Number of COVID-19 cases doubles in local district

More cases detected than ever before, Middlesex in high transmission area

(Editor’s note: As of Tuesday, the Virginia Department of Public Health reported 1,191 confirmed COVID-19 cases in Middlesex County. There were 36 Middlesex patient COVID-19-related hospitalizations and 34 deaths involving Middlesex residents. The Virginia Department of Public Health cautions that because of limited testing, the actual number of cases in Middlesex County is likely much higher than reported.)

COVID-19 cases are rising at unprecedented rates that have never been seen before. The new case rate in the U.S. is currently about 364,000/day seven-day rolling average according to the Johns Hopkins Coronavirus Resource Center. Virginia cases have also increased beyond any previous experience; currently we have about 13,200 cases/day seven-day average, new cases. This is well beyond the January 2021 peak.

Case numbers in the Three Rivers Health District, which includes Middlesex County, have more than doubled; we had 997 cases across all jurisdictions last week. 

The  seven-day average number of people hospitalized in Virginia with COVID-19 has increased, but at a lesser rate; it is currently 2,216.

Vaccination rates continue to slowly climb. About 67.7% of the total population in Virginia is fully vaccinated. 

Levels of community transmission are high in all Three Rivers jurisdictions, including in Middlesex.  

Quarantine period shortened

The Centers for Disease Control (CDC) is shortening the recommended time for isolation from 10 days to five days for people with COVID-19, if asymptomatic or symptoms are resolving, followed by five days of wearing a mask when around others. CDC is also updating the recommended quarantine period for those exposed to someone with COVID-19:

For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than two months after the J&J vaccine) and not yet boosted, CDC now recommends quarantine for five days followed by strict mask use for an additional five days. If a five-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure.

Individuals who have received their booster shot do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure.

For all those exposed, best practice would also include a test for SARS-CoV-2 at day five after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19.

CDC recommendations on isolation and quarantine

Virus update

The omicron variant has become dominant in the United States. Vaccination is by far our most powerful weapon in the fight against all COVID-19 variants. Preventing serious COVID-19 disease is critically important to protect our highly stressed hospitals. Please get vaccinated against COVID-19 as soon as possible. If you are vaccinated, and eligible for a booster dose, please get the booster dose as soon as possible.

Visit vaccinate.virginia.gov or call 1-877-VAX-IN-VA to find vaccination opportunities near you. Appointment opportunities in Three Rivers Health District vaccination clinics are available.

The omicron variant is continuing to spread very rapidly worldwide and in the commonwealth. The omicron variant is as transmissible as measles, which is the most highly contagious pathogen known.

People who have previously had COVID-19 could become re-infected more easily with omicron, as compared to other variants of concern.

Data from South Africa and the U.K. suggest that a smaller percentage of people with omicron are being hospitalized than occurred with Delta. However, even if this proves true in the United States, higher case rates can still result in high rates of severe COVID-19 disease and threaten our health care systems.

Data is evolving concerning the impact of this variant on vaccines, current tests, and current treatments.

Laboratory studies show that booster shots dramatically increase antibody levels against the COVID-19 virus. Even though the omicron variant is demonstrating the ability to evade immunity by vaccination or previous infection with another variant, COVID-19 vaccination remains protective against severe COVID-19 disease and death.

Preliminary study results of some antigen tests using patient samples containing live virus suggest that antigen tests detect the omicron variant but may have reduced sensitivity. SARS-CoV-2 Viral Mutations: Impact on COVID-19 Tests

Monoclonal antibody (MAB) therapy is administered in the outpatient setting to COVID-19 positive individuals who are at increased risk for developing serious disease requiring hospitalization. The omicron variant appears to be less susceptible to bamlanivimab and etesevimab together, etesevimab alone, and REGEN-COV. Sotrovimab appears to retain activity against the omicron variant. Info

The FDA has authorized Molnupiravir and Paxlovid for treatment of COVID-19 illness. These antiviral medications are capable of preventing progression of COVID-19 disease after infection. They will be available in highly limited supply initially; within several months they will be more readily available as supplies increase.

Public health recommendations for stopping the spread of COVID-19 will work for all variants. COVID-19 vaccination remains the most important tool to protect people from SARS-CoV-2 and its variants. In addition to vaccination, the layering of other public health recommendations for stopping the spread of COVID-19 (e.g., masking, distancing, hand washing, avoiding crowds and poorly ventilated spaces, getting testing and isolating at home as appropriate) remain important. Everyone should continue to keep up good prevention practices to protect themselves and others.

Evidence has emerged indicating immunity wanes at about the six-month mark from vaccine induced and probably from natural immunity as well. Studies agree that vaccination following natural infection provides enhanced protection. This is the evidence underlying the current public health recommendation that everyone, including those who have been naturally infected, receive COVID-19 vaccination. For information, a CDC document entitled Science Brief: SARS-CoV-2 Infection-induced and Vaccine-induced Immunity can be found at https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/vaccine-induced-immunity.html#anchor_1635539757101.

All persons 18 years of age and older who have completed a primary series of mRNA vaccination (Pfizer-BioNTech/Moderna) are recommended to receive a booster vaccine. Individuals 16 and 17 years of age are recommended to receive a booster dose with the Pfizer-BioNTech COVID-19 vaccine at least six months after completion of primary vaccination.

For isolation (people with confirmed or suspected COVID-19):

If an individual is unable to consistently and correctly wear a mask (e.g. young children, developmental issues, etc.), they should isolate at home for the full 10 days.

For quarantine (certain people exposed to someone with COVID-19):

If an individual is unvaccinated or has not yet received their recommended booster dose (more than six months since the second mRNA dose or more than two months after the J&J vaccine), and is unable to consistently and correctly wear a mask, they should quarantine at home for the full 10 days.

In the absence of further guidance from CDC, if a child was fully vaccinated more than 6 months ago, but is not currently eligible to receive a booster (specifically children aged 12-15 years), they should follow the previous guidance for fully vaccinated individuals, which does not require them to quarantine after an exposure. They should wear a well-fitting mask for 10 days. VDH is making this interim recommendation balancing disruptions to in-person learning with the risk of transmission.

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

FDA Fact Sheets

FDA fact sheets for recipients and caregivers for the Pfizer vaccine

FDA fact sheet for recipients and caregivers for the Moderna vaccine

FDA fact sheet for recipients and caregivers for the Johnson and Johnson vaccine

Virginia Department of Health COVID-19 Dashboards

https://www.vdh.virginia.gov/coronavirus/covid-19-vaccines-received/

https://www.vdh.virginia.gov/coronavirus/covid-19-vaccine-summary/   

VDH COVID-19 outbreak dashboard

VDH COVID-19 Variants of Concern Dashboard

Links to useful information about COVID-19 myths and facts:

American Academy of Family Physicians

CDC

American Association of Medical Colleges

(Richard Williams is the director of Three Rivers Health District of the Virginia Department of Health. The district includes Middlesex County. Williams’ email address is richard.williams@vdh.virginia.gov.)