Health Director's Weekly COVID Briefing for the Week of November 29, 2021

Pandemic Status: Cases declined in the US last week

• The new case rate in the US has declined: it is currently about 63,000/day 7 day rolling average according to the Johns Hopkins Coronavirus Resource Center.
• Virginia cases have stabilized; currently we have about 1468/day 7 day average, new cases.
• Three Rivers case numbers remained stable; we had 179 cases across all jurisdictions last week.
• The current 7 day average number of people hospitalized in Virginia with COVID 19 has leveled off; it is currently 877.
• Vaccination rates continue to slowly climb. About 64.7% of the total population in Virginia is fully vaccinated.
• With all 3 vaccines authorized for booster administration, everyone over the age of 18 recommended for boosters, and vaccination authorized for 5-17 year olds, vaccine doses administered in the Commonwealth have climbed. Current VDH data show 43,500 average daily vaccine doses administered across Virginia.
• Levels of community transmission have slowly changed to reflect slightly increased rates of COVID 19 infection, with only a few jurisdictions at moderate transmission levels (one at low transmission) currently. A VDH map showing indicators of community transmission can be found here:  https://www.vdh.virginia.gov/coronavirus/covid-19-in-virginia/community-transmission/

Everyone age 5 and older is now eligible for vaccination in Virginia.  Please visit vaccinate.virginia.gov or call 1-877-VAX-IN-VA to find vaccination opportunities. 

780 children ages 5-11 have been vaccinated with at least one dose in Three Rivers thus far.  Our Public Health Nurse teams are offering vaccines in schools and our partners are continuing their vaccination efforts for this age group.  The schedule of vaccination events (with appointment opportunities) in Three Rivers can be viewed at the Three Rivers Health District Website, which can be viewed here:  https://www.vdh.virginia.gov/three-rivers/

Over the past several days, we learned of a new variant with many mutations at the spike protein (which the COVID-19 virus uses to attach to target cells) first detected and emerging in South Africa.  The World Health Organization moved quickly to name this variant Omicron and classify it as a “variant of concern”.  Omicron has been detected in Europe, the Middle East, Africa, Asia, and Australia thus far.

• It is important to realize that very little is known about how the Omicron variant will behave at this point. The mutation pattern is of concern to evolutionary biologists, but we need to wait for the evidence to emerge about how effectively this variant will be able to spread.
• It is not known whether or not the Omicron variant causes more serious COVID-19 disease; health authorities are watching hospitalization rates and disease severity carefully in South Africa.
• It is not known at this point whether our current vaccines and natural immunity from previous infection will be effective against Omicron infection; most public health authorities are optimistic that we will continue to be protected.
• We will watch the evolution of the Omicron variant carefully. We will know much more in ten days to two weeks.

Flu vaccine is now widely available.  This flu season is likely to be far more severe than we saw last year.  Please get your flu shot this fall.  There is no problem getting the flu vaccine and the COVID 19 vaccine at or near the same time.

Virus, Vaccine, and Viral Therapeutics Update

• On November 19, 2021 the FDA authorized all persons 18 years of age up who have completed a primary series of mRNA vaccination (Pfizer-BioNTech/Moderna) to receive a booster vaccine, and the CDC updated its recommendations to match. Adults 18 years of age and up who received a J&J vaccine are already recommended for a booster vaccine.  The ability to "mix and match" a booster vaccine after the primary series of vaccine remains.
• The CDC released current guidance for COVID-19 safety during the holidays. Vaccination and exposure prevention are critically important to protect ourselves against infection.  The CDC holiday guidance can be found here:  https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays/celebrations.html
• The COVID 19 virus continues to genetically drift, as noted above. The Delta variant remains responsible for the vast majority of COVID 19 disease in Virginia.
• The United Kingdom and Europe are currently experiencing a surge in COVID-19 cases, still attributable to the Delta variant, which still accounts for the vast majority of all cases there.
• The VDH has established a COVID 19 Variants of Concern Dashboard. The dashboard can be accessed here:  https://www.vdh.virginia.gov/coronavirus/covid-19-data-insights/variants-of-concern/
• The COVID 19 vaccines are among the best and safest vaccines ever developed. As with all vaccines and medications, there are potential adverse effects.  All the adverse events following vaccination are extremely rare, and the risk of COVID 19 disease far exceeds the risk of any of the adverse events that have been reported.
• COVID 19 vaccines have been highly effective in preventing infection, serious disease, hospitalization, and death from COVID 19 infection. VDH data show that unvaccinated people get infected with COVID 19 at many times the rate of fully vaccinated people. The VDH COVID 19 Cases by Vaccination Status dashboard can be found here:  https://www.vdh.virginia.gov/coronavirus/covid-19-data-insights/covid-19-cases-by-vaccination-status/
• A recent study from Israel, which looks very credible but has not yet been peer reviewed, indicates natural immunity from infection may provide longer lasting and stronger immunity to COVID 19 . This study is entitled Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections and can be viewed here:  https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1.full.pdf

