The story of COVID-19 outbreaks in New Hampshire has largely played out in a handful of settings: nursing homes, schools, jails, restaurants and other places where people live, work and gather in close quarters.
But it’s been difficult to get a sense of the patterns underlying these breakouts, in part because of how the state reported the data.
Newly released numbers obtained by NHPR through a public information request offer a never-before-seen snapshot of what kind of outbreaks the state was monitoring across all work and community settings during the first 18 months of the pandemic.
In some ways, the data reinforces what we already knew: Long-term care and assisted living facilities saw more outbreaks and cases than any other setting, by a long shot. Outbreaks tied to K-12 schools spiked as students returned to the classroom earlier this fall. And, in general, if the state saw an overall surge in cases, it saw more outbreaks, too.
“When there are higher levels of community transmission, you're going to see more outbreaks in the community in various settings, including settings that the general public, or that we all, encounter in our day-to-day lives,” explained Katrina Hansen, chief of the New Hampshire Bureau of Infectious Disease Control’s Infectious Disease Surveillance Section.
When community transmission is really high, Hansen said it can make it hard for public health officials to pinpoint exactly where someone picked up the coronavirus.
In December of 2020, retail and service workers were among those most impacted by COVID-19 outbreaks, just behind people in long-term care or correctional facilities.
Last winter also saw lots of outbreak-related cases in colleges and universities, schools, therapeutic services, manufacturing and warehouse settings. Colleges and universities, in particular, saw a spike in outbreaks in late January and early February, as winter breaks ended and students returned to campuses.
And even at the peaks of the pandemic, the state's data suggests that a relatively small number of outbreaks were driving a large number of COVID-19 infections. Last November, for example, the state recorded more than 3,000 cases linked to 145 outbreaks.
At the same time, these numbers likely fall short of giving a complete picture of all of the COVID-19 outbreaks in New Hampshire. To come up with these totals, the state relies on information reported from laboratories and other healthcare providers, which have both been under significant strain throughout the pandemic. When trying to measure the scale of an outbreak, the state also relies on members of the public to tell the truth to contact tracers or other healthcare workers about where they were before their diagnosis.
And a relatively small team of state health workers are responsible for sorting through a seemingly endless stream of information about new COVID-19 cases. Hansen said the state’s infectious disease surveillance team processed more disease reports in the first few months of the pandemic than they typically do in a few years.
“The volume was enormous, and it has been enormous, and we're really experiencing something that is new to all of us,” she said.
Hansen and her team often go to painstaking lengths to collect, record and confirm information about new COVID-19 cases. A lot of information coming into the state’s disease surveillance bureau from other healthcare providers is sent by fax or hand-entered into databases and goes through multiple reviews to ensure its accuracy.
It takes a lot of time and energy. But Hansen and other health officials are hopeful that a recent influx of new federal coronavirus relief funding will make it easier for both the state health department and the providers they work with to track and monitor future outbreaks.
NHPR initially asked for more detailed demographic data about these outbreaks — including race, ethnicity and age of those infected — but the state said they were unable to provide that due to privacy concerns and other constraints in their ability to gather that information.
National data suggests that a large share of people working in essential jobs were Black and Hispanic, putting them at greater risk for COVID-19. New Hampshire’s own COVID-19 Equity Response Team also noted these disparities as it advised state leaders on pandemic strategy.
“People of Color were more likely to contract COVID-19; more likely to work in essential industries and positions that placed them in hazardous situations; more likely to not be able to easily access testing; less likely to be able to socially/physically distance and less likely to be able to recover from the economic and social impact of the pandemic,” the state’s COVID-19 equity response team wrote in a report issued in July 2020.
NHPR also asked the state to share data about the specific location and size of individual outbreaks — as it has consistently done for nursing homes, correctional facilities and other congregate settings — but the state said it was also unable to provide that information.
Jake Leon, DHHS director of communications, said the state has issued public notifications about outbreaks outside of congregate settings “based on the level of potential community risk.”
“This request in particular has required dozens and dozens of staff hours, which we’re more than happy to do, but in the middle of a pandemic it has been incredibly difficult to put all of that information out,” Leon said. “We've had to make decisions based on what we thought felt most informative to the people of New Hampshire to make good decisions to protect their own health.”
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