Pandemic status: Surge is unprecedented
The rolling 7-day average new case count in the United States, according to Johns Hopkins University, is over 260,000. There have been over 22 million documented cases of COVID 19 in the United States, and we have had over 374,000 deaths. Hospital system and health care worker overload and stress in some highly affected regions continue to worsen.
In Virginia, the 7-day moving average of cases by date reported is 5013; the 7-day average percent test positivity remains at 16.7%. 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 over 3100. We still have adequate hospital and ICU capability across the state at this time; ICU occupancy is 82% and 35% of ventilators are in use. All counties across the state remain at highest risk for community transmission as defined by the CDC.
In Three Rivers, we had 634 new cases last week. The timing of these cases is consistent with exposures over the holiday season. We are in the “pandemic surge-on-surge” that we discussed several weeks ago. 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. The viral load in wastewater in the HRSD is skyrocketing as well, commensurate with and confirming this surge.
THREE RIVERS VACCINATION UPDATE
For the last three weeks, area hospitals and the Three Rivers Health District have been vaccinating health care workers and first responders in vaccine phase 1a. Long-term health care and assisted living facility residents and staff are being vaccinated by Walgreen’s and CVS pharmacies through a federal partnership. As a reminder, the priority phases of the COVID 19 vaccination effort are:
- Phase 1a – Healthcare workers and long-term care facility residents.
- Phase 1b – Persons aged 75 years and older, and non–health care frontline essential workers such as law enforcement personnel, firefighters, educators, grocery store workers, transit and postal 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 have established a collaborative relationship with our local hospitals to engage our combined capabilities in the COVID 19 vaccination effort. We are in frequent communication with each other to coordinate our efforts to make sure we are as comprehensive and efficient as possible as we move through all phases. In the health district, we are coordinating our vaccination efforts from the Middlesex Health Department. The EMS staff are helping us with vaccine administration, logistics, and facility support in coordination with our vaccine team. 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 1/13/2021, please call the Three Rivers Health District at 804-815-4191.
There are a number of pharmacies and health care providers in our area that have indicated interest in participating in the COVID 19 vaccination effort. We are working with the VDH Central Office to identify these health care businesses and to help them meet all requirements to enter the vaccination effort with us as soon as possible.
We will be transitioning to begin phase 1b in the very near future in Three Rivers. We will begin with individuals 75 years of age and older, in collaboration with our hospital systems. We will also reach out to the K-12 school systems and offer vaccinations to their staff, and move on through other eligible groups as we are able to do so.
Last week I tried to provide an idea of what is involved in administering this vaccine. The COVID 19 vaccine involves a much higher level of administrative complexity than flu vaccine. 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 for reporting and tracking side effects. After receiving their vaccine, recipients must remain on site for 15 minutes to monitor for immediate side effects or complications.
The requirements of managing and tracking a scarce resource, adhering to eligibility criteria, administering a vaccine under FDA Emergency Use Authorization, assuring on site patient safety and health monitoring, and making sure we capture records of each recipient and assure follow up dosage availability all add to complexity. Contacting eligible individuals in each group for an appointment is challenging, and will require a combination of direct, targeted outreach to employers and individuals, and establishing/maintaining appointment capability by virtual means and telephone. Hospital systems are challenged by the high pandemic surge, and so are we at the health department. None of us have the staff for an effort of this magnitude, intensity and duration. We ask for your patience as we work through the priority groups and get to each person who desires vaccination as soon as possible; we are devoting every available resource to this effort.
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
Last Friday, the VDH announced that 11 health districts were ready to proceed to phase 1b on 1/11/2021. We are almost ready to proceed to phase 1b in the Three Rivers Health District. We are establishing and will maintain a COVID 19 vaccination status banner on our website and on social media platforms that we will constantly update. This banner will identify our current phase, and provide information for eligible individuals to understand how they will receive an appointment, either by contact through their place of employment or through individually contacting a vaccinating entity.
The new, more contagious strain of COVID 19 recently detected in the United Kingdom has been detected in several states. Evidence is increasing that the Pfizer vaccine is effective against both the UK strain and the South African strain. In addition, the Moderna vaccine should be effective against these strains. The virus will genetically drift over time. This is expected.
IMPORTANT: Even with the deployment of the vaccine and after receiving the vaccine, 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, are critical to our efforts at all times; we cannot operate during this pandemic without them. 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: Community testing remains available at request
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, please call 804-758-2381 ext. 19.
Pandemic mitigation: Containment efforts compromised by high pandemic surge
I will repeat the important message about case investigation and contact tracing this week: Our containment team is 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) 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 could 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 intact.
K-12 School Status: Most school system are set to reopen
Schools across all our jurisdictions are resuming operations, either virtually or in person under hybrid conditions. 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 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 we deploy the vaccine
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 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.