Lisa Reynolds, MD
Oregon Coronavirus Update: Numbers rising, Testing update, rethinking school
Oregon Coronavirus Update
Lisa Reynolds, MD, pediatrician and Democratic nominee for Oregon House District 36.
10/13/20 (numbers below are from 10/11/20)
Summary: Oregon’s COVID numbers are on the rise. Oregon is slated to receive rapid COVID tests from the federal government which will double Oregon’s testing capacity and should help facilitate tracing and, thus, help slow the spread of COVID. Oregon continues to have outdated masking guidelines and is still low on the PPE needed to protect frontline workers and make schools safe for in person learning. There are some promising vaccines on the horizon. We are still a long way from “back to normal” and need to find a middle ground, especially when it comes to return to school.
COVID in the World
We have surpassed a chilling milestone: At least a million people worldwide have died due to COVID19 and 37m have been sickened by the disease.
COVID in the US
Cases: 7.7 m Deaths: 214,000
So while the US makes up 4.4% of the world’s population, we make up over 20% of the world’s deaths. And we are the richest, most advanced country in the world. (Although the US has the highest degree of wealth inequality in the world.)
Cases are increasing - 12% over a two week period, especially in the upper Midwest and Rocky Mtn areas, with some uptick on the east coast.
COVID in Oregon
Cases: 37,000 (875/100K) - we had 3 days in a row of >400 cases (reported Thu, Fri, Sat) with 337 cases noted today.
Deaths: 600 (14/100K)
This is among the 10 best in the nation.
Our numbers/rate are increasing.
Clusters: Prisons: 1335 cases (5 locations), food processing 615 (5 locations), colleges/univ 504 cases (16 schools), Nursing homes 226 (3 locations)
Not happening in Oregon that needs to happen:
[Caveat: We must acknowledge: FEDERAL failure.]
Enforcing/monitoring Workplace Safety: Workplace surveillance/follow up on unsafe practices (Occupational Safety & Health Admin: OSHA). We have continued workplace outbreaks, including Pacific Foods in Clatsop county (77 cases).
Contact Tracing - no retrospective tracing of contacts of COVID+ people (the COVID+ people are being contacted, but not going retrospective….)
Testing Testing Testing - we’ve been outbid by larger states and Oregon has had among the lowest testing rates in the US. We have inadequate testing supply for reasons that are inexplicable.
Good news: Oregon expects tests from Fed Govt: 60,000-80,000 per week, rapid antigen tests (which can be falsely negative). ; Doubles current capacity. (Will maintain strategic reserve.)
This spurred a change in OHA criteria for testing: Any one with symptoms, OR anyone who has been in contact with someone who is COVID+
I maintain policy should follow science, not supply of tests.
Needed: Better Public Education and Enforcement of Masks and social distancing
SHIELDS alone are not adequate but are still allowed by OHA (CDC does not allow shield alone as sufficient protection from COVID).
PPE- decentralized - there is no state level action and counties are competing with each other or even with places like CA. There continues to be a PPE shortage in Oregon. This impacts health care and the ability for schools to reopen.
Recent survey (Aug 27-Sept 11; 1000 Oregonians):
Half say they attended 0-3 social gatherings in past 2 wks; 80% of these <10 people
⅓ attended 4-10 gatherings in the past 2 weeks.
84% almost always wear a mask indoors
Still alot of folks think COVID is not a huge concern/less likely to mask/quarantine etc
Schools in Oregon
Oregon: metrics for school reopening (these are being re-considered, in acknowledgement of the difficulties in meeting these metrics and the urgency in getting at least some students back to in person learning.)
County Metrics-metrics to be met three weeks in a row:
Case Rate ≤ 10 cases/100K in preceding 7 days (Mult: 41/; Wash: 42/
Test positivity ≤5% in preceding 7 days (Mult cty: 6.4%, Wash: 5.5%)
Test positivity ≤5% in preceding 7 days (current: 6.3%)
Local District announcements: PPS - virtual until Jan; BSD - virtual until Feb
There are risks to virtual learning.
School closures are especially difficult for working class families who cannot afford tutors, pods, or private schools.
Mental health issues - isolation, toxic stress
Achievement Gap - those already falling behind are most affected
Less active/less outdoor time.
Attendance is less than par. (Dr Hayes - 2 kids hadn’t registered yet)
WIFI and hardware challenges.
