Investigation and public health response to a COVID-19 outbreak in a rural resort community—Blaine County, Idaho, 2020

  1. Eileen M. Dunne
  2. Tanis Maxwell
  3. Christina Dawson-Skuza
  4. Matthew Burns
  5. Christopher Ball
  6. Kathryn Turner
  7. Christine G. Hahn
  8. Melody Bowyer
  9. Kris K. Carter
  10. Logan Hudson

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Blaine County, Idaho, a rural area with a renowned resort, experienced a COVID-19 outbreak early in the pandemic. We undertook an epidemiologic investigation to describe the outbreak and guide public health action. Confirmed cases of COVID-19 were identified from reports of SARS-CoV-2-positive laboratory test results to South Central Public Health District. Information on symptoms, hospitalization, recent travel, healthcare worker status, and close contacts was obtained by medical record review and patient interviews. Viral sequence analysis was conducted on a subset of available specimens. During March 13–April 10, 2020, a total of 451 COVID-19 cases among Blaine County residents (1,959 cases per 100,000 population) were reported, with earliest illness onset March 1. The median patient age was 51 years (interquartile range [IQR]: 37–63), 52 (11.5%) were hospitalized, and 5 (1.1%) died. The median duration between specimen collection and a positive laboratory result was 9 days (IQR: 4–10). Forty-four (9.8%) patients reported recent travel and an additional 37 cases occurred in out-of-state residents. Healthcare workers comprised 56 (12.4%) cases; 33 of whom worked at the only hospital in the county, leading to a 15-day disruption of hospital services. Among 562 close contacts monitored by public health authorities, laboratory-confirmed COVID-19 or compatible symptoms were identified in 51 (9.1%). Sequencing results from 34 specimens supported epidemiologic findings indicating travel as a source of SARS-CoV-2, and identified multiple lineages among hospital workers. Community mitigation strategies included school and resort closure, stay-at-home orders, and restrictions on incoming travelers. COVID-19 outbreaks in rural communities can disrupt health services. Lack of local laboratory capacity led to long turnaround times for COVID-19 test results. Rural communities frequented by tourists face unique challenges during the COVID-19 pandemic. Implementing restrictions on incoming travelers and other mitigation strategies helped reduce COVID-19 transmission early in the pandemic.

Article activity feed

  1. Version published to 10.1371/journal.pone.0250322
  2. ScreenIT

    SciScore for 10.1101/2021.02.09.21251216: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: As such, ethical approval and informed consent was not required.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Idaho sequences from Blaine County were BLASTed against this subset of sequences using the MEGABLAST tool within Bionumerics.
    MEGABLAST
    suggested: None
    The BLAST hits, Blaine County sequences, and sequences from other Idaho counties (collected March 1–April 1, 2020) were compared using Bionumerics Multiple Sequence Alignment Tool and clustered using a Minimum Spanning Tree.
    BLAST
    suggested: (BLASTX, RRID:SCR_001653)
    Data on the estimated proportion of county residents staying at home were made publicly available by SafeGraph, Inc.15 Data analysis: Data were analyzed using Stata version 14.2 and graphs created in Excel.
    Excel
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations on the use of viral sequencing for this epidemiologic investigation include that only a subset of specimens tested and stored at the state public health laboratory were available for sequence analysis, as commercial laboratories typically do not store specimens. Nearly 13% of cases in Blaine County occurred among healthcare workers. This proportion is consistent with data from 12 US states reporting healthcare profession status on >80% of COVID-19 case reports, in which healthcare personnel accounted for 11% of cases.20 Healthcare workers from Hospital A held both clinical and non-clinical roles, and it was not possible to determine whether they were infected in the community or in the workplace. Sequencing analysis of SARS-CoV-2 from Hospital A staff indicated multiple exposures rather than a point-source outbreak caused by a single viral strain. Rural counties have fewer healthcare workers and facilities compared with urban areas, and the high number of affected workers from Hospital A led to temporary cessation of inpatient services at the only hospital in the county. Work exclusion of Hospital A staff who were identified as close contacts of COVID-19 cases also contributed to the staffing shortage. As Hospital A is part of a larger and well-resourced health system, it was able to remain partially open and received support from partner hospitals. Hospital planning for community spread of COVID-19 and developing strategies for mitigating staffing shortages are c...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.02.09.21251216v1 on medRxiv