The West Virginia Color-coded county map continues to be a source of both frustration and controversy for parents and school officials. The map, which is used by the state Department of Education to determine the potential risk factor associated with the spread of COVID-19 within a county school-system, is based on the COVID Risk Level Map designed by the Harvard Global Health Institute. According to Danielle Allen, Director of the Edmond J. Safra Center for Ethics at Harvard University, the map was created because: “The public needs clear and consistent information about COVID risk levels in different jurisdictions for personal decision-making, and policy-makers need clear and consistent visibility that permits differentiating policy across jurisdictions. We also collectively need to keep focused on what should be our main target: a path to near zero case incidence.”
The primary criticism made about West Virginia’s version of the Harvard map is that it is neither clear, nor consistent. Several adjustments, or ‘tweaks’ as they are referred to by state officials, have been made to the Harvard model, leaving many residents to believe that West Virginia’s map-system is being actively massaged in order to make more counties eligible for in-person learning. This is a concern which West Virginia Governor Jim Justice addressed at his Monday, September 28 coronavirus media-briefing. “I really probably take terrible offense to someone that would say that we are manipulating numbers,” Gov. Justice said. “You know, first of all, I take incredible pride in the one thing that I will always do with you is tell you the truth. Incredible pride, in fact. You’re not going to catch me telling anybody something that I absolutely know to be wrong. I make mistakes just like anybody makes mistakes. But there is no chance on God’s earth, not one sliver of chance that I’m going to put up with us in any way manipulating numbers, for any kind of outcome.”
W.Va. Department of Health and Human Resources Cabinet Secretary Bill J. Crouch then reaffirmed the Governor’s comments, stating: “I think what happened in terms of the initial efforts, and we talked about this before, we inadvertently had a system whereby the incentive was to not test. And one of the worst things we can do is not test and have individuals who are positive out there roaming around who then become, within a week, you have 10 that you initially don’t find, and then you end up with 30, and you end up with 60, and you end up with 90. It’s that exponential growth that we’re working very hard to try to make sure it doesn’t happen. So the change to the positivity rates, and the science behind that is sound from the standpoint that we’re looking at counties below 16,000 using a 7-day rolling incidence rate and positivity rate, and then going to a 14-day rolling incidence rate and positivity rate for counties of a higher population. We’re also looking at case counts. If you have less than 20-cases in a county, then other federal agencies who do this and have done this forever, public health agencies, suppress that data because it’s not reliable from the standpoint of the numbers you need to know to have a sufficient count to have accurate data. So we are following the science. We do not manipulate this data. We make very, very careful decisions regarding how we do this. So there is science behind this. The idea of adding the positivity rate was to get more people tested. If we don’t get more people tested in West Virginia, we’re not going to beat this disease.” (Secretary Crouch stated that counties below 16,000 use a 7-day rolling average, and counties above use a 14-day rolling average. This was an error. It is, in fact, the other way around.)
The criticisms have been as wide-spread as the virus, itself. Everything from accusations of number manipulation, to politicizing the pandemic. Even the most extreme conspiracy theories have been hurled at W.Va. officials regarding the state’s response to the outbreak. And although the criticisms and accusations have been rampant for months, it was the inclusion of gold as the fifth color on the color-coded county map, combined with the ‘either-or’ option of the better of positivity-rate versus infection-rate that sent social media into a frenzy. However, this adjustment has been vehemently defended by Gov. Justice, DHHR Cabinet Secretary Crouch and W.Va. coronavirus Czar Dr. Clay Marsh. At the Friday, September 25 media-briefing, Dr. Marsh attempted, once again, to explain the methodology behind the modifications.
