Facebook Live 12/2- Answers

Hello everybody. Good to reconnect. So glad to be out of special session. We are rapidly preparing for the upcoming session with legislation and ideas of things that we think are really important to help solve some problems in Virginia; problems which have come to the forefront after the last many months. We’ve also been tracking them for a while and trying to come up with some viable solutions. So, more about that later. Today we’re going to do an update on COVID, and I think that’s appropriate because we are definitely seeing an uptick in the number of positive tests that are coming back. That has been getting a lot of conversation and hypothesis about what that means. We always need to have a conversation about what data matters. So, I’m going to show you some slides that we can look at real quickly and we'll go to the first one. Look at this slide which is all from the Virginia Department of Health, it’s from Sunday-Monday, which is when I went in and pulled some of this data for another presentation. I want to go through the data and some of my concerns about it. The first is here, this is legitimate, you can see following the yellow line, which is kind of the 7-day moving average, that there are more positive cases that we’ve demonstrated across Virginia over time. Next Slide. So, when you look at that though, and you look at hospitalizations there’s definitely a little uptick. But if you follow the line from June 1 though August back down in October and up again, you’ll see that’s kind of an undulating curve that is going back and forth over time. The problem with some of this data, for starters, is that it’s much more helpful if you look at it regionally because what we’re seeing now is the hospitals that are being utilized and the places where hospitalizations are happening are now happening in different places than they were back in May. That’s kind of a part of the conversation I want to have today. There’s the initial kind of infection rate, death rate, onslaught of COVID-virus. What we’re looking at now seems to be consistent with the endemic, or persistent rate of infection we’re going to see over time, in the general public. That is often expressed by moving though different regions that previously didn’t get exposed to it that now have to develop some immunity and maybe have some at risk populations that are being infected. It's important to note that you can’t look at Virginia as a whole and that’s part of the mistake the state is making. We’re not looking at this data on a week-to-week basis regionally. That is instructive of decisions we need to make to protect and to respond. Next slide. This goes to that information. If you look again, this is now the number of deaths in Virginia over time. You can clearly tell that when we were first exposed to this virus and when we were seeing a lot of cases in Northern Virginia, Central Virginia, and Tidewater that we had a great big spike. We had a lot of vulnerable populations that got exposed. We didn’t have great precautions. We hadn’t gotten our supply chain up to grade and that’s why we had a temporary shutdown then. It was to catch up with the virus and get ahead of it. Come over here and you look at this across time in a more even plane (which is the second half of the slides toward your right) and you’ll see that undulating curve where there is really a kind of window of deaths that are happening but there’s no serious spikes that are particularly high after the first infection. There seems to be a couple of exceptions but basically this is an undulating curve because it's not a particular spike. It’s more endemic or what we’re going to see long term. This is the lines were going to have to learn to battle long term base it's going to continue to take victims in the at-risk population. We’re trying to minimize that, but it’s a virus that’s hard to control. We need to keep it from big spikes but we’re not going to keep it away all together. Maybe with a vaccine, but there is going to be some ongoing illness associated with COVID. The other important factor to know about these slides and this data is, again all of Virginia is in these slides. If you look at these slides and you look at localities separately you would see that Northern Virginia, Tidewater, and Central Virginia make up most of the early curves that you see but they really don’t have many deaths. Now, Northern Virginia does have a little bit of a spike. If you look at Southwestern Virginia, they’re the ones now that are having high hospital occupancy and having more of the deaths. Next Slide. This also is informative. When you look here, remember our target is to keep our percent positive rate below 10%. We’ve been doing that a long time. We’ve been doing that since June if you look at this curve. It’s definitely been better than it is now. The percent positivity has a lot to do with the number of tests we’re doing. Look at how many tests were doing as evidenced by the blue bars there over time. So, we’re doing more tests but we’re finding that we’re reaching a steady state. It’s not zero but it’s more of a steady state that we’re seeing in percent positive. Next Slide. Great. This is important but I’m going to break from the slides for a minute and talk about what some of this means. So just to talk about this for a few minutes and get some basic concepts in here. The reason I have a problem with the data is that when you look at those curves it doesn’t tell us what we need to do to actually respond to the people in need. Particularly, if you’re following the news what we’re seeing is that the hospitals in Southwest Virginia are definitely under assault. They have much higher occupancy rates than other places in Virginia. The biggest challenge they have is not PPE, it’s not ventilators (we’re going to look at that later on). Virginia is only using 27% of the ventilators we have. In fact, one of the big booms that we have, that knowledge we have gained over the past many months, is that we have people that are hospitalized but we have so few people that are in the ICU’s now or using ventilators because we’re getting better on treating the virus. So, we’re definitely seeing a shift in what it means to get the virus, what it means to be sick with the virus, and