Pandemic Status: Three Rivers Health District shows decline in new cases
The COVID 19 new case trends across the United States are increasing; the 7-day moving average is over 50,000, and over 30 states are reporting higher case rates. We have had over 7.7 million cases in the United States, and we are approaching 215,000 deaths.
Across Virginia, the 7-day moving average of cases by date reported is 1002 on 10/12. The 7-day average percent positivity of tests is currently 4.5%. Community transmission extent in the Near Southwest region is substantial (high). Community transmission extent is substantial in the Central region, moderate in the Eastern, Northwest and Southwest regions, and low in the Northern region. The moving 7-day average of people hospitalized for COVID 19 is 951 on 10/12. We have good hospital and ICU capability across the state.
In Three Rivers, according to the UVA Biocomplexity Institute’s modeling, we have moved from slow growth to a decline in new cases. Four of our jurisdictions are above 10 cases/100,000 moving 7 day average (Northumberland, Mathews, Middlesex, Gloucester), King William, Lancaster, Richmond and Westmoreland are between 5-10, and Essex and King and Queen are below five. We had 116 cases reported last week across our jurisdictions. 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, unregulated events.
Across our country, people are getting tired of maintaining the discipline required to avoid COVID 19 infection. Many are gathering more often in large groups without masking and social distancing. This is responsible to some extent for our increasing case counts nationwide. We must continue protecting ourselves as best we can to limit pandemic surge this fall.
Virus update: CDC confirms airborne spread
The CDC reconfirmed last week that “the principal mode by which people are infected with SARS-CoV-2 (the virus that causes COVID-19) is through exposure to respiratory droplets carrying infectious virus.” The CDC also stated that “airborne transmission of SARS-CoV-2 can occur under special circumstances:
- Enclosed spaces within which an infectious person either exposed susceptible people at the same time or to which susceptible people were exposed shortly after the infectious person had left the space.
- Prolonged exposure to respiratory particles, often generated with expiratory exertion (e.g., shouting, singing, exercising) that increased the concentration of suspended respiratory droplets in the air space.
- Inadequate ventilation or air handling that allowed a build-up of suspended small respiratory droplets and particles.”
Social distance, masking, hand washing, hygiene and surface decontamination, good ventilation, and avoidance of indoor crowded spaces appear sufficient to address viral transmission by personal contact, respiratory droplet, or airborne modes.
To remind us all of what is coming in the near future, vaccine stage three clinical trials continue. In the U.S., Johnson and Johnson, Moderna, Pfizer and AstraZeneca all have vaccines in phase three 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. Novavax is in phase three clinical trials in South Africa and the UK, and will launch in the U.S. this month. The company could deliver 100 million doses by early next year if the vaccine is successful.
Executive Order Compliance: Businesses continue to comply with executive orders
We continue to investigate concerns and complaints and enforce executive order compliance to the best of our ability across the district, often in collaboration with the Department of Agriculture and Consumer Services and the Department of Labor and Industry. 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
Virginia has received a large shipment of Abbott BinaxNOW card tests. The federal government purchased 150 million of these rapid antigen test cards, aimed primarily at nursing home use. Abbott reports a sensitivity over 97% and specificity over 98% with these tests. This is higher than the demonstrated sensitivity of other rapid antigen tests; we will see how accurate the BinaxNOW card tests prove in practice. They are primarily useful in clinical settings to identify positive COVID 19 cases and in vulnerable facilities such as nursing homes.
The Virginia National Guard is available to help with focused testing events at vulnerable facilities across the Commonwealth. The Virginia Department of Health (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, 10/13: 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 currently about 1.7%.
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 (MRC), 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 both.
Pandemic Containment: Three Rivers continues case investigation and contact tracing
Our Three Rivers case investigation and contact-tracing capability remains excellent. Our team members are finding the tasks of case investigation and contact tracing to be challenging. Sometimes we receive delayed lab results, which limits the timeliness of our response. We sometimes obtain conflicting information, which can lead to different and contradictory advice to patients. In addition, we have encountered “gray zone” situations that may lead to different advice from different case investigators and contact tracers. We respectfully ask everyone to remember we are dealing with a novel, poorly understood pathogen causing a once-in-a-century pandemic, and we are learning as we gain experience. None of us has ever done containment activities on this particular pathogen or on this scale. We ask for your patience as we learn how to do this work as best we can.
Traditionally, respiratory disease transmission rates increase over the fall and winter months coincident with increasing indoor congregate activity. We may be seeing the beginnings of a fall and winter COVID 19 pandemic surge worldwide; 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 rarely suffer severe complications from COVID 19 infection, and long-term health effects among children remain unknown.
The VDH reviewed the world’s available literature to date concerning children and SARS-Co-V2 last week. The reviewers offered the following summary observations:
- The role of children in the transmission of SARS-CoV2 remains unclear.
- Researchers agree that children are not contracting the new coronavirus at the same rate as adults. According to CDC, children under the age of 18 account for under 2% of reported cases of Covid-19 in China, Italy, and the United States.
- Children seem to have a reduced risk of symptomatic COVID-19 and a lower risk for severe disease and secondary infection. (JAMA Pediatr. doi:10.1001/jamapediatrics.2020.4573.)
- Widespread school closures and a comparatively lower rate of testing for the new coronavirus among children could contribute to the low number of reported cases of COVID-19 among this population group. (Consistent with this, in recent weeks children make up 12-15% of new cases, so more pediatric cases will probably result as children go back to school.)
- Research has yet to show whether young children transmit the new coronavirus at a similar rate as adults.
I am cautiously encouraged by our experience in schools over the past several weeks. We continue to experience COVID 19 cases among school faculty, staff and students in multiple Three Rivers Health District jurisdictions. All of these have been community acquired, and we have seen only one case of viral transmission that actually occurred in the school setting. The combination of possibly more limited virus dynamics among young children, diligent attention to social distancing, masking, and hygiene in our schools, and early detection, case investigation and contact tracing appear to be working together to prevent large outbreaks thus far.
Our objective remains to prevent cases from occurring in schools, contain any COVID 19 cases that do occur, 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 work together to decrease virus transmission as much as possible.
Special topic: Halloween guidance
When celebrating Halloween, remember any activity that places people in close proximity to each other increases the risk of an exposure significant enough for viral transmission to occur. Wearing a mask, practicing social distancing, limiting the time spent in close proximity to others, and proper hand washing reduces the risk of transmission. Hand washing becomes more important if people transfer articles, like treats, one to another.
In general, the VDH classifies activities where people stay with others of their own household as lowest risk. Activities where people participate with others outside their own households but with protective measures maintained are moderate risk. Highest risk are activities involving larger crowds with people from multiple households, intermittent contact with people from multiple households, and shouting and screaming in settings like haunted houses, all with no or compromised masking or social distancing in place.
I have heard some organizations are planning trunk or treat activities. The VDH classifies trunk or treat activities as moderate risk as long as social distancing, masking, and hygiene can be maintained. Those protective measures are key no matter what we are doing outside our own homes. However you celebrate Halloween, please maintain protective measures and good hygiene at all times to keep your families safe.
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.