DeWine Unveils COVID Public Health Advisory Alert System for Ohio — Hamilton and Butler County Are 'Red'

The color-coded statewide system indicates the COVD-19 threat level in each of Ohio's 88 counties

Gov. Mike DeWine has unveiled a new statewide system to indicate the COVD-19 threat level in each of Ohio's 88 counties. 

The so-named Public Health Advisory Alert System is a four-level color-coded program built on a “data-driven framework” to evaluate the degree of the spread of the virus to inform, empower and engage health and government officials, business owners and the public in their response and reaction, said DeWine.

"In this next phase of the pandemic, saving lives and protecting fellow Ohioans remains top priority. We cannot move backward. Ohioans have come too far in this fight to cede ground now to this virus," he said. "Our best defense moving forward is to be on the offense. This means this next phase is not about hunkering down but learning to live with this virus."

"Doing both — keeping the economy moving and keeping safe — these are consistent and one is certainly dependent upon the other."

He said in the past three weeks, cases have jumped in Ohio: on June 17, there were 412 confirmed cases; on June 24, 632 cases; and on July 1, there were 1,076 confirmed daily COVID cases. He said this spread can be attributed to transmission among younger Ohioans in their 20s and 30s and to family gatherings, graduations, birthday parties, funerals, tourist destinations, bars, restaurants, etc. and because people aren’t social distancing or wearing masks. 

DeWine said in addition to continuing to follow the state's baseline orders, the goal of the new alert system will be to suggest enhanced safety measures to combat COVID flare-ups as they occur in different counties.

He did not announce any new closures or orders or step back any reopenings, but did say “all the great actions Ohioans have taken to this point are in danger frankly of being reversed" if we don't pay attention to the "worrisome and concerning trend" of the increase in cases.  

The four levels of severity in the Public Health Advisory Alert System — Level 1: Yellow; Level 2: Orange; Level 3: Red; and Level 4: Purple — are determined by seven data indicators that build on the current baseline risk.

  • Indicator 1: New cases per capita. If there are 50 cases per 100,000 people over a two-week period, it will trigger a flag for an increasing case rate. This is the same figure the CDC uses for going from moderate to moderately high.
  • Indicator 2: Sustained increase in new cases. This is triggered if there is a five day period of sustained new case growth.
  • Indicator 3: Proportion of cases that are not congregate cases. This is triggered if more than 50% of cases are from community spread and not congregate cases.
  • Indicator 4: Sustained increase in emergency room visits. This is triggered if there is an increase in ER visits with COVID symptoms over a five day period.
  • Indicator 5: Sustained increase in outpatient visits. This is triggered if there is an increase in visits with COVID symptoms over a five day period.
  • Indicator 6: Sustained increase in new COVID-19 hospital admissions. This is triggered if there is at least a five day period of county residents with COVID-19 being admitted to a hospital. The county where they come from is recorded, not the county where the hospital is located.
  • Indicator 7: Intensive Care Unit bed occupancy. This flag looks at COVID and non-COVID ICU beds. When regional ICU occupancy goes above 80% for at least three of the last seven days, this is triggered.

Eventually, DeWine says they plan to add indicators for contact tracing, tests per capita and percent positivity.

Right now, all 88 Ohio counties have community spread and all 88 are at a baseline threat level.

Here's what each level means. 

Level 1: Yellow  At this level there is active exposure and spread, but the county has triggered zero or one of the indicators. Today 53 counties are at Level 1. The recommendation at Level 1 is to follow the usual COVID-19 guidelines we all know — wash your hands, social distance, wear a mask in public places, etc. 

Level 2: Orange — This means a county has triggered two or three indicators and there is an increased amount of exposure and spread. Residents here should exercise a high degree of caution. Today, 28 counties are in Level 2.

In addition to standard COVID safety, Level 2 residents should: avoid contact with anyone considered high risk, decrease in-person interactions in general and limit or avoid unnecessary trips to visit people in hospital, nursing homes or residential care. 

Level 3: Red — This means there is a very high exposure and spread of COVID and the county has triggered four or five indicators. Seven counties are currently at Level 3. This means there are many cases of community spread present — in workplaces, social settings, long-term care facilities. 

In addition to regular COVID safety guidelines, residents in these counties should: limit activities as much as possible, wear a mask when they go out, consider online options,  even for church services, consider necessary travel only and limit attending gatherings of any kind.

The seven counties currently under a "Red" alert are Trumbull County, Huron County, Montgomery County, Butler County, Cuyahoga County, Franklin County and Hamilton County. DeWine said cases in Hamilton County quadrupled to 130 confirmed COVID cases per day (ER visits nearly tripled), that the county has met five of seven of the indicators and there is 89%-97% community spread.

Level 4: Purple — Counties in Level 4 have triggered six or seven indicators. This means there is severe exposure and spread. Ohioans in Level 4 should only leave home as necessary. No counties are at the Purple level, but Franklin County is now on the watch list. 


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