During the COVID-19 response in Virginia, the Virginia Department of Health (VDH) is reporting public health data in more detail and more quickly than ever before. VDH routinely performs ongoing and comprehensive quality assurance on COVID-19 cases, hospitalizations, and deaths, including those that have been previously reported to VDH. Performing data quality assurance, such as checking for correct addresses, re-classifying cases to align with national case definitions, and other efforts, is important for public health. It helps make sure that data that are reported and presented are as accurate and timely as possible. The data quality assurance steps VDH takes are not new. Public health professionals perform these data quality steps for many health conditions in addition to COVID-19. Because of these steps, it is important to note that
Checking for Locality of Residence:
One of the data quality assurance steps that VDH takes is checking for correct addresses. VDH initially assigns a case to a locality (county or independent city) based on the patient’s residential ZIP code. In Virginia, some ZIP codes cross between multiple localities. Upon further review of the case, which includes applying geocoding to the residential address, VDH may determine the original locality assigned to the case is not correct. In these scenarios, the case will be re-assigned to the appropriate locality, which may result in a negative count for the original locality and a positive case count in the re-assigned locality.
Classifying a COVID-19 Case:
To determine if a person should be counted as a COVID-19 case, VDH uses criteria outlined in a national case surveillance definition by the Centers for Disease Control and Prevention (CDC). Disease surveillance is foundational to public health practice. It helps understand diseases and their spread and informs appropriate actions to control outbreaks. VDH performs several steps to ensure each COVID-19 case reported in a Virginia resident meets these specified criteria.
Not every COVID-19 case involves a positive test, and not every positive test reported to VDH is counted as a COVID-19 case. Some cases are counted because they show symptoms of COVID-19 and had close contact to another known COVID-19 case as described in the national case surveillance definition. Additionally, there are people in Virginia who have been tested more than once for COVID-19. Some of these people are in higher risk settings such as healthcare or nursing homes, and others are known COVID-19 cases who needed negative tests to return to their normal routine. When a person is tested many times over the course of their COVID-19 infection, VDH reviews all the test results to ensure multiple positive test results for the same infection in one person are not counted as multiple COVID-19 cases.
The data quality steps described above may result in changes to the number of cases, hospitalizations, and deaths in your community or within the state. Negative numbers in case counts by report date on the VDH COVID-19 data dashboards may be observed as quality assurance steps are completed. The dashboards most likely to be impacted are: Locality, School Metrics, and Locality Metrics.
This data will be updated at the beginning of each month.
The meat and poultry data blog looks different this month—why the change?
The number of COVID-19 cases, outbreaks, hospitalizations and deaths associated with meat and poultry processing plants continue to remain very low throughout Virginia. As long as there is community transmission of COVID-19, it is likely that we will continue to see occasional cases in meat and poultry processing plant workers over time. The focus of the COVID-19 response efforts for meat and poultry processing plant workers has shifted from supporting outbreak investigations to providing vaccine access to this essential workforce.
What efforts have been made to improve COVID-19 vaccine access to meat and poultry processing workers?
VDH and the food sector have been working on various ways to distribute COVID-19 vaccines to meat and poultry processing workers. These include working with occupational health providers and local health departments. In addition to these efforts community-based organizations have been working to share information about COVID-19 vaccines with workers in the food and agriculture sector.
The Lord Fairfax Health District (LFHD) has been working with local food processors to set up vaccination clinics. They’ve vaccinated local fruit growers and a few food processing plants and are continuing to reach out to businesses to arrange coming on site to get more people vaccinated. Since January 2021, LFHD has vaccinated at least:
405 meat and poultry processing plant workers
255 dairy workers
170 produce workers
130 other food production workers
43 migrant workers
The Central Shenandoah Health District (CSHD) scheduled 15 clinics onsite at poultry plant facilities, administering over 2,770 1st and 2nd COVID-19 vaccine doses. The health district utilized Community Health Workers to work with poultry plant workers and their families to get connected to other clinics if they were unable to or uncomfortable with receiving the vaccine at the onsite clinics at their place of employment. These efforts supported the districts’ larger, weekly clinics at the Rockingham County Fairgrounds and James Madison University where essential workers, including poultry plant workers, food processing, and agricultural workers, were invited to come and receive a COVID-19 vaccine. Furthermore, CSHD engaged with poultry plant facilities to establish COVID-19 vaccine programs within their occupational health programs. So far, this effort has resulted in the establishment of one COVID-19 vaccine program at a local poultry plant.
The Eastern Shore Health District (ESHD) has:
Been offering COVID-19 vaccinations to seasonal workers as they arrive on the Shore and coordinating that effort with local farm managers and crew leaders. Out of approximately 130 workers currently on the Shore, it is estimated that 80-85% have been vaccinated; some received the vaccine before they arrived.
Partnered with Eastern Shore Rural Health to provide three onsite vaccination events at poultry plant facilities. Hispanic and Haitian Creole outreach workers helped provide education to workers as part of these events. A total of 91 night shift workers were vaccinated during these events and similar events are planned for day shift workers in early June. The Elite Marketing Group will be helping to host a pre-vaccination “party” with snacks and educational information as part of these upcoming events.
Offered weekly walk-in vaccination clinics on Tuesdays and Wednesdays at the local health department.
Partnered with Legal Aid and Eastern Shore Rural Health to plan an upcoming outdoor event at the local YMCA, to specifically offer COVID-19 vaccines to the refugee, immigrant and migrant populations. There will be informational tables for organizations who provide services to this community and walk-up vaccine opportunities for anyone 12+ with all three authorized vaccines available to maximize vaccine uptake.
