WHAT CITIES AND TOWNS SHOULD KNOW DURING THE COVID-19 PANDEMIC - Joe Thompson, MD, MPH
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WHAT CITIES AND TOWNS SHOULD KNOW DURING THE COVID-19 PANDEMIC Joe Thompson, MD, MPH President and CEO, ACHI Professor, UAMS Colleges of Medicine and Public Health 03.04.2021
SARS-CoV-2 illustration: CDC
COVID-19 IN THE UNITED STATES
At least
28,700,000
confirmed cases
At least
518,000
reported deaths
Sources: Washington Post and Johns Hopkins University, as of March 4, 2021.
COVID-19 IN ARKANSAS
As of March 3
Cumulative Cases: 323,353
Total Active Cases: 4,278
Hospitalized: 397
On Ventilators: 91
Daily Active
Cases per 1K
Total Deaths: 5,261
as of 3/3/21
Source: Arkansas Department of Health
CORONAVIRUS VARIANTS
o Variants of concern and where they first emerged:
o B.1.1.7 – U.K.
o B.1.351 – South Africa
o P.1 – Brazil / B.1.1.248 – Japan (nearly identical to P.1 strain)
o B.1.427/B.1.429 – U.S. (California)
o B.1.526 – U.S. (New York)
o Seem to spread more easily, possibly leading to more cases,
hospitalizations, and deaths
o ADH reported Tuesday variant from U.K. detected in Arkansas
Sources: CDC, Arkansas Department of Health
VIRUS VARIANTS: IMPORTANT QUESTIONS o Do current vaccines provide protection from variants? o Does infection with original virus provide immunity? o Are they likely to cause more severe or different symptoms? o Do current tests identify variants? o Do current treatments work as well? o Do variants spread more easily? o How widespread are the known variants? o Are some variants more contagious or severe than others?
VIRUS VARIANTS (NEW STRAINS)
VS.
NEW YORK TIMES VACCINE TRACKER Updated March 2, 2021 Source: Coronavirus Vaccine Tracker, New York Times: nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html
VACCINE ASSESSMENT: IMPORTANT QUESTIONS o Safety? o Effectiveness? o Duration of immunity? o Simplicity of distribution? o Level of threat from variants?
5 LEADING VACCINE CANDIDATES: TECHNOLOGY
JOHNSON & ASTRA-
PFIZER MODERNA NOVAVAX
JOHNSON ZENECA
Messenger Messenger Viral Viral
Protein
RNA RNA Vector Vector
Sources:
Pfizer-BioNTech: https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/pfizer-biontech-covid-19-vaccine-frequently-asked-questions
Moderna: https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/moderna-covid-19-vaccine-frequently-asked-questions
AstraZeneca: https://www.astrazeneca.com/media-centre/press-releases/2020/azd1222-oxford-phase-iii-trials-interim-analysis-results-published-in-the-lancet.html
Johnson & Johnson: https://www.jnj.com/johnson-johnson-covid-19-vaccine-authorized-by-u-s-fda-for-emergency-usefirst-single-shot-vaccine-in-fight-against-global-pandemic
Novovax: https://ir.novavax.com/news-releases/news-release-details/novavax-covid-19-vaccine-demonstrates-893-efficacy-uk-phase-35 LEADING VACCINE CANDIDATES: EFFICACY
JOHNSON & ASTRA-
PFIZER MODERNA NOVAVAX
JOHNSON ZENECA
94.1% 66% 70.4%*
95% symptomatic symptomatic symptomatic
89.3%
symptomatic
cases 100% 85% 100% symptomatic
severe severe severe
Sources:
Pfizer-BioNTech: https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/pfizer-biontech-covid-19-vaccine-frequently-asked-questions
Moderna: https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/moderna-covid-19-vaccine-frequently-asked-questions
AstraZeneca: https://www.astrazeneca.com/media-centre/press-releases/2020/azd1222-oxford-phase-iii-trials-interim-analysis-results-published-in-the-lancet.html
Johnson & Johnson: https://www.jnj.com/johnson-johnson-covid-19-vaccine-authorized-by-u-s-fda-for-emergency-usefirst-single-shot-vaccine-in-fight-against-global-pandemic
Novovax: https://ir.novavax.com/news-releases/news-release-details/novavax-covid-19-vaccine-demonstrates-893-efficacy-uk-phase-3
*Based on pooling of two dosing regimens. Further analysis of the efficacy regimens showed that when the vaccine was given as two full doses, vaccine efficacy was 62.1%
(n=8,895; CI 41.0% to 75.7%), and 90.0% (n=2,741; CI 67.4% to 97.0%) in participants who received a half dose followed by a full dose.VACCINE SIDE EFFECTS & ADVERSE REACTIONS
o Commonly reported side effects*
o Fatigue
o Chills
o Headache, muscle aches
o Soreness at injection site
o Low-grade fever
o Among 13.8M vaccinations, only 62 incidents of anaphylaxis
reported — Pfizer (46) and Moderna (16)**
o Reported anaphylaxis rates (4.5 episodes/million doses) comparable
with those of other vaccines
Sources: *CDC, https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html; **Gee J, Marquez P, Su J, et al. First Month of COVID-19 Vaccine Safety
Monitoring — United States, December 14, 2020–January 13, 2021. MMWR Morb Mortal Wkly Rep. ePub: 19 February 2021. DOI:http://dx.doi.org/10.15585/mmwr.mm7008e3WHO CAN GET THE VACCINE RIGHT NOW?
