statewide, 7 percent of the deaths reported statewide since the beginning of the pandemic.

One in 404 Nevadans has died from COVID-19.

Hospitalizations

The number of statewide COVID-19 hospitalizations has started to plateau, though hospitalizations are increasing again in Washoe County.

As of Wednesday, there were 635 people hospitalized with confirmed or suspected cases of COVID-19 across the state, slightly up from 628 last week though still significantly down from this wave’s peak of 1,317 on Aug. 10. The peak of last summer’s wave was 1,165, which the state hit on July 31, 2020, and the peak of the fall and winter wave was 2,025, on Dec. 13, 2020.

Of those hospitalizations, 115 were in Washoe County, up from a recent low of 83 on Oct. 15.

“The hospitals remain quite strained with the staffing levels that they're able to achieve, and with the number of COVID-19 cases that they're caring for, as well as all of the other cases and patients that are in the hospital for other health care needs that we have to be treated in our community,” Dick, Washoe County’s district health officer, said.

County by county

Twelve of the state’s 17 counties are flagged as at elevated risk for the spread of COVID-19, according to the state’s dashboard. That’s up from nine last week.

As of Thursday, only Carson City, White Pine, Pershing, Lincoln and Clark were not flagged.

Counties are considered at risk for elevated spread of COVID-19 if they meet two of the following three metrics:

• The average number of tests per day per 100,000, calculated over a 14-day period. If this number is less than 100, a county could be considered at risk.
• The case rate per 100,000, calculated by taking the number of cases diagnosed and reported over a 30-day period. If this number is greater than 200, a county could be considered at risk.
• The case rate per 100,000 and the test positivity rate, calculated over a 14-day period with a seven-day lag. If the case rate is greater than 50 and the test positivity rate is greater than 8.0 percent, a county could be considered at risk.

All Nevada counties except Storey are considered to have high case rates. Storey, however, continues to be flagged for low testing rates and a too-high test positivity rate.

The state continues to align its mask mandate with federal guidance, meaning it is using the CDC’s community transmission tracker to determine which counties are at substantial or high risk for the spread of COVID-19 and therefore required to abide by indoor mask mandates for vaccinated and unvaccinated individuals alike.

Under the CDC’s metrics, counties are considered at risk for “high” transmission if they have more than 100 cases per 100,000 residents in the last seven days, “substantial” if they have between 50 and 100, “moderate” if they have between 10 and 50 and “low” if they have fewer than 10.

As of Tuesday, all Nevada counties except Esmeralda were considered at “high” risk of transmission. As a result, all counties except Esmeralda remain subject to universal indoor masking precautions for both vaccinated and unvaccinated individuals.

Counties can have mask mandates put in place if they have two weeks of “substantial” or “high” transmission; those mask mandates will automatically be removed after two weeks of “low” or "moderate" transmission.

For perspective, Clark County’s case rate was 110 as of Wednesday, according to the CDC, meaning it remains more than double what it would need to be in order for the mask mandate to go away. Even then, the county’s mask mandate must remain low for two weeks in a row before it can be lifted and could be reimposed should cases climb again.

In Washoe County, the case rate stands at 148 as of Wednesday, meaning that it is nearly triple what it would need to be for its mask mandate to be removed.

Read more of our pandemic coverage here. You can also find the latest COVID-19 data on our data page.