Pandemic Status: Three Rivers Health District Is In Pandemic Surge
The COVID 19 new case trends across the United States continue at higher levels; the 7-day moving average is about 45,000, and today about 22 states are reporting higher case numbers. We have had over 7.1 million cases in the United States, and we are approaching 205,000 deaths.
Across Virginia, the 7-day moving average of cases by date reported is down to 779 on 9/28. The 7-day average percent positivity of tests is currently 4.7%, which is improved. Community transmission extent in the Near Southwest region is substantial (high). Community transmission extent is moderate and stable in the Eastern, Central, Far Southwest, and Northwest regions, and it is low in the Northern region. The moving 7-day average of people hospitalized for COVID 19 is 926 on 9/28, which is improved. We still have good hospital and ICU capability across the state.
In Three Rivers, according to the UVA Biocomplexity Institute’s modeling, we are one of three VDH health districts that are surging in cases. We have shown some improvement over the past week, however. Six of our jurisdictions are above 10 cases/100,000 moving 7 day average (Lancaster, Northumberland, Mathews, Westmoreland, Essex, Middlesex), Gloucester and King William are between 5-10, and Richmond and King and Queen are below 5. VDH considers high range to be over 10 cases/100,000 population, mid range is 5-10, and low range is less than 5. We had 124 cases reported last week across our jurisdictions, which does reflect improvement from the week before. We had one new smaller outbreak last week in a congregate setting. The main source of community transmission continues to be individual exposures and private events in venues that the VDH does not regulate.
We can reduce COVID 19 transmission greatly if we mask in public, practice social distancing in all venues, stay out of crowds, wash our hands, and practice good sanitation. This is important for all of us. Higher community transmission levels increase the risk of the virus getting into nursing homes, assisted living facilities, businesses, schools, and other places where people must live and work. We owe it to vulnerable people who will suffer badly with this disease, to our children, and to the welfare of our nation to protect each other during this pandemic. The SARS CoV 2 virus readily exploits any opportunities to spread.
Virus update: Four vaccines are now in phase 3 clinical trials in the United States
The Johnson and Johnson vaccine, which has provided protection to monkeys in experimental settings, entered phase 3 clinical trials this month. The Johnson and Johnson product is a modified adenovirus vaccine. The AstraZeneca vaccine clinical trial remains on hold in the United States to evaluate a possible serious adverse reaction in a recipient; the trial restarted in the UK on September 12. This is also an adenovirus vaccine, using an attenuated live chimpanzee adenovirus modified to express the SARS CoV 2 spike protein. The Pfizer and Moderna phase 3 clinical trials continue; both are RNA vaccines.
The COVID 19 vaccine group working in the VDH central office, with representation from community stakeholders, continues planning activities. Health departments are preparing to distribute the COVID 19 vaccine as soon as it becomes available. Plans are underway to vaccinate essential, high-risk groups such as health care workers and first responders, as well as vulnerable populations, early in the vaccine distribution process. Whenever a safe and effective vaccine is available, we will be ready to distribute it. The distribution process will take many months; we must all be prepared to continue our personal protective measures until we know the effectiveness of the vaccine and the duration of protection it affords.
Executive Order Compliance: No enforcement actions have been necessary
We will continue to investigate concerns and complaints and enforce executive order compliance to the best of our ability across the district. Businesses have been compliant with corrective recommendations, as far as we can see. Thus far, we have not identified any discrete sources of viral spread in any business or restaurant settings that have led significantly to ongoing community transmission.
Testing: Three Rivers Health District continues community testing
There is increasing access to rapid antigen testing across Virginia, especially in outpatient medical clinics. This testing detects viral proteins, not genetic material, and results are ready in about 15 minutes. Rapid antigen tests are not as sensitive as the genetic material tests; this means that there are more false negative results. Generally, in real world clinical use, the sensitivity of these tests is not proving to be as good as manufacturer data indicates. On the other hand, the specificity of these tests is very good. This means there are very few false positive results. A positive rapid antigen test result can be trusted. If COVID 19 disease is suspected, and a negative antigen test is received, confirmatory Reverse Transcription Polymerase Chain Reaction (RT-PCR) testing (for viral genetic material) should be strongly considered. Rapid antigen tests are most useful in the clinical environment and in vulnerable facilities, to detect as many positive cases as possible with minimal lag time and to contain outbreaks quickly.
The Virginia National Guard is again stepping up to pursue focused testing events at vulnerable facilities across the Commonwealth. The VDH has also contracted with two companies (BakoDX and Mako Medical Laboratories) to provide testing services for all Health Districts, Regional Emergency Offices and any other office under the Virginia Department of Health. They are now available to conduct testing events in the districts.