we’re seeing a much reduced death rate with those who do get the virus even though we are seeing some communities and localities who are maybe seeing the virus for the first time as it moves thorough the geography of Virginia. When I look at the news coming out of Southwest Virginia, the most important limit that is making it hard for us to manage COVID is healthcare workers. Just in that region, we have nurses that are worn out because they are working extra shifts and they have high occupancy rates. If we were following data in an instructive and instrumental way, the conversation we would be having right now is how do we mobilize healthcare workers from the rest of Virginia and get them where they’re needed so we can have respite for providers down in the areas where it is now causing higher occupancy and higher demands. We’re still waiting on the Virginia Department of Health to institute some of the changes I legislated in Special Session which would give us week over week what the new infections are. It’s very hard to follow and do that by demographic. So, it’s very hard to follow this virus when we don’t know who is getting it. There are many scientists who are now saying we shouldn’t be following testing data at all. PCR data, that polymerase chain reaction data, which is the test you do which takes a few days to get back is all that we’re measuring. Again, we’re not measuring rapid tests. That PCR data is not a great metric to follow. We need to be following hospitalization rate, where it’s happening regionally, what the needs are for that region, and of course death rate. So, that’s just a little bit about data overall and where we are. Let's go back to those slides now and kind of go to the next step in the conversation. All of this relates to what do we do next. I think this is a very informative slide off of the Virginia Department of Health. It’s looking where the infections happened and where the deaths happened. If you look at this, a lot of the cases we’re hearing about are in younger populations now. This is not as helpful as it could be because when you're looking at these counts it’s over the entire time. This is from March until now. I think if we were able to look at this data over time, we would see the case count in long-term facilities has gone from really big early on to really small now. Whereas the incidents in the college and younger age groups, if we adjust here by age, would have gone from really small too really big now. That’s an important metric to note. The at-risk people are the people you can see here amount to the death count. That is in long-term facilities, correctional facilities, congregate settings but not in colleges, child-care, or K-12. If we were able to plot on graph what the health risks were for people in those age groups was (colleges, child-care, or K-12) they would be heavily weighted towards non-COVID risks. Risk of depression, risk of injury, risk of suicide, risk of other things that are maybe going to increase the death rate of that population. Or at least the risk of serious disease whether it be mental health or physical health. Maybe it’s just having adequate food in-take but these risks are much greater. One of the ways we control for those risks in those populations are to put them in a safe setting with subject matter experts that can really look over them and make sure they’re picking up early warning signs of those other things that are health risks for that age group which is more of the testimony to why our schools need to open. It absolutely baffles me that the data is so extraordinarily weighted towards opening schools and we keep hearing more about schools closing. I just don’t understand it and it doesn’t make sense and it bothers me. I think when you’re talking about childcare or school and being a teacher… I know teachers and it's a vocation. That’s not just a job you go get paid for. It’s something you do to enrich the lives of other human beings and protect them and care for them. We are abdicating that intervention for our kids. I know many of you are parents out there who are as frustrated about this as I am. We just need to keep demanding that the data show us the evidence of what the next decision is we should be making. In addition to what the health risks are for COVID in that age group we should be looking at the other health risks that those kids have and seeing if we can’t control for that by making sure that they have access to the support systems they need. Next slide. This is now switching over to the Virginia Hospital and Healthcare Association website. You’re going to see here that we definitely have more people in the hospital than we had over the last few weeks. ICU occupancy is at 52%. That's all comers not just COVID and that is up a little bit. You have got to remember that hospitals are designed with a certain number of beds in order to make sure they have those filled most of the time because that is how they are able to be fiscally solvent. You can’t build beds and hire staff and not actually get reimbursed for those services, so you want certain level of occupancy. This is a little skewed because in some areas the hospitals are very highly occupied and in other areas it’s less. I know in central Virginia we have a few more admissions but we don’t have a lot of COVID in ICU’s. I think we have zero. So, this is skewed a little bit. Go here to the middle where it talks about ventilators and you can see we’re at 28% ventilator use. This was the hallmark variable that terrified us at the beginning of this COVID infection crisis. That (concern) was that we would run out of ventilators to take care of patients. Well, we’re not running out of ventilators. In fact, we are treating people better so very few people are getting sick enough to need ventilators. Thank God. We have also mobilized our resources, so we have more available. Next slide. This is a graph that you can find on the Virginia Hospital and Healthcare Association that I think is informative and helpful. If you look at some of these colors here, you can see these are confirmed (light-blue) hospitalizations for COVID. If you look down here at the orange and the red those are ICU hospitalizations and ventilators. See, we’re taking back to endemic. Epidemic means