What will convince people to wear masks, keep distance from each other, and stay out of crowds?
Week after week as I write this pandemic update the situation across the country grows worse. People who are in close contact with each other, with no respiratory source control or protection, are spreading the virus. The immediate and long-term consequences to many people who contract this virus are severe. The consequences to our economy from higher case numbers are also severe. The greatest direct threat to life from this disease is this: higher viral caseloads place severe stress on our health care system, and place health care providers at risk from the disease itself, as well as from fatigue and stress. This is happening in several areas of our country already. We do not have great depth and bench strength in our hospitals. When ER and ICU beds are full, and when ER and ICU staff are sick, fatigued, and unable to work, there is no place for people with heart attacks, trauma, strokes, and other medical emergencies to go and receive help. This is the worst-case scenario that we are trying to prevent – a scenario when bad outcomes from disease, including deaths, increase beyond those ill with COVID itself.
We are all hearing stories from people who have been severely affected by COVID 19 and people who have lost loved ones in this pandemic. Personal accounts of long-term health effects such as shortness of breath, fatigue, and cognitive troubles are becoming more and more frequent. And no one can ease the pain or fill the vacuum left by the loss of a loved one to this disease. Many of us will be prevented from being with our loved ones this holiday season due to COVID 19 precautions. For those of us who have lost loved ones to this disease, that loss will last as long as we live.
So what does it take to convince people to protect themselves, their families, and each other by preventing the spread of this virus? We all know how to do this, we just need to do it.
National, state and local pandemic status
The United States is in pandemic surge; there are no ICU beds available in Utah, the situation in the highly rural Dakotas is serious, and health care systems are in danger of being overwhelmed in other areas of our country. In Europe, cases continue to rise sharply, resulting in restaurant and bar restrictions and causing concern about potential health care system stress and compromise.
In Virginia, the pandemic has also accelerated. The 7-day moving average of cases by date reported is up to 1594 today. The 7-day average percent positivity of tests is currently 7.3%. Community transmission extent in the Central, Far and Near Southwest regions are substantial (high). Community transmission extent is moderate in the Eastern, Northwest, and Northern regions. The moving 7-day average of people hospitalized for COVID 19 is up to 1283. We still have good hospital and ICU capability across the state at this time.
In Three Rivers, we had an uptake in new cases last week, from 62 to 98. The UVA Biocomplexity Institute model depicts us in plateau. According to the CDC K-12 School Metrics, King William is the only county currently at highest risk levels from a case incidence perspective. Middlesex is at lower risk, and all other counties are at higher risk. Our 14 day percent PCR positivity rates remain low; King William is highest at 6.72%.
Virus update: Moderna’s vaccine is effective, Monoclonal antibody therapy shows promise
Moderna announced today that its vaccine is 94% effective. Their phase three clinical trial consists of 30,000 volunteers, 15,000 receiving placebo and 15,000 receiving the vaccine. 90 of the placebo volunteers developed COVID 19, with 11 cases of severe disease. 5 volunteers in the vaccine group developed COVID 19, and none of them developed severe disease. This is very promising news.
Messenger RNA is inherently unstable, and must be stored at very cold temperatures. The Pfizer vaccine, which appears to be about 90% effective as well, must be stored and distributed at minus 94 degrees, then thawed, refrigerated and used within 24 hours. The Moderna vaccine can be stored and transported at minus 4 degrees, thawed and used within 7 days, which will make distribution easier. Both vaccines require 2 doses. The Pfizer vaccine will be very valuable for institutional use, and the Moderna vaccine will be more useful in smaller settings like pharmacies and doctors offices.
Eli Lilly and Company received an FDA Emergency Use Authorization this week for its neutralizing antibody Bamlanivimab. This antibody drug is designed to be infused as an outpatient for mild to moderate disease in adults with high risk for severe disease. This product, and Regeneron’s REGN-COV2 antibody cocktail, are capable of reducing viral load and shortening recovery time if used prior to the onset of severe COVID 19 disease.
Executive Orders: Executive Orders 63 and 67 modified
Executive Orders 63 and 67 were modified on 13 November due to rising viral cases nationally and across the Commonwealth. The changes took effect at midnight on Sunday, November 15. The key changes are summarized below:
- Public and private gatherings are limited to 25 people
- All Virginians age 5 and over are required to wear face coverings in indoor public spaces
- Violations of statewide guidelines for physical distancing, wearing face coverings, and enhanced cleaning within essential retail businesses will be enforceable as a Class One Misdemeanor
- The on-site sale, consumption, and possession of alcohol is 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.
We continue to investigate concerns and complaints and enforce executive order compliance to the best of our ability across the district, in collaboration with the Department of Agriculture and Consumer Services, the Virginia Alcoholic Beverage Control Authority, and the Department of Labor and Industry. We have had outbreaks in many business settings, and in other congregate settings. We had a brief period of relief from new outbreaks, but this week we have had several, including a childcare center and a private school, and we have had worrisome increases in cases in staff members working in schools and other vulnerable facilities.
