Health Director's Weekly COVID Briefing for March 1-7, 2021

Three Rivers Health District COVID 19 Briefing                   03/01/2021

The only changes to this weekly report will reflect new information.  Most of the information (especially concerning the vaccination effort) remains the same, and will remain in the report.

 Pandemic status:  New case numbers continue to drop

1. 1. • Case numbers across the states have dropped dramatically, the new case count in the US is about 68,000/day 7 day rolling average. Almost all states report stable trends.  Hospitalization and death rates have fallen.
      • Virginia has improved, our new case rate is about 1700/day 7 day average. Hospitalization rates have dropped to 50% of levels in mid-January, less than 1500/day.
      • Three Rivers has dropped to 30 new cases/day, 7 day average.
      • This drop in cases may be due to better adherence to protective measures and some population immunity effect. Over 100,000,000 have had the disease, counting asymptomatic cases, and the percentage of people who have been vaccinated is steadily rising.  In Virginia, about 15% of us have received at least one dose.
      • We will watch closely for the effects of the new, more contagious variants, there is a possibility these may pose a problem on several fronts.Vaccination Program Update:  Supply is increasing
      • All health districts are in phase 1b. Our policy is to divide available doses approximately equally between age qualified individuals and essential frontline workers (this group includes people age 16-64 qualified by underlying health conditions).  There are a lot of ethical considerations attending prioritization of vaccine allocations; discussions are happening on revised allocation strategies, we may hear more about that in the coming weeks.  When the DHHS expanded phase 1b to include people aged 65 and older, and people aged 16-64 with underlying medical conditions, it greatly expanded the pool of eligible individuals and created expectations that could not be met quickly with the vaccine supplies and infrastructure we had at the time.  This has been disappointing on almost every front but we will pick up speed going forward into the spring and summer months.   For details of vaccination phases, please visit this website:  https://www.vdh.virginia.gov/covid-19-vaccine/#phase1b
      • This vaccine is much more complex than any vaccine we have ever administered. It is fragile, there are CDC requirements that must be met, such as approval to distribute the vaccine, usage under FDA authorization instead of approval; informed consent is required to administer the vaccine. The vaccine is fragile, temperature dependent, and there is a mandatory observation period after administration of at least 15 minutes to watch for severe allergic reactions.  The messenger RNA vaccines require 2 doses several weeks apart.  This slows everything down, it cuts forward progress in half.  Every 21 or 28 days you have to start over and vaccinate everyone you just vaccinated again.  There are only a couple of ways to do this;  keep half of your vaccinating capability moving forward while the other half follows up with second doses, or start over again when the second doses come through.  We all trained and planned for a flu like pathogen, with a single dose, durable vaccine.  Nobody has ever undertaken a vaccination program against a novel pathogen like this with a 2 shot campaign aimed at the entire population.  We are learning as we go along.
      • There is still a severe national vaccine shortage, but this is slowly improving. This is expected to continue to improve over the next several weeks and months, as Pfizer and Moderna enhance their manufacturing throughput and the Johnson & Johnson and AstraZeneca vaccines come on line.  Several months from now we will have an abundance of vaccine, but at present it is our main limiting factor.
      • The vaccine program varies from district to district but there are common challenges and methodologies we are employing to maximize efforts. Collaboration between hospital systems, physician practices, pharmacies, and free clinics and the health districts an imperative to get through this.  Local EMS personnel are also commonly engaged.
