School Reopening: : Some Public Health Context Chesterfield County School Board July 20, 2020 Alexander P Samuel MD MPH Health Director Chesterfield Health District
Outline • Assessing Community Transmission o Metrics o Modeling • Public Health Considerations related to Reopening
General Perspective https://preventepidemics.org/covid19/science/insights/adaptive-response/
Assessing Community Transmission Synthesis of Several Metrics Number of New Cases Percent Hospital Beds Occupied Hospitals Reporting Difficulty Obtaining PPE Number of Current Hospitalizations Test Percent Positivity Percent of New Cases Reported in Healthcare workers Number of New Confirmed Outbreaks (last 2 weeks) COVID-like illness & Influenza-like illness visits and hospitalizations Number of deaths by date of death or date of report
Central Region Transmission Status (7/18/20) Current Level of Transmission: Low Transmission Trend: Steady Some Key Indicators (Metrics) • Number of Cases – increased over the past 12 days Central Region o Compared to 28 days for Virginia as a whole o Generally declining over the month of June • Case Incidence = 9.0 new cases/100,000 people o Compared to 11.1 for Virginia as a whole
Central Region Transmission Status (7/18/20) Some Key Indicators/Metrics (CONTINUED) • Percent Positive PCR Tests in the Central Region o Decreased Steadily in June o Plateaued, but was still at good level, 6.3% (Goal < 10%), Virginia is at 7.9% • The rate of outbreaks was Low at 0.03 per 100,000 o Had been decreasing for 8 days o Virginia was at 0.05 per 100,000 • The rate of current COVID hospitalizations was 9.7 per 100,000 o Steady Decline in June, increased over past 10 days o Rate was 8.2 for Virginia, with increase over past 14 days
Interlude: Brief Focus on Percent Positivity July 20, 2020 Chesterfield County • Not a measure of level of virus in a Percent Positive test results = 7.8% population • Intended to be a measure of adequacy of testing resources • People get tested multiple times • Labile indicator – changes depending on number of people who get tested
Modeling (UVA COVID-19) Chesterfield: LR-BD-S • Projections based on current case numbers and trends. Impossible to be 100% precise. 100 - • Sensitive to mitigation efforts currently in place • Observes influence of policy and behavior 50 - • Chesterfield County currently fits the scenario: Light Rebound – Better Detection - Surge 0 - Mar Apr May Jun Jul Aug Sep 2020
Takeaways – Assessing Community Transmission • No single good Indicator of Transmission • Synthesis of key indicators can help with understanding level of current transmission and direction of trends • Modeling projections (though not absolutely precise) can speak to future situation based on current context and trends • Public awareness and behavior change is key driver to reducing transmission
Other Considerations - Children & COVID-19 What we Know • Children don’t contract the virus at the same rate adults do • Children are more likely to have mild symptoms or be asymptomatic • Hospitalization and more severe outcomes are linked to underlying chronic disease What we Don’t Know • The Role of Children in Transmitting the Virus is Unclear
Other Considerations – COVID-19 and Adults • Most adults have mild symptoms or are asymptomatic • Those at Higher Risk of Hospitalization & Severe Outcomes o Older age: > 65 Years Old o Chronic Medical Conditions: High Blood Pressure, Obesity, Cardiovascular disease, Asthma, COPD, Chronic Kidney or Liver Disease
Considerations – Mitigation Approaches • STAY HOME WHEN ILL • Symptom Screening • Distancing • Aim for 6 ft, but if not possible: 3 ft minimum AND face covering • Face Covering – Encourage for Everyone • Use when minimum of 6 ft of physical distancing cannot be maintained • As is medically and developmentally appropriate • Hand Hygiene – need to teach it & establish routines! • Environmental Cleaning • Regular wiping down of high-contact surfaces
Interlude: Face Coverings
Considerations - Preparation • Training for Parents, Students, Teachers, and Staff • Ensure Mitigation Practices and other Controls are in Place • Internal Protocols for what to Do when someone becomes sick • Isolation • Communication Plans • Plans for Closure (if necessary) and cleaning • Coordinate with Public Health – case/outbreak investigation
Thank You
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