Our testing team in the Three Rivers Health District is actively conducting testing events across our jurisdictions. Upcoming events include:
- 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
- Tuesday, 10/6: Mathews Health Department 10am-2pm (APPOINTMENT ONLY), 536 Church St, Mathews, VA 23109
- Wednesday, 10/7: Northumberland High School 10am-12pm, 201 Academic Ln, Heathsville, VA 22473
- Friday, 10/9: Richmond County Health Department 10am-2pm (APPOINTMENT ONLY), 5591 Richmond Rd, Warsaw, VA 22572
- Tuesday, 10/13: Lancaster County Health Department 10am-2pm (Appointment Only) , 9049 Mary Ball Rd # 100, Lancaster, VA 22503
- Thursday, 10/15: Gloucester Library 10am-2pm (Appointment Only) , 6920 Main St, Gloucester, VA 23061
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: Flu vaccine now available
We have held several drive through flu vaccination events thus far in Three Rivers Health District. We are providing flu vaccines to persons 10 years of age and older, free of charge.
We are planning two additional flu vaccination events in October. The first will occur on:
- Thursday, 10/1: 10am-2pm, 6489 Main Street, Gloucester, VA 23061.
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, ease the burden on our health care system, and help lessen confusion with COVID 19 cases, which may look just like flu. It is possible to have flu and COVID 19 at the same time; it is best to avoid this if possible.
Pandemic Containment: Three Rivers continues case investigation and contact tracing
Our Three Rivers case investigation and contact tracing capability remains excellent. We have hired 18 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.
K-12 School Status: Three Rivers Health District is supporting schools closely
School systems with fully remote learning are making plans to bring vulnerable children and K-3 students back into the schools and begin in-person operations, guided by current community transmission extent. It is important to remember that many cases of COVID 19 among children are asymptomatic or minimally symptomatic, children can rarely suffer severe complications from COVID 19 infection, and long-term health effects among children remain unknown.
The Virginia Department of Health placed its Pandemic Metrics Dashboard in the public domain today. Everyone can access the Dashboard at this link: https://www.vdh.virginia.gov/coronavirus/key-measures/pandemic-metrics/
The VDH includes this description of the dashboards on the website:
What these dashboards do:
- In the VDH Pandemic Metrics dashboards:
- The Daily Region Metrics dashboard shows where COVID-19 is spreading in Virginia and the changes over time.
- The Weekly Transmission Extent dashboard helps inform state and local officials about the effects of COVID-19 on each region to help them decide whether to act on additional mitigation measures for individual communities.
- VDH also created visualizations to display the CDC School Metrics to help communities and school divisions understand the risk of introduction and transmission of COVID-19 in schools.
- VDH recommends that communities and school divisions use the CDC Indicators for Dynamic School Decision-Making framework together with VDH Guidance for Mitigation Measures in K-12 Settings when considering actions related to school decision making.
The CDC Indicators for Dynamic School Decision Making stratify risk for viral transmission in schools via the following indicators:
- Number of new cases per 100,000 persons within the last 14 days
- Percentage of RT-PCR tests that are positive during the last 14 days
- Ability of the school to implement 5 key mitigation strategies:
- Consistent and correct use of masks
- Social distancing to the largest extent possible
- Hand hygiene and respiratory etiquette
- Cleaning and disinfection
- Contact tracing in collaboration with local health department
VDH revised the VDH Interim Guidance for Mitigation Measures in K-12 School Settings document to accommodate the CDC Indicators for Dynamic School Decision Making. In general, the new dashboard and guidance facilitates greater consideration of locality data in assessing viral transmission risk in schools, although regional transmission extent remains available as well. Local health district authorities will work closely with school officials to help them understand the new dashboard data and to advise them how to best use it in decision-making.
We continue to experience COVID 19 cases among school faculty, staff and students in multiple Three Rivers Health District jurisdictions. This reflects our current higher community transmission rates; we know the virus is actively circulating at higher levels. All these infections appear to have been acquired outside the school settings thus far; they were detected quickly and we have not yet seen virus transmission in schools. We are investigating every case carefully, with the close cooperation of our school officials. We are now beyond week 3 of hybrid school openings; we are seeing increased community transmission, but the fact that we are aware of no active viral transmission in the school systems remains encouraging. It is too early to draw firm conclusions about how readily this virus will transmit in our schools.
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 as appropriate, 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. We all hope for an effective vaccine, and we all hope for better medications to treat this virus. Our best defense remains to prevent virus exposure and 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 seeing a local surge in cases, and we expect to see further case increases during this fall and winter.
Remember, 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.