Local Challenges with Disease Prevention · Treatment Update • Hospitalized patients with severe COVID -19: dexamethasone or remdesivir or both, depending on oxygen or ventilatory

COVID-19 Update

Catherine M Bodnar, MD, MPHMedical DirectorMidland County Department of Public Health

Contents

• Risk Reduction………………..…3• Contagiousness……………….…4• Community assessment……..5• Ethnic & Racial Disparities….6• Michigan Update………………..7 – 9• Travel………………………………….10• Treatment…………………………..11 – 12• Vaccine Update…………………..13

How Do We Open Up & Stay Open?We need to learn to live with COVID-19 until we have definitive treatment &/or a safe and effective vaccine!

Non-pharmaceutical Measures to Reduce Risk of COVID-19• Socially distance: Stay at least 6 feet (about 2 arms’ length) from other people

• Stay out of crowded places and avoid mass gatherings• Do not gather in groups

• Use face coverings when in public spaces indoors and when unable to maintain social distance outdoors • Wash hands often with soap and water for at least 20 seconds, especially after going to the bathroom,

before eating and after blowing your nose, coughing or sneezing• If soap and water are not readily available, use an alcohol based sanitizer with at least 60% alcohol• Always wash hands with soap and water if hands are visibly dirty

• Avoid touching your eyes, nose and mouth• Staying home when sick• Covering coughs and sneezes• Throw used tissues in the trash right after use• Routinely cleaning frequently touched objects and surfaces using a regular household cleaning wipe or spray

Reference: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/index.html

R naught (R0)

Target: Effective R0 <1

Assessment Of COVID-19 in the Community

• Case Rate: 7 day rolling average standardized to # cases/common denominatorcommonly used: cases/million population or cases/hundred thousand population

• Percent Positivity: 7 day rolling average of the number of cases that test positive/total number of tests

• Outbreaks: two or more confirmed cases + at least two cases have symptom onset within 14 days of each other + evidence of transmission in a shared location other than a household

Highly Transmissible in Close Personal Setting• Social Gatherings• Nursing Facilities• Health Care Settings• Manufacturing Facilities• Restaurants

References: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/index.htmlhttps://www.jhsph.edu/covid-19/articles/covid-19-testing-understanding-the-percent-positive.html

Stay home when sick!Increased transmission seen because people with COVID-19 symptoms are not staying home.

Disproportionate Impact

Michigan Coronavirus Task Force on Racial Disparities

• African Americans make up 14% of state’s population, yet 40% of COVID-19 deaths

• The task force is studying the causes of racial disparities and recommend actions to address the historical and systemic inequities.

References:https://covidtracking.com/racehttps://www.michigan.gov/mdhhs/0,5885,7-339-71551_5460_99929---,00.html#:~:text=Michigan%20Coronavirus%20Task%20Force%20on,of%20the%20deaths%20from%20coronavirushttps://covid.cdc.gov/covid-data-tracker/#demographics

Michigan Update

Reference: https://covidactnow.org/?s=1019215 29September2020

Michigan Update

Reference: https://covidactnow.org/?s=1019215 29September2020

Michigan Regional Update

Reference: https://www.mistartmap.info/ 25Sept2020

8 Regions in MIDetroitGrand RapidsJacksonKalamazooLansingSaginaw Traverse CityUpper Peninsula

Public Health Capacity = Daily Tests/Million

7 day average

Travel• Staying home is the best way to protect yourself and others from COVID-19.• Is COVID-19 spreading at your destination?

• Check Each State’s Cases in the Last 7 Days• Travel Recommendations for Destinations Around the World

• Considerations• Do you live with someone who might be at risk for severe illness?• Are you at increased risk?• Does your destination have requirements or restrictions for travelers?

• Some high risk travel activities• Going to large social gatherings – weddings, funerals, or parties.• Attending mass gatherings like a sporting event, concert, or parade.• Being in crowds – restaurants, bars, airports, bus and train stations, or movie theaters• Traveling on a cruise ship or river boat.

https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html

Treatment Update• Hospitalized patients with severe COVID-19: dexamethasone or remdesivir or both, depending on oxygen or ventilatory

requirements• Severe COVID-19 on supplemental oxygen (including high-flow oxygen and noninvasive ventilation), remdesivir, if available, and low-

dose dexamethasone. (Grade 2C).• Severe COVID-19 requiring mechanical ventilation or ECMO, low-dose dexamethasone (Grade 1B).• Remdesivir, if available, for patients who have been intubated for a short period of time (eg, 24 to 48 hours) (Grade 2C).• Caveats:

• Prioritize remdesivir for patients who are on low-flow oxygen• If dexamethasone is not available, other glucocorticoids at equivalent doses are reasonable alternatives.

• Convalescent plasma for treatment of COVID-19 is uncertain, but it may provide a clinical benefit for some patients.• In August 2020, the US FDA issued an emergency use authorization for convalescent plasma for patients hospitalized with COVID-19 • Convalescent plasma with high antibody levels, administered early in the disease course, is a reasonable option for hospitalized

patients• Two randomized trials and several observational studies have suggested that convalescent plasma containing high levels of antibodies to

SARS-CoV-2 may reduce mortality when given to hospitalized patients early in the course of disease• These studies are limited by small size, imprecision, and/or potential confounding factors, and some are yet to be peer reviewed.• Some hospitals do not routinely use convalescent plasma for COVID-19 outside of a clinical trial.

• Prophylaxis of venous thromboembolism consistent with recommendations from several expert societies• ISTH interim guidance on recognition and management of coagulopathy in COVID-19.

Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, Clark C, Iba TJ Thromb Haemost. 2020;18(5):1023. Epub 2020 Apr 27

• https://www.hematology.org/covid-19/covid-19-and-vte-anticoagulation• https://www.sccm.org/SurvivingSepsisCampaign/Guidelines/COVID-19

Reference: UpToDatehttps://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-management-in-hospitalized-adults?search=covid-19%20treatment&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Copyrights apply

Vaccine Update

Reference: https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html

Coronavirus Vaccine Tracker:Updated 9/30/20

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