Brief Update from John Hopkins Center for Health Security
UNITED STATES The US CDC reported 1.30 million total cases (26,660 new; 81,630 since Friday’s briefing) and 78,771 deaths (1,737 new; 5,474 since Friday’s briefing). The United States could potentially reach 1.5 million cases by early next week. In total, 8 states (1 new) reported more than 40,000 cases, including New York with more than 300,000; New Jersey with more than 125,000; and Illinois and Massachusetts with more than 75,000 each. Additionally, 35 states (no change), plus Guam, are reporting widespread community transmission.
On May 8th, 2020, Oregon counties were given the opportunity to apply for Phase l given they follow seven prerequisites.
Phase 1 is followed by Phase 2 & Phase 3. Governor Kate Brown mapped out Oregonians’ future as we navigate the muddy waters of SARS-CoV-2 and prepare to re-open. The 7 prerequisites are:
1. Declining COVID-19 Prevalence 2. Minimum Testing Regimen 3. Contact Tracing System 4. Isolation/Quarantine Facilities 5. Finalized Statewide Sector Guidelines 6. Sufficient Healthcare Capacity 7. Sufficient PPE supply Certain prerequisites are done by health region; such as, 2, 6, & 7. The state is responsible for number 5. So that leaves 1, 3, & 4 for the county. A few details
In each county, hospitalizations for COVID-19 must decline for 14 days (only applies to counties with 5+ hospitalized cases in the last 28 days) and emergency department, ED, visits must be below the historic average for flu at the same time last year. May through September is considered off-season for the flu, so ED visits for influenza-like illness historically decline at this time. The Oregon Health Authority, OHA, says, normally 0.7% of Oregonians will go to the ED for flu-like symptoms. “If our normal percentage of ED visits for the flu or flu-like symptoms during the off-season goes above 1.5%, we will need to re-examine our plans for reinstating COVID-19 protections for the entire state.” Regarding number 3, contact tracing, counties must have 15 tracers per 100k population, able to trace 95% of contacts within 24 hours.
Phase 1
If Oregon completes these prerequisites, we enter Phase 1 by county starting May 15th, 2020. Phase 1 will allow the opening, with certain requirements like continued physical distancing and adequate sanitation, of restaurants, bars, personal-care professions like hairstylists, massage, gyms, and local gatherings of up to 25 people. Also starting May 15th, 2020, childcare, camps and youth programs will open as well as stand-alone retail (jewelry shops, boutiques). Day use at state parks where physical distancing can be followed opened on May 5th, 2020; although, starting May 11th, 2020, the Oregon Department of Forestry closed dispersed camping due to recent sanitation problems. They project re-opening in a couple weeks, while gently reminding campers to pack it in, pack it out, and dig at least a 6 inch hole to poop in. “The closure applies to dispersed camping on the Tillamook, Clatsop, Santiam, Sun Pass and Gilchrist state forests as well as all other lands managed by the Oregon Department of Forestry.” All campgrounds in Oregon and Washington remain closed. Forest roads and trails remain open.
https://oregonforestry.wpengine.com/2020/05/08/dispersed-camping-in-state-forests-temporarily-closed-effective-monday-may-11/
Phase 2 & 3 After 21 days in Phase 1, we may be able to enter Phase ll. The details of Phase 2 and Phase 3 are still being hammered out and depend on Phase l’s outcome. At this point, all large gatherings such as concerts and festivals are canceled or must be modified through September. We can expect further guidance in the summer. You can watch a video and learn more here: https://www.youtube.com/watch?v=1zSz5tb5SMw&feature=youtu.be&t=257s
Learn more about the guidelines and requirements specific to industries, outdoor recreation, retail shops, service providers, etc, here: https://www.oregon.gov/oha/ERD/Pages/covid-19-news.aspx
Update on COVID-19 Testing
Serological tests or antibody tests are not used to diagnose a person with COVID-19. These tests can tell us if someone has been exposed to SARS-CoV-2.
The FDA reminds us,
During this pandemic, there have been two types of tests for which the FDA has issued EUAs. One type are polymerase chain reaction (PCR) tests, a molecular diagnostic testing technique that detects the genetic material from the virus and can help diagnose an active COVID-19 infection. The other type are serological tests that look for antibodies to the virus, which can help identify individuals who have developed an adaptive immune response to the virus, as part of either an active infection or a prior infection (serological, orantibody, testsshould not be used to diagnose active infection).
*EUA stands for Emergency Use Authorization.
As I've stated before in a previous post, the PCR test is the one we've been using to diagnose COVID-19 infections. Antibody tests came on the scene most recently. And it looks like there is a new kind of test since May 9th, 2020. Details further below.
Below is a summarization of an interview with immunologist and integrative health expert, Dr. Zwickey: An interview on May 1st, 2020 about COVID-19 antibody testing. https://vimeo.com/414112097/c7d8e40186
There are over 120 labs that have developed antibody tests. Not every test can be trusted. More recently, the rapid finger prick test was resulting in many false positives as it was specific for the more common strain of coronavirus, the common cold. The top method of detecting antibodies is chemiluminescence because of increased sensitivity, but it’s important to consider what the test is specific for.
Chemiluminescence, CLIA, diagram from www.centerforhealthsecurity.org
What we don’t know:
- If antibodies confer immunity (if we can get reinfected and how often)
- The length of time we can shed the virus (at least 42 days)
- The length of the latency period (the time of infection to onset of symptoms; up to 20 days). Therefore, asymptomatic carriers may be in a latency period.
- ... and so much more.
For most people we can see antibodies IgM and IgG at 21 days since onset of symptoms. There may be additional shedding or ways of transmission, because since shelter in place, the curve has flattened but not gone down as we would expect. Dr. Zwickey's Recommended Resources: www.centerforhealthsecurity.org www.covidtestingproject.org
Now, more about the new antigen test:
The U.S. Food and Drug Administration has issued the first emergency use authorization (EUA) for a COVID-19 antigen test, a new category of tests for use in the ongoing pandemic. These diagnostic tests quickly detect fragments of proteins found on or within the virus by testing samples collected from the nasal cavity using swabs. The EUA was issued late Friday to Quidel Corporation for the Sofia 2 SARS Antigen FIA.
The advantages of the antigen test is that it can provide results in minutes and is very specific, which means positive results are highly accurate and negative results do not rule out an infection. These tests are also cheaper and will likely increase testing capacity in the US. The PCR test in contrast, takes longer for test results, is highly sensitive, and more expensive, which somewhat explains why testing has been scarce.
You can find a list of tests that have been approved for diagnostic in the United States here.
Here's to safety, health, and freedom! May we learn from this pandemic and become even more resilient. In health, Katherine Souza, ND, LAc
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