Pandemic status: Health care system integrity threatened nationwide
The post-Thanksgiving pandemic surge across the United States and the Commonwealth of Virginia is causing havoc within health care systems with lack of beds, resources, and provider compromise/fatigue. There have been over 16 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 220,000, and we have had over 299,000 deaths. At these high community transmission levels, the threat to our vulnerable facilities (nursing homes, prisons, and schools), our businesses, our economy, our health care system, and our loved ones is severe.
Please follow these simple steps for safety:
- Do not spend time in a confined space with people outside your household. Do not participate in group lunches; do not engage in close conversations with others inside or outside.
- Do not spend extended time in indoor spaces, even if most or all people are wearing masks. Shop quickly, stay 6 feet away from others, do all activities remotely at home if you can.
- You can safely walk, jog, and engage in other outdoor activities without masking as long as you maintain social distance from others.
- IF YOU ARE SICK FOR ANY REASON, STAY HOME AND SEEK MEDICAL CARE/TESTING!
In Virginia, the 7-day moving average of cases by date reported is 3837. The 7-day average percent positivity of tests is currently 10.9%. Community transmission extent in all regions of Virginia is substantial (high). The moving 7-day average of people hospitalized for COVID 19 is at 2016. We still have adequate hospital and ICU capability across the state at this time, ICU occupancy is 77% and 31% of ventilators are in use; these numbers are rising. From a community transmission perspective, all counties across the state are at highest risk as defined by the CDC with only three counties remaining at less than higher risk.
In Three Rivers, our cases continued to rise, from 333 to 461, yet another all-time high. 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 Pfizer vaccine for emergency use, injections begin this week
Last week, the FDA’s Vaccines and Related Biologics Advisory Committee (VRBPAC) met and voted to recommend approval of Emergency Use Authorization (EUA) for the Pfizer vaccine in individuals 16 years of age and older. The FDA approved the EUA over the weekend, and initial doses have been shipped to health care systems nationwide. The CDC’s Advisory Committee on Immunization Practices (ACIP) met yesterday to finalize recommendations on Pfizer vaccine usage. The highest priority group to receive the vaccine is 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. Hospitals will begin vaccinating their high-risk employees today or tomorrow. Public health districts are collaborating with hospital systems to assist in this effort as much as we can.
The following is a timeline of further expected events:
- December 17, 2020: The FDA’s Vaccines and Related Biologics Advisory Committee (VRBPAC) will meet to discuss EUA of the Moderna vaccine in individuals 16 years of age and older.
- The VRBPAC will provide recommendations to the FDA’s Center for Biologic Evaluations and Research (CBPR), which will make a decision concerning the Moderna EUA.
- Within 24 hours of approval, vaccine shipments to state authorities will ramp up.
- Distribution to local dispensing authorities, including health departments, hospitals, pharmacies, and nursing homes will occur as soon as possible following receipt of vaccine supplies.
- Vaccination of priority groups will begin as soon as possible after we receive vaccine supplies at the local level.
The Virginia Disaster Medical Advisory Committee (VDMAC) and the Virginia Unified Command voted to officially adopt ACIP recommendations and provide initial vaccines to both HCP (Health Care Providers) and Long Term Care Facility (LTCF) residents (and staff) in Virginia. The majority of LTCF residents and staff will be vaccinated by large pharmacy chains under a federal partnership. There are an estimated 500,000 HCP and LTCF residents in Virginia. Hospital systems and health districts will collaborate on vaccinating health care providers outside health care systems, collaborative planning for this effort continues.
Both Pfizer and Moderna vaccines require two doses: the Pfizer dosage interval is three weeks. The FDA included the following verbiage in a press release: “While not an FDA approval, today’s emergency use authorization of the Pfizer-BioNTech COVID-19 Vaccine holds the promise to alter the course of this pandemic in the United States,” said Peter Marks, M.D., Ph.D., Director of the FDA’s Center for Biologics Evaluation and Research. “With science guiding our decision-making, the available safety and effectiveness data support the authorization of the Pfizer-BioNTech COVID-19 Vaccine because the vaccine’s known and potential benefits clearly outweigh its known and potential risks. More detail on the FDA EUA approval can be found here: https://www.fda.gov/news-events/press-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-use-authorization-first-covid-19.
It is important to remember that the vaccines may not prevent COVID 19 infection in all individuals. The vaccines may prevent infection in some, and will lessen the severity of disease in others. We fully expect the vaccine to help drive case numbers down and prevent overburden 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, when we achieve a measure of herd immunity, we can begin to relax protective measures. Months of vaccination effort will be required to meet that goal.
We are getting ready to initiate our COVID 19 vaccine campaign in Three Rivers. 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 will hold its final scheduled community-testing events of 2020 this week:
- Monday, 12/14: Colonial Beach High School, 10am-2pm (APPOINTMENT ONLY), 100 1st St, Colonial Beach, VA 22443
- Tuesday, 12/15: Middlesex Health Department, 10am-2pm (APPOINTMENT ONLY), 2780 General Puller Hwy, Saluda VA 23149
To make an appointment for testing, please call 804-815-4191 Monday through Friday between the hours of 9am – 4pm. We will have limited laboratory analytic capability in December, which precludes further scheduled community testing events for the remainder of this year. We have administered over 3000 COVID 19 PCR tests across the Three Rivers Health District over the past several months. We will need to shift our focus to the vaccine effort, which will be extremely resource intensive, in 2021. We anticipate having 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, please monitor the Three Rivers Health Department website (https://www.vdh.virginia.gov/three-rivers/) or call 804-815-4191.
Reminder: It is not too late for flu vaccine
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. Governor Northam announced new restrictions on December 10 through Executive Order 72, summarized 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: Brisk community transmission is causing outbreaks in our schools
We continue to experience COVID 19 cases among school faculty, staff and students in multiple Three Rivers Health District jurisdictions. Experience to date, guided by symptomatic disease, strongly indicates the source of most COVID 19 disease is transmission in the community, and we have rarely seen transmission in the school setting. Until last week, we were only able to epidemiologically link COVID 19 school-based transmission in a couple of cases, involving only several people in two school systems. Last week we saw two new school outbreaks in another Three Rivers jurisdiction involving several cases, prompting a shift to virtual learning in those schools. We anticipated that school transmission would probably increase as community transmission continues to rise, and we are seeing evidence of it. Despite the increased community transmission levels, however, schools are 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 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 are prioritizing early detection, case investigation and contact tracing in our schools, to keep this containment mitigation measure as intact as possible. You can view the VDH K-12 COVID 19 outbreak dashboard at the following link: https://www.vdh.virginia.gov/coronavirus/outbreaks-in-school-settings/
Please protect yourselves; the vaccine is almost here
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. We are still hearing stories of people who fell ill, thought they had a bad cold or allergies, continued going to work and socializing with others, and then tested positive for COVID 19. GOING OUT IN PUBLIC WHILE ILL IS A MAJOR CAUSE OF COVID 19 SPREAD, DO NOT DO THIS. Again, difficulty breathing remains a sign of possible serious disease; if this develops, please seek help very quickly.