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June 22: Weekly Driftless COVID-19 round up
covid-19 graphic coronavirus

DRIFTLESS - Over the past week COVID-19 diagnoses statewide increased from 22,932 June 15 to 25,068 Monday, June 22. That is a statewide increase of 2,136 cases. The number of deaths increased from 694 to 745, and additional 51 deaths, according to the state Department of Health Services.

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CRAWFORD COUNTY’S outlook on the ‘Coulee COVID Compass’ is currently ‘Severe.’ More information on the ‘Coulee COVID Compass’ can be found at https://lacrossecounty.org/covid19compass

Crawford Countysaw four new cases, increasing to 31. The number of negative tests increased by 431, and there have been no deaths in the county.  In Crawford County, Prairie du Chien has 12 cases, central Crawford County has seven cases, and southwestern Crawford County has five cases.

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VERNON COUNTY’S out-look on the ‘Coulee COVID Compass’ is currently ‘High Risk.’ More information on the ‘Coulee COVID Compass’ can be found at https://lacrossecounty.org/covid19compass

Vernon Countysaw an increase of seven cases in the last week, increasing to 31. The number of negative tests increased by 289, and there have been no deaths.

Richland Countysaw an increase of one case, increasing to 15. The number of negative tests increased by 105, and the number of deaths in the county remained at four.
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MONROE COUNTY’S out-look on the ‘Coulee COVID Compass’ is currently ‘Severe.’ More information on the ‘Coulee COVID Compass’ can be found at https://lacrossecounty.org/covid19compass

Monroe County saw an increase of 14 cases in the last week, going from 36 to 50. Negative tests increased by 444, and the number of deaths in the county remains at one.

Chubby Cruisers
If you visited the Chubby Cruisers ‘Gentleman’s Club’ at the Wisconsin Dells between June 10 and 14, you may have been exposed to COVID-19. If you are experiencing any symptoms (headache, fatigue, cough, shortness of breath, fever, digestive dis-comfort), please contact your healthcare provider.

Juneau Countysaw an increase of five cases in the  last week, growing to 30. The number of deaths in the county remains at one.

The Juneau County Health Department is reporting a COVID-19 outbreak at Cruisin’ Chubbys in Wisconsin Dells. An outbreak is defined by the Wisconsin Department of Health Services as two or more laboratory-confirmed cases of COVID-19 in the same facility or associated with a single event, with onset within two maximum COVID-19 incubation periods of each other (28 days). The health department and the establishment have been working together to review and strengthen existing prevention measures.

If you visited this establishment between June 10 and 14, you may have been exposed to COVID-19. If you are experiencing any symptoms (headache, fatigue, cough, shortness of breath, fever, digestive discomfort), please contact your healthcare provider. You can view a full list of symptoms here: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

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LACROSSE COUNTY’S outlook on the ‘Coulee COVID Compass’ is currently ‘Severe.’ More information on the ‘Coulee COVID Compass’ can be found at https://lacrossecounty.org/covid19compass

LaCrosse Countyhas seen an exponential increase in new cases in the last week of 158, going from 132 to 290. There have been no deaths in the county.

The increasing number of cases of COVID-19 has prompted the La Crosse County Health Department to establish a dedicated page on the COVID-19 website to notify the public of locations where risk of exposure to the virus has occurred. 

It can be found at www.lacrossecounty.org/covid19 on the Outbreaks and Investigations page.

“This list of establishments, together with information from the Coulee COVID-19 Compass, inform community residents of actions they can take to protect themselves from exposure to the virus. It is not a list of businesses who have done something wrong,” said Jen Rombalski, RN, MPH, Director of the LaCrosse County Health Department. 

“The website includes locations where those who have a lab confirmed case of COVID 19 have been when they were in the period most likely to share the virus.”

The site includes locations categorized as low, medium and high risk; a measure determined based on the exposure risks, and the ability of the disease investigation team to identify and notify potential contacts. 

Locations will be included on the list for 14 days after the last known positive case was present. The page will be updated frequently as the information becomes available. Notification of high risk locations will also be asked to complete a Risk Screening and Referral Form and will be updated on Facebook.

