Three Rivers Health District COVID 19 Update  01/04/2021

Pandemic status:  New case counts remain high, hospital capacity remains good in Virginia

The rolling 7-day average new case count in the United States is about 223,000.  There have been over 20.6 million documented cases of COVID 19 in the United States, and we have had over 351,500 deaths.  Hospital system and health care worker overload and stress in some highly affected regions continue.

In Virginia, the 7-day moving average of cases by date reported is 4480; the 7-day average percent test positivity has increased to 15.8%.   Community transmission extent in all regions of Virginia remains substantial (high).  The moving 7-day average of people hospitalized for COVID 19, a lagging indicator, is up to 2726.  We still have adequate hospital and ICU capability across the state at this time; ICU occupancy is 82% and 34% of ventilators are in use.  All counties across the state have moved to highest risk for community transmission as defined by the CDC. 

In Three Rivers, our weekly case count went down to 440 new cases from 517 the previous week.  According to the CDC K-12 School Metrics, all jurisdictions in Three Rivers Health District remain at highest risk levels from a community transmission standpoint.

Vaccine update:  Pfizer and Moderna vaccines administration is underway

Pfizer and Moderna vaccines have arrived at hospitals and public health departments and are being administered to health care workers and long-term care facility residents and staff (by Walgreen’s and CVS pharmacies through a federal partnership).  The CDC’s Advisory Committee on Immunization Practices (ACIP) issued the following priority group recommendations for COVID 19 vaccine: 

  • Phase 1a - Healthcare workers and long-term care facility residents.
  • Phase 1b - Persons aged ≥75 years and non–health care frontline essential workers such as law enforcement personnel, firefighters, educators and grocery store workers.
  • Phase 1c - Persons aged 65–74 years, persons aged 16–64 years with high-risk medical conditions, and essential workers not included in Phase 1b.

In Three Rivers, we started our vaccination program using the Moderna product with two events last week.  We are coordinating our vaccination efforts from the Middlesex Health Department, and we are grateful to Richmond County for the use of their large EMS facility in Warsaw for holding larger drive through events.  The EMS staff are helping us with vaccine administration, logistics, and facility support in coordination with our vaccine team.  In collaboration with the Riverside Health Care System, we are vaccinating EMS providers and community based health care workers not affiliated with a health care system in phase 1a.  We are currently contacting all non-health care system based health care workers in the Three Rivers Health District through their places of employment to arrange appointments to receive the Moderna vaccine.  If you are a health care worker, and have not heard from us by 1/15/2021, please call the Three Rivers Health District at 804-815-4191.

Our initial experience with administering the COVID 19 vaccine indicates a higher level of administrative complexity than flu vaccine involves.  Vaccine recipients must be registered, and must answer a series of health related questions to make sure criteria for safely receiving the vaccine are met. Recipients also must be counseled on possible vaccine side effects and provided information concerning the CDC V-safe tool.  “V-safe is a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after you receive a COVID-19 vaccination. Through v-safe, you can quickly tell CDC if you have any side effects after getting the COVID-19 vaccine.”   V-safe sends text messages to remind them to log in and report any side effects for several days after injection. 

After receiving their vaccine, recipients must remain on site for 15 minutes to be monitored for immediate side effects or complications.

The Virginia Department of Health is maintaining a COVID-19 Vaccination Dashboard, which is available here: https://www.vdh.virginia.gov/coronavirus/covid-19-in-virginia/.  

As a reminder, Pfizer and Moderna vaccines each require two doses:  the Pfizer dosage interval is three weeks, and the Moderna interval is 4 weeks.  The FDA fact sheets for recipients and caregivers for the Pfizer vaccine can be found here:  https://www.fda.gov/media/144414/download

The FDA fact sheet for recipients and caregivers for the Moderna vaccine can be found here:  https://www.fda.gov/media/144638/download

We anticipate the Virginia Department of Health will announce authorization for all vaccine providers statewide to move to phase 1b and on to other phases in a coordinated fashion.  As more vaccine doses become available, more vaccine sites (such as pharmacies and medical practices) will come on line and multiply distribution capability.  We will all move as fast as we can to distribute the vaccine to those who want to receive it through the coming months. 

As expected, the new, more contagious strain of COVID 19 recently detected in the United Kingdom is in the United States.  There is no evidence that this strain causes worse disease, but they pass more readily from person to person.  Viral disease experts and public health authorities believe the existing Pfizer and Moderna vaccines will be effective against these new viral strains.  This virus is typical of coronaviruses, and will genetically drift over time.  It will remain important to continue masking, maintaining social distancing and avoiding crowded areas until we see case counts drop in the coming months and public health authorities indicate it is safe to relax protective measures.

The Medical Reserve Corps (MRC), our volunteers, remain critical to our efforts at all times, especially during this pandemic.  I want to sincerely thank our volunteers for their dedication and public service.  We will need additional volunteers during the vaccine campaign, which will last for many months.  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 is prioritizing the vaccination effort

We have shifted our focus to the vaccine effort, which will provide the best pathway out of this pandemic.  Our testing team is now fully engaged in the vaccination effort, and we are no longer able to hold routine community testing events at this time.  Community testing at a more focused level and testing in response to large-scale outbreaks can be requested by facilities and jurisdictions by using commercial firms on contract with the Commonwealth of Virginia or the Virginia National Guard.  For information and advice about how to request specific community or facility testing events, call 804-815-4191.

Pandemic mitigation measures:  High case numbers cause case investigation and contact tracing challenges

I will repeat the important message about case investigation and contact tracing this week:  Our containment team is now faced with working beyond our capability by high numbers of new cases; we are doing our best to keep up with the demand to investigate each new case, but it is extremely difficult to do so.  If you have a positive COVID-19 test, we might not be able to call you in a timely fashion during these high surge pandemic conditions.  We are forced to prioritize our case investigation to higher risk situations.  If you are diagnosed with COVID-19, we ask you to voluntarily isolate yourself for 10 days, and remain fever free for 24 hours with symptoms improving before you end your isolation.  We also ask that you inform your close contacts (anyone within 6 feet of you for 15 minutes or more) that they have been exposed to COVID-19 and should quarantine themselves.  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 period; 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.   Our executive order compliance capability remains completely intact. 

K-12 School Status:  Most school system are set to reopen

Schools across all our jurisdictions are preparing to return to session this week.  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 even with high community transmission levels.   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 measures in our schools have proven to be effective measures in limiting COVID 19 transmission.  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 going forward. 

The VDH maintains a COVID-19 outbreak dashboard which 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 continue to protect yourselves while the vaccine is deployed

Remember, we can help prevent virus exposure and disease through social distance, masking, avoiding crowds, washing our hands, and practicing good sanitation methods.  These simple methods have been shown to work well.  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.

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.

Associated Document