As we approach another pandemic holiday and beyond, Virginia Governor Ralph Northam offers cautious hope for the not-too-distant future. "A vaccine is in sight and while that take time to distribute and take effect, I hope that just a few months from now we may be past the worst of this. With Thanksgiving a week away, a quarter million Americans have died of COVID-19. The nations top expert on pandemics warns of hard times to come. "We are in the process of another resurgence as we enter into the much colder months of the late fall and early winter as people go indoors much more than outdoors and they're gathering with friends and with family." Dr. Fauci addressed the University of Virginia this week, and Northam held another press conference. In this 50th episode of the Charlottesville Quarantine Report, excerpts of both events, as well as a local update from the Blue Ridge Health District.
Episode 50 - Cautiously Waiting for a Vaccine
So far in this pandemic year, we’ve celebrated Easter, Memorial Day, Independent Day, Labor Day, and Halloween. Now as we approach a pandemic holiday season and beyond, Virginia Governor Ralph Northam offers cautious hope for the not-too-distant future.
"A vaccine is in sight and while that take time to distribute and take effect, I hope that just a few months from now we may be past the worst of this.
With Thanksgiving a week away, a quarter million Americans have died of COVID-19. The nation’s top expert on pandemics warns of hard times to come.
"We are in the process of another resurgence as we enter into the much colder months of the late fall and early winter as people go indoors much more than outdoors and they're gathering with friends and with family."
Dr. Anthony Fauci addressed the University of Virginia this week, and Northam held another press conference. In this 50th episode of the Charlottesville Quarantine Report, excerpts of both events, as well as a brief local update from the Blue Ridge Health District.
“While we’re seeing an increase, it’s not quite as sharp as some of our surrounding states and certainly not to the extent that we are seeing in the upper midwest,” McKay said.
I'm your host Sean Tubbs, and thanks for listening. Let's get on with the program.
Let's get the numbers as they are as of November 18, 2020. This show's fifth episode is called Waiting for the Numbers, and in so many ways that has been my daily routine for almost nine months. And it will continue to be for as long as this is needed.
There have been 208,833 cases of COVID-19 in Virginia. The current seven-day average for new daily cases is 1,761 and that number has been steadily increasing for some time. To look at new caseloads another way, the total number of new cases per 100,000 population is 270. That number was 167.5 on October 18.
Locally, in what we will soon call the Blue Ridge Health District there have been 4,912 cases. For most of the pandemic, Albemarle County led the district with the highest number of cases, but Charlottesville passed the county about six weeks ago.
In Virginia there have been 3,860 deaths to date. There have been 80 deaths in the Blue Ridge Health District. About 45 percent of confirmed cases have been in between people between the ages of 10 and 30. People over the age of 80 have made up five percent of COVID cases but 59 percent of fatalities.
At a press conference yesterday, Virginia Health Commissioner Norm Oliver described the situation.
“Cases have been increasing steadily over the past period,” Oliver said. “Our case incidence rate was about a month ago around 9 cases per 100,000 populations and now we’re doubling that and approaching 20 cases per 100,000.”
As of yesterday, the Virginia Department of Health reported that there have been three million PCR tests over the course of the pandemic. In the last week, there have been 130,000 tests processed.
“We have been doing a lot of testing,” Oliver said. “Our average testing is about 20,000 tests per day.”
Last night, Ryan McKay of the Blue Ridge Health District addressed the Albemarle Board of Supervisors. He said that Virginia continues to do better than most states in handling the pandemic.
“While we’re seeing an increase, it’s not quite as sharp as some of our surrounding states and certainly not to the extent that we are seeing in the upper midwest,” McKay said.
McKay showed the Board of Supervisors data that showed how tougher restrictions in some parts of Virginia helped bring down caseloads at different points of the pandemic. Right now, the numbers across the state continue to mount.
“We have been increasing in our cases per 100,000 per day for the last 27 days and again all of this contributes to decision-making that is happening that informs making those amendments to executive order 63 and 64 that implements the stronger mitigation strategy,” McKay said.
On November 18, the positive percentage in the Blue Ridge Health District was 1.9 percent. McKay said this metric is not necessarily a good indicator of community spread.