Is there a way to open schools to the most vulnerable (how to define?)
Can we shore up our schools NOW to prepare for in person learning sooner?
School Elsewhere (56 m kids in school starting in Mid Aug). Emily Oster/Brown Univ gathering data: COVID19 School Response Dashboard; https://www.theatlantic.com/ideas/archive/2020/10/schools-arent-superspreaders/616669/
So far, the mitigation that is most linked with preventing COVID spread is group size <25
Schools do not appear to be super-spreaders (rates of <<0.5% of kids getting COVID, much lower than feared.)
(Kids <12 y/o spread the virus less; kids have milder disease.)
WE NEED TO ACCEPT RISK THAT MAY BE HIGHER THAN ZERO.
Universities have much higher rate of outbreaks.
Thru vaccine, illness/recovery or both
If we continue with safety measures (handwashing) we can achieve herd immunity with a lower % “protected”.
Remdesivir: Shortens the course of illness in hospitalized patients with pneumonia.
Steroids (Dexamethasone): Helps blunt inflammation in hospitalized patients.
Monoclonal antibodies (investigational): Mass produced antibodies that are mimics of the molecules the body produces against the COVID virus. These molecules work in a variety of ways, including preventing the virus from infecting cells, or tamping down the number of virus in an infected patient. MAY EVEN BE USED as a preventative: giving the antibodies to those who have been exposed.
Eli Lilly product - paused clinical trials 10/13/20 d/t illness of a patient
Regeneron product - given to Trump
Hydroxychloroquine: not useful in treating COVID.
COVID Vaccine: Testing
Goal: Safe vaccine with at least 50% efficacy.
Need: understanding of genetic and molecular structure of the virus - record scientific breakthroughs on this.
Process (may be accelerated by combining phases, eg test on 100s of humans early.): Preclinical phase: test in cells, then in animals (mice, monkeys) to see if it triggers immune response. 91 vaccines
Phase 1 Safety: Small numbers of humans, for safety, dosage, and for immune response. 29 vaccines.
Phase 2 Expanded: Hundreds of humans of different ages, etc, for safety, dosage, and immune response. Does it vary with age group, gender? 14 vaccines.
(China and Russia have allowed early approval of 5 vaccines before results of Phase 3 available.)
Phase 3 Efficacy: Thousands of humans. Vs Placebo. Efficacy and safety (rare side effects). 11 vaccines.
Approval: 0 vaccines.
COVID Vaccine: Types/Leading Contenders
Genetic: Vaccines deliver viral genetic material into our own cells to produce viral proteins that trigger immune response. There has never been a successful vaccine using this technique.
Moderna vaccine (Phase 3): mRNA in lipid coat that “slides” into cells. mRNA codes for the spike proteins found in the coat of COVID (spikes give crown-like/corona appearance and are the proteins that bind to receptors in host cells), so cells start making these spikes. Immune system react to the (“foreign”) spikes with antibodies and other responses.
Pfizer (Phase ⅔):
Viral Vector: Vaccines contain viruses that carry coronavirus genes: (a) viral vectors enter cells and cause them to make viral proteins or (b) viral vectors slowly replicate, carrying covid proteins on their surface. There is an oral version of this type of vaccine in the works.
Oxford vaccine (Phase 3) w Astra Zeneca: weakened chimpanzee adenovirus (cannot replicate) with gene for COVID spike vaccine - triggers antibodies and other immune responses. “Live” vaccine may confer stronger/longer immunity but carries risks to immunocompromised.
[one case of transverse myelitis paused vaccine trial, now resumed]
CanSino (Phase 3): weakened human adenovirus.
Johnson & Johnson (Phase 3): weakened adenovirus, used same scaffold for Ebola vaccine. On pause for one ill patient, possibly vaccine related.
Protein-Based: COVID protein or parts of proteins, some are packaged on nanoparticles.
Novavax (Phase 3): Spike proteins stuck to nanoparticles + adjuvant (wc boosts immune system).
Inactivated or Attenuated Viruses: killed or weakened with chemicals
Sinovac (China) (Phase 3): CoronaVac in limited use in China. Inactivated - may need booster.
SinoPharm (Phase 3): in limited use in China/UAE
Repurposed: Vaccines designed for other diseases that may protect against COVID.