sudden surge. Endemic means this is a fairly constant, measurable variable. It’s a result of a particular virus but not an epidemic or a surge. It is kind of the indolent, long-term course that we can expect. That we have to manage and make sure we respond to. That might mean regional mobilization to respond effectively but overall, it is not in epidemic proportions. Next slide. This is some data. We’re going to put up a conversation that is available on YouTube talking about England where we have seen an increased surge. Some scientists are looking at data overall to explain is this a second surge of the epidemic or is this the endemic oscillation that we're going to see of this illness until we find a way to absolutely stamp this out. Which, by the way, is in Virginia. There has been a long ongoing preparation for distribution of that vaccine. In case you don’t know it does require two injections. You get one and then about a month later you get the other. The Pfizer vaccine that has to be kept at very low temperatures is the one that is in Virginia. We’ll begin distribution within the next couple of weeks. Vaccination protocols across a bunch of different systems in the state via priority that they’re all working out. I don’t exactly know the priority, but I know healthcare workers and high-risk like long-term facilities are at the top of that scale. The second vaccine going through emergency approval at the FDA. That will be coming out soon. The problem with the virus is going to be how much can we get at once. I think we’re going to be able to mobilize vaccination clinics very quickly, but I think we need to have enough vaccinations to get to everybody. The big, black curve in the beginning of time over in April was the big onslaught of COVID virus in England. As you plot that out you can see there are other spikes. COVID is the blue down below. Black is the cumulative effect. See the gray line that comes under the backline. That is death from other causes which contributes to how high the black line is. That is hypothesized to be those deaths that were happening as a result of patients not seeking medical care while we were in shutdown for COVID. That black curve is a cumulative effect from the blue and the gray making that top peak but not all of the deaths. This is what we’ve been saying. There are consequences for how we respond to perceived COVID cases that are non-COVID which is contributing to some of the issues we have going on. You can see as that plots out we now have a small rise back in November in England that is shown on the graph. The dotted gray line that is the highest beneath the black line is the upper limit for where you would see flu virus and other respiratory infections that are normal. So, if you map those two dotted lines you can see there is a range of oscillations. Most of the curve, except that big, black spike, is within that margin. The little pyramid that you see down there around August was a heat wave in England which was associated with a lot of deaths that were non-COVID. Next slide. This is the really interesting part that I was alluding to earlier. When you look at these two upticks in death from COVID, in England they were able to demonstrate (and in Virginia I believe we could do this too, if we could pull the data in this format) that the people who were affected by COVID and died early on with the epidemic when it came through earlier in the year are from different localities than are now making up the deaths in England now. That speaks to this not being an unpredictable virus that hits twice in the same population but rather a virus that moves through populations at different times until they develop enough immunity in that area to begin to manage what’s going on. That’s kind of the end of the slides and what I what I wanted to talk with you about. Yes, we have an uptick in infections. Just to summarize up we have an uptick in positive tests both symptomatic and asymptomatic. Some of that is related to seasonal changes. We are moving into the season where people go indoors, and more respiratory viruses are spread. Some of that has to do with different regions of the state being exposed to the virus more than they ever were early on during the epidemic phase. Some of that is just the process of developing herd immunity as we go along. The most important thing is that far fewer people are dying from COVID than they were before. They are dying in many of the same risk buckets that we thought of before: people who are at risk already because they’re elderly or have co-morbidities. We need to make sure we have viable teams of healthcare providers who don’t get overly tired and can provide care in hospitals that have high volume now. We need make sure that we diligently protect the at-risk populations. We need to institute the vaccination protocols so that we can get more and more people immune so that if they were in geographies that weren’t exposed… America as a whole… if you look at it again… think about what you’re seeing… we saw the Northeast effected early on when this swept into the country early and we didn’t have the resources to manage it. It’s now moving to Texas and out in the Southwest where geographically they had very little exposure with very few deaths and positive tests early on. Now they’re getting exposed to this and we’re seeing a smaller response and a quicker ability to adapt. I always think data that makes sense is probably more accurate than data you try to piece together, and it just doesn’t make sense. But this makes sense. There are confounding variables affecting what we are seeing in these curves and it’s not just that the virus that spikes unpredictably and we have a resumed epidemic. It’s not something that’s going to respond to us shutting down Virginia especially when its more so concentrated in certain regions and causing the economic risk factors that we have for everybody's health, access to reliable food, and ability to provide for their families. That’s why I think it’s really important we look at this data with the perspective of how seasonal changes effect it and how regions effect it and how age, demographics, and school doesn’t effect it. I think that’s mostly what I wanted to get to. I think I have a question or two coming in.

