Adam Anderson knows the morass of sifting through mountains of local data related to COVID-19.
He created it. Twice.
As the health data and GIS supervisor for the Tri-County Health Department, he’s had to scramble, automate and code hundreds of charts, rates and tallies related to the virus.
About a month ago, the local health department that oversees all of Aurora’s three counties upended its entire system for COVID-19 contact tracing and case investigations after the Google spreadsheet that had been the original solution became too bearish and started running into glitches. The sheet had more than 9,000 rows and 230 columns, according to Gabriela Reyes, a population health epidemiologist with Tri-County who works with Anderson to sort through the group’s ever-thickening grove of data.
“The whole system became unwieldy and almost was crashing,” Reyes said.
As has been the situation for months, the State Department of Public Health and Environment is still in the process of implementing its own investigation and tracing software, according to Anderson. So instead of waiting for state officials to roll it out, he and Reyes made their own.
“We didn’t have a statewide system, so in lieu of that, we needed something because we were just getting too many cases and the workflows were getting more and more complicated,” Anderson said. “We needed a better way to store and manage our data … We opted to just create an in-house solution ourselves.”
The result was a completely rejiggered system designed to present the local health department’s trove of coronavirus investigations data. It meant new dashboards and new programs to show how the pandemic is weaving into local communities.
“Now it’s just a matter of rebuilding all of our dashboards,” Anderson said. In the coming weeks, Anderson and Reyes plan to unveil a new dashboard that will show contact tracing happening in real time. So far, they’ve only shown beta versions of the data to local government officials, who have lauded the efforts.
“We’ve gotten some really good responses,” Anderson said.
Last week, he and Reyes presented their new system to further praise at an industry teleconference. At least one other public health entity in the metro area has expressed interest in using their program, too.
But before the pats on the back came rolling in, both he and Reyes were feverishly working to tailor GIS data for Tri-County’s growing fleet of investigators and tracers. The local entity currently has about 150 people working those positions, with another 50 slated to start next week. And even that may not be enough, according to Anderson.
“We probably could still even use more,” he said. “We’ve definitely seen an influx in the past week in terms of a backlog of cases.”
Indeed, like in so many places across the country, cases of COVID-19 have been trending upward in recent weeks, according to local data.
There have been slightly more than 5,000 confirmed cases of COVID-19 in Aurora alone, according to the most recent municipal-level data available. More than 43,000 city residents have been tested for the virus, giving the city an overall positivity rate hovering around 12%. Recent weekly averages of positive tests are far better than the overall rate — Aurora held about a 7.2% positivity rate last week — but it’s still several clicks higher than the current state average of about 4.5%.
The heart of the city continues to be a viral hotspot, with the city’s Expo Park, Aurora Hills and City Center neighborhoods boasting the highest number of cases in the entire Tri-County network. The region flanking Interstate 225 that nearly 63,000 call home claimed 1,043 cases of COVID-19 as of July 27. The area is roughly one third Hispanic, one third white and a quarter Black, according to numbers compiled by the U.S. Census Bureau. A third of residents work in retail.
Those highly-localized, neighborhood-level data are among the most insightful when compiling a local picture of the virus, according to Anderson, who said the testing rates and incidence rates of the virus in specific pockets can reveal a unique portrait of where the virus is spreading, and to whom.
“To me that’s more interesting because you can see a lot of geographic variation to what’s going on,” he said. “County level counts really don’t show you that there’s some pretty severe spikes in different neighborhoods and in these small geographic areas … They’re all trending upward, but not at the same trajectory. Some neighborhoods are flat or declining versus others that are seeing real spikes. You start to see these waves that move across the neighborhoods.”
Tracking those microcosmic hotspots is a valuable tool available to local residents who could consider altering their daily activities based on increased incidence rates in certain neighborhoods, Anderson added.
“It can help to inform individuals’ own personal choices of maybe not going to the park today by seeing that there’s a wave in this area,” he said. “ … I think there’s a certain level of caution, obviously, all of us can have. But, it’s easy to pull down your mask when talking to someone, or not wash your hands, or forget your hand sanitizer. If you’re seeing those spikes, it promotes you to be a bit more cautious or not take those shortcuts.”
Another good measure of waves — as opposed to sharp peaks and valleys — are the three-day and 14-day rolling averages presented on the Tri-County website, Anderson said. Those help show a more complete picture over time, as opposed to single days that can be skewed by temporary glitches or large data dumps if labs happen to process an extraordinary number of tests.
“Those smooth out those reporting trends — those spikes and valleys in single day estimates,” Anderson said. “It accounts for that and gives you a better understanding of the overall trajectory.”
