Post-Thanksgiving surge is beginning: High pandemic case numbers threaten the health care system
We are now seeing the post-Thanksgiving pandemic surge across the United States and the Commonwealth of Virginia. There have been over 14 million documented cases of COVID 19 in the United States. Our current 7-day average of new cases daily in the United States is almost 215,000, and we have over 282,000 deaths. Even if asymptomatic, undetected cases bring the total that have been infected to 50 million or more, over 85% of us remain naive to the disease and susceptible to infection. 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. Be smart about protecting yourselves in the coming weeks, this is a dangerous and unpredictable virus. Your life and the lives of your family and friends may depend on your behavior.
Follow these simple steps for safety:
1. 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.
2. 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.
3. You can safely walk, jog, and engage in other outdoor activities without masking as long as you maintain social distance from others.
In Virginia, the 7-day moving average of cases by date reported is at 3005. The 7-day average percent positivity of tests is currently 10.8%. Community transmission extent in all regions of Virginia is substantial (high). The moving 7-day average of people hospitalized for COVID 19 is at 1885. We still have adequate hospital and ICU capability across the state at this time, ICU occupancy is 75% and 28% of ventilators are in use. From a community transmission perspective, all counties across the state are at highest or higher risk as defined by the CDC.
In Three Rivers, our cases continued to rise, from 267 to 333, another all-time high. The high numbers in Westmoreland and Richmond Counties are related to Long Term Care Facility (LTCF) outbreaks. According to the CDC K-12 School Metrics, King William, King and Queen, Lancaster, and Mathews Counties are at higher risk and all other jurisdictions are at highest risk levels from a community transmission standpoint.
Vaccine update: Timeline of coming events
Moderna and Pfizer have both announced effectiveness in the 95% range for their vaccines, and both companies have applied for a U.S. Food and Drug Administration Emergency Use Authorization (EUA). The following is a timeline of expected events:
• December 1, 2020: The CDC’s Advisory Committee on Immunization Practices (ACIP) held an emergency meeting to develop and recommend guidelines for COVID 19 prioritization and deployment. Health care workers and nursing home residents are in the first wave of recipients.
• December 10, 2020: The FDA’s Vaccines and Related Biologics Advisory Committee (VRBPAC) will meet to discuss EUA of the Pfizer vaccines 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 Pfizer EUA.
• 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. Virginia will receive its first shipment from Pfizer in mid-December, which will go to health care systems with ultra-cold storage capability. Subsequent vaccine shipments will go to both health care systems and pharmacies. The majority of LTCF residents and staff will be vaccinated by pharmacies under a federal partnership. There are an estimated 500,000 HCP and LTCF residents in Virginia.
It is important to remember that the vaccines may not prevent COVID 19 disease in all individuals. The vaccines will prevent disease in many, and will lessen the severity of disease in others. 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, 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 in the final stages of planning for 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: Free Three Rivers Health District COVID 19 testing continues
Our COVID 19 testing team remains very active across our jurisdictions. Upcoming testing events include:
• Monday, 12/7: Mathews Health Department, 10am-2pm (APPOINTMENT ONLY), 536 Church St, Mathews, VA 23109
• Wednesday, 12/9: Northumberland Health Department, 10am-2pm (APPOINTMENT ONLY), 6373 Northumberland Hwy Ste B, Heathsville, VA 22473
• Friday, 12/11: Richmond County Department of Emergency Services Station, 10am-1pm, 152 Community Park Drive, Warsaw, VA 22572
• Monday, 12/14: Colonial Beach High School, 10am-2pm (APPOINTMENT ONLY), 100 1st St, Colonial Beach, VA 22443
We have administered 2961 COVID 19 PCR tests across the Three Rivers Health District over the past several months. 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 (ages two and up), there is no charge for the testing, and all events are open to the public. Our overall test positivity rate for these community events has been about 1.9%. The current testing schedule can change, please go to the Three Rivers Health Department website (https://www.vdh.virginia.gov/three-rivers/) or call 804-815-4191 for the latest updates to the testing events.
Reminder: Get your flu vaccine
It is more important than ever to get the 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.
Pandemic mitigation measures: Containment and executive order compliance activities go on
Our containment team is extremely busy; thus far, we are able to continue case investigation and contact tracing fully. Our executive order compliance team continues to investigate every complaint. The majority of new cases occur due to small group, close exposure activities in unregulated venues, but at current higher community transmission levels, we are experiencing increasing numbers of outbreaks in businesses and long-termcare facilities. Long-term care facility outbreaks can generate large numbers of cases. This dynamic has contributed to our high case counts in recent weeks.
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.
Up until today, 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. Today 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 today we saw evidence of it. Schools are able to detect cases and transmission quickly, and then to initiate isolation and quarantine measures to contain outbreaks.
We are investigating every case and tracing every significant contact. Thus far, we have been able to keep most schools open in hybrid mode even at highest levels of community transmission, with school mitigation measures intact. Keeping our schools open for in-person learning mitigates the risks facing some students if they are restricted to home learning. Nutritional risks, personal safety risks, educational risks, and economic risks are reduced by keeping our hybrid learning system intact, so we are highly motivated to continue this optionif possible. Social distancing, masking, and hygiene in our schools are imperative if we are to keep them open. We must also maintain early detection, case investigation and contact tracing in our schools. When community transmission is too high, and protective measures prove inadequate, we see transmission and outbreaks. We are prepared, in cooperation with school officials, to take containment measures to limit and stop outbreaks. 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. We encourage all of our constituents to take these protective measures. We are on the verge of access to effective vaccines; we can save many 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 hear stories all the time 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. Many of our outbreaks are due to these actions. Again, difficulty breathing remains a sign of possible serious disease; if this develops, please seek help very quickly.