Will Humble Disease Control, Wills Blog

Journal Articles of the Week 

SARS-CoV-2-reactive T cells in healthy donors and patients with COVID-19 

Abstract https://www.nature.com/articles/s41586-020-2598-9

Some people that have been infected with certain cold viruses (coronaviruses) have antibodies that might help them fight off the SARS CoV2 virus, and lead to fewer severe symptoms.

The study about published in the journal Nature found that among a sample of 68 healthy adults in Germany who had not been exposed to the coronavirus, 35% had T cells in their blood that were reactive to the SARS CoV2 virus.  One possible implication for these results is that perhaps because young kids often have colds that fact might be a reason why they are less likely to get infected with the SARS CoV2 virus and have bad outcomes.

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MMWR: SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp

CDC released an MMWR summarizing a case study of SARS-CoV-2 transmission at an overnight camp in Georgia. While the camp instituted most of the CDC’s suggestions for summer camps, they did not require cloth face coverings or opening windows and doors to increase ventilation.

A total of 597 Georgia residents attended the camp and the overall attack rate was 44%. The study demonstrates that youth are susceptible to SARS-CoV-2 infection and that asymptomatic infection is a critical component of disease transmission.

Will Humble Oral Health, Wills Blog

Arizona Rural & Public Health Policy Forum

AZ Board of Dental Examiners held its first special meeting to discuss proposed dental therapy rules on July 17th. They pushed much of the discussion around the rules to a special meeting in August. That meeting has now been scheduled for Friday, August 21 at 8am.

The BODEX staff have indicated that a new version of the rules is being developed that incorporates suggestions from stakeholders, including the Board, AzDA (Arizona Dental Association) and the Arizona Oral Health Coalition.

Here’s the AzDA’s recommendations. Their recommended changes, among other limitations, would eliminate the “limited license” provisions of the coalition draft. This would mean that a dental therapist who was educated in a different state and doesn’t have training in the complete scope for dental therapists in Arizona, would not be able to practice until they could show that they had received training and were competent to perform 100% of Arizona’s dental therapy scope.

Will Humble Uncategorized, Wills Blog

Dr. Jack Dillenberg Elected Mayor of Jerome

Longtime AzPHA member and former ADHS Director Jack Dillenberg will become the new mayor of Jerome when he’s sworn in on November 10. Dr. Dillenberg has been on the Town Council there since he moving to Jerome a couple of years ago. He is currently serving as the Vice Mayor.

Jerome has an interesting way of selecting a Mayor. The Town appoints the person with the most votes as mayor, but the full council officially appoints the mayor.

“I believe that my years in public health leadership will help me guide the establishment of a self-health clinic for the town while furthering our effort to improve infrastructure, develop affordable housing and get our community garden going,” Dillenberg said about his goals as mayor.

Jack served as the ADHS Director for 5 years during the Symington Administration.  Among his many signature achievements was his focus on youth tobacco use prevention and improving oral health.  Perhaps you remember the Tobacco: Tumor Causing, Teeth Staining, Smelly, Pukey Habit campaign.  That was Jack’s handiwork. After his ADHS Director job he went on to serve as the Dean for the AT Still University Dental School for many years.

Jack, thank you for your continuing service!

Will Humble Public Health, Public Health Law, State Legislature, Wills Blog

A Special Thank You to Senator Heather Carter

A huge Thank You goes out to Senator Heather Carter from the Board of Directors and Membership of the AzPHA to Senator Carter for her unwavering support of public health in her years of service in the Arizona State Legislature, first in the House of Representatives and for the last 2 years in the State Senate. 

Senator Carter has successfully sponsored literally dozens of public health bills over the years that have made enormous improvements in public health in Arizona and she was awarded our Policy Maker of the Year award in 2017. It’s impossible to overstate how important Representative and then Senator Carter has been to public health in Arizona.

