Facebook Live 8/12- Answers

Sorry guys for the delay we had some technical difficulties! Hi everybody and thanks for being so flexible. The last two weeks I couldn’t get on, my son got married and it was great. Last week we were short at the hospital and I was on for twelve hours and I just couldn’t get on to talk with you, so we are going to try and catch up this week. We are going to talk about the Special Session coming up next week and of course talk about education and some other things. Let me start by talking a little bit about data for the state of Virginia. This is really important because I am going to be talking about data next week at Special Session as well. To me, data has been one of the biggest challenges we have had during this process because there has been such a lack of diligence in sharing with the public what data points are valuable and salient to decision making. It is not that hard because we have been talking this whole time about that. I think that we are in a different phase of COVID now and we have been for a while, we are in a post-peak phase where this is going to go on indolently for a while, it could be month, it could be until we get a vaccine, it could be until we develop an effective and reliable treatment, we just don’t know how long this is going to go on. So, we have to learn how we can measure safety while we are in that indolent course because it is different than before looking at the spike. What is being published on the Virginia Department of Health’s is not helping us with that, and the reason I say that is because we need to be able to measure when the number of cases and the location of the cases are such that we now have risk for more hospitalizations than the indolent number we are expecting, more people that are sick and more people that die. Don’t get me wrong, this is a situation unfortunately, where it is a medical issue that is going to continue to take lives. It is heart breaking and heart wrenching and it is vulnerable people, so it is even worse. The fact of the matter is the expectation that there won’t be any new cases and deaths, or hospitalizations is unrealistic and sets people up for panic when we don’t achieve an unrealistic goal. So, what are we looking for? We need a better discernment of who the new positive cases are. When you look at the Virginia Department of Health, all you are seeing is cumulatively what was the age group for the group of people who were testing positive, what was the age group for the group of people that died, or were hospitalized and that is not relevant for decision making now. For decision making now, we need to know in the new cases who are getting sick. We can stratify risk based on the age group that are getting it. It is not perfect, but statistically, the risk for younger people is profoundly less than for older people. Virtually 65% or more of our deaths have occurred in individuals 75 and older. So, as we are looking at stratifying risk and what markers of data we need to look at if we are in trouble or not. In my opinion, we need to be looking at who is turning out positive or not based on their demographics- their age group, but there are other demographics we need to look at and we have talked about this before. Those are like community living locations. That is going to be jails, nursing homes, group homes, that is a whole different risk group based on their proximity and social distancing limits and other issues that they have. We need to have age stratification, and we also need to have community living identified and I think the other piece of data we need to have is where are the outbreaks? How many of the new positives especially in a particular region are related to outbreaks that we are tracing? All of that is relevant for us deciding. For instance. If all of the new cases we have are coming back are coming from people who are 30 and younger with little or no hospitalizations and we are able to track when we are exposing people in a high risk group we now are in a containment scenario and that is where we need to be. This is important also because we are doing better is being recognized in the data and the way it is being reported. Our percent positive rate has stayed well under 10%, in Henrico it is under 7% and that is a really great benchmark. Let’s review because one of the questions I have today, and I am going to get to the questions in a minute, “what does the positive rate mean?” So, the general positive rate where you say 100,000 Virginians have tested positive for COVID, it doesn’t mean anything because you can’t use that number to analyze relative risk. When you say “percent positive” that is a reflection of how many tests you are doing and we know that we need to do a certain benchmark of tests in order to be sure that we are looking for outbreaks and other situations that could lead to a safety issue. We know that percent positive needs to stay below 10%. So, percent positive is more a reflection of the number of tests we are doing than really crises in the community. When we look at what the hospital rates are, we need to be able to compare percent of hospitalization and utilization of ICUs and ventilators to the baseline so when you look back on the historical perspective of the ICUs from data from 2013 it says that normal hospital occupancy is around 80-85%. That is what we are running in Virginia. You have to have perspective. Data in isolation is not helpful. Data is meant to be comparative – compare it to the benchmark. So, next week I am going to be asking the state to measure their data differently, to report it differently, and to give us the benchmarks that we need to use so that we can measure it again. Bottom line is we need to make sure that the public gets data that helps them make decisions because the media and the failure to give comparative benchmarks for data is part of what is making people so scared. Being scared doesn’t help. We need to deescalate the fear with data and reason and ability for people to feel as if they are in control as to what to expect. There is none of that now. It is incredibly frustrating because it is accessible, but it is not being reported.

With that in mind, let’s talk about a couple of things. We have some state data to look at over the last week. We have some high percent positives in some other states, but we have hospital capacity that is at low average. Looking at all of this now- I haven’t had a chance to review all of this but the bottom line is that Virginia’s rate today is 7.2% so we are in check and doing what we need to do. I am going to go to some questions and then we will talk about Special Session for next week.

The first question is: I’m very confused about what the positivity rate means. I thought that it would show the spread in the community, but he seems to indicate that is not the case and it is a measure of testing ability? Can someone clarify this because the Governor and so many report this as a number indicating prevalence. If that’s not the case, then I’m not sure why it’s being used in the manner it is to determine what is open and what to close.

