Three Rivers Health District COVID 19 Update  10/5/2020

Pandemic Status:  Three Rivers Health District is in slow pandemic growth

The COVID 19 new case trends across the United States continue to fluctuate; the 7-day moving average is about 47,000, and over 30 states are reporting higher case rates.  We have had over 7.4 million cases in the United States, and we are approaching 210,000 deaths.  

Across Virginia, the 7-day moving average of cases by date reported is 852 on 10/5.  The 7-day average percent positivity of tests is currently 4.8%.  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 906 on 10/4, 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 have moved from pandemic surge to slow growth.  We have shown continued improvement over the past week.  Four of our jurisdictions are above 10 cases/100,000 moving 7 day average (Lancaster, Northumberland, Mathews, King and Queen), Gloucester, Richmond and Middlesex are between 5-10, and King William, Essex, and Westmoreland are below 5.  We had 91 cases reported last week across our jurisdictions, which does reflect improvement from the week before.  We continue to have outbreaks, which are powerful indicators of enhanced viral spread.  The main source of community transmission continues to be individual exposures during private events in venues that the VDH does not regulate.  

The message that we have been repeating over and over again remains critically important:  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.  The SARS CoV 2 virus readily exploits any opportunities to spread, vividly demonstrated at the highest levels of our government.  All of us are getting tired of practicing preventive measures, but the virus remains agnostic to our feelings, desires, and beliefs.  It is prevalent in our communities, it has not changed or gone away, it is a very serious threat, and we must try to protect ourselves as much as possible.

Virus update:  COVID 19 clinical progression review, MIS-A described

It might be useful at this time to review experience thus far about the typical progression of COVID 19 infections.  The incubation period extends to 14 days from exposure, with symptoms appearing in most people within 4-5 days.  Symptoms at onset can vary, but most people experience the following: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea.  Asymptomatic and pre-symptomatic patients can transmit COVID 19.  Eight-one percent of patients have mild to moderate disease, 14% have severe disease, and 5% develop critical illness.  The overall case fatality rate is between 2 and 3%.   The majority of critical illnesses and deaths occur in older age groups, but the disease can result in very poor outcomes at any age.

Most patients who develop severe disease experience shortness of breath within 5-8 days of onset of symptoms.  Acute Respiratory Distress Syndrome (ARDS) develops between 8-12 days, which corresponds to mean time from onset of symptoms to ICU admission in most critically ill patients.  Mortality among patients admitted to the ICU ranges from 35% to 72%, depending on the study referenced.  Risk factors for severe disease are age, cardiovascular disease, diabetes, chronic respiratory disease, cancer, chronic kidney disease, and hypertension (in combination with other co-morbidities). COVID 19 has disproportionally affected people of color, with African American and Hispanic populations suffering worse disease outcomes.  Remember, COVID 19 disease can appear identical to allergies, any respiratory viral illness, gastrointestinal illness, and a variety of other diseases.  Loss of taste and smell are unique to COVID 19; patients who experience those symptoms should seek medical care and testing early.  Shortness of breath is a warning sign that could indicate very high risk of critical illness.  A variety of long term health effects are being described following COVID 19 infection, including fatigue, cognitive changes, and cardiac issues.  Much remains unknown about this virus.

From a therapeutics standpoint, we saw the mainstays of COVID 19 therapeutics employed very publicly over the last weekend.  Remdesivir, an antiviral agent, has been shown to decrease the severity and duration of disease.  Dexamethasone reduces the severity of the inflammatory response to COVID 19, which is the COVID 19 feature that leads to SARS and other organ system damage.  We also saw Regeneron’s REGN-COV2 novel antibody cocktail used, which has been shown to reduce viral loads and symptoms in an initial clinical trial with 275 outpatient participants, randomized to receive REGN-COV2 in high or low dose or placebo.  Notably, according to the Regeneron website, “REGN-COV2 is an investigational medicine, and its safety and efficacy have not been fully evaluated by any regulatory authority”.