      • Only about 15% of the vaccinating capability of the health district is within the Three Rivers Health District organization; the remaining capability rests with our clinical partners, which include health care systems, pharmacies, free clinics, federally qualified health centers, and private practices. We are working with our partners to establish larger scale vaccination centers which will be ready when vaccine supplies increase.  This sort of activity is happening all over the state.  It is imperative we engage the full capability of the district for the people on our waiting list and essential frontline workers going forward.  We continue to work on plans to leverage all our vaccinating power to work through the existing list and move forward as eligibility expands beyond phase 1b.
      • Large, regional state run vaccination events are planned when more vaccine becomes available. We have suggested providing mobile vaccination units to visit rural health districts in a circuit fashion as well.
      • We also heard last week that plans are underway to engage commercial vaccination providers to hold events as well; the Virginia Department of Emergency Management is looking for venues to support those activities.
      • It still may be weeks or longer before vaccination appointments become available for all those who have registered for a vaccination.
      • With the limited doses, our nursing staff is visiting local government and court systems, and will vaccinate remaining school employees as they are able to do so. They are coordinating this with Emergency Planning staff in each jurisdiction with regard to location and timing; this will vary between jurisdictions.  While our nursing staff is forging ahead with first doses, our Point of Dispensing teams (PODs) are following up with second doses.  There have been vaccine shipping delays as well as POD delays due to weather.  This has placed us behind in second dose clinics.  Administering the second dose too soon is not advisable, but administering the second dose up to 6 weeks after the first dose is permissible under CDC guidelines.  We are confident we can offer second doses within the approved time frame, but there may be delays beyond the 28 day period.  Please be patient if you are waiting for your second dose, we will contact you to schedule an appointment.
      • Second doses are allocated based on the first dose; if you get your first dose of vaccine, we will call you when it is time for your second dose.
      • Despite these limitations, Three Rivers Health District jurisdictions compare very favorably with surrounding counties in vaccine doses delivered per 100,000 population. These data can be reviewed here: https://www.vdh.virginia.gov/coronavirus/covid-19-vaccine-summary/  
      • The Federal Retail Pharmacy Partnership phase 2 has started in Virginia. CVS is the retail pharmacy offering vaccinations in Virginia.  Other pharmacies have been added in the last several days:  CVS, Albertsons (Safeway), Food City Giant Corporation, Kroger Corporation, Walmart, Walgreens and a Network of multiple independent community pharmacies are receiving vaccine this week and starting vaccination operations.  The VDH continues to try and find ways for our pharmacy partners to accept patients from our waiting list.
      • CVS is initially offering vaccinations at 36 locations in the following localities: Abingdon, Alexandria, Arlington, Bedford, Blacksburg, Charlottesville, Chatham, Chesapeake, Danville, Dublin, Fairfax, Fredericksburg, Gainesville, Hampton, Harrisonburg, Leesburg, Lynchburg, Martinsville, Mechanicsville, Midlothian, Newport News, Norfolk, Portsmouth, Richmond, Roanoke, Rocky Mount, Stafford, Suffolk, Virginia Beach, Warrenton, Williamsburg, Winchester, and Woodstock.  The Virginia Department of Health will provide input and recommendations to CVS for future locations as they continue to expand beyond the initial 36 locations that are currently offering vaccine.  The number of doses allocated to pharmacies in Virginia will increase to over 52,000 per week, and will be expanded to new partners such as Kroger, Walmart, Walgreens and independent pharmacies.  The VDH continues to try and find ways for our pharmacy partners to accept patients from our waiting list.  The CVS location in Three Rivers has been added to the list of CVS stores to be considered in the future, and two independent pharmacies in Three Rivers will began receiving doses under the federal program next week.  Those pharmacies will be contacting people on our waiting list to offer vaccination appointments. We will follow this closely, and hope to obtain more retail pharmacy vaccination support in Three Rivers as more vaccine becomes available.

