Pandemic status: COVID 19 new case counts remain high in Virginia, test percent positivity is up
The rolling 7 day average new case counts in the United States has declined to about 189,000. There have been over 19 million documented cases of COVID 19 in the United States, and we have had over 332,000 deaths. Hospital systems and health care workers continue to be stressed across the country.
In Virginia, the 7-day moving average of cases by date reported is 3612; the 7-day average percent test positivity has increased to 12.3%. 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 2523. We still have adequate hospital and ICU capability across the state at this time; ICU occupancy is 78% and 33% of ventilators are in use. All counties across the state are at highest risk as defined by the CDC except one (Cumberland County).
In Three Rivers, our weekly case count went to 517 new cases from 501 the previous week; our case investigation and contact tracing efforts remain severely stressed. 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: Pfizer and Moderna vaccines are being administered across the country
Pfizer and Modern vaccines have both received Emergency Use Authorization from the FDA. The CDC’s Advisory Committee on Immunization Practices (ACIP) met on 12/19-20 and 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.
Hospital systems have been vaccinating health care personnel for a week. Most public health districts received shipments of the Moderna vaccine last Tuesday and Wednesday and have begun vaccinating their own high-risk personnel and non-health care system based health care workers. In Three Rivers, we received our initial shipment of Moderna vaccine doses and will begin our vaccination efforts this week. We will be concentrating on vaccinating our employees who will be administering the vaccine and Emergency Medical Services providers first. We have already ordered additional Moderna vaccine doses and will proceed as fast as we can through Phase 1a. We will coordinate our vaccination efforts from the Middlesex Health Department, and we will be contacting health care workers through their places of employment to offer vaccination appointments soon. We will collaborate 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 beginning this week. There are an estimated 500,000 Health Care Providers and LTCF residents in Virginia. The Virginia Department of Health launched a COVID-19 Vaccination Dashboard last week, which is available here: https://www.vdh.virginia.gov/coronavirus/covid-19-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 for Moderna 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 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. Many questions remain about the effects of vaccination on the course of this pandemic. The answers to these questions will be clear over time. We will need to continue masking and social distancing after receiving the vaccine. When the number of cases fall to very low levels across the nation, and when we achieve a degree of herd immunity, we will be able to begin relaxing protective measures. Many months of intense, constant vaccination effort will be required to realize benefits from herd immunity effect.
Reports from the United Kingdom, indicate two new strains of COVID 19 virus much more contagious than previous strains, have emerged. There is no evidence that these strains cause worse disease, but they pass more readily from person to person. Efforts to limit the spread of the new viral strains to the United Kingdom through pre-travel testing and other travel restrictions have been initiated, but these strains have already been detected in other European countries and Japan. They are probably here in the United States as well. Viral disease experts and public health authorities are optimistic that the existing Pfizer and Moderna vaccines will be effective against these new viral strains. This virus is genetically drifting constantly; the pandemic is a force of nature, and it is evolving. Please do everything you can to avoid catching it or passing it on to others while we work hard to deliver the vaccine. We have a long way to go in this pandemic.
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
We have shifted our focus to the vaccine effort, which will be the most demanding activity this pandemic requires, 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: Get your flu shot now
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 efforts remain challenged by pandemic surge
Our containment team is extremely stressed by the large number 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; 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 the most part, businesses and individuals appear to us to be cooperating and complying with Executive Order compliance mandates. Most high risk exposures and viral transmissions continue to be happening in non-regulated venues such as private gatherings.
K-12 School Status: The holidays bring a welcome break to administrators, faculty, staff and students in our schools
Schools across all our jurisdictions are out of session for the holidays, a welcome break from potential exposures for all school officials, faculty and staff. 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 epidemiologically linked COVID 19 school-based transmission events (outbreaks) in five schools across three school districts as community spread increased over the past several weeks. This clearly demonstrated the risk that high community transmission poses to any congregate environment, including our schools. 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 continue to protect yourselves during the holidays
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 now in the middle of a two week holiday season. Travel and gathering with family and friends in congregate settings are extremely dangerous activities at this time. Please remain with members of your own household this season. Please do not attend parties or gatherings with multiple people in a congregate setting, this behavior can be a fatal mistake in current pandemic conditions.
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.
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.