A recent CDC publication in the Mortality and Morbidity Weekly review indicated vaccine induced immunity provides better protection than COVID-19 infection.  This study can be viewed here:  https://www.cdc.gov/mmwr/volumes/70/wr/mm7044e1.htm.   There is also evidence that antibody levels are inconsistent post infection and are dependent to some degree on the severity of the infection, as compared to antibody levels post vaccination.  More data needs to be gathered and analyzed at the population level to understand immunity from infection and vaccine induced immunity.  Evidence has emerged which indicates immunity wanes at about the 6 month mark from vaccine induced and probably from natural immunity as well.  The studies agree that vaccination following natural infection provides enhanced protection.  This is the principle underlying the current public health recommendation that everyone, including those who have been naturally infected, receive COVID 19 vaccination.  Israel has based the mainstay of its COVID 19 Delta surge response on this principle, offering boosters to those who have received the primary vaccine series (only Pfizer is available in Israel) and Pfizer vaccine to all who have been infected naturally, as well as masking and a proof of immunity passport policy.  For further information, a CDC document entitled Science Brief:  SARS-CoV-2 Infection-induced and Vaccine-induced Immunity, can be found here:

https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/vaccine-induced-immunity.html#anchor_1635539757101

• Virginia COVID vaccine providers are now delivering Pfizer, Moderna, and Johnson and Johnson booster vaccinations in accordance with CDC recommendations for everyone aged 18 and above. As previously mentioned, for people who received the Johnson and Johnson vaccine, booster shots are also recommended for all those who were vaccinated two or more months ago.  The CDC recommendations include the ability to "mix and match" with a booster vaccine that is different from the primary series received.
• The 5-11 year old vaccination program is progressing using the Pfizer-BioNTech COVID-19 vaccine. This vaccine is effective; immune responses of children 5 through 11 years of age were comparable to those of individuals 16 through 25 years of age. In the clinical trials study, the vaccine was 90.7% effective in preventing COVID-19 in children 5 through 11.  The vaccine is also safe;  the vaccine was studied in approximately 3,100 children age 5 through 11 who received it and no serious side effects have been detected in the ongoing study.
• Vaccines will remain readily available to all unvaccinated individuals as our highest priority. We recommend COVID 19 vaccination for everyone eligible in the strongest possible terms.
• Monoclonal antibody (MAB) therapy is readily available in Virginia. Monoclonal antibody therapy is administered in the outpatient setting to COVID 19 positive individuals who are at increased risk for developing serious disease requiring hospitalization.
• Merck and Ridgeback announced their oral antiviral drug Molnupiravir reduced the risk of hospitalization or death by approximately 50 percent for patients with mild or moderate COVID-19 disease. Molnupiravir has been authorized in the UK last.  Merck has applied for FDA Emergency Use Authorization in the US.
• Pfizer announced their new antiviral drug (Paxlovid) prevents severe COVID-19 disease at the 89% effectiveness level last Friday. These are the first examples of a new series of medications to further reduce the risk of COVID-19 illness.

 Testing, pandemic containment efforts

• We are conducting COVID 19 testing in our local health departments in conjunction with our continued vaccination outreach. COVID-19 Rapid Testing and PCR Testing are available through the Three Rivers Health District COVID-19 Testing Team by appointment.  Please call your local health department or call 804-815-4191 to schedule an appointment for testing.
• Our containment team has resumed full case investigation and contact tracing in accordance with established VDH recommendations.

K-12 Update             

• The Virginia Department of Health (VDH) and Virginia Department of Education (VDOE) have partnered to offer a vendor provided COVID-19 testing program for the 2021 - 2022 school year, Virginia School Screening Testing for Assurance (ViSSTA).  The ViSSTA program will be initiated in schools choosing to participate this month.  More details are available at the VDH K-12 testing website here:  https://www.vdh.virginia.gov/coronavirus/k-12-testing/
• We have seen COVID 19 transmission in-school and in athletic teams at higher rates with the Delta variant, but outbreaks are usually limited to several students. Exposure prevention and containment measures in the schools are limiting the extent of outbreaks and schools are able to remain open for in-person learning.
• We will follow each school system closely and be ready to support them in any way we can as we progress into the season of highest respiratory disease transmission risk.

Additional 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 FDA fact sheet for recipients and caregivers for the Johnson and Johnson vaccine can be found here: https://www.fda.gov/media/146305/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/
• Links to useful information about COVID 19 myths and facts:
  1. American Academy of Family Physicians: https://www.aafp.org/dam/AAFP/documents/patient_care/public_health/COVID19-Vaccine-Myths.pdf
  2. CDC: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html
  3. American Association of Medical Colleges: https://www.aamc.org/news-insights/transcript-vaccinevoices-covid-19-vaccine-myths-debunked

•  If you have an appointment at the Health Department:

Please stay in 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.

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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.