Three Rivers Health District COVID 19 Update-8/31/2020

REMEMBER:  SOCIAL DISTANCE AND MASKS HELP PROTECT US ALL

Pandemic Status:  Transmission levels in Virginia are fluctuating

The COVID 19 new case trends across the United States are still improving, but the 5 day moving average is back up to 47.000 and over 20 states are reporting higher case numbers.  We will exceed 6 million cases in the United States today, and there have been over 183,000 deaths.  

In Virginia, the 7-day moving average of cases by date reported was 995 on 8/31.  The 7-day average percent positivity of tests was back up to 7.4% on 8/28.   Community transmission levels in the Eastern and Central regions are substantial, they are moderate in the Southwest and Northwest regions, and they are low in the Northern region.  The substantial transmission trend in the Eastern Region continues to decrease.  The moving 7-day average of people hospitalized for COVID 19 dropped to 1134 on 8/30.  We still have good hospital and ICU capability across the state at this time.

In Three Rivers, 6 of our jurisdictions are below 5 cases/100,000 moving 7 day average (Gloucester, Mathews, Middlesex, King and Queen, Westmoreland, and Northumberland), 2 are between 5-10 cases per 100,000 (King William and Richmond), and 2 (Lancaster and Essex) are over 10 cases/100,000.  We had 59 new cases last week across our jurisdictions.  We had no new outbreaks in our district last week. 

We all must still 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 the viral threat.  Even at lower levels of community transmission, this virus will readily exploit any opportunities to spread.

Executive Order Compliance:  Thus far, businesses are not a major source of transmission

We continue to respond to every complaint we receive concerning non-compliance with Governor Northam’s Executive Orders.  We have investigated reports of athletic activities, not school related, being pursued without prescribed protective measures and we have provided consultation and advice to oversight authorities.  We must guard against a false sense of security and not engage in high risk activities as long as this virus is circulating and we are without inherent immunity to it.

Virus update:  We may have a vaccine by late this year or early 2021; questions about duration of immunity remain

The federal government continues to invest in the Moderna, AstraZeneca, Novovax, Pfizer and Johnson and Johnson vaccine development efforts, and phase 3 clinical trials continue.  National level pandemic experts continue to express optimism that we may have a vaccine (or vaccines) available by late this year or early 2021.  Public health departments are planning vaccine distribution efforts nationwide.

Supportive care, Remdesivir, systemic steroids, and convalescent plasma remain the only treatments currently available for COVID 19.   Remdesivir has been approved for all hospitalized patients, regardless of severity of disease.  The FDA issued an emergency authorization order for the use of convalescent serum on 8/23/2020.

The University of Nevada Reno School of Medicine and the Nevada State Public Health Laboratory reported the first case of COVID 19 viral reinfection in the United States on 8/28.  The patient, a 25 year old male, suffered his first infection with COVID 19 in April.  A little over a month later, he was hospitalized with similar symptoms and again tested positive.  Analysis of viral genetic material indicated serial infection with 2 different viral types.   We still do not know how common reinfection is, what the implications are for duration of immunity to COVID 19 following initial infection, or what this means for COVID 19 vaccination effectiveness. 

The CDC revised testing recommendations last week, and caused concern among some public health authorities and in the national press.  The CDC now says “If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms:

You do not necessarily need a test unless you are a vulnerable individual or your health care provider or State or local public health officials recommend you take one.

A negative test does not mean you will not develop an infection from the close contact or contract an infection at a later time.”

This change means that people who have had a high risk exposure and are in quarantine do not necessarily need to be tested, but they do need to stay in quarantine for the prescribed 14 day period.  A negative test does not clear an exposed person from quarantine; anyone can turn positive at any time during the quarantine period.  If healthy exposed people go out seeking a test, they have to break quarantine to do so, and may expose others if they are positive but asymptomatic.  If they develop symptoms, they should seek medical care and testing at that point.  There is a risk that people will interpret a negative test as permission to break quarantine, only to develop the disease later in the quarantine period and transmit the disease.

Many questions remain about this virus.   Long-term health effects such as chronic fatigue, impaired lung function, impaired heart function, clotting abnormalities, and neurologic problems occur, even in asymptomatic patients.  It is much better to avoid infection with this pathogen than to risk the potential consequences of infection.   Social distancing, masking, staying out of crowds, washing our hands, and practicing good sanitation and hygiene are imperative to help us prevent COVID 19 infection.  

