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 04.15.2021
COVID-19 IN THE UNITED STATES
At least
31,400,000
confirmed cases
At least
564,000
reported deaths
Sources: Washington Post and Johns Hopkins University, as of April 15, 2021.
COVID-19 IN THE UNITED STATES: DAILY CASES Source: New York Times, April 14, 2021 (using data from state, county and regional health department reports); www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
JHU COVID-19 DATA: NEW CASES SPREAD
April 13, 2021
Sources: Johns Hopkins Coronavirus Resource Center, from Data in Motion published April 14, 2021
DAILY CONFIRMED NEW CASES, 7-DAY MOVING AVG Source: Johns Hopkins University Coronavirus Research Center, www.coronavirus.jhu.edu/data/new-cases, retrieved April 14, 2021
EUROPEAN COUNTRIES BRING BACK RESTRICTIONS o France entered third national lockdown on April 3 o Spain introduced new rules last month requiring masks in outdoor public spaces o Poland closed non-essential shops, hotels, and other facilities last month o After re-entering lockdown in January, U.K. slowly easing out Sources: France and Poland increase lockdown measures as infections surge. BBC. March 20, 2021; UK to ease lockdown next week, will test vaccine passports. AP. April 5, 2021; How Europe's lockdowns could affect holidays from restrictions to face mask rules. The Daily Mirror, April 6, 2021.
COVID-19 IN ARKANSAS
As of April 14
Cumulative Cases: 332,666
Total Active Cases: 1,715
Hospitalized: 151
On Ventilators: 20
Daily Active
Cases per 1K
Total Deaths: 5,680
as of 4/14/21
Source: Arkansas Department of Health
COVID-19 POSITIVE TESTS SINCE SEPTEMBER Source: ACHI analysis of Arkansas Department of Health data.
Image: Picspree
COVID-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 10/1310/2010/27 11/3 11/1011/1711/24 12/1 12/8 12/1512/2212/29 1/5 1/12 1/19 1/26 2/2 2/9 2/16 2/23 3/2 3/9 3/16 3/23 3/30 4/6 4/13
Source: Arkansas Department of HealthCOVID-19 HOSPITALIZATIONS & DEATHS BY AGE
6,000
5,407
Cumulative numbers in Arkansas,
5,000 4,651
as of April 12, 2021
4,000
3,911
3,371
3,000
2,375
2,000
1,267
930
1,000
302 477
164 2 6 131
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. | All death data are provisional and subject to change based on further review by the Arkansas
Department of Health.NEW REPORTED COVID-19 DEATHS IN AR PER DAY
30
28
27
26
25
25 24
22
20 19
18
15
15 14 14 14 14 14
13 13
12 12 12 12 12
11
10 10 10101010 10 1010
10 9
8 8
7 7 7 7 7 7
6 6 6
5 5 5 5
5 4 4 4
3 3
2 2 2
0 0
0
2/15 2/23 * 3/3 3/11 3/19 3/27 4/4 4/12
-1
-5
* On Feb. 28, the Arkansas Department of Health conducted a data clean-up resulting in 174 deaths being removed due to reclassification or duplication.
Source: Arkansas Department of HealthCOVID-19 LONG-TERM EFFECTS: STUDIES o JAMA study of recovered patients: 78% with structural heart damage, 60% had myocarditis* o JAMA Big Ten Study: 15% of COVID-positive athletes had signs of myocarditis, another 30% had inconclusive evidence of strain** o The Lancet: 6 months after COVID-19 infection, 34% of patients had new neurologic or psychiatric diagnosis and 13% had first-time neurologic or psychiatric diagnosis*** * 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 ** Rajpal S, Tong MS, Borchers J, et al. Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection. JAMA Cardiol. Published online Sept. 11, 2020 *** Taquet M., et al. 6-month Neurological and Psychiatric Outcomes in 236,379 Survivors of COVID-19. The Lancet Psychiatry. doi: https://doi.org/10.1101/2021.01.16.21249950. April 6, 2021.
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)
o B.1.427/B.1.429 – U.S. (California)
o B.1.526 – U.S. (New York)
o Study of B.1.1.7 variant: more infectious, suggests higher
death rate*
o Now most common strain in U.S., CDC chief said last week**
Sources: CDC, Arkansas Department of Health
* BMJ 2021;372:n579 (R. Challen, et al. Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study); Published March 10, 2021.
** CDC says variant from the UK is now the most common strain circulating in the U.S. https://www.cnbc.com/2021/04/07/cdc-says-variant-from-the-uk-is-now-the-most-common-strain-circulating-in-the-us.htmlTRACKING THE SPREAD OF VARIANTS IN THE U.S.
1 Variant of Concern:
B.1.1.7 (discovered, U.K.)
2 Variants of Concern:
B.1.1.7
P.1 (discovered, Brazil)
2 Variants of Concern:
B.1.1.7
B.1.351 (discovered, S. Africa)
3 Variants of Concern:
B.1.1.7
P.1
B.1.351
Source: NBCNews.com. Map: Track the spread of the Covid-19 variants across the United States, updated April 12, 2021.NEW YORK TIMES VACCINE TRACKER
Updated April 15, 2021
Pfizer asked the FDA on April 9 to authorize
its vaccine for children ages 12–15
Source: Coronavirus Vaccine Tracker, New York Times: nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.htmlCOVID-19 VACCINATION PROGRESS IN ARKANSAS
All Arkansans 16 or older are eligible for the COVID-19 vaccine
Source: Arkansas Department of Health, as of April 14.COVID-19 VACCINATION PROGRESS IN ARKANSAS Source: Arkansas Department of Health, as of April 14.
