Three Rivers Health District COVID 19 Update 8/10/2020


Pandemic Status:  This pandemic is not under control

COVID 19 cases remain at high levels across many states, today the upward trend continues in 18 of them.  Florida, California, and Louisiana have reversed their strongly positive trends, again demonstrating that we can protect ourselves against this virus by maintaining social distance, masking, avoiding crowds, hand washing, and sanitation practices.  Death rates remain high as a lagging indicator.  We have over 5 million cases in the United States, and over 163,000 deaths.  Well over 90% of us remain naive to the disease at this point.

In Virginia, the 7-day moving average of cases by date reported is currently over 1100.  Percent positivity of tests is up to 7.6%.   Community transmission levels in the Eastern and Far Southwest regions are at substantial levels, and in the Central and Near Southwest regions, the trend is moderate and increasing.  We still have good hospital and ICU capability across the state at this time, but a couple of hospitals have reported difficulty in obtaining supplies and PPE.

In Three Rivers, our new case counts have increased over the last week to 96.  Over the last week, staff members of three different schools across our jurisdictions tested positive for coronavirus, and we experienced a large outbreak at a long term care facility.  This reflects increasing community spread across our jurisdictions.  We all must make every effort to mask in public, practice social distancing in all venues, stay out of crowds, wash our hands, and practice good sanitation, to help reduce this increasing viral threat.

Executive Order Compliance:  Businesses across our jurisdictions are for the most part compliant

We are responding to every complaint we receive about allegations of non-compliance with Governor Northam’s Executive Orders.  Thus far, through our compliance visits or through our contact tracing efforts, we have not identified any clear sources of community transmission in any of the businesses we are inspecting or visiting.

Virus update:  We may have a vaccine by early 2021

Vaccine development continues with six vaccines around the world entering phase 3 clinical trials.  The federal government is investing in the Moderna, AstraZeneca, Novovax, Pfizer and Johnson and Johnson vaccine development efforts.  National level pandemic experts are expressing optimism that we may have a vaccine (or vaccines) available by early 2021.  No new advances in viral therapeutics have been made over the last several weeks.

Reports emerged last week that T cells reactive to the SARS CV 2 spike protein exist in blood samples from some people who have never had the disease.  Another research project in the UK demonstrated reactive antibodies in blood samples taken before this virus emerged, with higher levels in children.  This may help explain why COVID 19 disease does not appear to be as severe in young children. This T cell reactivity and antibody presence may be the result of exposure to other coronaviruses, such as those that cause the common cold and the previous SARS CoV 1 virus.  It is important to remember that many questions remain about quality and duration of immunity, and about the effectiveness of vaccines that are being developed.

Testing:  Working to obtain rapid testing capability in Virginia

Our laboratory capacity remains stressed, resulting in delays receiving results. VDH Chief Deputy for Public Health and Preparedness Dr. Parham Jaberi continues to lead the VDH effort to address this issue.    Governor Northam announced last week that Virginia is joining five other states (Maryland, Louisiana, Massachusetts, Michigan and Ohio) in discussions to purchase 500,000 rapid tests per state from a US manufacturer.

We on-boarded our testing team in the Three Rivers Health District, and held our first testing event in Lancaster County last week.  We have other events upcoming in Essex and Middlesex counties.  Planning for larger scale community testing events in Lancaster and Northumberland is underway as well.

Vaccination Campaign:  Make sure you get the flu vaccine this year

We will begin our very aggressive Flu Vaccination campaign in September.  This will involve two large-scale events:  One in partnership with Richmond & Westmoreland Counties and the other in partnership with Middlesex, Mathews and Gloucester Counties.  These events will prepare us for the upcoming large vaccination effort when COVID 19 vaccines are available.  It is more important than ever to get our flu vaccine, to reduce flu case rates and help lessen confusion with COVID 19 cases, which may look just like flu.

Pandemic Containment:  Virginia launches the COVIDWISE smart phone app

Governor Northam announced last week that Virginians can now download the COVIDWISE app.  COVIDWISE is a smart phone app that can alert users when they have been in close contact with someone who has COVID 19.  The app assigns a random PIN to users, does not store personal information, and can help with personal situational awareness about potential COVID 19 exposure.  The more of us who download and use this app, the more effective a tool it will be.

The Three Rivers case investigation and contact tracing capability is good, and we continue to hire additional case investigators and contact tracers for this fall in anticipation of seasonal increasing community transmission levels. 

K-12 Planning:  School boards are watching transmission levels carefully

New evidence emerged over the past several weeks that causes increased concern about the ability of the COVID 19 virus to spread among children.  Additionally, early experience with school openings shows COVID 19 cases and closures in North Carolina, Georgia, Tennessee, Mississippi, Indiana, and Texas.  In Three Rivers, we already have seen COVID 19 cases among school staff members in the earliest stages of preparations for this school year.  This reflects the relatively high rate of community transmission we are currently experiencing in the Eastern Region, and in our jurisdictions.

I want to reiterate from last week’s report that school officials should make decisions about mitigation activities and closures in collaboration with local health officials based on a number of factors, including the level of community transmission.  The VDH has developed a pandemic dashboard, considering many metrics such as case rates, percent PCR test positivity, outbreaks, percent cases among health care workers, ICU admission rates, emergency department visits, hospital beds available, numbers of patients admitted with COVID 19, and PPE availability.  The dashboard assigns pandemic transmission levels at the regional level.  There is a companion document, which advises school mitigation measures, linked to phase guidance, based on community transmission levels.  The dashboard does not have enough data to assign pandemic transmission levels at the community level.  The recent state of substantial transmission in the Eastern Region continues to be of great concern.

We will continue consulting with school officials, advising them on community transmission levels, and helping them with reopening and sustaining activities.  We are emphasizing the principles of social distancing, masking when possible, sanitation, keeping sick students and staff out of the school, detecting sick children at school, isolating them, and getting them out of the school to health care as soon as possible.  There is no question, the lower the level of community transmission, the safer we all will be, and the better our economy will be.  We must get control of this pandemic to the greatest extent possible as quickly as we can.

Forward Plans:  Best defense is prevention of disease by social distance, masking, staying out of crowds

To repeat our most important message, this virus has demonstrated its ability to transmit briskly if given the opportunity.  With a highly susceptible population, no potential for rapid widespread population immunity, and no effective antiviral therapy, we can be confident this virus will remain in the community for the time being.  We all hope for an effective vaccine, but that is in our future.  Our best defense is to prevent exposures by social distance, masking, avoiding crowds, washing our hands, and practicing good sanitation methods.  Our secondary line of defense is containment activity with testing, case investigation and contact tracing, initiated to control spread of active infections that have not been prevented.   We are all preparing for more pandemic surge in our future, especially during the fall and winter months.  Health districts are augmenting COVID 19 response capability, including case investigators, contact tracers, Executive Order compliance personnel, epidemiologists, long term care facilities/assisted living facilities liaison, K-12 liaison, testing personnel, immunization personnel, and communications abilities.  We are receiving augmentation for our COVID 19 team through the VDH Central Office.  We are hiring new personnel through contracts, and local governments will incur no additional costs.

Remember, as always, masking, social distancing, avoiding crowds, hand washing, and good sanitization practices all work together to reduce transmission risk and to get this pandemic under control.  If you are sick at all, even if your symptoms do not feel like COVID 19, stay at home and consult your health care provider.  The virus can masquerade as many other diseases, and can fool us all.  Difficulty breathing remains a sign of possible serious disease; if this develops, seek help very quickly.