“What we have found is that percent positive, while it is an indicator of what may be happening here, it has really been a great reflection of what could be happening locally,” McKay said. “The University of Virginia to their credit has drastically increased access to testing for students and faculty. Testing across our district particularly in Albemarle and Charlottesville has increased significantly over time so that number may not be a great reflection of what’s truly occurring in our community.”
The takeaway? As you’ll hear in the rest of the show, now is not the time to let down your guard.
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At his press conference on November 18, Governor Ralph Northam made no new announcements of restrictions, but held the event to reinforce the message that a vaccine is not imminent. He began by stating that news of the Pfizer and Moderna vaccines is promising.
"Both appear to be close to 95 percent effective in clinical trials and could be ready to start rolling out by the end of this year. We have been planning for distribution for months and we will be ready."
Northam said the news should give people hope but implored caution.
"It means a light at the end of this tunnel and I think we can all agree this has been a long tunnel. As a doctor, I have to caution everyone that the light is a few months away still. These vaccines will take time to distribute. Until then we all need to keep taking precautions."
Northam said that Virginia continues to rank lower than most states in numbers of cases but the surge we are seeing now is national.
"The COVID pandemic is surging across our nation. Case counts, hospitalizations and deaths are all rising dramatically. We do not want to see this situation here in Virginia get worse so while we're doing well compared to other states we are also seeing greater spread off this virus."
This week, Virginia's percent positivity climbed back above seven percent for the first time since mid-September. We've had two days in a row of more than 2,000 new cases.
"The most rapid and concerning spread remains in the southwest region but all of our regions are seeing increases."
Last week, Northam order alcohol sales at restaurants to stop at 10 p.m., lowered the requirement for masks to age 5, and lowered the limit for social gatherings from 250 people to 25 people or fewer.
"I strongly discourage Virginians from having social events with that many people, especially indoors. It's just too dangerous and you increase the risk of spreading this disease."
Small gathering in homes is cited as one of the ways that Southwest Virginia has seen an increase in cases and a higher percent positivity in recent weeks. With Thanksgiving approaching, Northam is concerned.
"While socializing virtually is the safest way right now, if you must get together with people outside your household, do it outside if you can."
Now, why ban alcohol sales in restaurants at 10 p.m. Why make them shut down at midnight?
"While the virus can certainly spread at restaurants before ten, we know that the later the event gets the more likely people are to drink and forget about social distancing."
Northam also explained why masks are now required for children aged five and above, even in schools.
"The science shows us that wearing masks reduces the spread of the virus and can protect the person wearing the mask. This is such an easy thing we can do to help other people so please wear a mask."
Northam also said the state would step up enforcement of violations of the existing emergency rules across all of Virginia.
"Back during the summer when cases surged in Hampton Roads, we implemented similar mitigation measures there and we saw case counts go back down. It can work again but we all need to follow the rules."
Northam said following the rules is about helping more than just ourselves.
"A vaccine is in sight and while that take time to distribute and take effect, I hope that just a few months from now we may be past the worst of this. So let's not make this winter any worse than it has to be. Be smart. Be careful. And think of those around you."
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One of the ways I pay myself to do this work it through Patreon. For $25 a month, people have the opportunity to give shout-outs to various causes. Lonnie Murray of Albemarle County wants you to know about the Plant Northern Piedmont Natives Campaign, an initiative that wants you to plant native plants in yards, farms, public spaces and gardens in the northern Piedmont. Native plants provide habitat, food sources for wildlife, ecosystem resiliency in the face of climate change, and clean water. Start at the Plant Northern Piedmont Natives Facebook page and tell them Lonnie Murray sent you!
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What we have been going through since the spring has been something that might have been stopped if there had been a thorough commitment to public health driven through science and epidemiology. But we’re here now in mid-November.
On November 18, Dr. Anthony Fauci spoke as the Hayden-Farr lecturer at the final University of Virginia Medical Center Hour of the semester. Dr. Fauci has become a household name across the world for his occasional position in the outgoing presidential administration. He is the director of the National Institute of Allergy and Infectious Diseases, a position he has held since 1984. At the beginning of his tenure, the world was facing the HIV epidemic. His presentation on November 18 was entitled The Public Health and Scientific Challenges of COVID-19.