“I wanted to spend the time that I have explaining the process that we’re going through for the different color-coding for both the public health map, which is published by DHHR on a daily basis and our school map,” Dr. Marsh said. He then continued: “So as we have talked at some length, we have adopted two different methodologies, two metrics that we want to use to make sure that we are fairly assessing the public health spread of COVID-19 in each one of our counties, and as we talked about early in the pandemic that we wanted to go from a state-strategy, where we are trying to treat each county as just part of a big state of West Virginia, which was that sort of suppression-phase, the hammer-phase. And then we wanted to move to a more precise phase where we looked at every county more independently as 55 parts of a whole, and start to assess the COVID spread in each county, so that we could make a fair assessment about the risk of opening businesses and schools and activities, etc.”
Dr. Marsh went on to explain how at the beginning, a single infection-rate was used to evaluate the spread of the virus over a 7 or 14-day timeframe. “Every county was judged on a standard population of 100,00,” Dr. Marsh said. “Which means on the small counties you multiplied the population to get to 100,000. And on the larger counties, we divided sometimes the counties like Kanawha County or Mon County to be able to get down to 100,000. And that is a very well-accepted metric, and we created the five color-codes to reflect a low-rate of COVID spread, which is 0 to 3 cases per 100,000 population. A low-moderate, which is the yellow color, 3 to 10 cases per 100,000 population. A gold color, where we used a metric of 10 to 15 cases per 100,000 population. The orange color, which is 15 to 25 cases per 100,000 population. And then the red color, which is over 25 cases per 100,000 population.”
Additional criticism stems from the fact that cases identified on college campuses or at nursing facilities are not counted individually. This means that if 5 residents of a care facility test positive, it is counted as one single case. According to the DHHR, these are considered to be ‘contained outbreaks,’ and therefore only count as one case on the school map. It should be noted that the DHHR publishes the number of individual cases at care facilities, colleges and correctional facilities as part of their daily updates. Last week, the W.Va. Department of Education took steps to alleviate some of the confusion. On Friday, September 25, state education-officials released new guidelines which illustrate how the state defines a school-related outbreak. According to the Department of Education’s website: “A confirmed outbreak is defined as two or more confirmed COVID-19 cases among students/staff from separate households, within a 14-day period in a single classroom or core group. The Current Outbreaks in Schools chart is based on information provided by the West Virginia Department of Health and Human Resources and is updated as details are made available.”
West Virginia Superintendent of Schools Clayton Burch is yet another state official who stands in support of the adjustments made to the W.Va. map. On Friday, September 25, Superintendent Burch stated: “We get that map on Saturday, and I’ve continually told the superintendents, the teachers, the parents…that one map that gets posted on Saturday is indeed a map that has been scrutinized, it’s been scrubbed. It is a map we can trust to be the best health map we’re going to put up to make those decisions. So I do appreciate all the work the health panel and the Governor does in about a 48-hour period to make that happen.”
As Superintendent Burch inferd, the W.Va. Department of Education updates the color-coded county map every Saturday at 5 p.m. However, that version of the map is typically significantly different from the daily-map made available through the DHHR. This is yet another point of confusion for many parents and county school-officials. Pocahontas County School Superintendent Terrence Beam has been fielding these questions from parents now for several weeks. “When we first got started, I was getting emails and phone calls all the time,” Superintendent Beam said. “It was confusing for a lot of people. Especially when they see us go from green to orange to gold over a 10-day period. I think we’ve been 4 out of the 5 colors in the last three-weeks.” And so they have. Since the school year began on September 8, Pocahontas has been designated as orange, gold, yellow and green, which is their current designation. For a county with only 975-students, these frequent fluctuations can be difficult to contend with. Especially when due to the county’s smaller-size, they are supposed to be tracked on a 14-day rolling average, not the 7-day cycle used by counties of over 16,000 residents. But Superintendent Beam remains proactive, having a near-daily dialogue with the county health department to stay on top of outbreak and containment-trends. “What I tell people is that the map on Saturday, that’s the report card. And what the DHHR puts out every day, that’s the progress report,” the Superintendent said. “But the questions have gotten less. People seem to be settling into the system.”
