Three Rivers Health District COVID 19 Update   8/3/2020


Pandemic Status:  Case counts continue high, trends are improving in many areas

COVID 19 cases continue to surge across the United States.  Many states currently are experiencing increasing case counts, but the case count trend has leveled off and reversed in California, Texas, and Florida where pandemic control measures have increased.  Once again, this demonstrates that we can protect ourselves against this virus by maintaining social distance, masking, avoiding crowds, hand washing, and sanitation practices.  Death rates, which inevitably follow new cases by several weeks, remain at record highs in the hardest hit areas.  We now have over 4.6 million cases in the United States, and almost 155,000 deaths.  The CDC published a serology study (antibody testing) earlier this month that suggests 10 times more people in the United States have been infected than previously thought.

In Virginia, the 7-day moving average of cases by date reported is currently over 900.  Percent positivity of tests is at 7.2%.   Community transmission levels in the Eastern and Southwest regions are at substantial levels.  Percent positivity of PCR testing in the Hampton Roads health districts has improved, and currently ranges from 6 to 14%.  We have good hospital and ICU capability across the state at this time.

We received early results of a large serology study across the Commonwealth led by Dr. David Trump.  This study sought participation by adults seeking health care.  Thus far, about 2.5% of these adult volunteer participants have antibodies to the COVID 19 virus, confirming again that the majority of us remain naïve to this pathogen.

In Three Rivers, case counts have stabilized at about three times the weekly new case rate we had in phase two.  We had 64 new cases in the district last week, and the same number the week before.  Looking at our case investigation information thus far, it appears most of our new cases are due to social gatherings in private settings and smaller, non-commercial venues.  We are not able to identify any clear sources of community spread in specific retail or food businesses.  Remember:  If we all mask in public, practice social distancing, stay out of crowds, wash our hands, and practice good sanitation, we can drive community levels of this virus to low levels and resume all activities far more safely.

Executive Order Compliance:  Phase regression instituted with Executive Order 68

Governor Northam announced phase regression in the Hampton Roads municipalities in Executive Order 68, effective at 12:00 AM on 31 July 2020.  No alcohol will be sold after 10 PM, restaurants and other businesses close at 12:00, indoor dining is limited to 50% of normal capacity, patrons limited to 50 or less, gatherings of more than 50 people are prohibited, there are a number of other signage and physical distancing requirements.  Enforcement authority remains with the Virginia Alcoholic Beverage Control Authority and the VDH.    



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 Moderna vaccine clinical trials began last Monday.  Primates who received the vaccine were deliberately infected with the COVID 19 virus, and were able to clear disease rapidly.  This is an encouraging sign.  The Astrozeneca/Oxford and Pfizer vaccines are also in phase three trials.  The federal government is investing in the Moderna, AstraZeneca, Novovax, Pfizer and Johnson and Johnson vaccine development efforts.  No new developments emerged in therapeutics this week.  Remdesivir and steroids may help recovery and survival in very ill patients.  Many questions remain about quality and duration of immunity, and about the effectiveness of vaccines that are developed.

Testing:  Working to improve long delays in obtaining test results

Testing results delays from exceeding laboratory capacity are very significant at this point.  Delays in detecting new cases impedes our case investigation and contact tracing effort, which is our primary public health protective activity after infections occur.  Dr. Parham Jaberi, VDH Chief Deputy for Public Health and Preparedness, is leading the VDH effort to address this.  Obviously, more testing is better, but we can’t test to the point that we negate our infection control containment measures.  None of us has a ready solution for this other than to increase lab capacity or to reduce testing requirements, but we are working on it at all levels. 

We on-boarded our testing team in the Three Rivers Health District this week.  We are beginning to schedule events, beginning with several schools in Essex, Lancaster, 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 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 for us 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:  Three Rivers pandemic containment capability remains good

Our 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 increased community transmission levels.  That will allow most of our nursing staff to return to their normal duties, and augment the containment team to meet surge demands.



K-12 Planning:  New evidence emerges about COVID 19 transmission in children

I want to add some context to the duties of the school boards and school officials at this point in the pandemic.  We really know very little about this virus.  What we do know is frightening and unprecedented, and what we don’t know is even more concerning to me.  This includes whether or not young children can readily be infected and transmit this disease.  Last week a new study from a Chicago Children’s Hospital showed very large amounts of viral genetic material in nasal swabs from very young children, even more than adults harbor.  The CDC also reported a large outbreak in an overnight summer camp in Georgia, beginning with a single symptomatic case on 23 June.  The camp was closed by 27 June.  Eventually, 260 campers tested positive for COVID-19 in this outbreak, clearly demonstrating the ability of this virus to spread rapidly among school age children.  With this information, and in the midst of a national pandemic surge, school officials and school boards must make decisions about opening our schools.

School superintendents and school boards have completed their planning and are at the point of making decisions about opening configurations.  We have been in constant communication with superintendents, staff, teacher’s organizations, and school board members, and never have I had such profound respect for the professionals and the board officials responsible for educating and caring for our children.  They are charged with considering all evidence and risks concerning this pandemic, which is very incomplete, balancing that information with all the risks of keeping children out of school and leveraging virtual learning, and risk mitigation decisions.  Those decisions may have life and death implications, and they are well aware of that fact.  Educators have never had to make decisions such as this, and many are agonizing over the best course to take.  We are maintaining close contact with them and will continue to do so, supporting them in any way we can.   I am reassured, however, that our children and grandchildren are in great hands. 

The consistent message from the CDC, the American Academy of Pediatrics, and the World Health Organization is that it is better for the majority of students and families for children to be in school, but we must mitigate the pandemic risks as best we can.   Administrators 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.  This dashboard, revealed last week to superintendents at a Department of Education meeting, will be very useful in decision making throughout the upcoming school year.  The recent state of substantial transmission in the Eastern Region is leading some school systems to lean more towards virtual learning, at least during the first several weeks of the school year.

We will continue consulting with school officials, advising them on community transmission levels, and helping them with reopening 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 need to get control of this pandemic as best we can, as soon as we can.


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

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 indefinite 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, initiated to control spread of active infections that have not been prevented.   We are all preparing for pandemic surges 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 will receive augmentation for our COVID 19 team through the VDH Central Office.  We will hire all new personnel through contracts, and local governments will incur no additional costs.

Remember, 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.