A reminder that COVID-19 is a novel coronavirus.
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"For decades and decades, we've had experience with coronavirus. This was just not something that was totally new to us."
The various strains of the common cold are caused by a form of coronavirus.
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"That was essentially considered really not a particularly important series of infections until we got into 2002 and 2012 with the first and then the second pandemic coronavirus
with SARS, the Severe Acute Respiratory Syndrome, and MERS."
SARS emerged from the Guangdong province where it transferred from a bat into a cat and then into the human population where about 8,000 infections and 780 deaths. Fauci said the numbers didn't grow higher than that because it was completely contained by public health measures we've all been asked to follow for three quarters of this year - identification, isolation, contact tracing and quarantine.
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"Ten years later in 2012, another pandemic coronavirus called Middle East Respiratory Syndrome. This was a disease that passed from bats to camels to humans. It did not have the capability of spreading easily and still smoulders somewhat in the Middle East."
COVID-19 is the third pandemic coronavirus, and it has not been contained. Fauci said it was intially identified as an "unusual pneumonia" from the Wuhan province in Central China.
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"The disease caused by this novel coronavirus is called COVID-19 for Coronavirus Disease 2019 based on its recognition in December of 2019. This virus as we all sadly know has exploded upon our planet as the worst outbreak of a respiratory infection in 102 years since the 1918 Spanish Flu."
As of November 17, there were 56 million cases and 1.3 million deaths across the world. Fauci said the United States of America is the country that has been hit the hardest. There have been 11.1 million cases and over 245,000 deaths and counting. And as many of us know, it's about to get a lot worse.
(FAUCI)
"We are in the process of another resurgence as we enter into the much colder months of the late fall and early winter as people go indoors much more than outdoors and they're gathering with friends and with family."
Fauci said during the first nationwide surge, there were up to 70,000 cases a day. That leveled off to about 40,000 cases a day over the summer and into the fall. But now?
(FAUCI)
"Right now we, and the European Union is right there with us, are in a major surge of cases where we are now breaking all current records before with over a thousand deaths per day, over a hundred thousand, the last was about 150,000 cases in a day."
Three-quarters of the year in, and we know more than we did about how COVID spreads. But, it's always good to hear again from the expert.
"Transmissions are common among household contacts and in congregate settings and in those health care settings where PPE is not used. There's reasonably good protection if health care workers have adequate and appropriate PPE. But we've seen outbreaks in closed settings such as cruise ships, nursing homes and prisons. And factors that increase the risk are crowded and closed spaces with poor ventilation and interestingly it isn't only coughing and sneezing, but its singing, speaking loudly or breathing heavily."
There's a week to go until Thanksgiving and what Fauci said next is worth keeping in mind if there are relatives you've not seen for a while.
"Right now to day in mid-to-late November we're finding that innocent occurrences such as groups and friends and family meeting indoors because of the cold weather for dinner are becoming a major source of asymptomatic spread to the group in the dinner party or in the social event. That seems to be driving infections much more so than the obvious settings of bars and other settings."
Asymptomatic means that someone has a viral load of the disease in their body but they do not have symptoms.
"One of the most unusual aspects of this disease, this infection, is that about 40 to 45 percent of infected people are without symptoms and we know now from modeling studies that a substantial proportion of transmissions occur from an asymptomatic person to an uninfected individual which makes contact tracing all the more problematic particularly when we have a high degree of community spread the way we have right now."
Eighty percent of those with symptoms have mild cases for which Fauci recommends staying home and avoiding contact with others.
"About 15 to 20 percent of people however have severe or critical symptoms of which the case fatality rate varies from a few percent of those to about 20 to 25 percent of those requiring mechanical ventilation. This becomes so confusing when you have a virus, and I've never seen anything like it, where you go from no symptoms at all to a substantial, to mild symptoms to situations where individuals because of age or underlying conditions, have a serious risk of high morbidity and mortality. That is so unprecedented to see a virus that can kill you and can cause severe morbidity and yet so many people have no symptoms at all."
