Pandemic Status: COVID 19 new cases set records in the US
COVID 19 new cases across the United States continue to surge; the 7-day moving average of new cases per 100,000 population is at an all-time high (over 119,000, according to the Johns Hopkins Coronavirus Resource Center) and many states are reporting higher numbers. The number of people hospitalized across the US has doubled since mid-September, corresponding to the rise in cases. We have had over 9.9 million cases in the United States, and over 237,000 deaths. In Europe, cases continue to rise sharply, causing concern about potential health care system stress and compromise.
In Virginia, the pandemic is also accelerating, but at a slower rate. The 7-day moving average of cases by date reported is up to 1437 on 11/9. The 7-day average percent positivity of tests is currently 6.1%. 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 1066. We still have good hospital and ICU capability across the state.
In Three Rivers, we continued to improve last week. We had 62 cases reported last week across our jurisdictions, and the UVA Biocomplexity Institute model continued to depict us in decline. According to the CDC K-12 School Metrics, King William is the only county currently at highest risk levels from a case incidence perspective. Mathews, Westmoreland, Northumberland, Essex, King William, King and Queen, and Gloucester counties are at higher risk. Middlesex is at moderate risk, and Richmond County is at lowest risk. Our 14 day percent PCR positivity ranges from 0.32 (Richmond County) to 6.36 (Westmorland County).
Virus update: Virus may be more contagious, Pfizer announces 90% effectiveness of its vaccine, cardiac evaluation not necessary in athletes with mild disease
Johnson and Johnson, Moderna, Pfizer and AstraZeneca continue phase three vaccine trials in the U.S. Vaccines in phase three clinical trials are administered to thousands of volunteers, while a roughly equal number of volunteers receive a placebo. Side effects are tracked and documented to establish vaccine safety. COVID 19 infections occurring in all participants are also tracked. For the COVID 19 pandemic, the FDA considers a vaccine effective if it protects at least 50 percent of those who receive it. Vaccine manufacturers can apply for an FDA Emergency Use Authorization (EUA) prior to formal approval of their products based on favorable phase three clinical trial results.
Pfizer reported this morning that an interim evaluation of its vaccine revealed 90% effectiveness. Among the first 94 cases of volunteers who received either the vaccine or a placebo, over 90% had received the placebo. These are small numbers, but the data is very encouraging. Pfizer plans to apply for an FDA EUA after they monitor their volunteers for two months following second dose vaccine administration to assure safety. We hope to see the first vaccines available before the end of this year. Collaborative preparations to distribute the vaccine among health care delivery systems, the VDH, and many other partners continue.
The virus is undergoing genetic drift over time. A study published October 30 in the online journal mBio revealed a common mutation on the spike protein, known as the D614G mutation, now predominates in 99.9% of the COVID 19 strains circulating. This mutation is thought to make the virus more transmissible; there is no evidence that it affects the course of disease or clinical outcome at this time. Another area that bears close watching is the evolution of this virus in animal populations, and through the animal-human interface. The WHO reported last week that 214 human cases of COVID 19 associated with farmed minks have occurred in Denmark. Twelve of these cases have mutations that have not been previously observed. The implications of these findings are not yet clear, but this demonstrates the potential for the virus to mutate as it passes through multiple host species.
The American College of Cardiology made new recommendations for adult and younger athletes returning to sports activities following COVID 19 infection. Cardiac injury following COVID 19 infection is not as common as originally thought, and young people with mild infection are at very low risk of associated heart complications. These athletes may return to exercise and sports activities without extensive cardiac testing. Athletes with severe disease and those whose symptoms return or worsen with resumption of exercise should suspend their activities and pursue cardiac evaluation.
Executive Orders: Executive Order 67 update implications
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.
School officials are receiving questions about the resumption of competitive sports activities. The VDH regards sports requiring extensive close contact as higher risk activities for viral transmission. The risk increases with higher levels of community spread. School officials, parents and athletes should understand and consider the risks of disease transmission, and the potential consequences of COVID 19 infection, before participating in close contact sports activities. Whether schools conduct close contact sporting activities, and whether athletes participate or not must be an individual informed risk acceptance decision.
We continue to investigate concerns and complaints and enforce executive order compliance to the best of our ability across the district, in collaboration with the Department of Agriculture and Consumer Services, the Virginia Alcoholic Beverage Control Authority, and the Department of Labor and Industry. We have had outbreaks in many business settings, and in other congregate settings, but over the past several weeks, outbreaks have decreased in number across our district.
Testing: Three Rivers Health District COVID 19 testing is available to everyone
Our COVID 19 testing team remains very active across our jurisdictions. We specifically invite all poll workers to attend one of our testing events, especially if they are concerned that they might have been exposed to someone with COVID 19 disease. Upcoming testing events include:
- 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
- Tuesday, 11/17: Colonial Beach High School, 1pm-3pm, (APPOINTMENT ONLY), 100 1st. St. Colonial Beach, VA 22443
- 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 remains 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 conduct in-person operations, guided by current community transmission extent. We continue 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 many individuals working in our schools and for some classes experiencing extensive exposures, but we have not yet had an outbreak in any of our schools. Thus far, our schools continue to be able to 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 should have a safe and effective vaccine soon and our ability to treat people with severe COVID 19 disease is improving. It remains, however, a very great threat to all of us. 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. 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.
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.