Hired one Hispanic and one Haitian Creole Community Health Worker who will be working primarily with poultry, agricultural, aquaculture and seasonal workers, which comprise a large part of the refugee, immigrant and migrant community.
Why is COVID-19 vaccination so important?
COVID-19 vaccination is an important tool to help us get back to normal; every vaccine administered helps us get closer to reaching population immunity. Population immunity means that enough people in a community are protected from getting a disease because they’ve already had the disease or because they’ve been vaccinated. Population immunity makes it hard for the disease to spread from person to person. It even protects those who cannot be vaccinated, like newborns or people who are allergic to the vaccine. Learn more about the benefits of getting vaccinated.
Why the focus on meat and poultry processing workers?
Initial cases of COVID-19 associated with meat and poultry processing plants were reported in Virginia in March of 2020. Cases peaked in April and May of 2020 with large outbreaks reported in several processing plants throughout the United States, including Virginia. Workers in these facilities need to work closely to one another, often for prolonged periods of time, making transmission of COVID-19 from one worker to another easy. Protecting this vulnerable workforce is important to protect both the workers, who produce the food we eat, and the communities in which they live.
In addition to vaccination, what other interventions were put in place to prevent the transmission of disease within these facilities and the wider communities in which they exist?
The Virginia Department of Health worked with affected facilities to put a variety of interventions in place to reduce disease transmission. The most common interventions implemented in Virginia included:
educating employees about the transmission of COVID-19
screening employees for signs and symptoms of illness
adding hand hygiene stations
adding physical barriers between workers where physical distancing was not possible, and
requiring universal face coverings
For more information about recommended interventions for meat and poultry processing facilities, check out the links below:
COVID-19 Death Disparities by Census Tract Poverty Level, Health Opportunity Index and Rurality
Disparities for key COVID-19 indicators by race/ethnicity in Virginia and the United States have been well documented (see March 8, 2021 COVID-19 Health and Disease Disparities by Race and Ethnicity in Virginia blog post). This report focuses on COVID-19 death rate disparities for adults 35-54 years of age in Virginia by census tract level poverty, health opportunity index and rurality. The entire age range was not used for this analysis because subpopulations, such as those with different poverty levels, have different age structures and therefore can’t be fairly compared for an outcome that is associated with age such as COVID-19 death. The 35-54 year age group was chosen for these comparisons because it is the youngest age group with sufficient numbers of deaths to allow for reasonable death rate comparisons at the census tract level.
Poverty Level Disparities
A person’s income is not included in their death records, however, the percentage of persons living below the federal poverty level by census tract is available. COVID-19 deaths among persons 35-54 years of age can be grouped by this percentage. The largest disparity in the COVID-19 death rate was found between those living in census tracts with the greatest percentage of persons living in poverty, >= 40%, and those living in census tracts with the lowest percentage of persons living in poverty, < 10%. Persons living in census tracts with the highest percentage of people in poverty were 2.3 times more likely to die of COVID-19 than those from the lowest poverty census tracts (Figure 1).
Health Opportunity Index Disparities
The Virginia Department of Health provides the Virginia Health Opportunity Index (HOI) which is a composite measure of the social determinants of health – the social, economic, educational and environmental factors that relate to a community’s well-being – at the census tract level. The index is divided into 5 levels – very high, high, moderate, low, and very low – and census tracts can be grouped into these 5 levels. In general, persons living in census tracts with a higher HOI tend to have lower disease and death rates. COVID-19 deaths among persons 35-54 years of age can be grouped by the level of HOI for the census tract in which they reside. The largest disparity in the COVID-19 death rate for this age group was found between those living in census tracts with the lowest HOI and those living in census tracts with the highest HOI. Persons living in census tracts with the lowest HOI were 1.9 times more likely to die of COVID-19 than those from census tracts with the highest HOI (Figure 2).
Persons living in rural areas, in general, tend to have higher disease and death rates than those living in metropolitan areas. Rural and urban census tracts can be classified by the Rural/Urban Community Area (RUCA) taxonomy and then further classified into groups – metropolitan, micropolitan, small town and rural. COVID-19 deaths among persons 35-54 years of age can be grouped by these RUCA groups for the census tract in which they resided. The largest disparity in the COVID-19 death rate for this age group was found between those living in small town census tracts and those living in metropolitan census tracts. Persons living in small town census tracts were 1.5 times more likely to die of COVID-19 than those from metropolitan census tracts, and both persons from micropolitan census tracts and persons from rural census tracts were 1.4 times more likely to die of COVID-19 than those from metropolitan census tracts (Figure 3).
COVID-19 death rates for those 35-54 years are higher in non-metropolitan communities and for persons living in communities with a higher percentage of people living in poverty in Virginia. This is not surprising since many health indicators are worse for communities with high poverty rates and for rural communities. In general, these communities may have fewer opportunities than communities with lower poverty and metropolitan communities. One approach to reducing these disparities is to increase social, economic, vocational and educational opportunities in these high poverty communities and rural communities. An “opportunity” specifically related to COVID-19 is vaccination, and these vaccinations should continue to be prioritized for persons in rural communities and those with high poverty rates or percentages.
Average daily cases per 100k Virginia residents declined to the single digits for the first time since last summer. Cases are declining or plateauing in all of Virginia’s Local Health Districts – a first since UVA began reporting trajectories.
New vaccinations have declined dramatically, while mitigation measures are being relaxed, heralding an new environment compared to April.
Scenarios have changed to include the dominance of the B1.1.7 variant, behavioral changes in response to surges, and different vaccination rates.
Masks and social distancing are still recommended for people who are unvaccinated, and masks are still recommended in certain situations for those who are vaccinated.