Pandemic status: COVID 19 rages worldwide and in the United States
The pandemic is raging across the globe, continuing to compromise health care systems regionally in the United States with lack of beds and critical resources, and causing provider compromise/fatigue. There have been over 18 million documented cases of COVID 19 in the United States. Our current 7-day average of new cases daily in the United States is over 232,000, and we have had over 318,000 deaths.
In Virginia, the 7-day moving average of cases by date reported is 3677; there was transient improvement but case counts appear to be rising again. The 7-day average percent test positivity is currently 11.5%. Community transmission extent in all regions of Virginia is substantial (high). The moving 7-day average of people hospitalized for COVID 19, a lagging indicator, is at 2399. We still have adequate hospital and ICU capability across the state at this time, ICU occupancy is 80% and 33% of ventilators are in use. All counties across the state are at highest risk as defined by the CDC with only two counties remaining at less than higher risk.
In Three Rivers, our weekly case count went to 501 new cases documented from 461 the previous week, a dramatic increase that has seriously stressed our case investigation and contact tracing efforts. According to the CDC K-12 School Metrics, all jurisdictions in Three Rivers Health District are at highest risk levels from a community transmission standpoint.
Vaccine update: FDA authorizes the Moderna vaccine for emergency use
The FDA’s Vaccines and Related Biologics Advisory Committee (VRBPAC) met and voted unanimously to recommend approval of Emergency Use Authorization (EUA) for the Moderna vaccine in individuals 18 years of age and older. The FDA issued an Emergency Use Authorization for the Moderna Vaccine on 12/18/20. The CDC’s Advisory Committee on Immunization Practices (ACIP) met on 12/19-20 and issued recommendations on Moderna vaccine usage and further recommendations on priority groups. The ACIP recommended individuals aged 75 and older, and front line workers such as first responders (law enforcement, firefighters), educators and grocery store workers receive the vaccine in the next highest priority group. The highest priority individuals to receive the vaccine are hospital based health care workers; they are the most exposed to COVID 19 and they need to remain on duty to prevent health care system collapse. Non Health Care System Health Care Workers and Emergency Medical Services (EMS) First Responders are also a high priority; we will concentrating on vaccinating those personnel through the health department as soon as we get vaccine. Hospitals began vaccinating their high-risk employees last week. We expect to get a shipment of Moderna vaccine in our health department this week, and we are collaborating with the Riverside Health Care System in the vaccination effort going forward.
Teams from large pharmacy chains (Walgreens and CVS) will vaccinate the vast majority of Long Term Care Facility (LTCF) residents and staff under a federal partnership. This effort will begin later this month. There are an estimated 500,000 Health Care Providers and LTCF residents in Virginia.
Both Pfizer and Moderna vaccines require two doses: the Pfizer dosage interval is three weeks, and the Moderna interval is 4 weeks. More detail on the FDA EUA approval can be found here: https://www.fda.gov/news-events/press-announcements/fda-takes-additional-action-fight-against-covid-19-issuing-emergency-use-authorization-second-covid
It is important to remember that the vaccines may not prevent COVID 19 infection in all individuals. The vaccines will prevent infection in many, and will lessen the severity of disease in others. Moderna data indicates their vaccine may be more effective in actually preventing disease. The duration of immunity following vaccination is unknown. We fully expect the vaccine to help drive case numbers down and prevent overburden/collapse of the health care system. We will need to continue masking and social distancing, however, after receiving the vaccine. When the number of cases fall to very low levels across the nation, and when we achieve a measure of herd immunity, we will be able to begin relaxing protective measures. Months of vaccination effort will be required to reach that state.
We plan to initiate our COVID 19 vaccine campaign in Three Rivers as soon as we receive our first shipment of Moderna vaccines, which we hope will be this week. The COVID19 vaccination effort will be a very demanding process that will take many months of constant, high-level effort by our vaccination team, our nursing staff, our administrative staff, and our nursing staff. The Medical Reserve Corps (MRC), our volunteers, have been helping us immensely every step of the way through this pandemic. We will need additional volunteers during the vaccine campaign, which will be the single most important response effort we do. If you are interested in becoming an MRC volunteer, or have family or friends that are interested, please visit www.vamrc.org to learn more. Prospective volunteers will need to create a profile, participate in orientation, complete a background investigation and participate in required training. If you have questions about the process, please reach out to Johanna Hardesty, Three Rivers Medical Reserve Corps Coordinator at 804-758-2381 x 14. We welcome your help and participation in the fight against COVID 19.
Testing and Vaccination: Three Rivers Health District evolves to prioritize vaccination effort
Our COVID 19 testing team has concluded its summer and fall community testing campaign. We administered over 3400 tests with an overall positivity rate of 2.2%.
We must now shift our focus to the vaccine effort, which will be extremely resource intensive, for the remainder of this year and into 2021. We hope to have the ability to continue our community testing effort at a more focused, limited level utilizing turnkey events staffed by commercial firms or the Virginia National Guard. For information about availability of community testing events in the new year, please monitor the Three Rivers Health Department website (https://www.vdh.virginia.gov/three-rivers/) or call 804-815-4191.
Reminder: Please get your flu vaccine if you have not done so already
It is not too late to get your flu vaccine, it is extremely important 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.