Establishments have been contacted before their appearance on this list and guidance is provided about reducing future risk to staff and customers. 

You can see current guidance on the Coulee COVID-19 Compass at https://lacrossecounty.org/covid19compass.
UW-Platteville COVID testing
THE THIRD of Grant County’s public tests for COVID-19 took place in a UW–Platteville parking lot on Wednesday, June 17. The public test, taken by 395 people who lived inside and outside of Grant County is credited for the increase in the number of county residents who tested positive in the past week.

Grant Countyhas seen an increase of 23 cases in the last week, going from 107 to 130. There have been no additional deaths in the county, with the number remaining at 12.

The third of Grant County’s public tests for the COVID-19 coronavirus took place in a UW–Platteville parking lot Wednesday.

The public test, taken by 395 people who lived inside and outside of Grant County according to the Grant County Health Department, is credited for the part of the increase in the number of county residents who tested positive, from 116 to 129 in the past week.

Eight Grant County residents tested positive at the UWP testing, and an unreported number of people living in other counties who came to UWP for the test also tested positive, according to the Health Department. Three other people who tested positive were tested elsewhere, according to the Health Department.

The DHS census-level map that shows approximate counts of positive tests and deaths by range for 5 or more cases is now led by Platteville, with 30 cases. The census tract of the approximate boundaries of the towns of Clifton, Ellenboro, Liberty, Lima and South Lancaster, which led the county this week, has 29 of Grant County’s 129 positive tests and 11 of the county’s 12 deaths. The Hazel Green and Jamestown area has 17 cases. Lancaster has 14 cases. The census tract that includes Cuba City, Dickeyville and Smelser has 11 cases. The census tract that includes Cassville, Beetown, Glen Haven, Waterloo and North Lancaster has seven cases. Northwestern Grant County has five cases.

Lafayette Countyhas seen an increase of 16 cases in the last week, going from 43 to 59. There have been no deaths in the county. 

Iowa Countyhas seen an increase of five cases in the last week, increasing to 22. There have been no deaths in the county.

Platteville Journal editor Steve Prestegard contributed to this story.

Population studies

Two studies will help public health experts understand the COVID-19 virus and inform public guidance

The Wisconsin Department of Health Services (DHS) is partnering with the University of Wisconsin-Madison’s Survey of the Health of Wisconsin, Wisconsin State Laboratory of Hygiene, the University of Wisconsin-Milwaukee and the Wisconsin Department of Natural Resources to conduct two population health studies that will examine the presence of COVID-19 in Wisconsin. 

Together, these studies will provide researchers and public health experts with a better understanding of where COVID-19 has been and help identify communities that may be at risk for a future outbreak. This research will be a valuable tool for informing future public health practices while maximizing containment efforts.

 “One of the most challenging things about COVID-19 is that as a new virus, there is still so much to learn” said DHS Secretary-designee Andrea Palm. “That is why this type of research is essential to our statewide efforts and until there is a vaccine, we must do everything we can to protect our communities and ensure that we are safely reopening the state.”

Parenting workshop

The COVID-19 pandemic has brought our families closer together. Issues have been brought to light that might otherwise have gone unnoticed. Let's embrace this opportunity to address the needs of the children in your care—with the added benefit of helping you regain some control during this unprecedented time whether as a parent or as a teacher. 

We invite you to join us for this online, four-part Parenting Workshop Series that will address specific topics allowing you to ask Paul your own questions - all from the convenience of your home. To register, go to: https://www.uwplatt.edu/department/continuing-education-institute/enrichment-classes

The workshop presenter, Paul Gasser, is a Marriage and Family therapist and instructor for the University of Wisconsin-Platteville in the Continuing Education department for 27 years. He also has presented nationally for the Love and Logic Institute of Golden, Colorado. He and his wife are the parents of four children.