Sadly, she lost her primary race in Legislative District 15 last week meaning that she won’t be in the Legislature next session to continue her work for public health – at least in that capacity.  She will of course continue as faculty in the Arizona Center for Rural Health and will be able to be a strong advocate for public health on other ways. Thank you!

Will Humble Disease Control, Vaccination, Wills Blog

It’s Time to Plan for Vaccine Prioritization & Distribution

With the clinical trials showing promising results and manufacturers of several vaccines already in production (even though they are still only in Phase III Trials), it’s time to start planning how to distribute the likely vaccine(s).

Immunizing the U.S. population to prevent COVID will probably be the largest vaccination campaign ever undertaken.  A successful and equitable vaccination plan will require participation by county health departments, community health centers, healthcare providers of all kinds, emergency managers and private & nonprofit sector partners.

An effective response will need a comprehensive plan to address:

  • prioritization of the vaccine to critical populations

  • distribution of the vaccine from the manufacturers or the federal government to states

  • legal considerations

  • logistical considerations; and

  • effective communicators and communication.

A couple of weeks ago the CDC outlined a general framework for vaccine distribution. Their initial plan alludes to a distribution model similar to the one we used for H1N1 vaccine.  Manufacturers would deliver vaccine to a central distributor and states would get weekly allocations.

Vaccination sites (private providers, clinics, government-run points of dispensing) would make requests to the state for the vaccine and states prioritize and approve the requests after looking at their weekly allotment.  When the state approves a request, the vaccine goes from the central distributor to the site. 

The CDC also contemplates making direct allocations to retail clinics (like CVS and Walgreens).

Among the more challenging policy decisions will be prioritizing populations for early vaccination. The CDC urges states to “develop prioritization schedules based on CDC guidelines, disease burden, and vaccine supply”.  A National Governor’s Association memo states that the current CDC leadership says that the top considerations should be:

  • Maintenance of homeland and national security

  • Provision of health care and community support services

  • Maintenance of critical infrastructure; and

  • Protection of the general population.

I personally take issue with this priority list. It makes no reference to health disparities or vulnerable populations. Indeed, does placing “maintenance of homeland and national security” suggest that employees of the border patrol for example would be the first to be vaccinated? I sure hope not!

The National Governors Association put out a policy memo this week that outlines a planning process that states can consider as they build their vaccination plan. It might seem a fair piece away, but the upcoming weeks will be critical in developing a workable plan so that decisions aren’t being made “on the fly” when the vaccine becomes available.

We urge the state to begin the vaccine prioritization and planning process right now.

Will Humble Disease Control, Wills Blog

Benchmarks for In-person School Instruction Released

At the urging of Superintendent Hoffman and other stakeholders including AzPHA, the governor signed Executive Order #51 a couple of weeks ago outlining a process to make better decisions about whether and how to set in-person instruction start dates.  Prior to last Thursday, the governor had been setting proposed in-person instruction dates without objective criteria. 

The Order required ADHS to develop public health benchmarks that school districts may use to inform their in-person instruction dates.

ADHS released those benchmark criteria last week. The product is quite good, and the metrics make sense. The benchmarks are classified into minimal, moderate, and substantial transmission and align with the Arizona Department of Education’s Roadmap for Reopening Schools. 

The new Benchmarks for Safely Returning to In-Person Instruction pose county-specific public health benchmarks related to community transmission. They’re designed to be used in conjunction with ADE’s Roadmap. The criteria include benchmarks around new cases, PCR percent positivity, and COVID-19 related hospitalizations measured through syndromic surveillance.

For example, for a school district to meet the benchmarks for a hybrid model that includes both virtual and in-person learning (hybrid), the District is urged to meet the following criteria:

  • Cases: a two-week decline in weekly average cases OR two weeks below 100 cases per 100,000 population per week

  • Diagnostic test percent positivity: two weeks with positivity below 7% 

  • COVID-19-Like-Illness Syndromic Surveillance: two weeks with less than 10% of hospital visits due to COVID-like illness

Here’s where you can check out the Benchmarks for Safely Returning to In-Person Instruction criteria.  Solid work by the entire team of folks at ADHS, ADE, and the county health departments.