He said such measures have become particularly popular among government officials who have been pressured to reopen businesses, but encouraged to do so only when there have been flat or decreasing trends in recent weeks.
Red herrings also abound in now ubiquitous data sets, according to Anderson, who cautioned people to look at statistics like hospitalization rates with a grain of salt. He said some hospitalizations are not captured by investigators if the case is closed, but someone’s condition ultimately worsens and causes them to be admitted to a hospital later.
“Those hospitalization numbers are extremely conservative estimates,” Anderson said.
Masking rates, too, are more political bluster than illustrative datasets, he added.
“That one is just such a point of contention for a lot of people,” Anderson said. “It’s something of interest, but to me, it is the least impactful when it comes to understanding what is happening in our community. I would rather see the testing and case data.”
Still, Aurora’s health department has poured resources into keeping boots on the ground to gauge how many residents are masking up when they venture out.
Since April, the Tri-County Health Department has quietly deployed a cohort of volunteers collecting data on how many people wear masks — and wear them properly — when entering stores.
The data then becomes part of an important metric that now appears on the Tri-County website.
The intelligence-gathering operation long preceded a statewide mandate that most Coloradans wear a face covering in public Gov. Jared Polis imposed this month.
Brian Hlavacek, the department’s environmental health director said unpaid volunteers have been working the job.
He explained the typical day of a mask narc. A volunteer typically parks their car near the entrance of a business and will spend half an hour tallying everyone that walks into a store and whether a person successfully wore a mask that day, Hlavacek said. Then, they’ll cruise to their next spot. The volunteer might watch people at five to 10 stores in a day across the Tri-County region.
If a person is wearing a bandana covering their nose and face, they might earn a pass from the volunteer. But if a mask or face covering is too small or only covering the mouth, that person would land on the shameful side of the dataset.
The result? A user on Tri-County’s website can now compare the mask-wearing rate across individual cities and counties.
The recent results themselves are “really, really good,” Hlavacek said.
As of July 28, the most recent data posted concerned store patrons on July 5. That day, volunteers observed 87% of people wore a mask in Aurora, compared to just 47% in Northglenn and 58% of all residents in Adams County.
In Douglas County, where commissioners moved to secede from Tri-County after its Board of Health imposed a mask mandate on the region, volunteers counted 80% of people properly wore a mask.
Hlavecek said the method isn’t exactly sophisticated science, but he said it is a helpful and accurate data point. He thinks residents can peek at the data and get beyond anecdotal observations to realize that, in Aurora and the region, pluralities of people are usually donning masks before their grocery run.
He also said that the data collection operation isn’t a part of Tri-County’s mechanism to penalize people who don’t wear masks when required.
The state health department is gathering all of that local data, like Aurora masking rates and testing percentages in Hoffman Heights, into a bigger pile, available on the agency’s website. But it can be a lot to sort through, and without knowing what’s what it can easily be overwhelming.
State health officials say they’re looking at all that data a bevy of ways to track the pandemic.
First, an overall count of cases. But not just day-to-day.
“We focus on the seven-day moving average of daily case counts and on how the weekly total of new cases is changing week to week,” a spokesperson for the agency said. “Because there are often artificial variations in day-to-day cases that are reported to the state, looking at a moving average or weekly sum can make overall trends more clear.”
And despite Anderson’s caution, hospitalizations have also become an important factor for public health leaders. That gives them a pulse on how overwhelmed — or not — the health care system is.
For the average person, the easiest map to follow may be the two-week cumulative incidence rate, which labels each county or region and their incidence rates, calculated per 100,000 people. Right now, nowhere in the state sits below “moderate.”
Adams, Arapahoe and Douglas counties are rated “high.”
For Anderson, who lives in Denver but still often works at the Tri-County office in Arapahoe County, those labels and slowly increasing trend lines are both concerning and difficult. He’s unsure if his 5-year-old will start kindergarten as originally planned, and summer camps meant to occupy his kids in the summer months have effectively gone kaput. He says he and his wife have limited much of their social interactions and canceled several out-of-state trips to visit family, but they still mountain bike and hike in the Fraser Valley near Winter Park.
“We just do what we can,” he said of his family’s efforts to curb viral spread.
Still, like umpteen Americans, he said navigating parenting while working full-time has been a challenge.
“If they don’t get out and about and feel like they’re doing stuff, they’re a terror at home,” he said with a chuckle. “And you can only deal with that so long.”
Cover photography by Philip B. Poston, design by Robert Sausaman