The Highland County COVID-19 Case Epidemiology chart, as of May 21. (Photo courtesy of the Highland County Health Department)
The Highland County COVID-19 Case Epidemiology chart, as of May 21. (Photo courtesy of the Highland County Health Department)
The Highland County Emergency Operations Center’s Thursday, May 21 COVID-19 update included an in-depth look at the epidemiology of local cases, with a new graphic illustrating how the county’s coronavirus patients are connected.

The weekly Facebook live conference, hosted by Highland County Health Commissioner Jared Warner and Paint Creek Joint EMS/Fire District and Highland County EOC Public Information Officer Branden Jackman, also outlined Highland County’s COVID-19 outlook as of May 21. The county has 17 cases (14 lab-confirmed and three probable); 12 recovered patients; one death; four actively sick patients; five total hospitalizations, zero currently; and 14 individuals currently monitored for symptoms.

One viewer asked why those 14 individuals couldn’t be tested for the virus instead of being put under surveillance.

“The way that this works with people who are not currently sick, and the way our testing works, is you have to have a certain amount of viral load in your system in order for the test to find it and be able to detect it,” Warner said. “If you are really early in your sickness, or you are not very sick yet, a lot of times they can do a swab and not collect any virus, and therefore the test come back showing that you’re not sick, even though it might be still be in your system.

“We tend to wait until somebody shows symptoms because that gives us a much stronger reliability or much stronger chance that they are going to test positive if they are positive. That’s the reason we do quarantine rather than just test everybody who’s been in close contact.”

Another viewer asked if there were cases in which only one individual in a household contracted the virus and managed not to spread it to others.

“We’ve had several instances where we’ve had individuals sick in a home, and it didn’t spread any farther than that one individual,” Warner said.

The health commissioner credited contact tracing and educating patients and their families on how to avoid spreading the virus.

“The other people that live in that household, we place under quarantine, and we watch them for symptoms as well,” Warner said. “We have had several instances where people inside a household have caught it, and we’ve also had some cases where the rest of the household managed to not get sick at all. A little bit of both is happening out there.”

Warner and Jackman shared a local epidemiology graphic, which Warner said Highland County Health Department Director of Nursing Bonnie Ruche helped create, that further explains which local cases are connected.

The graphic includes a “rough estimate” of when individuals became sick and whether these were connected to other known cases. Warner explained the graphic (which can be viewed with this article) in detail.

“You can see our very first case popped up somewhere around March 15,” he said. “Any of the dots that you see in red, or any of the areas you see in red, indicate a case that appeared where we don’t have a great idea of where it came from. It’s not been linked to any other outbreak. It’s not been linked to any other positive case. Those are the real indicators that we have some level of community spread occurring in Highland County that we just don’t have eyes on.”

There are eight cases — six confirmed and two probable — meeting that community spread criteria.

The graphic also includes “three different out-of-county clusters that have impacted Highland County,” Warner said. The other nine cases in Highland County were either directly or indirectly affected by these clusters.

“These are larger clusters that are based in either large businesses or health care facilities or other circumstances where the outbreak itself hasn’t been in Highland County, but we’ve had residents in Highland County who have been connected,” Warner said. “That’s where you see Case No. 2 showing up.”

That particular case eventually led to a close contact (Case No. 3) contracting the virus. That has happened in three separate instances, Warner said, with two patients infecting one other person and one patient infecting two other people.

“We’ve had that happen in three different occasions in Highland County, where we’ve had a person that we’ve identified or that’s been reported to us as a positive case, and they went on to infect other people,” Warner said.

However, he added that thanks to mitigation efforts, there are no “third-generation” cases, where the contacts of initial patients have in turn gone on to infect others.

The county’s lone COVID-19-related death was connected to an out-of-county cluster but not to any other local cases, according to the graphic.

“This is a way that we’re using to try to help the community and help our staff visualize how these cases are connected on the epidemiological side of things and how some of our cases have led to new cases,” Warner said. “Other new cases have appeared out of the blue, without warning.

“That’s why it’s so important that our nursing staff and our health department has the staffing, funding and resources to do contact tracing, isolation and quarantine, because that’s how we prevent the individual cases from resulting in multiple cases.”

Jackman said that Lt. Gov. Jon Husted spoke recently about how early in the pandemic, “the spread of contagion was typically one infected [person] infected two more people.”

“We see that there on the graph, right there in the middle,” Jackman said. “We’re now down to one-to-one. One infected person typically infects one more person, so we’re slowing that spread. The clusters out of county show just how quickly it jumps counties.”

In other discussion, Warner and Jackman shared some information on the reopening of businesses, with Governor DeWine’s office releasing more opening dates after the Facebook Live conference had already ended. Warner gave an update of upcoming dates to watch, including Thursday, May 21, which marked the first date that restaurants could reopen for indoor dining and the date for campground reopening.

Other reopening dates, Warner said, are:

• May 22: horse racing;

• May 26: gyms, fitness centers, sports leagues for non-contact and low-contact sports, public swimming pools licensed by the health department and the Bureau of Motor Vehicles; and

• May 31: child care and day camps.

Additional sector openings can be read in the governor’s update from Thursday at

“For each of those different areas that opens, the state will be providing us some written orders for what are the actual legal rules we have to follow,” Warner said. “Right now, we’re really relying on the information that we are getting from the governor’s office, those guidelines.

“Hopefully we are going to see some orders coming through for some of the other sectors here soon.”

Regarding the reopening of the Bureau of Motor Vehicles offices across the state, Jackman warned the community that “you don’t have to be running right out if your license is expired.”

“Just because it opens back up on the 26th doesn’t mean they’re going to start enforcing everything again just like they always have,” Jackman said. “You’ve still got that grace period.