Testing: Three Rivers Health District COVID 19 testing is available to everyone
Our COVID 19 testing team remains very active across our jurisdictions. We specifically invite all poll workers to attend one of our testing events, especially if they are concerned that they might have been exposed to someone with COVID 19 disease. Upcoming testing events include:
- Monday, 11/16: Gloucester Library, 10am-2pm, (APPOINTMENT ONLY), 6920 Main St. Gloucester, VA 23061
- Tuesday, 11/17: Colonial Beach High School, 1pm-3pm, (APPOINTMENT ONLY), 100 1st. St. Colonial Beach, VA 22443
- Monday, 11/30: Middlesex Health Department, 2pm-6pm (APPOINTMENT ONLY), 2780 General Puller Highway, Saluda, VA 23149
- Wednesday, 12/2: Richmond County Health Department, 10am-2pm (APPOINTMENT ONLY), 5591 Richmond Rd, Warsaw, VA 22572
- 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
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, there is no charge for the testing, and all events are open to the public. Our overall test positivity rate for these community events remains about 1.8%.
Flu Season is coming: Please get your flu vaccine
It is more important than ever to get our 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. We are starting to receive reports of flu in our communities.
In Three Rivers Health District, we used our community flu vaccination events to exercise our community vaccine distribution capability. We are now preparing to acquire very cold storage capability and hiring extra staff to create a vaccination team for the COVID 19 effort. We should be ready to support vaccine distribution when it becomes available to us.
Pandemic Containment: Case investigation and contact tracing are important
Our Three Rivers case investigation and contact-tracing capability remains excellent. If you become infected with COVID 19, or if you become a close contact of someone with COVID 19 disease, please cooperate fully with our case investigators and contact tracers fully. This system is designed to isolate the disease where it happens, and to limit the spread of disease to others. It is a critical defense measure against community transmission, and will be more important as new case numbers rise.
K-12 School Status: Our schools are being challenged by community spread
Most school systems are proceeding to bring students back into the schools and conduct in-person operations, guided by current community transmission extent. We continue to experience COVID 19 cases among school faculty, staff and students in multiple Three Rivers Health District jurisdictions. We have recommended isolation and quarantine for many individuals working in our schools and for some classes experiencing extensive exposures. We are currently evaluating an outbreak at a private school that may prove to be a significant event. Our schools for the most part have been able to maintain social distancing, masking, and hygiene. This, in combination with early detection, case investigation and contact tracing appear to be working together to protect our educators and students within the schools themselves. Exposures outside the schools, mostly in private settings and events, appear to be the major problem. The VDH K-12 COVID 19 outbreak dashboard can be viewed at the following link: https://www.vdh.virginia.gov/coronavirus/outbreaks-in-school-settings/.
Holiday guidance
Most of the COVID 19 transmission we see is due to individual exposures in smaller, non-regulated venues like family gatherings and dinners between friends. The upcoming holiday season obviously provides abundant opportunities for family gatherings to occur, and is likely to make community spread much worse than it already is across our country and the Commonwealth. Anyone who is not living with you, including family members living elsewhere, should be considered members of another household. Precautions for exposure control should be taken when with people other than members of your household. It is best to hold virtual celebrations this year; by next year, we should be able to gather in person with far less risk. If there is no exposure, there will be no disease.
The following factors affect the risk of holiday gatherings:
- Levels of local community transmission
- Guests who have been exposed recently to travel in the public transportation system
- Location of the gathering (outdoors is safer, small indoor venues with poor ventilation are high risk)
- Duration of the gathering (longer exposures are higher risk)
- Number of people at the gathering (higher numbers are higher risk)
- Behavior of people before the gathering (have people been masking, keeping social distance, staying out of crowds, and practicing good hygiene?)
- Behavior during the gathering (are people practicing social distancing, wearing masks when in close contact with each other, washing hands frequently?)
I advise the following steps to celebrate the holidays with less risk this year:
- Ask any guests to strictly control their personal exposures for 2 weeks prior to the date of the event, avoiding crowds, maintaining social distance, wearing a mask in public, and avoiding travel
- Check local and regional community transmission rates, if they are high then the risk for the gathering is much higher
- Limit the number of attendees as much as possible
- Hold gatherings outside. If inside, keep windows open and the HVAC system on continuous circulation
- Require guests to maintain 6 feet of separation at all times. Wear masks, unless eating and drinking
- Avoid singing and loud talking
- Wash hands frequently
- Limit contact with shared utensils and commonly touched surfaces
- Use similar precautions for pets – the virus can move between animals and humans
More in-depth guidance regarding holiday safety is available from the CDC at the following website: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays.html
Our best defense remains prevention of disease by social distance, masking, staying out of crowds, hygiene and sanitation
Our most important message cannot be repeated enough: This virus repeatedly demonstrates its ability to transmit briskly if given the opportunity. 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. Recent studies clearly demonstrate that masking prevents spread from those infected, and protects those who wear them. The CDC has updated its guidance to reflect this “two way street”. 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. Three Rivers Health District employees will continue doing our best to protect our communities, and we encourage all of our constituents to take these simple measures to protect yourselves.
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 encounter 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. Again, difficulty breathing remains a sign of possible serious disease; if this develops, please seek help very quickly.