Gastrointestinal issues

A subset of patients with coronavirus disease 2019 (COVID-19) may present with low disease severity marked only by digestive symptoms, and patients with possible COVID-19 contact who present with new-onset acute digestive symptoms should be tested, according to research published in the American Journal of Gastroenterology.

While respiratory symptoms are most common signs of COVID-19, investigators believe that there may be a large cohort of patients experiencing low-severity illness with mainly digestive symptoms, such as diarrhea, who unknowingly contribute to the spread of the virus. As such, researchers set out to better understand both the prevalence and clinical characteristics of these patients.

A retrospective study was conducted in Wuhan, China, at a hospital designated for the management of patients with COVID-19. Investigators reviewed clinical records from 850 consecutively hospitalized patients who were admitted between February 13 and February 29, 2020, who had laboratory-confirmed COVID-19. Patients were included if they met criteria for mild disease severity, and were then evaluated to identify digestive symptoms including diarrhea, nausea, and vomiting. Patients were then matched with another patient with confirmed COVID-19 who experienced only respiratory symptoms (cough, expectoration, chest discomfort, sore throat, and shortness of breath). Patients were subdivided into one of three groups: digestive symptoms only, digestive plus respiratory symptoms, and respiratory symptoms only.

The final study cohort included 206 patients, all of whom were residents of Wuhan (mean age 62.5 years; 56.8 percent older than 60 years; 55.8 percent women). A total of 10.2 percent of patients were aware of clear, direct exposure to individuals with known or highly suspected COVID-19 infection.

Clinical features were similar across the three groups, although those with digestive plus respiratory symptoms were more likely to report shortness of breath and constitutional symptoms compared with those in the respiratory symptoms only group.

In total, 67 patients reported diarrhea; 19.4 percent of those experienced diarrhea as their first symptom, appearing before the onset of respiratory symptoms. Women were more likely to report diarrhea than men (65.7 percent vs 51.1 percent), the symptoms of which lasted from 1 to 14 days, overall (mean duration 5.4±3.1 days; mean daily frequency of bowel movements 4.3±2.2 per day).

Of patients with digestive symptoms, 62.4 percent had an accompanying fever. Among patients with specifically diarrhea, 73.1 percent experienced concurrent fever. Patients with both upper and lower digestive symptoms were more likely to experience a fever compared with those who had either upper or lower symptoms alone (94.4 percent vs 57.1 percent vs 63.3 percent, respectively).

Results showed that the mean interval between symptom onset and viral clearance across the study cohort was 38.1±8.7 days, with an average hospital stay of 23.7 days. Those with digestive symptoms experienced a longer period between initial symptom onset and hospital admission compared with patients with respiratory symptoms only. Patients with only digestive symptoms and those with digestive plus respiratory symptoms also experienced a significantly longer time between symptom onset and viral clearance compared with the respiratory-only group (40.9 days vs 42.0 days vs 33.5 days, respectively).

All patients received fecal leukocyte and occult blood testing, and 1.9 percent of patients demonstrated abnormal results consistent with viral diarrhea. In a subgroup of 22 patients with COVID-19, stool RNA was tested using real time reverse-transcriptase polymerase-chain-reaction. Of these, 54.5 percent of patients tested positive for viral RNA in their stool. These patients had a significantly longer time to viral clearance compared with the 10 patients who tested negative.

Study limitations included the limited sample size, an inability to perform correlations between fecal virus RNA and digestive symptom severity, and the limitations inherent in retrospective studies. Investigators also cautioned that this study “does not directly confirm that viral particles in stool are infections and capable of disease transmission,” but rather provides further elucidation of how COVID-19 may present.

 “These data emphasize that patients with new-onset diarrhea after a possible COVID-19 contact should be suspected for the illness, even in the absence of cough, shortness of breath, sore throat, or even fever,” the researchers concluded. “These patients should self-quarantine and seek medical care if not already under evaluation.”

Reference: Han C, Duan C, Zhang S, et al. Digestive symptoms in COVID-19 patients with mild disease severity: Clinical presentation, stool viral RNA testing, and outcomes [published online March 30, 2020]. Am J Gastroenterol. In press.