MANSFIELD -- Richland County remained "red," or level three, on Thursday for the eighth straight week in Ohio's color-coded, COVID-19 ratings system.
Richland County is one of 72 of Ohio’s 88 counties this week with the "red" designation. Ashland, Crawford and Knox counties also remained red this week.
Franklin County on Thursday became the first "purple," or level four county, since the Public Health Advisory System began in July as Gov. Mike DeWine continued to warn residents about hospital facilities and medical staff workers being overwhelmed.
"While Franklin is the only county moving to purple this week, we see similar stories in much of the state," DeWine said.
"Our healthcare system is feeling the impact of this disease and hospitals are worried about being able to keep up with staffing of nurses and doctors and other support staff," the governor said.
"Other counties may not yet be seeing continuous, uninterrupted increases in the same way that is causing Franklin to move to purple, but make no mistake — almost all counties are seeing more cases and more healthcare use that could threaten the medical system if they continue," DeWine said.
He had several medical experts as speakers during the bi-weekly press conference, including Bruce White, chief executive officer at Knox Community Hospital, who described the growing number of COVID-19 cases at the rural facility.
"Earlier on in the process, we were worried about PPE and supplies. Now, it's manpower and resources. People are tired. I work with amazing people. Every day, they perform miracles, but they cannot perform magic," White said.
White said the intensive care units at KCH had no COVID-19 patients two months ago and now that number is 30 percent.
"We have to buckle down as a state," White said, adding that KCH "flirts" every day with maximum patient usage. "This is not a drill."
There are 15 "orange," or level two, counties, though all 88 counties are considered "high incidence" for virus spread by CDC standards. There are no "yellow," or level one, counties.
DeWine said three other counties -- Lake, Lorain and Montgomery -- have been placed on the state "watch list" and could become purple next week.
Richland County triggered four of the public health advisory system's seven categories and remained "high incidence" for spread of the virus under CDC standards.
Here are the categories met this week in Richland County:
New cases per capita -- Flagged if greater than 50 cases per 100,000 residents over the last two weeks. Richland County continues to soar in this category with 642 new cases in the last 14 days, or 529.9 per 100,000 residents. The county has seen a dramatic rise in the last month, growing from 130.41 on Oct. 22.
Proportion of cases not in a congregate setting -- Flagged if 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 was at 100 percent in the past week after weeks of 95.94 and 99.54 in the two prior weeks.
Sustained increase in Emergency Department (ED) visits for COVID-like illness -- Flagged if 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 has actually seen nine straight days of growth in this category, rising from 12.71 on a seven-day average as of Nov. 8 to 22.43 on Nov. 17.
Sustained increase in outpatient visits for COVID-like illness -- Flagged if 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 have five such days of growth between Nov. 12 and Nov. 16, rising from 50.14 on a seven-day average to 58.86.
The new statewide 10 p.m. to 5 a.m. curfew begins Thursday night, though DeWine said he didn't anticipate law enforcement officers stopping motorists driving during curfew hours.
"I trust Ohioans to take personal responsibility not to be out after 10 p.m. unless they need to be," DeWine said, adding officers who see people gathering together outside during curfew hours may tell them to go home.
In response to a question, the governor said he was not ready to order a statewide shutdown as he did during the spring, closing "non-essential" businesses.
"If you can stay home, stay home. This is very, very, very serious," he said.
"We have to take this down. The reason why we haven't issued a statewide shutdown is because of the ramifications of a shutdown. Everything we do during the pandemic is a balance," DeWine said.
"We know that Ohioans have it in their power to slow this down. That's why we put an emphasis on personal responsibility. The big spread is coming from what people do in their personal lives when interacting with friends and family outside of their household," he said.
Reed Richmond, health educator at Richland Public Health, said local residents should follow the recommended guidelines to reduce the spread of COVID-19:
-- Wear a face covering (cloth mask) when out in the public.
-- Must wear a face covering (cloth mask) when entering a retail business or grocery
-- Maintain social distancing of at least six feet from non-household members.
-- Consider necessary travel only.
-- Follow good hygiene standards, including:
Wash hands frequently with soap and water for at least 20 seconds.
Use hand sanitizer frequently.
Avoid touching your face.
Cover coughs or sneezes (e.g., into a tissue, or elbow).
Symptom self-evaluation monitoring.
-- Decrease in-person interactions with others.
-- Limit attending gatherings of any number.
-- Conduct a daily health/symptom self-evaluation and stay at home if symptomatic.
-- Seek medical care as needed, but limit or avoid unnecessary visits to hospitals, nursing homes, and residential care facilities to see others as much as possible.