Lisa Reynolds, MD, pediatrician and Representative-Elect for Oregon House
Summary: Oregon’s COVID numbers continue to rise, more quickly than most any other state in the US. Our testing is insufficient. Gov Brown has hit “pause” in several counties in an attempt to slow the spread. We need to hunker down. Again. Herd immunity explained. There is good news about the Pfizer vaccine.
COVID in the World
Cases: 51m
Deaths: 1.2 million
(pace: 500,000 cases/day)
COVID in the US
Cases: 10 m Deaths: 239,000
(pace: 130,000 cases/day; our 14 day case count is up 64% compared with previous 2 wks)
So while the US makes up 4.4% of the world’s population, we make up about 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: 64% 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: 51,000 (1200/100K) - we are averaging >700 cases/day; up 95% and the highest daily cases we’ve seen since the beginning of the pandemic. Oregon’s rate of increase in cases (ie spread) is among the top in the US (4th in the US). Our Rt is 1.25, which means for every case of COVID, 1.25 people catch COVID. Goal is to <1 (then our case counts go down). [https://rt.live]
Deaths: 738 (17/100K); up 63%
Testing: 7 day average- about 6K tests a day (the number of tests performed has been higher this past month than previous months, tho not markedly and not the “double” the capacity promised a month ago). We are seeing an uptick in % positive tests (goal <5%, currently close to 10%). Testing is insufficient.
Hosp: 250-300/day, rising.
Governor Brown hits “pause” on several counties effective 11/11/20 until 11/24/20 in an effor to slow the spread of COVID.
Counties: Multnomah/Clackamas/Washington, Baker, Union, Marion, Malheur, Jackson and Umatilla.
The new guidelines
prohibit indoor visits at long-term care facilities;
mandate working at home to the extent possible;
set new capacity limits at restaurants and gyms to 50 people, including customers and staff;
recommend not gathering with people outside your household, or capping group sizes at six for Oregonians who do gather (except houses of worship).
Not happening in Oregon that needs to happen:
[Caveat: We must acknowledge: FEDERAL failure.]
Contact Tracing - inadequate retrospective tracing and informing of contacts of COVID+ people
Opening criteria in May required 15 contact tracers/100,000 population and to trace 95% of cases within 24 hours.
As of Oct 29, Mult has 77 tracers, 94 investigators (should have 122 [met])
Wash county has 68 tracers, 20 investigators (should have 90 [not met])
Clack county has 13 tracers, 25 investigators (should have 63 [not met])
Testing Testing Testing - We continue to have inadequate testing supply for reasons that are inexplicable.
Masking/Face Shields
Needed: Better Public Education and Enforcement of Masks and social distancing (Oregon Nurses? Weiden+Kennedy?)
SHIELDS alone are not adequate but are still allowed (tho discouraged) by OHA (CDC does not allow shield alone as sufficient protection from COVID).
Masks with vents should not be allowed in Oregon
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.
Schools in Oregon
Oregon: metrics for school reopening have been updated so that the bar is easier to clear.
OLD Metrics: metrics to be met three weeks in a row (county):
Case Rate ≤ 10 cases/100K people in county in preceding 7 days
Test positivity ≤5% in preceding 7 days
NEW Metrics:
If >200 cases/100K over 14 days: remain remote learning
If 100-200 cases/100K over 14 days: transition
If 50-100 cases/100K over 14 days, test 5-8% pos: hybrid of in person + remote
If <50 cases/100K over 14 days, test <5% positive: on site learning
Multnomah County is at 245/100K over 7 days (ending 11/7), with 10.6% pos rate
Washington County is at 190/100K over 7 days with 10.2% positive rate
Clackamas County is at 195/100K over 7 days with 10% pos rate.
There are risks to virtual learning, so I welcome the loosening of restrictions for return to school
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?
COVID Therapies (recycled from Oct newsletter)
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.
Herd immunity
Thru vaccine + illness/recovery or both
We need (estimated) 60-70% herd immunity to slow or eliminate community transmission.
A 90% effective vaccine (see below) needs to be administered to 70% of the population to confer immunity to 60% of the population. There will be additional (presumed) immunity for people who have been sick and recovered from COVID.
If we continue with safety measures (handwashing, masks) we can achieve adequate protection from community spread with a lower % “immune”.
COVID Vaccine News: Pfizer Vaccine
Pfizer (Phase ⅔): Announced that early trials (44,000 patients) suggest their vaccine is 90% effective! This is above the bar of 50% effective that the FDA has set for advancing the vaccine toward the production line.
How it works: Vaccine delivers viral genetic material (mRNA) into our own cells which then produce viral proteins, ie spike proteins found in the coat of COVID. The immune system reacts to the (“foreign”) spikes with antibodies and other responses. The antibodies then get activated when a COVID virus (with its spikes) enters a body and the antibodies disarm the COVID virus, preventing infection. There has never before been a successful mRNA vaccine.
Hoping for 30-40 million vaccine doses produced by the end of 2020. Two doses of the vaccine are required to confer immunity. Difficult issue: the vaccine needs to be shipped/stored frozen.
Priority for first vaccines: Health care workers and those with highest fatality rate from COVID.
Funded: $2B from US govt as “pre-purchase” of 100 millions doses; no fed money for research and development.
This is good news for all of the different vaccines being tested, especially those that use spike protein, or the mRNA model.
Oregon has a plan to procure, distribute and administer COVID vaccine, using pop up clinics, Emergency Medical Services,