       How to sign up for a vaccination appointment

      • People eligible for COVID 19 vaccination in phase 1b seeking a vaccination appointment can contact their health care providers for initial consultation.
      • The VDH has opened a central call center to address all COVID 19 related questions and to preregister for a COVID 19 vaccination opportunity. This is a work in progress, but preregistration for a vaccination appointment and maintenance of our waiting lists are now maintained centrally.  As of last night there were 2.6 million individuals preregistered with the call center statewide.  The following information was distributed to health districts:  Virginia Residents and workers can now sign up (pre-register) to get a COVID-19 vaccine through our new Statewide Vaccine Pre-registration System. They can sign up online 24/7 through the new website at vaccinate.virginia.gov; or by phone 8am-8pm 7 days a week by calling the 1-877-VAX-IN-VA.  TTY service is available to assist people who are deaf, hard of hearing, or speech impaired by calling Virginia Relay at 7-1-1.  People age 75 & older will be placed in an express lane to speak to a live agent when calling 1-877-VAX-IN-VA.  Our new centralized COVID Information Center will not be perfect overnight. Based on observations of other state roll-outs, we anticipate wait times will be higher initially, but will begin to stabilize within 1-2 weeks as we continue analyzing Information Center data to drive operational improvements.  If your residents / workers pre-registered with their local health department previously, or were registered by their employer previously, there is no need for them to pre-register again, as they have been automatically moved over to the new centralized list.  Residents can confirm they’re still pre-registered anytime by “Checking the List” at vaccinate.virginia.gov.  After residents pre-register they will be given a reference code and contacted when it’s their turn to schedule vaccination. Regular confirmation updates via email or text will also be sent to assure residents they are still on this list and will be contacted when it’s their turn.  In the new Statewide Pre-Registration System, employers will no longer submit lists of their employees to the Health Department (or “VAMS”). Instead, employees will fill out their own Pre-Registration Form independently. In the form, employees will provide their job type so that correct eligibility can be determined on an individual basis.  Please remember, vaccine supply is limited and each individual’s turn for vaccination will be based on individual eligibility and prioritization category, per CDC guidelines.
      • Again, we are sharing names on our waiting list with our community vaccination partners as they have availability in their systems to offer appointments.
      • There are many thousands who have registered with Three Rivers Health District for a COVID 19 vaccine and we will work through the list as fast as we can.

      Vaccine development and virus update

      • Janssen Biotech (Johnson and Johnson) applied for and received FDA Emergency Use Authorization for its single dose COVID 19 vaccine. We have been informed we will receive 69,000 doses of Johnson and Johnson vaccine distributed in Virginia this week. The J&J vaccine lends itself well to mass vaccination venues, and planning is underway across the state for such events.  The J&J vaccine presented data to the FDA that indicates effectiveness in preventing serious COVID 19 disease, and high effectiveness in preventing critical, life threatening COVID 19 disease.  Public health authorities recommend taking the first vaccination opportunity afforded to us regardless of manufacturer; there is no guarantee any of the available vaccines will prevent infection.  They are all very effective in preventing serious and critical COVID 19 disease, and can turn a life threatening infection into a much less serious health threat.
      • Pfizer has submitted an application to the FDA to change the cold storage requirements for its vaccine, based on emerging data that supports this.
      • The COVID 19 virus continues to genetically drift.
        • The United Kingdom, South African, and Brazilian variants are all in the United States now.
        • A comparable variant with similar mutations has also emerged in California and has become the dominant strain there.
        • Another similar strain has emerged and is becoming prevalent in New York.
        • These strains are more contagious than the UK strain and is expected to become dominant across the United States in the relatively near future.
        • Vaccine effectiveness against these new strains is being evaluated; it appears our existing vaccine is very effective against the UK strain. Proceeding with vaccination is recommended for all of us.
        • Wearing more efficient masks, or double masking, has emerged as a recommendation to protect against these more contagious strains.
        • A study entitled Emergence in late 2020 of multiple lineages of SARS-CoV-2 Spike protein variants affecting amino acid position 677 appeared in pre-publication and pre-peer reviewed form on 2/14/2021. This study identified 7 more variants of the COVID 19 virus with mutations of the spike protein that have emerged across the United States.  The implications of this are currently not known, but these findings are consistent with expectations concerning this SARS coronavirus.
        • We are in a race to vaccinate people as fast as we can to drive case levels down if possible. The higher the case levels in the population, the more opportunity for the virus to continue to drift. Protective measures such as masking and social distancing remain very important.
        • Persons who have had COVID 19 disease can seek vaccination after their isolation period ends, and after their symptoms, including fever, have resolved. While the vaccine remains in short supply, people recovered from recent COVID 19 infections may elect to temporarily postpone vaccination with the understanding that immunity from natural infection may decrease over time.
        • After receiving COVID 19 vaccination, public health authorities are recommending we all continue masking, maintaining social distancing and avoiding crowded areas.
        • The vaccine may not prevent all COVID 19 infections
        • Public health authorities will let us know when it is safe to relax protective measures. This will occur when case numbers in the population fall to very low levels.           

