12/08/2020
To our general Health The Villages Health
An Important Message from Our Chief Medical Officer, Jeffrey Lowenkron, MD
Coronavirus (COVID-19) Advisory - December 8, 2020
Cases of COVID-19 are occurring in Florida and locally at an increased rate compared to a month ago. Since the last advisory Florida has surpassed one million cases and is approaching a prevalence for the entire pandemic of 5% of the state being tested positive for COVID. As of December 4, there are 3,681 cases in Sumter County, with 268 occurring in the last week. In Lake County, there are 10,985 cases with 565 occurring in the last week. In Marion County, there are 13,763 cases with 867 occurring in the last week. As of Saturday morning, there were 25 patients in the UF The Villages Hospital and 25 in UF Leesburg Hospital. Fourteen of these patients are in intensive care with three on ventilators.
Hospitalization has been climbing with average daily totals moving from the 20s to 30s to 40s over the last three weeks and now at 50. Hospitalization peaked on July 21 with a total of 81 patients at the two hospitals. While it is true that the number of positive cases is related to more widespread testing, the increase in percentage testing positive indicates an actual increase in spread.
At The Villages Health, we care for almost 60,000 patients. As of December 4, we know of 356 cases with 75 hospitalizations and eight deaths. There are likely cases among our patients we have not heard about. We likely heard about nearly all our patients who were hospitalized or died. Our employees are also not immune. As of December 7, we have tested 73 team members with 22 being positive and 51 negative. All 22 team members are back at work having completed the necessary quarantine period. Most health care workers, whether at hospitals, nursing homes or our care centers have their exposures outside of work.
TVH has been running rapid testing with support from the State of Florida using Abbott Labs Binax tests supplied by the federal government. To date, TVH is approaching 4,000 tests run and overall positive rate is over 7%. Peak day testing has been about 13%. Another 5,000 test kits were recently received so testing will continue. There is no cost for testing, and you do not have to be a TVH patient to be tested. Testing is being offered at our Brownwood and Creekside Care Centers by online appointment. The website is www.tvhcovidtest.com with availability on first come, first served basis.
As Florida moved into Phase 3 in September, there have been more people out and about with a higher likelihood of exposure. While there is scattered evidence of “pandemic fatigue,” maintaining vigilance is important. As cases have surged in multiple places around the state, country and world, locally case increases have also occurred. In many parts of the country, the increased risk of COVID infection led to restrictions on elective procedures being re-enacted; yet locally, that directive has not been given.
Communities where large populations of seniors live, are advised to take proactive steps to reduce the risk of disease transmission. The Villages® Community is the nation’s largest 55 and older active living community.
Seniors who have serious medical conditions, such as heart or lung disease, diabetes, or conditions reflective of weakened immunity, are at even higher risk. These individuals can make decisions that reduce their risk of getting COVID-19. They should consider postponing participation in large scale social events, particularly those events held indoors with multiple close contacts. Everyone can help reduce the risk of community spread until the magnitude and severity of this infection is more widely known and understood.
For mild or moderate disease, Bamlanivimab received Emergency Use Authorization from the FDA. It is intended for use in infected patients within five days of symptoms who are at higher risk of hospitalization. It may be harmful for those with more severe illness. In a small demonstration study, it was shown to reduce the likelihood of being hospitalized with no effect on mortality (link for more information below). There are approximately 25 doses available in the community through the hospital. It is a one-hour infusion followed by one hour of observation. Given the limited availability, for most with mild or moderate illness, rest, fluids, quarantine, and time are often the recommended treatment. Many different treatments are being tested and have their advocates and detractors. The science is not there yet for recommendation. Of recent studies completed, it is unlikely that hydroxychloroquine or azithromycin will be effective for treatment. For those with severe disease, in intensive care and on ventilators, there are two medications that help with symptoms and survival: dexamethasone and remdesivir. There is an ongoing study of interleukin 6 inhibitors nationally. None of these are intended for prevention and should not be taken outside a hospital setting.
There has been remarkable progress made toward a usable vaccine. It is not clear when these will be widely available, but there is great focus on speeding this along. Some general information about vaccines and what to expect: Flu vaccines are crafted each year based on predicted strain. The effectiveness ranges from a low of about 15% to a high of about 60%. There are two vaccines to protect from pneumococca infections: Prevnar 13 which protects against 13 strains of pneumococcus and Pneumovax which protects against 23 strains. These are typically 50% to 85% effective. The rapid pace of development of the COVID-19 vaccine means we will have to learn about effectiveness after use. If it is 50% effective it means that those who are exposed to COVID-19 reduce their risk of getting sick by half. There are two vaccines both developed through the same technology and both claiming 90-95% effectiveness. Both work to get the body to produce a protein that your immune system responds to that should protect against COVID-19. There is no chance of catching COVID from the vaccine. These are a direct result of Operation Warp Speed (link below).
As we move into Phase 3 of reopening, the best way to continue progressing back to normal is maintain practices that reduce the likelihood of spread.
Everyone can help by taking the following actions:
People should not attend in-person events if they are sick
Social distancing of at least six feet is important
Consistent mask wearing is advised
Frequent handwashing, avoid shaking hands and minimize hand-to-face contact
Cover your nose and mouth when sneezing and coughing, then wash your hands
Avoid interactions that last 15 minutes and are within six feet of others, especially without masks
Flu vaccines are available and people should strongly consider vaccination.
The Villages Health current actions to create a safer environment:
Temperature checks and questionnaire for all staff, patients and guests who enter a care center.
Employees who are ill or exposed are being quarantined at home until safe for return to work
Social distancing practiced throughout the workplace
Required mask use for all in the care center (patients and guests are provided masks if they need them)
Telephone triage to help assess risk, need for testing and need for aggressive care like hospital visits
COVID-19 testing, if recommended, is performed in the parking lot to avoid potential infection of others
Patients will be called and offered a telehealth visit to provide needed care without risk of exposure in a care center
Four resources for more information:
https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html
http://www.floridahealth.gov/diseases-and-conditions/COVID-19/
https://www.hhs.gov/coronavirus/explaining-operation-warp-speed/index.html
https://www.fda.gov/media/143602/download
The Florida Department of Health has established a call center for general questions at 866-779-6121, which is manned from
8 AM – 5 PM. Specific questions related to guidance may be directed to the Sumter County Health Department at 352-569-3102.
The Villages Health is working hard to keep you safe while also assuring we take care of your health care needs. As we all work together, we will continue our path to becoming America’s Healthiest Hometown.
Sincerely,
Jeffrey Lowenkron, MD
Chief Medical Officer
The Villages Health
