COLUMBUS -- Two north central Ohio counties recorded unhealthy firsts Thursday when Gov. Mike DeWine updated the state's color-coded Public Health Advisory System.
Ashland County rated as "red," or level three, for the first time since the state launched the system in July. Crawford County, which has been "yellow," or level one, each week, was moved to level two this week.
Richland County remained "orange" this week and Knox County remained yellow.
The system uses seven indicators to monitor spread of COVID-19 in each county.
If a county meets 0-1 of the seven indicators, it's ranked "yellow," or level one. That rating becomes "orange," or level two, if it meets 2-3 indicators. The ranking moves to "red" if 4-5 indicators are triggered and becomes "purple," or level four, if 6-7 indicators are met.
Ashland County met four indicators while Richland County met three and Crawford County met two.
No county has been rated level four since the ratings scale was launched. Gov. Mike DeWine updates the ratings each Thursday during his meetings with media members.
Ashland County is one of nine red counties this week, up from five last week. Other counties are Delaware, Pike, Scioto, Stark, Butler, Mercer, Montgomery and Putnam.
"The population of Ohioans living in yellow counties has decreased during the past four weeks, indicating that we have significant spread of the virus across the state," DeWine said.
However, the seven-day average positivity rate for Ohioans tested for COVID-19 was at 2.8 percent on Sept. 22, down from 4.4 percent on Sept. 3, continuing a gradual statewide decline since the middle of August.
Ashland County's "red" rating, according to the system, means there is "very high exposure and spread" in the county and residents are asked to "limit activities as much as possible."
“While there may be small differences in our understanding of the data, the Ashland County Health Department accepts the designation of Level 3 Red status from the state," Ashland County Health Commissioner Heather Reffett said.
"The number of positive cases continues to rise in our county and our residents should take this very seriously," Reffett said.
Ashland had been rated "yellow" throughout the system until it moved to "orange" on Sept. 10 and remained at that level on Sept. 17.
Ashland and Richland counties are both offering free, pop-up mobile COVID-19 testing sites on Saturday.
Here are the indicators "triggered" in Ashland, Richland and Crawford counties this week:
New cases per capita -- A county meets this indicator if it has more than 50 cases per 100,000 residents over the last two weeks. Ashland County reported 36 new positive tests in the last two weeks. With a population of 53,484, that is 67.31 new cases per 100,000 residents.
Sustained increase in new cases -- This indicator is flagged when a county reports an increasing trend of at least five consecutive days in overall cases by onset date over the last three weeks. Ashland County such a five-day period from Sept. 7 (1.57 on a seven-day average) to 2.86 on Sept. 11. It peaked at 3.71 on Sept. 16 and had declined to 1.57 on Sept. 22.
Proportion of cases not in a congregate setting -- A county is flagged here if the proportion of cases that are not in a congregate setting goes over 50 percent in at least one of the last three weeks. Ashland County has reported 100 percent of its cases in non-congregate settings for the last several weeks.
Sustained increase in outpatient visits for COVID-like illness -- This indicator is met if a county has an increasing trend of at least five consecutive days in the number of people going to a health care provider with COVID symptoms who then receive a COVID confirmed or suspected diagnosis over the last three weeks. Ashland County saw a daily increase from Sept. 10 (2.71 on a seven-day average) to Sept. 14 (5.71). This number has continued to increase and was at 8.57 on Sept. 22.
Richland County met the same three indicators it met last week -- proportion of cases not in a congregate setting, sustained increase in ER visits for COVID-like illness and sustained increase in outpatient visits for COVID-like illness.
Proportion of cases not in a congregate setting -- A county is flagged here if the proportion of cases that are not in a congregate setting goes over 50 percent in at least one of the last three weeks. Richland County, which has seen an outbreak at the Richland Correctional Institution in the last week, was at 41.38 percent Sept. 16-22. But it was at 56.67 percent the week before and 91.67 Sept. 2-8.
Sustained increase in emergency room visits for COVID-like illness -- A county meets this indicator if it has an increasing trend of at least five consecutive days in the number of visits to the emergency department with COVID-like illness or a diagnosis over the last three weeks. Richland County saw an increase from Sept. 5 (1.57 on seven-day average) to Sept. 9 (3.43). This indicator peaked at 3.71 on Sept. 11 and has declined to 1.71 on Sept. 22.
Sustained increase in outpatient visits for COVID-like illness -- This indicator is met if a county has an increasing trend of at least five consecutive days in the number of people going to a health care provider with COVID symptoms who then receive a COVID confirmed or suspected diagnosis over the last three weeks. Richland County had such an increase from Sept. 10 (14.57 on seven-day average) to Sept. 14 (23.43). It was still at 21.29 on Sept. 22.
Sustained increase in new cases -- A county is flagged if it reports an increasing trend of at least five consecutive days in overall positive cases by onset date over the last three weeks. Crawford County had such a sustained growth from Sept. 15 (1.29 in a seven-day average) to 2.43 on Sept. 19. It has since declined to 1.43 as of Sept. 22.
Proportion of cases not in a congregate setting -- In terms of percentage of cases not found in non-congregate care settings, a county is flagged if the proportion of cases that are not in a congregate setting goes over 50 percent in at least one of the last three weeks. Crawford County has met this indicator for the past several weeks.
According to the ODH website, updated Wednesday, there is a current virus outbreak at Heartland Bucyrus Nursing Home. The website shows five residents at the nursing home and 10 staff members are currently positive for COVID-19.
Also on Thursday, DeWine said he had activated about 300 Ohio National Guard members to "ensure a safe and secure environment for those attending Tuesday’s presidential debate in Cleveland."
The governor said he issued the order after receiving a former request from the City of Cleveland.
DeWine also announced today Ohio's ResponsibleRestart guidelines for higher education will now include a recommendation all residential colleges and universities regularly test a sample population of asymptomatic students.
"Some schools are already doing this, and screening asymptomatic students really gives school leaders a good idea about virus spread on their campuses," DeWine said. "Our expectation is that colleges and universities will screen at least 3 percent of their at-risk population on a regular basis."
DeWine also announced two new health orders that will allow for indoor visitation at nursing homes, assisted living facilities, and intermediate care facilities in Ohio.
Intermediate care facilities for Ohioans with developmental disabilities can resume indoor visitation beginning on Sept. 28, if safety standards outlined in the order are met.
Nursing homes and assisted living facilities can begin allowing indoor visitation on Oct. 12. This date was selected to allow adequate time for the facilities to prepare their physical plants, adjust staffing levels, update visitation policies, and communicate expectations with residents and families, DeWine said.
Indoor visitation at nursing homes and assisted living facilities should only resume if certain safety standards are met. These standards will be outlined in a forthcoming public health order.