      How to volunteer with the Three Rivers Health District

      • The Medical Reserve Corps (MRC), our volunteers, are absolutely critical to our efforts at all times
      • 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 vamrc.org to learn more.
      • 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, pandemic containment efforts

      • Community testing and testing in response to vulnerable facility outbreaks can be requested by facilities and jurisdictions by using commercial firms on contract with the Commonwealth of Virginia or the Virginia National Guard.
      • Our containment team has resumed investigation of all new cases with contact tracing of all high risk exposures.
      • Our Executive Order Compliance team continues with full capability and activity.

      K-12 School Status:  The CDC published new school guidance

      • The CDC published comprehensive K-12 school guidance based on latest evidence concerning viral transmission in children and adolescents and on the experience base gained during school operations over the past year. The guidance, which facilitates return to in-person learning, leverages the protective measures we have had in place all year and is tied to levels of community transmission.  The guidance stipulates universal and correct use of masks, maintaining at least 6 feet of physical distancing, handwashing and respiratory etiquette, cleaning and maintaining health facilities, and maintaining effective contact tracing in cooperation with local health departments.  The detailed CDC school guidance can be found here:  https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/index.html
      • Our Three Rivers Nursing staff and our community partners have finished first dose vaccinations to most school faculty and staff, and will make every effort to complete the school first doses in the coming weeks. The vaccine shortage forced us to prioritize our first efforts to faculty and staff who are exposed to students and others in the line of duty.  We will vaccinate all school faculty and staff as we receive more vaccine.
      • Schools have been able to continue offering in-person education under a hybrid model, with mitigations in place.
        • Three Rivers staff will continue to work closely with schools and school boards to help make the best decisions going forward.
        • Three Rivers staff will continue to help with all school based COVID 19 infections and outbreaks.

      Useful links

      • 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 COVID-19 Vaccination Dashboards, which are available here: https://www.vdh.virginia.gov/coronavirus/covid-19-vaccines-received/ and here: https://www.vdh.virginia.gov/coronavirus/covid-19-vaccine-summary/
      • The VDH COVID 19 outbreak dashboard can be found here: https://www.vdh.virginia.gov/coronavirus/covid-19-data-insights/

       

   If you have an appointment in the Health Department:

2. Please return to your vehicle and call us at 804.758.2381

We will arrange to meet you via appointment or to provide service by telephone or email.

If you have a fever or cough, please return home and visit us when you are well.

♦♦♦♦♦

THREE RIVERS HEALTH DISTRICT is a 10 county Virginia Department of Health district for Virginia’s beautiful Northern Neck and Middle Peninsula regions. This 2,000 square mile area is located between the waters of the Potomac, Rappahannock, and York Rivers and borders the Chesapeake Bay on the east. Our public health professionals serve a population of approximately 140,000, including 2 Native American reservations, 9 incorporated towns, and a large number of visitors.

Whether you are a resident here, just visiting the area, or thinking of relocating your family or business, I hope that you will take time to explore our website and Annual Report to see the many ways our health professionals keep our communities and shorelines healthy and safe. Building healthy communities is our mission.