VACCINES AGAINST 3 VARIANTS OF CONCERN
o B.1.1.7 (U.K.): Pfizer, Moderna remain highly effective
o P.1 (Brazil): Pfizer, Moderna are 4–7 times less effective
o Appear to be within an important "cushion of protection," particularly
after 2 doses
o B.1.351 (South Africa): Pfizer, Moderna 6–8 times less effective
o AstraZeneca vaccine was 86 times less effective against B.1.351
o J&J also less effective during clinical trials in South Africa
o J&J, Moderna, Pfizer exploring options to improve effectiveness
against variants (additional doses, reformulations, etc.)
Source: Where Do COVID Vaccines Stand Against the Variants? March 30, 2021. webmd.com/vaccines/covid-19-vaccine/news/20210330/where-do-covid-vaccines-stand-against-the-variantsCOVID-19 VACCINES AND BLOOD CLOTS
o Johnson & Johnson vaccine rollout on pause in U.S. while
FDA investigates blood clots in 6 recipients (out of 6.8M)
o Cases extremely rare (fewer than 1 per million)
o All cases were in women between 18 and 48 years of age
o One death and one hospitalized in critical condition
o AstraZeneca — not approved in U.S. — also on pause or
restricted in some countries
o J&J and AstraZenica share similar technology that is different
from Moderna and Pfizer vaccines
o Blood clots have not been observed with Moderna or Pfizer vaccines
Source: New York Times. https://www.nytimes.com/2021/04/13/us/politics/johnson-johnson-vaccine-blood-clots-fda-cdc.htmlCDC GUIDANCE FOR FULLY VACCINATED PEOPLE
o Fully vaccinated defined as:
o 2 weeks after single-dose vaccine OR the second dose in 2-dose series
o Fully vaccinated individuals can gather:
o Indoors with other fully vaccinated people w/o masks
o Indoors with unvaccinated people from 1 other household w/o masks,
unless they or someone they live with is at high risk
o If exposed to COVID-19:
o No need to isolate or get tested unless you develop symptoms
o Except in group living: isolate 14 days & get tested, even w/o symptoms
Source: Centers for Disease Control and Prevention, updated April 2, 2021, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.htmlFULLY VACCINATED? WHAT HAS NOT CHANGED
o Wear a mask, stay 6 feet apart, avoid crowds:
o In public
o At gatherings with unvaccinated people from more than 1 household
o When visiting with unvaccinated people at high risk
o Continue to avoid medium- or large-sized gatherings
o Watch for symptoms, especially if around someone sick
o If you develop symptoms: get tested, stay home
o Continue to follow guidance at your workplace
Source: Centers for Disease Control and Prevention, updated April 2, 2021, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.htmlCDC GUIDANCE ON DOMESTIC TRAVEL
o Recommended to delay
travel unless fully vaccinated
o Fully vaccinated travelers:
o Don’t need to get tested, unless
destination requires it
o Don’t need to self-quarantine
o Should still wear masks, stay 6
feet apart, wash hands often
o Self monitor after travel & Photo by Ashim D’Silva on Unsplash
follow all local requirements
Source: CDC. Domestic Travel During COVID-19, updated April 2, 2021. https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.htmlENGINEERING MODEL SHOWING VENTILATION IMPACT
INFECTED
STUDENT
Source: Why Opening Windows Is a Key to Reopening Schools, The New York Times, Feb. 26, 2021. nytimes.com/interactive/2021/02/26/science/reopen-schools-safety-ventilation.htmlSCENARIO 1: CLASSROOM WINDOWS CLOSED
Dense reddish fog shows high
INFECTED STUDENT concentration of contaminants
spreading far beyond 6 feet
from the infected student. The
pattern would be different, but
the buildup similar, no matter
where the student was seated.
Source: Why Opening Windows Is a Key to Reopening Schools, The New York Times, Feb. 26, 2021. nytimes.com/interactive/2021/02/26/science/reopen-schools-safety-ventilation.htmlSCENARIO 2: WINDOW OPEN
WINDOW OPEN
With the window open, the
INFECTED STUDENT
concentration remains densest
near the infected student, but
contaminants are diluted in the
rest of the room. Exposure for
other students is reduced.
Source: Why Opening Windows Is a Key to Reopening Schools, The New York Times, Feb. 26, 2021. nytimes.com/interactive/2021/02/26/science/reopen-schools-safety-ventilation.htmlSCENARIO 3: FAN BLOWING & AIR CLEANER
FAN
With an air cleaner and a fan,
INFECTED STUDENT
overall concentration levels are
at their lowest. Contaminants
are concentrated at the front
where the fan is blowing and
diluted everywhere else.
AIR CLEANER
Source: Why Opening Windows Is a Key to Reopening Schools, The New York Times, Feb. 26, 2021. nytimes.com/interactive/2021/02/26/science/reopen-schools-safety-ventilation.html2021 COVID-19 STRATEGY
Action
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