Pandemic status: New case numbers are dropping
The rolling 7-day average new case count in the United States is down to about 180,000. There have been over 25 million documented cases of COVID 19 in the United States, and we have had over 419,000 deaths. The trend is improving in many states.
In Virginia, the 7-day moving average of cases by date reported has decreased to 4735; the 7-day average percent test positivity has improved to 12.7%. 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 3022. We still have adequate hospital and ICU capability across the state at this time; ICU occupancy is 83% and 35% of ventilators are in use.
In Three Rivers, we improved from about 90-100 cases/day to about 65-70 cases/day. 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.
Three Rivers Vaccine Update
The Three Rivers Health District transitioned into phase 1b last weekend. Long-term health care and assisted living facility residents and staff are being vaccinated by Walgreens and CVS pharmacies through a federal partnership. A map of COVID 19 Vaccine Phase by Health District can be viewed here: https://www.vdh.virginia.gov/covid-19-vaccine/phase-by-health-district/
The new priority phases of the COVID 19 vaccination effort are:
Phase 1a – Healthcare workers and long-term care facility residents.
Phase 1b – Persons aged 65 years and older, persons aged 16–64 years with underlying medical conditions, and non–health care frontline essential workers such as law enforcement personnel, firefighters, educators, grocery store workers, transit and postal workers.
Phase 1c – 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 for coordination. The EMS staff of several jurisdictions and our Medical Reserve Corps volunteers are helping us with vaccine administration, logistics, and facility support. 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 to help them meet all requirements to enter the vaccination effort with us as soon as possible. In the near future, we expect larger chain stores and pharmacies such as Kroger, Wal-Mart, CVS, and Walgreens to come on line and begin offering vaccinations to the community. Plans are also being developed at the state level to open large scale vaccination centers at the regional level.
There is currently a national vaccine shortage. This is a federal issue. Virginia is getting only 100,000 -110,000 doses per week, and all health districts are getting only a fraction of what they can administer. In the Three Rivers Health District, we are getting about 25% of the vaccine we are able to administer through the combined effort of our partnerships. We have received guidance to balance the vaccination effort between individuals who qualify in phase 1b based on age and underlying health conditions and critical infrastructure workers such as school teachers, law enforcement personnel, and correctional facility workers. The health district, hospital systems, pharmacies, and clinical practices will continue to collaborate in this effort. VDH sent the following language to partners in an update yesterday:
- Starting tomorrow, all Local Health Districts in Virginia will have moved into Phase 1b of vaccine eligibility. This means that approximately 50% of Virginia’s population is now eligible, including frontline essential workers, people aged 65 years and older, people with high-risk medical conditions identified by the CDC, and people living in correctional facilities, homeless shelters, and migrant labor camps. Other than the healthcare workers and residents of long-term care facilities in Phase 1a, the Virginians in Phase 1b are at the highest risk of exposure to COVID-19 or serious illness if infected.
- There are simply not enough doses available yet for everyone who is eligible to receive them. Virginia is not likely to meet the demand for Phase 1b until March or April.
- Anyone eligible for Phase 1a or 1b based on occupation should check with their employer to see if arrangements have already been made, and should otherwise register with the local health department in the locality where they work. Anyone eligible based on age or medical condition should register with the local health department in the locality where they live. Virginia is reaching out to neighboring states and the District of Columbia to ensure consistency in this approach. Assistance in English, Spanish, and other languages is also available through the VDH Call Center at 877-ASK-VDH3 (877-275-8343).
- Unfortunately, it may be weeks or longer before vaccination appointments become available for those who have registered.
In Three Rivers, the hospital systems will continue to contact phase 1b eligible patients enrolled in their outpatient health care practices to offer opportunities to receive a vaccine. They will also work with local medical practices to help vaccinate their patients. The Three Rivers Health District will continue to hold drive through vaccination events for patients eligible to receive vaccine in phase 1b. These events are by appointment only. We are also deploying teams of our public health nurses to administer vaccine to employees in critical infrastructure facilities. Our Public Health nurses are starting with the K-12 school systems. We are also conducting smaller, focused outreach efforts to begin to vaccinate vulnerable populations in our communities; the hospital systems will partner with us in these efforts. We will reach out to critical infrastructure workers by place of employment as we are able to do so.
People eligible for COVID 19 vaccination in phase 1b seeking a vaccination appointment can contact their health care providers for initial consultation. Any eligible people who cannot receive vaccination through their health care system, or anyone with a COVID 19 related question, should call our COVID 19 resource center at 804-824-2733 Monday through Friday 8:30 – 4:30. Eligible individuals can also visit our Three Rivers Health District website to access an online survey to give us contact information and request an appointment at: https://www.vdh.virginia.gov/three-rivers/
We ask for your patience as we work to enhance our vaccination capability and wait for more vaccine supply. This is a massive and complex vaccination campaign, with vaccines that are fragile and challenging to handle. Everyone who wants a COVID 19 vaccine will receive one, it will just take time to get to everybody.
IMPORTANT: The vaccines we are using are highly effective against the COVID 19 pathogen, but for the time being public health authorities are recommending we all continue masking, maintaining social distancing and avoiding crowded areas after being vaccinated. Immunity from vaccination takes time to build up, and we need to see evidence of case counts dropping at the population level. Public health authorities will let us know when it is safe to relax protective measures.
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
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/.
The Johnson and Johnson vaccine might be only several weeks away from consideration for FDA Emergency Use Authorization. This vaccine, made from an attenuated virus, has several advantages over the Pfizer and Modern vaccines currently in use. The Johnson and Johnson product has less stringent cold chain storage requirements, and is administered in a single dose. This vaccine would save significant time in the overall vaccination campaign.
The CDC amended recommendations for vaccination after having COVID 19 disease and for the second dose interval. Persons who have had COVID 19 disease can seek vaccination after their isolation period ends, and after their symptoms including fever, have resolved. Anyone receiving monoclonal antibody therapy for COVID 19 disease should wait three months before seeking vaccination. Second dosages of the Pfizer and Moderna vaccines can be delayed up to six weeks from the initial dose if necessary, although it is best to follow the prescribed dosage intervals in the Emergency Use Authorization for both products.
The new, more contagious strain of COVID 19 recently detected in the United Kingdom has been detected now in 23 states in the US. Other strains have emerged simultaneously, notably in Brazil and South Africa. The CDC is carefully evaluating evidence concerning all these new strains. This virus will genetically drift over time, this is expected. The best thing we can do is to continue with our vaccination campaign and continue protective measures while new case numbers continue to decrease nationwide.
The Medical Reserve Corps (MRC), our volunteers, are absolutely 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 now faced with 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) 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 period; 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. Our executive order compliance capability remains completely intact.
K-12 School Status: Three Rivers Health District is vaccinating teachers and staff
Schools across all our jurisdictions have resumed 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 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 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.
Our Three Rivers Nursing staff and our community partners are actively engaged in offering vaccinations to school faculty and staff. The vaccine shortage has forced us to prioritize our efforts to faculty and staff who are exposed to students and others in the line of duty. When we get more vaccine, we will return and vaccinate all school faculty and staff.
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 been shown to work well.
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.