Evidence is emerging that adults can develop a condition very similar to Multisystem Inflammatory Syndrome in Children (MIS-C).  This condition is known as Multisystem Inflammatory Syndrome in Adults (MIS-A).  The CDC published a case series of MIS-A associated with COVID 19 infection in the United Kingdom and United States on October 2.  The etiology of this syndrome in both children and adults remains unknown.

Vaccine stage 3 clinical trials continue.  In the US, Johnson and Johnson, Moderna, Pfizer and AstraZeneca all have vaccines in phase 3 trials.  The AstraZeneca trail remains suspended in the United States due to FDA concerns about a serious side effect experienced in a patient in the United Kingdom.  Early evidence indicates the Moderna vaccine produces antibody response in older individuals comparable to that seen in younger people, which is encouraging.

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

I would like to repeat concerns about rapid antigen testing accuracy.  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.  The specificity of rapid antigen tests is very good; there are very few false positive results, and 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 available to help with 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. 

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

  • Tuesday, 10/6: Mathews Health Department 10am-2pm (APPOINTMENT ONLY), 536 Church St, Mathews, VA 23109
  • Wednesday, 10/7: Light of Christ Anglican Church, 10am-12pm, 9500 Northumberland Highway 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
  • Friday, 10/16:  Essex County Health Department, 10am- 2pm (APPOINTMENT ONLY), 423 N Church Ln, Tappahannock, VA 22560
  • Monday, 10/19:  Northumberland Health Department 10am-2pm (APPOINTMENT ONLY), 6373 Northumberland Hwy Ste B, Heathsville, VA 22473
  • Tuesday, 10/20:  King William Health Department, 10am-2pm (APPOINTMENT ONLY), 172 Courthouse Rd, King William, VA 23086
  • Wednesday, 10/26:  Westmoreland Health Department, 10am-2pm (APPOINTMENT ONLY), 18849 Kings Hwy, Montross, VA 22520

We are offering 150 – 250 tests per event, there is no charge for the testing, and all events are open to the public.  Our overall test positivity rate for these community events is about 2.1%.

Flu Vaccination Campaign:  Paving the way for the COVID 19 vaccine

We have held several drive-thru 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. 

Our next drive through flu vaccination event is:

  • Thursday, 10/22: 11am-1pm, Beale Memorial Baptist Church, 19622 Tidewater Trail, Tappahannock, VA

The Three Rivers Testing Team, the Medical Reserve Corps, and the Community Emergency Response Teams are collaborating to hold these events, which are preparing us for the upcoming large COVID 19 vaccination effort.  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.  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 working with 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 last week.  Everyone can access the Dashboard at this link:  https://www.vdh.virginia.gov/coronavirus/key-measures/pandemic-metrics/

The CDC Indicators for Dynamic School Decision Making stratify risk for viral transmission in schools via the following indicators:

  1.  Number of new cases per 100,000 persons within the last 14 days
  2.  Percentage of RT-PCR tests that are positive during the last 14 days
  3.  Ability of the school to implement 5 key mitigation strategies:
    1. Consistent and correct use of masks
    2. Social distancing to the largest extent possible
    3. Hand hygiene and respiratory etiquette
    4. Cleaning and disinfection
    5. 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.  We are working 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 week we have seen the first case of viral transmission that actually occurred in the school setting during class sessions.  It is still too early to draw firm conclusions about how readily this virus will transmit in our schools, but we can expect transmission to occur.  Our objective is to contain any COVID 19 cases that occur in schools, 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.

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 repeatedly demonstrates 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.   

If you are sick at all, even if your symptoms do not feel like COVID 19, stay at home, consult your health care provider, and do not hesitate to seek testing.  The virus can masquerade as many other diseases, and can fool us all.  Again, difficulty breathing remains a sign of possible serious disease; if this develops, please seek help very quickly.