The question is: Pfizer claimed that we need 80% of the population to get two shots. My question is what the actual number is likely to be (and COVID survivors would add to that over the next two years). What’s your opinion on the current outlook?

I think we’re going to have to see how that plays out. It may be that if we can articulate to the health department exactly what data we should be tracking. They have subject matter experts there. I wish it was easier to get the data without having to demand that we get it. I think we're going to see a dramatic change as the vaccinations. We honestly don’t know how many people already have immunity. If we follow the references (I’ll post some YouTube videos that go into greater depth) and look at seasonality and the evidence that we have some herd immunity, which needs to be 80%-95% of people immune to a virus before people are confident that people are protected. I don’t have the answer to the Pfizer assertion of 80% but I think as we start to get the vaccination in place were going to see even lower curves of hospitalizations and deaths and other things as we go forward. That is going to help us discern if we are headed in the right direction. 80% is just a general concept of how vaccinations work. We would be able to nail this down more specifically if we looked at the at-risk population. Is it 80% of the population with co-morbidities? Is it 80% of the people in age groups 45 and older? It’s going to take a bit more specificity that we have articulated with Pfizer.

What are your thoughts on at-home antigen style testing?

Well, I don’t know. I would have to look at the sensitivity and specificity. The rapid tests that we have now may have a false negative rate of as high as 20%. I can only assume that, and at-home antigen style test may be the same. The most accurate general statement I can make about those kinds of tests are that if they are positive, they’re probably quite reliable. That’s true for the rapid test. I think that’s true for the antigen test. It’s unlikely to get a false positive. It’s probably moderately possible you could get a false negative if that helps.

What happened to contact tracing?

Contact tracing is happening but I don’t really understand how it’s happening either. I haven’t really been in the focus of an outbreak. I assume most of the contact tracing is done in outbreaks. It's really hard to comb through the Virginia Department of Health information. Its particularly hard because they haven’t stratified it over time. When you look at it it’s everything that happened over the last months in bulk. It's very hard to understand what’s happening on that. I will follow up on contact tracing and find out. I know it's happening. Anecdotally, I think we all have personal experience of people who tested positive and no contact tracing was done. So, I don’t know where it is being prioritized but I will try and find that out and let you know.

I think that is most of what I wanted to go over today. I hope it was helpful. These videos are a commitment because they’re long but if you don’t mind I, of course, love that kind of detail. What I find so lacking in the political turn that COVID has taken is that it has suffocated a robust, scientific conversation about COVID. I have to go on YouTube to find it and look at obscure studies done out of Europe. There’s a lot of other explanations that make this data less scary and more comprehensible. Such as, what does the population do when they’re exposed to flu? A lot of the patterns were seeing with COVID have a reference point in how the population responds to flu. There’s an intellectual conversation that can happen that makes this a little less threatening, but I don’t think it fits the narrative that the press is interested in which is basically we should all be terrified. Unfortunately, that narrative is resulting in us making bad decisions like shutting down our economy in perpetuity and also shutting down our schools. I’m frustrated because I don’t hear enough people standing up and saying that there is enough data to support that neither of those things should be happening. I’m going to keep championing those ideas. I’m going to carry legislation to see if we can’t reverse some of those decisions. It’s very hard when the agencies and the governor seem to be making a lot of unilateral decisions. You’re not getting much press on any other opinion. That’s it for today. I hope it wasn’t too science geeky. That’s where my brain goes. I hope this was helpful and as we submitted most of the legislation I will be carrying in concept form to the drafters down at legislative services. We will be limited to 12 bills this year. I think that’s a good thing. I think we’ve been in session a long time. I think we ought to be able to edit what we were doing and be very focused on the legislation we present and try and get through in a manageable way. I’m particularly concerned as we go forward that you have access to your legislators. We had a lot of problems with online testimony from constituents and interest groups. I hope that is going to be a lot better when we got to session. I hope the vaccine is going to help make us more accessible. I want you to know I am an email away. dunnavantdelivers@gmail.com. If you have issues you’re interested in or concerned about let me know. We’ll try and do these Facebook lives weekly. They’re going to move to a small segment on COVID after today’s big scope conversation and we’ll target toward legislation we see coming from the democrats, the governor, and what I am proposing. We’ll have those conversations. I just want to keep you up to date. Thank you everybody. Hopefully it wasn’t too long. Have a wonderful week and I’ll see you next week.