Dear Colleagues,
I hope everyone had a nice and safe Thanksgiving. Aimee has invited me to share a COVID-19 Update this week on testing capabilities and vaccine distribution planning.
First, Solano County and NorthBay by the Numbers:
- Solano County’s latest data shows a 7-day testing positivity rate of 12.3. This is double compared to October. There have been several days in recent weeks with daily reported cases above 150. As a comparison, the summer’s highest daily case peak was 129 on July 8. County hospitalizations were reported yesterday at 63, approximately triple compared to a month ago.
- Solano has exceeded 10,000 cases to date.
- Our NBMC COVID inpatient census this morning is 23 with 9 requiring an ICU level of care. Our inpatient COVID volume has been gradually trending up just not to the magnitude we are seeing in the county and state. We anticipate a continued rise in hospitalizations in the coming weeks following the multi-generational holiday gatherings. We will monitor this closely and are ready to activate our surge policy as necessary.
- Our urgent care centers continue to see very high utilization with 30 positive tests received over the four-day holiday weekend. Our new Center Primary Care overflow drive-thru testing sites have been in place for several days. As of yesterday, we tested 17 patients with 4 positive cases.
The Solano numbers are sobering, reflecting the state and national trends of late. While NorthBay’s census is high in inpatient and ambulatory settings, you are all doing great work to manage throughput well with minimal need for Code Capacity discussions or use of our surge plan.
Where Are We With Testing?
Throughout the pandemic, our highest priority has been staff safety. If we cannot protect our NorthBay family, we cannot care for patients and our community. Testing is essential.
Our lab and supply chain leadership dedicate significant resources researching and securing maximum testing capability. These efforts sometimes result in quick changes, accompanied by confusing emails and complex algorithms.
This may be more than you want to know, but here is – in detail – a review of the COVID tests we have available now, how we are using them and the stability of our supply.
Hospital-based PCR tests: We are fortunate to have two types of PCR tests available in our hospital labs - BioFire and Genmark. These are high-accuracy nasopharyngeal swabs that can detect small viral loads. They are close in accuracy to the best testing available at Quest and through our county lab, but with the benefit of providing results within hours, not days. A high-sensitivity test is a mixed blessing. It picks up virus particles late in the lifecycle of the disease when a patient may no longer be contagious. However, it can also turn positive early on when a patient is just starting to be contagious, possibly before symptoms have started. Our supply of these tests is difficult to maintain because of high demand across the country. Our allocation can often be redirected to other states suffering higher rates. With a variability in supply, it is a challenge to use these tests as part of a standardized plan. Often we have no confirmation when the next delivery will arrive. We order a BioFire or Genmark test on a case-by-case basis when there is concern that our other screening tests are incorrect, especially when the patient is asymptomatic or symptoms have been present for longer than a week.
Antigen tests: These are our most widely used rapid nasal swab tests. They are used in our hospital labs, urgent care and at our primary care curbside testing sites (only when Urgent Care is at capacity). These are similar to rapid flu swabs we have used for years. We use two brands – Abbott BinaxNOW and the BD Veritor. These have moderate accuracy, better than some tests but not as sensitive as our PCR options. We believe it has accuracy where it counts, picking up those at risk for transmission, especially patients with symptoms. We currently use these tests as a first screen for all admissions. They are also being used for symptomatic patients in our clinics and in our staff-testing algorithm.
Abbott ID NOW: This is another rapid nasal swab test by Abbott, but it uses a different technology to measure the virus. It is a bit controversial because some independent studies early in the pandemic showed low sensitivity. Since then, studies have shown mixed results. Similar to our discussion about antigen tests, we feel this test has value in identifying those that are contagious. We are currently using the Abbott ID NOW for asymptomatic staff members that have a confirmed exposure through our Command Center contract tracing program.
In summary, we are constantly monitoring and researching options to provide testing to our patients and staff. Unfortunately, despite our efforts, test supplies continue to be a scarce resource. We will continue to provide as much testing capacity as possible. Our current staff testing program includes same day results for those that are symptomatic and/or have a confirmed exposure. We are making every effort to expand this program to include routine screening tests for as many staff as possible.
Are We Getting Vaccine Soon?
The answer likely is yes. Gov. Newsom last Monday said health care workers will be offered the vaccines first. The Advisory Committee on Immunization Practices (ACIP) is voting today on this very topic. At NorthBay, we have a multi-disciplinary task force, led by our outstanding pharmacy leadership, spearheading our vaccine implementation plan. We are working with the county and CDPH learning everything we can about these vaccines. We have submitted required applications to the state. Freezers are en route. We understand every step of implementation, from shipping to injection.
What we do not know is exactly how many doses we will receive and exactly which NorthBay health care staff will be offered the vaccine during the first phase. Of course, your decision to receive the vaccine will be
voluntary.
We remain supportive and cautiously optimistic, both in the effectiveness and safety of these new mRNA vaccines (Pfizer, Moderna for now) and the ability for these companies and our government to distribute them quickly. Data coming from these companies and reported through the media are encouraging. Pfizer reported a 95% effective rate with no serious adverse effects thus far in a Phase 3 trial of approximately 43,000 participants. The most common side effects were headache (2.0%) and fatigue (3.8%). And, Moderna just yesterday released fairly similar data.
We do not rely on company reports or media summaries to safely implement new treatments and vaccines. We need to see the data ourselves. We hope independent analysis from the FDA and California will be as encouraging. We anticipate their report to be available around
Dec. 10 when the Pfizer vaccine is reviewed for an Emergency Use Authorization (EUA). When this happens, you should expect a robust summary from us discussing the effectiveness, side effects and the implementation plan moving forward.
Summary
As we approach one year from the outbreak of this pandemic, our priority remains to keep you safe so we are able to care for our community. Be assured:
· We will continue to monitor closely our current testing capabilities and research new options.
· We are prepared to implement a COVID vaccine program when a safe and effective option is available.
We have effective preventive measures at our disposal today that do not require any safety reviews or even a needle. Mask wearing, distancing and hand hygiene are very effective. Even if you are one of the unfortunate ones who contract COVID while wearing a mask, UCSF data have shown you have a lower risk of experiencing severe illness or any symptoms at all. These interventions, while unfortunately remaining controversial in some areas of our country are very effective at keeping you safe.
As Aimee eloquently wrote last week, at NorthBay we are most concerned about common areas. We know from Mayo Clinic and others that transmission within the organization, while rare, are mostly from break rooms. Please be diligent in your mask wearing and distancing. Do not eat together. Keep the mask up and we will get through this together.
Thank you for setting the example within the organization and within our community.