o Minimum age lowered from 70 to 65, effective February 23
o Additional 115,000 Arkansans eligible
o Vaccines available in pharmacies, clinics in every county
o Food manufacturing workers, effective March 2
o Includes meat processing, grain and oilseed milling
o Additional 49,000 eligible
o Vaccines available in pharmacies, clinics, and may be arranged
through some worksites
o Will open to additional Phase 1-B groups as supply increases
o Groups in Phase 1-A also continue
Source: Arkansas Department of HealthVACCINATION PHASE 1-B: LATER
o Frontline essential workers
o Fire and police not in 1-A – TBD
o Manufacturing – 35,322
o Food service – 107,872
o Public Transit – TBD
o U.S. Postal Service – 5,375
o Correctional workers – 5,610
o Essential government – 25,672
Source: Overview of the Arkansas Vaccine Plan in Response to the COVID-19 Pandemic, Jennifer Dillaha, MD, Medical Director, Immunization and Outbreak Response
Arkansas Department of Health, Jan. 21, 2021.VACCINATION PHASE 1-C
o Timing: Estimated April 2021
o Individuals 16–64 with high-risk medical conditions
o Essential workers:
o Transportation, logistics – 240,528 o Finance – 51,688
o Water, wastewater – 1,484 o IT, communications – 19,535
o Food service – TBD o Energy – 22,992
o Shelter, housing – 75,201 o Media – TBD
o Public safety – 8,560 o Public health workers – 4,829
Source: Overview of the Arkansas Vaccine Plan in Response to the COVID-19 Pandemic, Jennifer Dillaha, MD, Medical Director, Immunization and Outbreak Response
Arkansas Department of Health, Jan. 21, 2021.COVID-19 VACCINATION PROGRESS IN ARKANSAS
As of March 3 STATE FEDERAL
PROGRAM PROGRAM
Hospitals, state long-term care, and Retail (Walmart) & long-term care
others since Dec. 14, 2020. (CVS, Walgreens) since Dec. 28, 2020.
Received: Allocated:
977,710 91,070
Administered: Administered:
Current Phase: 1-B
622,719 46,060
• 65 and older Percentage: Percentage:
• Education workers
• Food manufacturing 63.7% 50.6%
Source: Arkansas Department of Health, https://www.healthy.arkansas.gov/programs-services/topics/covid-19-vaccination-planCOVID-19 VACCINATIONS IN THE UNITED STATES
Map updated
March 3
22,779 administered per 100K;
31,972 distributed per 100K
Source: CDC COVID Data Tracker. https://covid.cdc.gov/covid-data-tracker/#vaccinationsTWO STUDIES SUGGEST VACCINES EFFECTIVE AT
REDUCING TRANSMISSION OF COVID-19
o Israeli Pfizer vaccine study*
o 89% effective at preventing lab-confirmed infections
o Separately, Israeli authorities said the Pfizer vaccine was 99% effective
at preventing deaths
o University of Oxford AstraZeneca vaccine study**
o Preliminary results revealed rates of PCR positive tests fell by 50%
after two doses and by 67% after just one dose**
Sources: *bloomberg.com/news/articles/2021-02-21/pfizer-biontech-shot-stops-covid-s-spread-israeli-study-shows; **cnn.com/2021/02/03/health/astrazeneca-vaccine-transmission-
gbr-intl/index.htmlEMPLOYER DECISIONS ON COVID-19 VACCINES
o Educate and encourage employees to get vaccinated
o Incentivize employee vaccination through:
o Wellness program (Washington Regional Medical Center)
o Paid time off (Olive Garden)
o Monetary bonus (Dollar General)
o Mandate vaccination (United Airlines considering)
o Medical/religious exemptions
o Liability risk during emergency use authorization period
Source: CDC, https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant.htmlCOVID-19 HOSPITALIZATIONS IN ARK. PER DAY
1400
1300
1200
Total of “currently hospitalized”
1100 each day since Sept. 1, 2020
1000
900
800
700
600
500
400
300
200
100
0
9/1 9/8 9/15 9/22 9/29 10/6 10/13 10/20 10/27 11/3 11/10 11/17 11/24 12/1 12/8 12/15 12/22 12/29 1/5 1/12 1/19 1/26 2/2 2/9 2/16 2/23 3/2
Source: Arkansas Department of HealthCOVID-19 HOSPITALIZATIONS & DEATHS BY AGE
6,000
5,188
Cumulative numbers in Arkansas,
5,000
as of March 1, 2021* 4,502
4,000 3,775
3,291
3,000
2,247
2,000
1,204
1,000
896
281 445
151 2 4 125
0
0-5 6-18 19-24 25-44 45-64 65-74 75+
Age Group