“It was to the end of the state of emergency that was declared by the state of Ohio or 90 days, whichever was the furthest out. Don’t think on the 26th you’ve got to go rushing to the BMV.”

Jackman added that the BMVs are also offering a “Get In Line, Online” program to limit customers’ time spent waiting inside the actual BMV offices.

Several viewers asked for a reopening date for area libraries, as Highland County’s libraries have been closed to the public since March 18.

“The libraries were not specifically closed by any state orders,” Warner said. “They decided to close on their own. I’ve been talking to local Highland County libraries, and they are working through some processes for what they’re going to do when they open back up.”

Jackman spoke against “mask shaming” in the community as additional businesses continue to reopen.

“We’ve got to be diligent,” Jackman said. “I know there’s a lot of pushback, and there’s a lot of negative connotation to those that wear masks.

“I think the lieutenant governor said it very well: it’s the responsible thing to do. It’s not that it’s going to stop the spread or anything else, but it’s protecting you, it’s protecting them, it’s slowing the spread once again.”

Warner said that the health department has encountered the thought that masks are a “sign of weakness,” but the masks should be thought of as “taking responsibility and being kind to your neighbor.”

“Wearing a mask is not the single silver bullet that’s going to fix all of our problems,” Warner said. “Neither is social distancing. Neither is washing high-contact surfaces. We really need to look at each of these as a little piece, one layer, of protection that we’re adding. By themselves, they don’t fix all our problems, but when we start putting them on top of each other and have multiple barriers in place, that’s what helps slow down the spread of this disease.”

A viewer said that there is also pushback against businesses requiring patrons to wear masks. Jackman said that it is the right of businesses to enforce that rule.

“If it’s a small mom-and-pop shop and they want to feel safe and don’t want to take something home to their family, by all means, they can require you to wear a mask,” Jackman said. “There have been some big-box retailers that have done that.

“Please don’t bash businesses or shame businesses or anything else. Like Jared said, it’s all personal responsibility.”

In other discussion of state mandates, this week Ohio Department of Health Director Amy Acton rescinded and modified portions of the Stay Safe Ohio order, which Warner reviewed.

“It goes through and specifically rescinds two sections and then rewords another,” Warner said. “Basically, it is removing the ‘stay at home or place of residence’ part of the Stay Safe Ohio order and making that a recommendation instead.

“It previously said ‘stay home or at your place of residence’ and it talks about the reasons you’re allowed to leave, and that is all being removed. They’re also removing the ‘prohibited or permitted travel’ piece.”

Under that revision, Warner said, the state is only prohibiting individuals with COVID-19 in other states from entering Ohio unless they are seeking medical treatment.

“I think that makes people feel more comfortable going and visiting family and starting to do some of those smaller gatherings — having lunch with friends and things like that,” Warner said.

Warner also discussed physical distancing during the continued search and rescue efforts around the Greenfield area as law enforcement and volunteers search for Madison Bell, 18, who was reported missing Sunday. The health commissioner said that the health department and Emergency Operations Center have “reached out” to Greenfield and county officials to offer support and help with search efforts.

“We also reached out to Greenfield Church of Christ, who held the prayer vigil last night,” Warner said. “We explained to them that we completely understand the importance of this for the community. We just ask that as people go through and hold their vigils or do their searches that they take some common-sense precautions: avoid holding hands, get some distance between yourself and other people, encourage the face coverings.

“There’s got to be a balance here between what’s good for the community as far as how important it is to be out there and supporting that family, and also the importance of preventing a pandemic.”

Jackman agreed, saying that the EOC “understands the exigent circumstances of what they’re trying to do. We just want to do our best to not create a cluster of sickness while we’re doing it.”

The cancellation of several events, including the Ohio State Fair and Greenfield’s Greene Countrie Towne Festival, were announced Thursday. One viewer asked if Warner believed any major events would be permitted to continue this summer. The health commissioner said his personal guess is “they’re going to stair-step” the number of people permitted for large gatherings gradually.

“I think it’ll be quite a while before we get to the point we’re having tens of thousands of people together,” Warner said. “My guess is that we won’t be seeing those really, really large events anytime soon.”

Another viewer asked if one portion of the county would be quarantined if an outbreak occurs there.

“Right now, we’re really focused closely on our high-risk groups and trying to identify, before we have outbreaks, our potential problem spots,” Warner said. “As far as quarantining part of our county or not, with this particular disease it’s tough to do that, because we have people who carry the disease and are asymptomatic.

“We also have people who will be contagious 48 hours, potentially, before they show any symptoms, combined with the fact that this virus is also present in all the counties around us. Quarantining off any particular part of our county doesn’t really make the other part any safer.”

In his closing comments, Warner continued to encourage individuals in the community to be patient and kind with one another, including with restaurant staff members as those businesses begin to reopen to the public.

“There are a lot of things that are going to be different in our restaurants right now,” Warner said. “There’s a lot of things they’re trying to figure out, and we’re going to have a bumpy road to get where restaurants are comfortable doing things and the public understands what’s happening. Just be patient with your restaurant staff, and leave a big tip, because they’re all dealing with a lot of really difficult situations also at their workplaces.”

Jackman concluded with his usual message of “We’re all in this together; be nice,” and encouraged people to pray for local leaders and health care workers.

“Pray that God will show us a way through this,” he said.

The conference also included answers to some questions already discussed at previous meetings, including whether the virus can be contracted more than once; whether 2020 graduates can hold parties; serologic and antibody testing; the importance of fact-checking information read on social media; outdoor recreation; the reopening of schools; the importance of avoiding cross-contamination with gloves; how the virus is spread; and using hydroxychloroquine and remdesivir.