Testing:  Three Rivers Health District is actively testing for COVID 19

Laboratory capacity and turn-around times continue to improve.  In Three Rivers, we are currently receiving COVID 19 test results from our state laboratory within 48 hours of the testing event. 

Our testing team in the Three Rivers Health District is actively conducting testing events.   Upcoming events include:

Monday 8/31: Middlesex County Health Department (Appointment only), 2780 General Puller Hwy, Saluda, VA 23149

Wednesday 9/2: Northumberland High School 10am-2pm, 201 Academic Ln, Heathsville, VA 22473

Friday 9/4: Middlesex County Health Department (Appointment) 2pm - 6pm, 2780 General Puller Hwy, Saluda, VA 23149

Wednesday 9/16:  Gleaning Baptist Church (Gloucester) 10am - 12pm, 7749 Dutton Rd Gloucester, VA 23061

We are offering 150 tests per event, there is no charge for the testing, and all events are open to the public.  Thus far, we are exceeding our testing goals in the Three Rivers Health District.

Vaccination Campaign:  Preparing for the COVID 19 vaccine

We will begin our very aggressive Flu Vaccination campaign very soon.  We have two vaccination events scheduled for September:

Wednesday 9/9: Middlesex County Health Department 2pm - 6pm, 2780 General Puller Hwy, Saluda, VA 23149

Saturday 9/19: Warsaw Rescue Squad 10am - 2pm, 152 Community Park Drive Warsaw, VA 22572

We are also planning two additional events in October.  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:  We have very good case investigation and contact tracing capability in Three Rivers

Our Three Rivers case investigation and contact tracing capability is good, and we have on-boarded 13 additional case investigators and contact tracers for this fall in anticipation of increasing community transmission levels.  Traditionally, respiratory disease transmission rates increase over the fall and winter months coincident with increasing indoor congregate activity.

K-12 Planning:  Three Rivers Health District will support schools closely as they begin operations

School systems have finalized their opening plans.  According to the Virginia Department of Education, school systems in the Three Rivers Health District are opening under the following configurations:

King William, King and Queen, Richmond, Northumberland, Mathews, and Westmoreland Counties:  Hybrid Plan

Gloucester, Middlesex, Essex, and Lancaster Counties:  Fully Remote Plan

Evidence has emerged that children are susceptible to COVID 19 infection, they are capable of spreading the virus very effectively, and that cases among children have gone undetected because many of them are minimally symptomatic or asymptomatic.  Children can rarely suffer severe complications from COVID 19 infection, and long term health effects among children remain unknown.  We can expect COVID 19 cases to occur when children are in congregate environments, especially with higher levels of community transmission, but we can prevent secondary transmission with strict adherence to protective requirements and rapid containment efforts.

We will remain in close communication with all school superintendents in the Three Rivers Health District, as well as leaders of private schools, throughout the school year.  We are advising them frequently on community transmission levels according to the VDH Pandemic dashboard.  To reiterate, this tool considers 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.  It assigns pandemic transmission levels at the regional level, and a companion document provides advice on mitigation measures linked to phase guidance.  This tool will become public facing as soon as the developers gain experience and more confidence with it.

We will continue emphasizing the principles of social distancing, masking when possible, sanitation, keeping sick students and staff out of school, detecting sick children at school, isolating them, and getting them out of the school to health care as soon as possible.  It is highly probable that COVID 19 cases will occur in our schools:  our objective is to contain COVID 19 cases, minimize outbreaks and prevent further community spread.  There is absolutely no question that the lower the level of community transmission, the safer we all will be, the better our economy will be, and the safer it will be to send our children in person to school.  We are moving in the right direction; we must continue to decrease transmission as much as possible and keep it low.

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.  This has been clearly demonstrated again by large scale outbreaks at colleges and universities nationwide with reopening activities.  With a highly susceptible population, no population immunity, and highly limited antiviral therapy, we can be confident this virus will remain with us for many months and possibly years.  We all hope for an effective vaccine, and we all hope for better medicines to treat this virus.  Our best defense remains to prevent disease through social distance, masking, avoiding crowds, washing our hands, and practicing good sanitation methods.  Our secondary line of defense is containment activity with extensive testing, case investigation and contact tracing, intended to control spread of active infections that we are unable to prevent.   We are all preparing for more pandemic surges in our future, especially during the fall and winter months, and we continue to augment our COVID 19 response capability. 

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, please seek help very quickly.