National, state and local pandemic status: Bad news first – COVID 19 cases skyrocket across the country
The United States continues in extremely brisk pandemic surge; health care systems are in danger of being overwhelmed in many areas of our country. The rolling 7-day average of new cases in the US is over 176,000. We now have had over 12 million cases and 256,000 deaths. In Europe, restaurant and bar restrictions and other measures seem to be having a positive effect with cases falling in the UK, France, Spain, Austria, and some eastern European countries.
In Virginia, the pandemic has also accelerated. The 7-day moving average of cases by date reported is up to 2243. For reference, it was 1594 a week ago. The 7-day average percent positivity of tests is currently 7.2%. Community transmission extent in the Central, Far and Near Southwest regions are substantial (high) and increasing. Community transmission extent is moderate in the Eastern, Northwest, and Northern regions and increasing, approaching substantial. The moving 7-day average of people hospitalized for COVID 19 is up to 1489. We still have good hospital and ICU capability across the state at this time. From a community transmission perspective, all counties across the state are at highest or higher risk as defined by the CDC except one: Highland County.
In Three Rivers, we had a brisk rise in new cases last week, from 98 to 171, our highest week yet. According to the CDC K-12 School Metrics, King William, Essex, Richmond, Westmoreland and Northumberland counties currently are highest risk levels from a case incidence perspective. All other counties are at higher risk. Our 14-day percent PCR positivity rates remain at lower levels, with all counties below 6%.
Virus update: Great news – three effective vaccines are on the way!
Moderna and Pfizer have both announced high effectiveness, in the 95% range, for their vaccines. Pfizer applied for a U.S. Food and Drug Administration Emergency Use Authorization (EUA) over the weekend, and Moderna is expected to follow suit soon. The FDA has scheduled a meeting of its Vaccines and Related Biological Products Advisory Committee (VRBPAC) for 10 December to review the EUA requests. The FDA’s Center for Biologics Evaluation and Research (CBER) will be responsible for providing disposition of requests, based on VRBPAC recommendations. The CDC’s Advisory Committee on Immunizations Practices (ACIP), in collaboration with the National Academies of Science, Engineering and Medicine, is expected to develop guidelines for Covid-19 vaccine prioritization and deployment. Vaccine distribution and usage could begin as early as mid to late December.
AstraZeneca last week released phase 2 data for its vaccine, which showed production of high levels of neutralizing antibody in all age ranges, including older volunteers, with fewer side effects in the older age group. Early this morning, AstraZeneca announced that interim data from its clinical trial involving 20,000 volunteers in the UK and Brazil provided 70% protection from COVID 19 infection. Nobody who received the vaccine developed severe disease. This exceeds seasonal flu vaccine effectiveness. A smaller group of 3000 volunteers who received a half sized first dose and full sized second dose were protected at the 90% level. The Oxford/AstraZeneca vaccine is cheaper to make and distribute than the Moderna and Pfizer products, making it more suitable for world-wide use. Achieving herd immunity across the world is critical to allow a return to normal travel patterns, international trade, and economic health.
On 21 November, the FDA issued an EUA for Regeneron’s monoclonal antibody product REGEN-COV2, containing casirivimab and imdevimab, for the treatment of mild to moderate COVID 19 disease in adults and children who are at high risk for progression to severe disease. The Regeneron product joins the Eli Lilly product bamlanivimab as a therapeutic option, used in the outpatient setting, to reduce viral load and enhance recovery.
The FDA also issued an EUA for the Lucira COVID-19 All-In-One Test Kit, the first test consumers can administer completely at home. This test detects viral RNA, and is an important step forward in ramping up testing availability and frequency as we fight to bring this pandemic under control.
Lastly, a UK study of healthcare workers shows that people who have had COVID 19 infection are unlikely to become reinfected for at least 6 months. Reinfection has occurred in a few cases across the world but remains an extremely rare event.
Executive Order Compliance: Private events remain the major problem
Modification of Executive Orders 63 and 67 have not required enhanced enforcement activity on our part at this time. We are, however, experiencing increasing numbers of outbreaks, especially in vulnerable facilities such as nursing homes, assisted living facilities, and now our schools. This directly reflects enhanced community transmission, which continues to be due mainly to high-risk exposures in private, unregulated settings and then imported to the facilities.
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, 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
- Monday, 12/14: Colonial Beach High School, 10am-2pm (APPOINTMENT ONLY), 100 1st St, Colonial Beach, VA 22443
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 has been about 1.9%.
Reminder: 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.
Pandemic Containment: Case investigation and contact tracing continue
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. 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: We are starting to see outbreaks in our schools
We continue to experience COVID 19 cases among school faculty, staff and students in multiple Three Rivers Health District jurisdictions. We have an outbreak in the Northumberland School System (investigation is ongoing) and we are evaluating another transmission event in Richmond County. As community spread increases, our schools will be increasingly challenged to avoid in school transmission and outbreaks. This makes maintain social distancing, masking, and hygiene in our schools imperative if we are to keep them open. We must also maintain early detection, case investigation and contact tracing in our schools. The schools themselves are not serving as major sources of disease spread; exposures outside the schools, mostly in private settings and events, appear to be the major problem. We will continue paying very close attention to this going forward. Our goal is to keep our schools open. 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/.
Holiday guidance repeated
I am repeating the holiday guidance published in last week’s update. All the recommendations below remain valid. With the intense viral surge (over 1 million new cases in the past 7 days), the CDC has recommended the safest way to celebrate Thanksgiving is to “celebrate at home with the people you live with”. Travel is not advisable at this time.
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. We should consider anyone who is not living with us, including family members living elsewhere, as members of a different household. We should take precautions for exposure control with people other than members of our 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
We must not let down our guard; we must continue to prevent viral spread while we wait for a vaccine
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. 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. We are on the verge of access to effective vaccines – taking high risks with exposure to this virus now
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.