Three Rivers Health District COVID 19 Update  9/14/2020

Pandemic Status:  Higher new case numbers in Three Rivers

The COVID 19 new case trends across the United States are fluctuating; the 5 day moving average is moving between 35,000 and 45,000, and today 20 states are reporting higher case numbers.  We have had over 6.5 million cases in the United States, and over 194,000 deaths.  Brisk transmission has occurred nationally with reopening of colleges and universities.  Currently there are over 88,000 cases in over 1190 colleges and universities nationwide.  Most of these cases are due to social interactions outside the classroom.

In Virginia, the 7-day moving average of cases by date reported is 1000 on 9/14.  The 7-day average percent positivity of tests is currently 7.2%.  Community transmission levels in the Central and Southwest regions are substantial (high), they are moderate in the Eastern and Northwest regions, and they are low in the Northern region.  The moderate transmission trend in the Eastern Region continues to decrease.  The moving 7-day average of people hospitalized for COVID 19 is 1050 on 9/14.  We still have good hospital and ICU capability across the state at this time. 

In Three Rivers, we are experiencing indicators of increased community transmission.  Only one of our jurisdictions is below five cases/100,000 moving 7 day average (Mathews), three are between 5-10 cases per 100,000 (Gloucester, Westmoreland and Richmond), and six (King and Queen, King William, Essex, Lancaster, Northumberland, Middlesex) are over 10 cases/100,000.  We had 132 new cases last week across our jurisdictions, the largest single week increase in cases since the pandemic began.  We had one correctional facility outbreak, one resurgence of a previous long term health care facility outbreak, and one outbreak related to a congregate setting last week.  The main source of community transmission appears to be individual exposures and private events.  

We all must redouble our efforts 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 threat of a viral surge.  The SARS CoV 2 virus will readily exploit any opportunities to spread.

Virus update:  Phase 3 vaccine trials continue

Aggressive vaccine development and clinical trials continue worldwide.   The AstraZeneca vaccine clinical trial was halted on September 6 to evaluate a possible adverse reaction in a recipient; the trial was restarted in the UK on September 12.  The Pfizer and Moderna vaccine clinical trials continue.  Health departments are preparing to distribute the COVID 19 vaccine as soon as it becomes available.  Speculations and concerns over safety continue as efforts increase to have a vaccine available as early as October or November.  Whenever a safe and effective vaccine is available, we will be ready to distribute it.  The distribution process will take many months, during which time we must all be prepared to continue our personal protective measures.

We continue to emphasize that masking, social distancing, staying out of crowds, good sanitation and hygiene, are very effective in preventing transmission.  We have proven this in many venues.  We must be strictly adherent to these measures, though – if we break protective discipline, the virus will transmit if it is present.  The higher the community transmission rates, the greater the risk of encountering someone with the virus.  It is much better to avoid infection with this pathogen than to risk the potential consequences of COVID 19 disease.  

Supportive care, Remdesivir, systemic steroids, and convalescent plasma remain the only treatments currently available for COVID 19.   Supercomputing and artificial intelligence are being leveraged to try to identify promising combinations of existing therapies that may be useful to treat COVID 19.  Existing therapies identified by supercomputing are good candidates for clinical trials.

Executive Order Compliance:  Businesses do not appear to be a major source of transmission

The Governor returned the Eastern Region to Phase 3 Forward Virginia status last week, removing restrictions that have been in place for about 6 weeks.

We will continue to investigate concerns and complaints and enforce executive order compliance to the best of our ability across the district.  Thus far, we still have not identified any businesses as a major source of viral transmission in any of our jurisdictions.

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

Laboratory capacity and turn-around times have improved.  In Three Rivers, we are currently receiving COVID 19 test results from our state laboratory within 48-72 hours of the testing event.  There is increasing access to rapid antigen testing, especially in outpatient medical clinics.  This testing detects viral proteins, not genetic material, and results are ready in about 15 minutes.  These tests are not as sensitive as the PCR tests; this means that there are more false negative results.  If COVID 19 disease is strongly suspected, and a negative antigen test is received, confirmatory PCR testing (for viral genetic material) should be done.  The rapid antigen tests are most useful in the clinical environment and in vulnerable facilities, to detect as many cases as possible with no lag time and to contain outbreaks quickly.