On Friday, September 18, two very contradictory things happened. First, a story was released in the Mountain State Spotlight in which a Harvard University researcher was quoted as saying: “that doesn’t follow the public health guidance” when discussing the changes made by W.Va. to the Harvard map. And second, the CDC adopted what Dr. Clay Marsh has dubbed ‘the West Virginia model’ for use nationwide to determine potential spread-risk of COVID-19.
According to the Mountain State Spotlight, Dr. Thomas Tsai is a health policy researcher and surgeon at Harvard, and was also a member of the team that developed Harvard’s COVID Risk Level Map. (Harvard University’s website does list Dr. Thomas Tsai as an Assistant Professor in the Department of Health Policy and Management, and a collaborator of the Harvard Global Health Institute.) The article goes on to further quote Dr. Tsai. With regard to W.Va. adding a fifth color, Dr. Tsai allegedly said: “It’s like they’re saying you have five downs now, instead of four.” A request made by the WV Daily News of Harvard University Media Relations to confirm the statements made to the Mountain State Spotlight was not immediately answered.
The Mountain State Spotlight article further implied that West Virginia’s map was designed to look similar to the Harvard model in order to “lend a veneer of academic rigor to the state’s school reopening plan.” This was an implication to which Gov. Justice responded with indignation, saying: “You know, at the point in time when we start reacting and we start even considering something that hit-job Ken Ward’s (editor of the Mountain State Spotlight) people would be putting out, we’ve got to have lost our minds.” The Governor continued: “I mean really and truly Ken Ward is just an arm of the Democrat party that’s trying to do anything and everything they can to throw mud, and especially throw mud at me. And if we get to the point in time where we’re listening to a man that the Charleston Gazette got rid of and fired or whatever it may be, the Charleston Gazette, you know, as liberal as they come and everything, then we got real problems in life.”
Those comments were made at the same media-briefing where it was announced that the CDC had adopted ‘the West Virginia model’ to be used as “indicators for dynamic school-decision making.” The CDC’s map also uses a five-color scale as opposed to the four-colors used by the Harvard model. In a press release issued on September 15, the CDC stated: “Today, CDC releases indicators to help schools make dynamic decisions about in-person learning as local conditions evolve throughout the pandemic. When coupled with local data about community spread, these indicators are an important tool to help local health officials, school administrators and communities prepare, plan and respond to COVID-19. These indicators are the latest resources CDC has provided for schools during the COVID-19 pandemic, and they supplement previously released CDC guidance.” The only significant difference between the map that the CDC has implemented and the one currently used by W.Va. is in the suggested number of cases per 100,000 residents. The acceptable limits on the CDC map are considerably higher than those of the West Virginia system.
West Virginia Senator Stephen Baldwin believes that the confusion and frustration comes down to the way the map is intended to be used, versus the way the state is currently using it. Through a post on social media, the Senator said: “these tweaks make the West Virginia map much greener than the Harvard map. It should also be noted that the Harvard map is intended to guide all public health decisions, not just schools. The W.Va. map is mostly all about schools.” In the same post, Sen. Baldwin went on to say: “I too want schools open so long as it’s safe. Thus far, the data on school transmission is that it’s quite low when guidelines are followed. This is good news. But we shouldn’t be tweaking the data just so it tells us what we want to hear.” While speaking with the WV Daily News on Monday, September 28, Sen. Baldwin stressed that he does not believe there to be any malicious intent behind the ‘tweaks’ to the state map. “They are not manipulating numbers. The numbers are accurate the way they’re counting them. But we’re talking about two different things,” the Senator said. He then continued: “We need to be clear about what we’re looking at. We’re looking at a school map, not a public health map.” This is a distinction which Senator Baldwin feels should be made clear by both the Department of Education, and the DHHR.
Currently, the Harvard map shows five West Virginia counties designated as green, and three counties designated as red. The West Virginia map shows there to be 39 counties designated as green, and no counties designated as red. The W.Va. Department of Education will next update the color-coded county map on Saturday, October 3 at 5 p.m. The Harvard map is also updated every Saturday.