Outbreaks and Clusters COVID-19 Clusters in North Carolina Report will be updated every other week. COVID-19 Ongoing Outbreaks in Congregate Living Settings Report will be updated every week. COVID-19 Ongoing Clusters in Child Care and School Settings Report will be updated every week. COVID-19 Outbreaks and Clusters Congregate Living Setting A congregate living setting is a facility where people live for an extended period in a shared space, either in individual units with a shared building and common spaces, or with shared rooms or units. Because people are living in close proximity, these are settings that many states monitor for the spread of COVID-19. NCDHHS tracks cases, deaths and outbreaks in congregate living settings: these include nursing homes (nursing homes/skilled nursing facilities) which provide nursing or convalescent care; residential care facilities can include adult care homes, family care homes, multi-unit assisted housing, group homes; correctional facilities such as state prisons and local jails; and others such as Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) homes. NC COVID has a field to note whether a case or death was in a congregate living setting. Often, after a case is reported in NC COVID, a case investigation is conducted, at which point the person is identified as being in a congregate living setting. At that point, the case or death is then marked as being part of a congregate living setting. In some situations, the congregate living setting proactively reports cases and deaths to the LHD or state, and so the case or death is entered with information that it was part of a congregate living setting. “Missing” represents the number of cases and deaths that are missing congregate living setting information. All numbers are preliminary and may change as cases are investigated. Data within the Congregate Living Settings include cases and deaths in both staff and residents. NCDHHS also tracks the number of outbreaks in congregate living settings. An outbreak in a congregate living setting is defined as two or more laboratory-confirmed cases. NCDHHS displays the number of facilities with ongoing outbreaks by county on the data dashboard. Data include cases that are part of the ongoing outbreaks as well as cases associated with these settings that are not part of an ongoing outbreak. The COVID-19 Ongoing Outbreaks in Congregate Living Settings Report lists facilities with an ongoing outbreak which is posted twice a week. An outbreak is considered over once there is not evidence of sustained transmission - this means 28 days after the last case began having symptoms, or the date they were tested if they didn’t have symptoms. Once an outbreak is over, it is no longer reported as an “ongoing outbreak.” Cases and deaths in congregate living settings are the total number of molecular (PCR) positive and antigen positive COVID-19 cases and deaths among residents or staff of the congregate living settings that is regulated by NCDHHS. Time is required to determine whether a given COVID-19 case or death is associated with a congregate living setting, gather follow-up information, and enter it into NC COVID. These cases or deaths could be part of an ongoing outbreak or could be in a congregate living setting that is not experiencing an ongoing outbreak. Outbreaks in congregate living settings are the number of ongoing outbreaks in congregate living settings. COVID-19 Child Care and School Settings Child care operators and school principals are required per G.S. 130A-136 to report suspected cases of reportable communicable diseases (including COVID-19) to the local health director of the county or district in which the school or facility is located. Data on our NC COVID-19 Outbreaks and Clusters dashboard include cases that are part of the ongoing clusters as well as cases associated clusters that are no longer active. In a child care or school setting, a COVID-19 cluster is defined as a minimum of five confirmed diagnostic cases with illness onsets or initial positive results within a 14-day period and plausible epidemiologic linkage between cases. A cluster is considered over if there is not evidence of continued transmission within the setting. This is measured as 28 days after the latest date of onset in a symptomatic person or the latest date of specimen collection in an asymptomatic person, whichever is later. If another case is detected in a child care or school setting after a cluster is declared over, the cluster is not reopened. If additional cases are subsequently reported and a new cluster exists, it will be reported as a second, new cluster in that setting. COVID-19 case and cluster investigations are conducted by local health departments. Time is required to determine whether a given COVID-19 case is associated with a child care or school setting, gather follow-up information, and enter it into NC COVID. Thus, data included on our data dashboards may differ from data available through media and other sources. Child care or school settings with less than 10 children or staff are not included to protect confidentiality. Data are preliminary, and these numbers and settings are subject to change as more information is obtained during cluster investigations.