People who are obese, have diabetes, are smokers are more likely to have serious cases. Fauci said about 45 percent of Americans have an underlying condition that could lead to a serious case. Thirty percent of Americans are obese.
"Another aspect of this particular disease is the profound ratio in ethnic disparity. Actually on two accounts. One is the risk of actually getting infected. Because as a group, and you never want to generalize but in this cases its informative, as a group African Americans and Latinx and Native Americans more likely have employment, jobs which more likely put them out into the essential workers where they do things that put them in contact with others as opposed to having the capability in their employment to be going to a computer and doing things virtually the way we are doing right now. And also once they get infected they have much more of the predominance of the underlying conditions."
Another recognized situation is that some who have been through the infection have lasting conditions that persist. Fauci said this needs further study.
"And when I say persistence, I'm talking about weeks to months and maybe even longer of extremely bothersome and in some cases incapacitating symptoms and signs such as severe fatigue, shortness of breath such as athletic people who now have difficult climbing one set of stairs."
Fauci said some of these patients report a lack of concentration, a brain fog if you will.
Now, much of the talk now is about what will happen with the vaccines. Fauci said the federal government has been investing in six vaccines, and these have been all been monitored using the same safety protocols. Each of these seek to attack the virus in different ways and trials are underway.
Two vaccines have reported out. In the early days of the pandemic, terms like community spread and social distancing became commonplace. Now it's up to many of us to become familiar with new terms.
"A week ago this past Monday Pfizer announced that in their trial they had a situation where there were I believe four infections in the vaccine group. Actually five infections in the vaccine group and 90 in the placebo. Now they came out literally today with the announcement that that's a 95 percent efficacy."
A second vaccine by Moderna reports similar efficacy rates. Both of these vaccines attack the nucleic structure of the virus.
"So what we're dealing with now is a brand new platform that many people had concern about because it was a new platform which clearly has shown a very striking efficacy signal, almost identical in two separate studies done by two separate companies using the same platform."
However, as Governor Northam said at the beginning of the program, the light at the end of the tunnel is still in the distance. Fauci laid out how a vaccine will become a reality.
"Now, we don't want to get ahead of ourselves because the ultimate decision about how it should be distributed is actually going to be made as usual by the CDC with input from the Advisory Committee on Immunization practices, or ACIP. Because of the seriousness of the situation, the National Academy of Medicine was asked to weigh in on suggestions for what the distribution should be when you have early on not enough doses to give to everyone."
Their early recommendation is that the vaccine go first to high-risk individuals. This includes health care workers and the elderly. Then they would novevthey before moving on to other categories. Fauci said between now and then, trust needs to be built to persuade the greater population to accept the vaccine.
"What we showed you just a moment ago was vaccine efficacy in a trial. Whether or not a vaccine is going to be effective in the community is going to be whether or not people take the vaccine."
Fauci said a recent survey published in the magazine Science found that 50 percent of Americans said they will get the vaccine. Minority populations in particular are not sure at this time, or say they will not take the vaccine.
"Forty percent of Blacks say they don't want it and 32 percent say they're not sure, and with Hispanic, it's 23 percent and 37 percent. This is something that we must address by outreach in the community by individuals that the community actually trusts. So we've got to get that done and we've got to get it done quickly because we would not have an efficacious vaccine that at the population level is not effective because of a lack of uptake."
That may take some time as this all comes together, and as infection rates continue to increase across the country. Fauci said it is perhaps more critical than ever to stay the course.
"We cannot abandon public health measures, even in the presence of a vaccine that's highly efficacious. A, because it's going to take a while to get the community completely protected as you would say. By completely, I mean a veil of protection that truly is herd immunity for this particular infection. So we don't want there to be a signal to the community that 'ah, we have a vaccine so let down our guard!' No! It should actually be an incentive to double down until we get everybody vaccinated."
Fauci said that this pandemic will teach the world lessons about how to respond and that other outbreaks are likely.
"The critical issue is that we cannot prevent the emergence of a new microbe but what we can do is by our preparedness prevent that emergence from becoming a pandemic process and that's going to be the challenge of the future as we learn lessons from the past and we make sure that we don't lose corporate memory of what we're going through right now as we go into the future beyond the control of this outbreak."
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PEC shout-out to conclude.