Pandemic Status: The fall and winter pandemic surge is increasing
COVID 19 new cases across the United States continue to increase rapidly; the 7-day moving average of new cases per 100.000 population is at an all-time high (over 87,000) and over 30 states are reporting higher case rates. We have had over 9.2 million cases in the United States, and we have over 231,000 deaths. In Europe, cases continue to increase rapidly across the continent and government restrictions are being imposed in several countries.
In Virginia, the pandemic is not accelerating as fast as elsewhere. The 7-day moving average of cases by date reported is up to 1306 on 11/2. The 7-day average percent positivity of tests is currently 5.8%. Community transmission extent in the Central, Far and Near Southwest regions are substantial (high). Community transmission extent is moderate in the Eastern, Northwest, and Northern regions. The moving 7-day average of people hospitalized for COVID 19 is 1052 today. We have good hospital and ICU capability across the state.
In Three Rivers, we improved significantly. We had 77 cases reported last week across our jurisdictions, and the UVA Biocomplexity Institute model depicted us in decline. According to the CDC K-12 School Metrics, Lancaster is the only county currently at highest risk levels from a case incidence perspective. Mathews, Westmoreland, Northumberland, Essex, King William, Middlesex, and Gloucester counties are at higher risk. King and Queen is at moderate risk, and Richmond County is at lowest risk. Our 14 day percent PCR positivity ranges from 1.0 (Middlesex County) to 6.36 (Lancaster County).
Virus update: Phase 3 clinical trials proceed, Monoclonal Antibody results promising
Johnson and Johnson, Moderna, Pfizer and AstraZeneca continue phase three vaccine trials in the U.S. Novavax, a Maryland based company, has a vaccine in phase three clinical trials in South Africa and the UK, and now plans to start phase three clinical in the U.S. during November. The company could deliver 100 million doses by early next year if the vaccine is successful. The Moderna and Pfizer vaccines are based on messenger RNA, and must be stored at minus 80 degrees Celsius prior to injection, which poses a challenge for many facilities. We are working to gain ultra-cold storage capability in our health district, and we are in discussion with hospitals systems who currently have this capability and can act as storage hubs. Most COVID 19 vaccines will require two doses. Last week the Center for Medicare and Medicaid Services announced it “is taking steps to ensure all Americans, including the nation’s seniors, have access to the coronavirus disease 2019 (COVID-19) vaccine at no cost when it becomes available.”
Eli Lilly and Regeneron both reported positive results with their monoclonal antibody products. The Eli Lilly product seems to lower the risk of hospitalizations in patients with mild to moderate symptoms, and Regeneron said its treatment “significantly reduced viral load and reduced the need for a patient to go to the hospital, emergency room, urgent care or doctor's office.” Both companies have applied for FDA Emergency Use Authorization.
A new study, not yet peer reviewed, was published on line last week that indicates the COVID 19 virus can cause “autoantibody” production, targeting human cells, that can be similar to autoimmune disorders such as lupus and rheumatoid arthritis. These findings were in patients with more severe COVID 19 illness, and could be related to the blood clotting problems seen with this disease.
Executive Orders: Executive Order 67 Updated
Executive Order 67 was modified last week to remove the requirement that 10 feet of distance be maintained between participants in sports activities. This clears the way for reinstating competitive events in high school sports, planned for December. Executive Order 67 was also modified to establish a new category of large outdoor amusement parks/zoos.
We continue to investigate concerns and complaints and enforce executive order compliance to the best of our ability across the district, sometimes in collaboration with the Department of Agriculture and Consumer Services and the Department of Labor and Industry. We have had outbreaks in many business settings, and in other congregate settings, which are reflected in our overall case numbers. We have not yet had an outbreak in an educational setting. Most of these outbreaks are indicators of enhanced community spread, but have not in and of themselves served as major sources of widespread community transmission. Most of our transmissions continue to occur between friends and family members, and in private venues that are unregulated by any authority.
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. They are primarily useful in clinical settings to identify positive COVID 19 cases and in vulnerable facilities such as nursing homes. The VDH health districts will receive some of these rapid tests for local use. We are discussing plans for using these testing resources in our health district when we receive them.
Our testing team in the Three Rivers Health District is actively conducting testing events across our jurisdictions. Upcoming events include:
- Thursday , 11/5: Rappahannock Bon Secours Hospital, Dream Fields, 10am-1pm, 1385 Irvington Rd. Weems, VA 22576
- Monday, 11/9: Middlesex Health Department, 10am-2pm, (APPOINTMENT ONLY), 2780 General Puller Highway, Saluda, VA 23149
- Thursday, 11/12: Northumberland Health Department, 10am-2pm, (APPOINTMENT ONLY), 6373 Northumberland Highway Ste B, Heathsville, VA 22473
- Monday, 11/16: Gloucester Library, 10am-2pm, (APPOINTMENT ONLY), 6920 Main St. Gloucester, VA 23061
- Monday, 11/30: Middlesex Health Department, 2pm-6pm (APPOINTMENT ONLY), 2780 General Puller Highway, Saluda, VA 23149
To make an appointment for testing, please call 804-815-4191 Monday through Friday between the hours of 9am - 4pm. 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 1.9%.
Flu Season is coming: Please get your flu vaccine
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 pandemic cases, which may look just like flu. It is possible to have flu and COVID 19 at the same time; getting your flu vaccine lessens your risk of becoming infected with flu virus, and may lessen the severity of flu disease if you do get sick. We are starting to receive reports of flu in our communities.
Pandemic Containment: Our case investigation and contact tracing capability is strong
Our Three Rivers case investigation and contact-tracing capability remains excellent. To date we have hired 11 case investigators, 10 contact tracers, and one team supervisor. It is clear that we have entered a period of increased viral transmission across the country, commensurate with increasing indoor congregate activity and a worldwide northern hemisphere fall/winter pandemic surge, and we are prepared to help contain further spread in our district should it happen. We have been able to detect outbreaks early thus far and will work to contain them quickly.
K-12 School Status: Our schools are doing well thus far
Most school systems are proceeding to bring students back into the schools and begin in-person operations, guided by current community transmission extent. Last week we continued to experience COVID 19 cases among school faculty, staff and students in multiple Three Rivers Health District jurisdictions. We have still seen only one case of viral transmission that actually occurred in the school setting. We have recommended isolation and quarantine for some individuals working in our schools and for some classes experiencing extensive exposures, but we have not yet experienced an outbreak in any of our schools. Thus far, our schools continue to be able to pay diligent attention to and maintain social distancing, masking, and hygiene. This, in combination with early detection, case investigation and contact tracing appear to be working together to protect our educators and students. The VDH launched a K-12 COVID 19 outbreak dashboard last week, which can be viewed at the following link: https://www.vdh.virginia.gov/coronavirus/outbreaks-in-school-settings/
Our objective remains to prevent cases from occurring in schools, contain any 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 keep virus transmission as low 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 soon, 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. These simple methods work 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. Three Rivers Health District employees will continue doing our best to protect our communities, and we encourage all of our constituents to take these simple measures to protect yourselves.
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.