The bottom line is, we can use percent positive as a comparative analysis. If you know the benchmark that it should be 10% and below, when a state goes over 10% percent positivity that’s a spike. But, just the raw number in of itself doesn’t matter. But this is the one variable that we have been talking about all along. You have the ability to make a benchmark comparison to. So, what you have to think about – you don’t to look at the percent of people positive as a total number, you want to look at the percent positive and track that to see as it varies we need to dive deeper into the data to say is our increase in percent positivity related to an outbreak? Is it related to prisons or nursing homes? Is it in the community? Where are the contact tracing we need to ensure that we isolate that exposure and make sure that it is limited or not spread at all to the high-risk populations? If that starts to make sense it is the first marker we look at as it is trending.

Also, is the question I had about hospitalizations and how it is possible for the number of COVID patients to continue to increase despite the fact that discharges are outpacing admissions by 2 to 1 this entire month being looked into?

I think that that person is looking at the Virginia Hospital and Healthcare Association Database and that is a specific data question where you are just trying to look at what they are reporting. I am trying to go to that site now so I can get you that answer, but one thing about the hospital data that you need to know is that anybody in the hospital that is positive for COVID is listed in their COVID positive numbers. I have reached out to VHHA and I have asked them to report their data differently because there are people who are hospitalized because they are sick with COVID and there are other people who are hospitalized, most hospitalized are screening elective admissions now, so that they know if they have to isolate someone because they are COVID positive. They are screening them before they come to the hospital and there is a percentage of those people- let’s say it is 7% like the rest of Virginia that is positive for COVID that is going in for non-COVID related procedures and interventions. They are being lumped together with people who are being treated for COVID. I think that the take home message for that question is that I don’t know you can get the answers you are looking for by looking at how many people have been admitted versus how many people have been discharged. What you need to look at is the total ventilators in use. That is a really important number because the scary part of COVID is what happened in Italy which is when they ran out of ventilators and we were afraid it was going to happen in the USA, and with the adaptations they needed to make in New York and other places it never did. We never ran out of ventilators. We never ran out of accessible beds. But, that is the real scare. We want to make sure that everyone who is sick with COVID has the benefit of medical interventions and so that is what we are always tracking. We are at a 20% use of our ventilators now. So, with that in mind, I think that is one of the most important metrics you can look at on the VHHA database.

Is there anything we as parents can do to push Dr. Cashwell and the school board to acknowledge next steps to be open in-person?

I know there are a lot of people who are hopeless out there and I have talked to Dr. Cashwell several times and I will be carrying legislation next week that they feel is essential to give them the tools that they need to open. So, I still find this a mystery when we see that 92% of our teachers were willing to go back in person and we’ve discussed the evidence and data. If you actually look at the data of transmission between children and adults and how well children and adults in other childcare situations have done with transmission, if the data was presented in a good way it would support being back in person in school at least for those who chose to. There should always be a robust virtual option for those who don’t want to go. Here is the problem with the decision, people who don’t want to go to school and who have the means and resources to be at home have the option, but people who need bricks and mortar don’t - and let’s remember, schools are not just curriculum, it is not just sending out on the internet the classroom information. Schools are so much more than curriculum and we have fought, and we have funded to make sure those resources are there, it is a safe place. It is reliable food; it is screening experts and subject matter experts who know how to identify challenges for kids and know how to intervene early. School is so much more than curriculum and virtual education, honestly, is curriculum only. So now, families and parents that depend upon schools to be a safe place for their children and to provide all those other services have to figure out how to find another place. That is the crisis in Virginia. It is not a conflict between people the crisis is we don’t have our normal safe place for our kids. We must figure that out. Our kids must be somewhere. I can’t tell you how many families I have talked with over the last several months that have their 12-year-old or their 15-year-old in charge of three or four other children at home trying to help them with their school work, trying to make sure they are fed and they are safe because their parents are essential workers and have to go to work every day. So that is the crisis we have to identify. Dr. Cashwell told me that one of the things she needs is education so that people understand what the risks are and she could have used a lot better advice from the state and from the governor. What should have been said to our school divisions is “spend your energy, your time, and your resources figuring out how to open school for those who need it for a safe way for teachers and children.” But that didn’t happen. They were instead given an unsolvable riddle of how to abide by a bunch of guidelines. Guidelines are not what the goal here is. The goal here is our children being safe and getting the opportunity to learn which is the ticket to succeeding and achieving in America. We all know that, and we know that is one of our disparity and inequity issues, that not everybody has access to an equal education. By all means they should have access to a school building. So, if you want to help Dr. Cashwell, we need to make sure the state provides reliable data to the schools and the teachers and other people to help reassure them so they aren’t panicked.

What is "our" next step in advocating to get schools opened back up? I feel like since the decision to go virtual was made, we (parents, county residents, etc.) haven't really had any "calls to action".

I know most parents are scrambling to find a place for their kids. Especially two working and two income families. It was ironic to me that Dr. Cashwell said “I don’t have the time to prepare to open schools by the beginning of September because I need more planning time.” But, by default our schools didn’t open and parents were given that short timeline to figure something else in a world where childcare providers and private schools were already pretty much fully booked. I think that you need to be a part of the constructive conversation next week to provide schools with the tools that they need to reopen. They will need money. I personally believe the state should reimburse the school divisions for monies they invest for PPE and for cleaning. I know Henrico has already spent the money. I think with limited resources at the state’s level we need to make sure that families have the resources they need to find a safe place for their kids for the next nine weeks, longer if necessary and when schools open and provide that spa