Collaboration works.

Will Humble Disease Control, Wills Blog

Cases and Percent Positives Moderate Somewhat in Dr. Gerald’s Latest Analysis: But Both Way Too High to Support In Person School

Slow turn around times still impeding progress with more than 1/2 of all test still taking more than 5 days to come back from labs

Current Covid-19 test capacity is inadequate to meet both clinical and public health demands as the test positive percentage is 12%, well above the recommended 3 – 5%. With about half of results taking ≥5 days, public health efforts to respond to this outbreak remain constrained by inadequate capacity.

Despite reporting delays, recent trends indicate viral transmission is waning. The rapidity of improvement is surprising given that April’s broader stay-at-home order only slowed transmission enough to cause cases to plateau. Given that face-mask ordinances are an important different between then and now, they would seem to be the most likely explanation.

Because PCR testing has been stable or slightly declining since early-July, the exact magnitude of recent declines is somewhat uncertain. Long reporting delays suggest some of the decline could be attributable to shortages of critical supplies or personnel (supply side); however, waning transmission could be causing fewer patients to seek care (demand side).

While PCR testing results are incomplete, the percent of patients testing positive has declined from a peak of 23% the week ending July 25th to 12% the week ending August 2nd. A declining test positive percentage in the face of stagnant testing supports slowing viral transmission. The percent of patients testing positive on the antibody (serology) test has remained steady at 12%.

Here is Dr. Gerald’s latest analysis for the full detail and the graphics.

Will Humble Disease Control, Vaccination, Wills Blog

National Academies Launch Study on Equitable Allocation of COVID-19 Vaccine

Once a vaccine is given approval (or more likely Emergency Use Authorization) we’ll need to prioritize who qualifies to get the vaccine first. Most likely, the vaccine will roll out with a few million doses per week- so there won’t be enough to go around at first.

The National Academy of Medicine has formed a committee to propose an equitable way to prioritize the early doses. They’ll be considering health disparities, health status, occupation, living conditions, and geographic distribution. The committee held it’s first meeting last week To attend future meetings visit here.

Will Humble Disease Control, Vaccination, Wills Blog

Journal Articles of the Week

Immunogenicity and safety of a recombinant adenovirus type-5-vectored COVID-19 vaccine in healthy adults aged 18 years or older: a phase 2 trial

Published:July 20, 2020DOI: https://doi.org/10.1016/S0140-6736(20)31605-6

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Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2

This is the study that you likely heard about early in the week with the promising results from the Astra Zenica Phase II vaccine trial in the UK.  Promising results indeed! Not only did the vaccine tested form antibodies at several doses, it also generated cell mediated immunity (called killer T cells).

Will Humble Disease Control, Vaccination, Wills Blog

U.S. Buying 100M COVID Vaccines from Pfizer and Sanofi/GSK

The US government has agreed to pay Pfizer $2B for 100M doses of a potential COVID-19 vaccine.  There’s a separate contract with Sanofi/GSK for an additional 100M doses to the tune of $2.1B.  Back in May, AstraZeneca scored a $1.2B contract as an investment in the R & D and with an option to buy 100M doses. That’s basically $20/dose.

The companies expect to manufacture 100M doses by the end of 2020 and more than 1.3B doses by the end of 2021. For more information, click here.

The contracts are through a little known agency called the the Biomedical Advanced Research and Development Authority located in HHS’ Office of the Secretary. 

Side Note: Rick Bright was removed from his post as the head of BARDA back in April. He has filed an 89-page whistle-blower complaint with the Office of the Special Counsel. His complaint alleges that he was moved out of the post because of his objections to millions of dollars in contracts that have been awarded on the basis of political connections rather than scientific merit.

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