Many people have concerns and questions regarding when the COVID-19 vaccinations will be available to our patients and the community. With the rapidity of vaccine development and only recently being approved by the FDA, vaccine production and distribution will take time to catch up to the global demand. As the vaccine becomes available, the plan is to distribute it as rapidly as possible. We will continue to keep the community updated as information becomes available to us. We kindly request your patience during this time. Thank you.
Read the detailed advisory below:
Coronavirus (COVID-19) Advisory 24 December 2020
Cases of COVID-19 are occurring in Florida and locally at an increased rate compared to a month ago. Local hospitalization numbers for COVID are at the highest they have been and rising. On December 23, 2020 there were 94 patients with COVID in the 2 hospitals with 19 patients in intensive care. Only one is requiring a ventilator. This is consistent with the trend we have seen of late. TVH has seen an increase in positive test numbers in our test sites as well as among our staff who are treating patients. There are anecdotal reports of increased positive tests in hospital staff as well.
Since the last advisory, two vaccines have Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA). A third is expected to receive review and approval in January 2021. Governor Desantis signed Executive Order 20-315 (link below) prioritizing the order of those who will be vaccinated. The prioritization is guided by preventing death. The groups prioritized include front line health care workers who take care of patients. If they are infected, they risk infecting people who are already sick enough to be in the hospital or have other illnesses that put them at risk. Residents of long-term care facilities as they represent about 5% of cases but 38% of deaths. Residents over 65. Using age is the easiest criteria to administer and removes all individual judgment. Case fatality rate is the percentage of those who get infected who die. Case fatality rate in those over 85: 23.7%, 75-84: 11.4%, 65-74: 4.5% and 55-64: 1.4%. Below age 55 case fatality rate is well below 1%. The only place where individual judgment is included is hospital providers may vaccinate persons they deem to be extremely vulnerable to COVID-19.
The biggest issues with the two approved vaccines are production and distribution. It is not clear when these will be widely available, but there is great focus on speeding this along. Approximately 100,000 doses of the Pfizer vaccine have been distributed and Florida is preparing to receive 367,000 doses of the Moderna vaccine. Virtually all these initial doses are going to hospitals to vaccinate front line providers and to residents of long-term care facilities. As more vaccines become available, the plan is to use it. The Pfizer and Moderna vaccines each require 2 doses. The Janssen vaccine may be available in January and only need 1 dose, although they are looking at whether a second dose at 57 days may be helpful. All producers are working to meet global demand. In Florida there are 4 million residents over the age of 65 so there will need to be a supply of 8 million vaccine doses to cover these folks. The Villages Health, in conjunction with the local Department of Health, the University of Florida hospitals and likely others are working to put together a plan for a community based broad vaccination program. Expect the program to be on-line sign up, drive through with space for 15-minute observation after the vaccination, and an automated reminder system for the second dose of vaccine. Many of the logistics will be similar to the broad-based testing that occurred with the University of Florida and The Villages Health in April and May of this year.
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 pneumococcal 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. The three vaccines developed work to get the body to produce a protein that your immune system responds to that should protect against COVID-19. All have been projected to be 90-95% effective. There is no chance of catching COVID from the vaccine. These are a direct result of Operation Warp Speed (link below).
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 6,500 tests run and overall positive rate is over 8%. Peak day testing has been about 13%. Another 5,000 test kits were recently requested 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 on-line 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 and with increased prevalence there is also a higher likelihood of exposure. While there is scattered evidence of “pandemic fatigue”, maintaining vigilance is important. In many parts of the country the increased risk of COVID infection led to a second round of shutdowns, 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 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 5 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.
As we move into the holiday season, 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 6 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 is 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:
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.
Jeffrey Lowenkron, MD
Chief Medical Officer
The Villages Health