County Public Health Report ~ 1/04

Today, Public Health Officer Dr. Tom Locke Locke shared his assessment of the pandemic in Jefferson County: Nationally, new cases have leveled off, although at a very high plateau. Record deaths and new cases have been recorded nationally and statewide. The most impacted areas still are Southern California and Arizona, with ICU capacity stretched to its limits. The consensus is that the worst still lies ahead.

Washington has leveled off with nearly 2,500 new cases a day. ICU bed capacity remains available, still with the chance to still accept transfers. Locally, Jefferson County recorded 25 cases in the last two weeks, with a slightly higher 78.7 cases per 100,000 population. Recent cases reported reflect holiday gatherings of households, which drove the surge and are expected to be reflected in new cases about mid-January. To date, we remain a county with one of the lowest rates in the state.

Dr. Locke stated that although holiday travel has brought new cases to our county, transmission to other community members can be stopped by the simple effort of quarantining yourself for 14 days and monitoring for symptoms of infection.

Dr. Locke also answered questions submitted from KPTZ listeners:

  • Revisiting your POLST directives regarding use of ventilators is wise, although current treatment for COVID-19 has improved, requiring use of ventilators less likely. One can make the distinction between use in futile care versus temporary use for recovery.
  • The two primary benefits of masking are trapping secretions from the source person and filtering the air you breathe. If your nose is uncovered, you are providing a direct route to the target cells of the coronavirus. The receptor cells are present in the highest numbers in your nose. It is also a violation of state law not to cover your nose when wearing a mask.
  • President-elect Biden’s national mandate for universal masking follows the science. It slows transmission and can prevent illness and deaths.
  • New viral strains are not uncommon as it is a well-established phenomenon that viruses mutate and errors can occur during replication. However, the newly discovered more infectious strains, one in Britain and South Africa have complicated the pandemic. Nearly 50% of identified close contacts in Britain are genetically linked to this more infectious strain. New vaccine technology includes genetic material from the whole spike protein and is unlikely to thwart the current vaccine.
  • Current vaccines in use have been granted under an Emergency Use Authorization (EUA) from the FDA and are still considered experimental. Health care workers (HCWs) who have not taken the vaccine are not likely, at this point in time, to be required to be vaccinated. The vaccines are expected to “sell” themselves by their remarkable efficacy. It is expected that the hesitancy among HCWs may subside over time, but may be required when the vaccines get final approval from the FDA, as is seen with other vaccinations for infectious conditions.
  • Persons testing positive for COVID-19, without symptoms, should isolate for 10 days from the date of the test.
  • The process for establishing priority for limited supplies of vaccines has been in the works for months. CDC has an advisory committee that has produced a schematic based on the science of who is most at risk of morbidity and mortality. It is a tiered hierarchy that has been sent to all states as a guidance document. State governments have discretionary powers to make some changes based on the pandemic numbers in their respective states. In Washington, the Governor has produced a document for the 1A tier. Additional directions for 1B and 1C population specifics are expected this week. A number of issues continue to be considered and confound the timely rollout of these documents.
  • Age (over 75) is the single most independent variable of progression to serious disease and death when considering an individual’s placement in the vaccination hierarchy. Immune-suppressing health conditions at any age, or in combination with age, are a high priority.
  • The quantities of vaccines delivered to Jefferson County are highlighted at the hospital’s incident command meeting each week. As of today, 970 vaccinations have been administered, with 980 held in reserve for the upcoming second dose to be given this week as per Pfizer’s protocol. Dr. Locke states they are using the vaccines aggressively for those in the 1A tier.
  • Currently, 61% of healthcare workers in 1A have been vaccinated, with a goal of 70% fully vaccinated with two doses. Next, tier 1B and 1C will receive the first dose of the vaccine. Medical staff are waiting for the state document from the Governor’s Office for further clarification on 1B and 1C populations. By the middle of January, essential workers are expected to be vaccinated.
  • Handling requirements for the two available vaccines limits which local providers are able to provide vaccinations for the local population. Currently, we are advised to follow website information for Jefferson Healthcare for the notification process, or the Washington state DOH, listed above. All notifications are dependent upon governing documents, vaccine supplies and actual arrival of shipments.
  • The currently available vaccine (Pfizer) takes about 10-14 days to develop immunity to the virus. Pfizer’s vaccine, after the first dose alone, provides about 52% protection of developing severe disease if you are exposed and infected, with Moderna’s being higher with one dose. Vaccination with two doses of either vaccine provides 95% protection.
  • Herd immunity levels to bring this pandemic to a close needs to be about 75% of the current population in Jefferson County to be fully vaccinated.
  • Recent clinical trials of both available vaccines were not designed to study the effect on contagion or viral loads if a person becomes infected after getting the vaccine. These studies are currently being done. This requires participants in the trial, which is ongoing, to have their noses swabbed every other day, an intensive process.
  • Individuals in the 1B priority ranking are expected to be vaccinated within a few weeks. Continue to check the Jefferson Healthcare and Jefferson County Public Health websites listed above for information. A drive-thru clinic will be established in Manresa Castle parking lot and available by appointments.
  • For those households who have older individuals in different priority categories, clinical judgement should be used to vaccinate clusters within a residence, focusing on the highest risk individuals.
  • Currently, medical personnel are extracting 6 doses from each prepped vial of the Pfizer vaccine and they are on track not to waste a single dose. An on-call list has been established in the priority hierarchy if anyone misses an appointment so the dose will get used, as there is no preservative in this Pfizer vaccine.
  • A current controversy surrounds the issue of using all doses of the vaccine delivered for one dose only, then waiting until enough vaccine becomes available for a second dose to boost the immune response, as the supply becomes available. Most experts are against this variation as the clinical trials did not provide data on this scenario. If the goal is to STOP transmission, the vaccines need to be delivered on the schedule recommended by the manufacturers, Pfizer and Moderna. One possibility is that Moderna could be used this way as the dosage uses more micrograms of the genetic material than Pfizer and has good protection with the first dose.
  • Dr. Locke continues to meet every Tuesday with the local school districts. The focus remains on moving toward in-person attendance soon, with a robust plan for mitigation if and when a COVID-19 case is reported in these settings, which is expected.

Department of Emergency Management Director Willie Bence reported that area Fire and Rescue EMT’s are not currently involved in vaccine rollout, but may be in the future, but continue their regular duties. Citizens are reminded that road closure and power outages continue to pose problems and are reminded to update and refresh their emergency supplies and plans.

Mr. Bence did request any persons with medical backgrounds to please contact him to help as volunteers in the vaccination campaign. This would start the process to register as emergency workers.

Submit your Public Health questions to Dr. Tom Locke by emailing [email protected].