Indiana begins to reopen Monday amid stabilizing COVID-19 rates

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INDIANAPOLIS, Ind. — When Governor Eric Holcomb announced he was gradually reopening Indiana’s economy Monday morning, his decision was based on four factors: declining coronavirus patient hospitalizations, fewer intensive care unit beds and ventilators in demand and improved testing and tracing capabilities.

An analysis of COVID-19 positive test results over the last seven weeks by the Indiana State Department of Health indicates that the state is holding its own in the battle against the pandemic and showing modest signs of momentum in halting the coronavirus spread, even though local and national statistical models recommend Monday is too early to be reopening Indiana’s economy.

On March 22, Eli Lilly & Company conducted the first public drive-thru testing for coronavirus infection at its downtown Indianapolis headquarters.

On that day, the state’s positive testing rate stood at 13.4% of nearly 1,500 tests conducted statewide.

Once reaching a Sunday high point of 19.4% on April 5, the positive test rate for COVID-19 has plateaued three Sundays in a row at 18.3%, despite the addition of hundreds of unexpected new cases related to the Tyson processing plant in Logansport.

“I don’t worry so much about individual spikes like these,” said Dr. Shaun Grannis of the Regenstrief Institute. “As much as I do just making sure that we’re tracking the long-term trend, and the long-term trend has been very clear since late March, the number of hospitalizations are going down, the relative percentage of patients testing positive is trending down, so we’re heading in the right direction. We know that the social distancing works, so we know that’s encouraging.”

While enhanced testing and tracing capabilities across the state were announced or have gone into effect in the last week, the coronavirus demand on Indiana’s medical care system has decreased.

As of Sunday, ISDH reported 43.7% of the state’s ICU beds were open, and of those that were filled, just 16.3% were occupied by coronavirus patients.

80.4% of Indiana’s more than 3,000 ventilators were available, and of those in use, just 7.8% were assigned to treating COVID-19 patients.

“We want to continue to watch those downward trends,” said Dr. Grannis. “As we start thinking about opening up, we want to watch not only those positive tests, we also want to start watching symptoms.”

The Institute for Health Metrics and Evaluation at the University of Washington recommends, based on infection numbers and resource availability, that Governor Holcomb may be relaxing his statewide shutdown order too soon in order to maintain momentum in defeating the pandemic.

A model developed by the Fairbanks School of Public Health at IUPUI reaches a similar conclusion.

“The tail end of the Fairbanks model and the IHME model are very well correlated,” said Dr. Grannis, “so IHME is looking at about May 22nd, and that’s right in the range plus or minus a couple days of the Fairbanks model, so there is alignment there.”

Marion County, with 30% of Indiana’s positive coronavirus cases and a 22% positive test rate, has just begun public testing and will keep its stay-at-home orders in effect until at least May 15.

“We learn more and more everyday,” said Dr. Grannis. “Predicting the future is hard, but I do think we are going to have more information, and particularly with this broader testing, we are going to get a better sense of prevalence.

“Social distancing and sheltering at home does reduce the number of cases. We know that. So we have that in our arsenal as we move forward. Again, as we open up, we go back to this is a throttling exercise now to make sure that as we open up, we open up in a way that does not create a second wave as many people have referred to. In order to do that, you have to test, you have to do contact tracing, isolating, etc., but to know where the potential cases might be, you have to do a lot of monitoring, so we’re going to be entering into a phase of continued monitoring of symptoms of cases of hospitalizations as we think about opening up.”

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