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

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

Wednesday, 9/23: West Point Middle School (King William) 10am-12pm, 1040 Thompson Ave, West Point, VA 23181

Thursday, 9/24: Dream Fields (sponsored by Bon Secours Rappahannock General Hospital), 10am-2pm, 1385 Irvington Rd, Weems, VA 22576  

Tuesday, 9/29: Washington and Lee High School (Westmoreland) 10am-2pm, 16380 Kings Hwy, Montross, VA 22520

Wednesday, 9/30: West Point Middle School (King William) 10am-12pm, 1040 Thompson Ave, West Point, VA 23181 

We are offering 150 tests per event, there is no charge for the testing, no appointment is needed and all events are open to the public.

Flu Vaccination Campaign:  Please get your flu shot this year!

We held our first drive through flu vaccination event this Wednesday at the Middlesex Health Department.  We are providing flu vaccines to persons 10 years of age and older, free of charge.  We will hold our next flu vaccine event on Saturday, 9/19 at the Warsaw Rescue Squad 10am - 2pm, 152 Community Park Drive, Warsaw, VA 22572.

We are also planning two additional flu vaccination 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:  Our case investigation and contact tracing ability is good

Our Three Rivers case investigation and contact tracing capability remains excellent.  We have hired 16 additional containment team members thus far.  Traditionally, respiratory disease transmission rates increase over the fall and winter months coincident with increasing indoor congregate activity.  We expect COVID 19 to do the same, and we are prepared to respond to help limit spread of the virus.

The case investigation and contact tracing process requires extensive effort and community cooperation.  If you become infected with COVID 19, you will be asked to isolate and a Three Rivers case investigator will contact you.  Please cooperate by identifying your close contacts to the case investigator (anyone that was within 6 feet of you for 15 minutes or more).  Our contact tracers will then inform those people that they have had a high risk exposure, and should quarantine themselves for one virus incubation period (2 weeks from the exposure event).  People in quarantine should pursue testing, especially if symptoms develop.   If you are in quarantine and test negative, you must continue to stay in quarantine (you could turn positive anytime in the 2 week post exposure period).  If you develop symptoms and/or have a positive test, then you will go into isolation and will need to identify your close contacts to a case investigator.  Containing COVID 19 cases and interrupting the spread of disease is critically important to us all.  Our contact tracing efforts will not succeed without strong community support and cooperation.  

K-12 School Status:  Three Rivers Health District is supporting schools closely

School systems have opened across the state.  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

School systems with fully remote learning are making plans to bring vulnerable children back into the schools and begin to hybrid operations, community transmission allowing.

To reiterate, 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 go undetected because many of them are minimally symptomatic or asymptomatic.  There have been questions concerning how effectively children can transmit the disease to household members.  The CDC published a report on September 11 relevant to this topic, entitled Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities — Salt Lake City, Utah, April–July 2020.  The report summary states: 

 

“ What is already known about this topic?

Children aged ≥10 years have been shown to transmit SARS-CoV-2 in school settings.

 

What is added by this report?  

Twelve children acquired COVID-19 in child care facilities.  Transmission was documented from these children to at least 12 (26%) of 46 nonfacility contacts (confirmed or probable cases).  One parent was hospitalized. Transmission was observed from two of three children with confirmed, asymptomatic COVID-19. 

 

What are the implications for public health practice?

SARS-CoV-2 Infections among young children acquired in child care settings were transmitted to their household members.  Testing of contacts of laboratory-confirmed COVID-19 cases in child care settings, including children who might not have symptoms, could improve control of transmission from child

care attendees to family members.“

 

Children can suffer severe complications from COVID 19 infection, and long term health effects among children remain unknown. 

 

We have experienced COVID 19 cases among school faculty and staff in multiple Three Rivers Health District jurisdictions over the past several weeks.  This reflects our current community transmission rates; we know the virus is actively circulating.  All these infections appear to have been acquired outside the school settings, they were detected quickly and no virus transmission in schools has been documented thus far.

To reiterate:  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 will support our school officials as they endeavor to maintain 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 must continue to decrease virus transmission as much as possible and keep it low.

Our best defense remains prevention of disease by social distance, masking, staying out of crowds, hygiene and sanitation

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 a long time.  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 surge during the fall and winter months, and we continue to augment our Three Rivers 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.