Hospitalizations Deaths
Source: ACHI Analyses of Arkansas Department of Health data. | * Note: For Arkansas residents only. A previously reported death in the 0-5 category is under further
investigation. All death data are provisional and subject to change based on further review by the Arkansas Department of Health.ADJUSTED RELATIVE RISK OF SEVERE OUTCOMES
FOR SELECTED CONDITIONS
Hospitalization ICU admission Intubation Death
Immunocompromised +90% +100% +110% +90%
Kidney Failure +80% +100% +120% +80%
Congestive Heart Failure +70% +110% +130% +60%
Diabetes +80% +100% +120% +60%
Dementia 0% 10% -20% +80%
COPD +60% +70% +70% +60%
Mental and Behavioral
Disorders +20% +20% +20% +50%
Asthma +50% +40% +60% +30%
Coronary Heart Disease +50% +40% +50% +30%
Other Heart Diseases +10% 0% -10% -10%
Note: As of Feb. 15, 2021. Sample size more than 80,000 COVID-19 patients, chosen based upon data availability.ARKANSAS DEATHS PER DAY COMPARISON
Deaths per Day in 2020-21 compared to
Average Deaths per Day in 2014-2019
Source: Health Care Cost Institute, Retrieved March 3, 2021. https://healthcostinstitute.org/hcci-research/daily-deaths-during-coronavirus-pandemic-by-stateLEGISLATIVE UPDATE: BILLS PERTAINING TO PUBLIC HEALTH AUTHORITY o SB 378: Permits Legislative Council or Joint Budget Committee to request detailed expenditure plan for unanticipated emergency funds related to health; cannot be spent unless plan approved o SB 379: Sets up process for review, extension of public health emergency declarations; would authorize General Assembly to deny renewal after 60 days by concurrent resolution. Both bills given "Do Pass" recommendations by Senate Public Health, Welfare and Labor Committee on Wednesday
LEGISLATIVE UPDATE: BILLS PERTAINING TO PUBLIC HEALTH AUTHORITY o SB 15: Requires suspension of any rule or regulation by the governor under an emergency declaration to expire after 30 days, unless approved by concurrent resolution of General Assembly or resolution of the Legislative Council o SB 301: Requires Department of Health and Alcoholic Beverage Control Division to return fines collected between March 2020 and March 2021 o Passed Senate on Feb. 25 (Yes: 19, No: 14)
COVID-19 DIRECTIVES CHANGED TO GUIDANCE Effective Feb. 26 o Business Limitations o Restaurant Dine-in Operations o Bar or Club Operations o Barber Shops, Body Art Establishments, Cosmetology Establishments, Massage Therapy & Medical Spas o Casinos o Gym, Fitness Center, Athletic Club & Weight Room Source: Arkansas Department of Health
DIRECTIVES CHANGED TO GUIDANCE, CONTINUED o Large Outdoor Venues o Indoor Venues o Community & School-Sponsored Team Sports o Community-School Sponsored Music & Theater Return to Play o Long-Term Care Facilities Visitation, Screening & Staffing o Resuming Elective Procedures, Phase IV o Resuming Elective Dental Services o Approval of Emergency Responder Activities Source: Arkansas Department of Health
SARS-CoV-2 illustration: CDC
COVID-19 LONG-TERM EFFECTS
o Organ damage
o Heart
o Lung
o Brain
o Blood Clots
o Mood and fatigue issues
o Many others still unknown
Source: Mayo Clinic, COVID-19 (coronavirus): Long-term effects. https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351COVID-19 PATIENTS EXHIBIT HEART DAMAGE o JAMA study of recovered patients: 78% had structural heart damage, 60% had myocarditis* o JAMA study of COVID-related deaths: 41% of older individuals exhibited evidence of the virus infecting the heart** o Preliminary study of Big 10 student-athletes: nearly 15% of COVID-positive athletes showed signs of myocarditis*** * Puntmann VO, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. July 27, 2020 ** Lindner D, Fitzek A, Bräuninger H, et al. Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases. JAMA Cardiol. Published online July 27, 2020 *** Penn State clarifies remark by doctor about myocarditis and covid-19 positive Big Ten athletes, Washington Post, Sept. 3, 2020.
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