Pandemic mitigation measures: Containment limited by surge, Executive Order 72 is in place
Our containment team is extremely stressed by the large number of new cases; for the first time in Three Rivers, we have been forced to prioritize our case investigation and contact tracing efforts to higher risk situations. The CDC recently amended its guidance regarding quarantine for people with high-risk COVID 19 exposures. Quarantine can now end at 7 days with a negative COVID 19 test, or at 10 days without a test. The CDC still recommends a full 14-day quarantine; if someone chooses a shorter quarantine time, they may still develop COVID 19 through 14 days from exposure, and there is increased risk of them unintentionally spreading the disease. The new CDC guidance is available here: https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-options-to-reduce-quarantine.html
Our executive order compliance team continues to investigate every complaint. For reference, the provisions Executive Order 72 are summarized again here:
- Modified Stay at Home Order - All individuals in Virginia must remain at their place of residence between the hours of 12:00 a.m. and 5:00 a.m. Exceptions include obtaining food and goods, traveling to and from work, and seeking medical attention.
- Universal mask requirement - All Virginians aged five and over are required to wear face coverings in indoor settings shared with others and when outdoors within six feet of another person. This order expands the current statewide mask mandate, which has been in place since May 29, and requires all individuals aged five and over to wear face coverings in indoor and outdoor public settings outside of their own household. These changes are consistent with new CDC guidelines, released December 4, which recommend universal wearing of face coverings.
- Reduction in social gatherings - All social gatherings must be limited to 10 individuals, down from the current cap of 25 people. Social gatherings include, but are not limited to, parties, celebrations, or other social events, regardless of whether they occur indoors or outdoors. This does not apply to religious services, employment settings, or educational settings. Restaurants and retail stores are already governed by strict social distancing requirements, and are not included in this limit.
- Continued limits on dining establishments - Virginia restaurants are currently governed by strict social distancing and sanitization requirements, which remain in place. The on-site sale, consumption, and possession of alcohol remains prohibited after 10:00 p.m. in any restaurant, dining establishment, food court, brewery, microbrewery, distillery, winery, or tasting room. All restaurants, dining establishments, food courts, breweries, microbreweries, distilleries, wineries, and tasting rooms must close by midnight.
- Teleworking - Employees that can telework are strongly encouraged to do so.
The full text of Executive Order 72 may be viewed here: https://www.governor.virginia.gov/media/governorvirginiagov/executive-actions/EO-72-and-Order-of-Public-Health-Emergency-Nine-Common-Sense-Surge-Restrictions-Certain-Temporary-Restrictions-Due-to-Novel-Coronavirus-(COVID-19).pdf
K-12 School Status: The holidays bring a welcome break to administrators, faculty, staff and students in our schools
We continued to experience numerous COVID 19 cases among school faculty, staff and students in multiple Three Rivers Health District jurisdictions right up until the holiday break began. Experience through the fall, guided by symptomatic disease, strongly indicates the source of most COVID 19 disease is transmission in the community, and we rarely saw virus transmission in the school setting. We were only able to epidemiologically link COVID 19 school-based transmission in several cases, involving only a few schools across the health district. The minimal amount of school transmission that we saw was coincident with very high community transmission rates, so we demonstrated the risk increased under these conditions. Despite the increased community transmission levels, however, schools were able to detect cases and transmission quickly, and then to initiate isolation and quarantine measures to contain outbreaks. Keeping our schools open for in-person learning reduces the very powerful risks facing some students if they are restricted to home learning. Nutritional risks, personal safety risks, educational risks, and economic risks are mitigated by keeping our hybrid learning system intact, so we are highly motivated to continue this option if possible. Social distancing, masking, and hygiene in our schools are imperative if we are to keep them open. We will continue to prioritize early detection, case investigation and contact tracing in our schools, to keep this containment mitigation measure as intact as possible in the New Year. Last week the VDH launched a COVID-19 outbreak dashboard in response to the requirements of HB5048 of the 2020 Virginia General Assembly Special Session. The dashboard includes outbreaks that occurred in medical care facilities, residential or day programs licensed by VDH, Department of Social Services (DSS) or Department of Behavioral Health and Developmental Services (DBHDS), summer camps, and kindergarten (K)-12th grade schools. The dashboard is available on the VDH website at https://www.vdh.virginia.gov/coronavirus/covid-19-data-insights/.
Please protect yourselves during the holidays to prevent another disastrous post-holiday surge
We saw a tragic post-Thanksgiving pandemic surge across the country that has resulted in almost unbelievable numbers of new cases, hospitalizations, and death. Thanksgiving was a four-day holiday; we are facing an upcoming two week holiday season. Travel and gathering with family and friends in congregate settings are extremely dangerous activities at this time. If we repeat Thanksgiving behaviors, the threat to all of us and our health care systems will be severe. Please remain with members of your own household this season. Please do not attend parties or gatherings with many people in a congregate setting, this behavior can be a fatal mistake in current pandemic conditions. Reports from the United Kingdom indicate a new strain of COVID 19 virus, much more contagious than previous strains, has emerged. While apparently not more deadly, the strain passes more readily from person to person. This virus is genetically shifting – please do everything you can to avoid catching it or passing it on to others while we work hard to deliver the vaccine.
Remember, we can effectively prevent virus exposure and disease through social distance, masking, avoiding crowds, washing our hands, and practicing good sanitation methods. These simple methods work well. 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. The extremely high community transmission levels we are experiencing compromises our ability to achieve beneficial pandemic containment. We urgently encourage all our constituents to take protective measures. Many of us now have personal experience with this virus; some of us have had COVID 19 disease, others know someone who has had the disease, some of us know someone who has died. We are on the verge of access to effective vaccines; we can save many thousands of lives if we protect each other in the coming weeks and months.
Remember, 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.