DOVER — The year 2020 will always be remembered as the year of COVID-19, but there’s optimism around 2021 thanks to the rollout of the vaccine.
Health experts and public health officials faced many challenges last year as much was still unknown about the virus. Dr. Bill Chasanov, infectious disease physician at Beebe Healthcare, said the medical community is in a much better place to begin the new year, both in terms of knowing how to prevent the spread of the COVID-19 and treating patients if they are infected.
“It is really amazing how far we have come in terms of our knowledge of COVID-19 since last winter,” Dr. Chasanov said. “The treatments have evolved from supportive care to the introduction of convalescent plasma therapy, the use of steroids, approval of the anti-viral medication remdesivir and to the recent Emergency Use Authorized monoclonal antibodies.
“Beebe was the first hospital to use convalescent plasma and monoclonal antibody therapy in Delaware, which we are really proud of,” Dr. Chasanov added. “We have also learned more about how the virus spreads and the best practices to mitigate the spread. Wearing a mask is scientifically proven to reduce the spread of COVID-19 and it is why we continue to remind our community to do so.”
When COVID-19 first arrived in Delaware in March, the state experienced its first version of a shutdown after an emergency order by Gov. John Carney.
Since then, there have been 27 modifications to Gov. Carney’s State of Emergency Declaration. Delaware has gone from a full stay-at-home order to Phase 1 in the early summer — which featured a limited reopening of the economy — then to Phase 2, which opened things even further before more restrictions came in the early winter, shifting the state back to something similar to the Phase 1 guidelines.
Delaware is currently under a stay-at-home advisory until Jan. 11. The state also has had a public mask mandate since April 28, requiring Delawareans and visitors to wear a cloth face covering in public settings where social distancing is not possible.
Gov. Carney said hoping every Delawarean follows whatever restrictions are in place is the biggest challenge the state has faced on the policy side.
“I think the biggest challenge we’ve had is the tension between individual freedom and liberty and public health,” Gov. Carney said. “We know what protects public health. It’s for everyone to wear a mask, to social distance and when we had to shut down, to shut down or when we had the stay-at-home order, to stay at home. There are lots of our neighbors who believe they have the right not to do that if the government tells them to. I think that’s the challenging thing.”
As of Friday at 6 p.m., there have been 930 COVID-19 related deaths and 58,873 positive cases in Delaware since March 11. The current number of individuals hospitalized with the virus was at 412 as of Friday at 6 p.m., as that number has stayed over 400 for more than two weeks.
These statistics are what Gov. Carney cites when he receives pushback on restrictions.
“Many of those folks have told me they think the whole thing is a hoax,” Gov. Carney said. “Well, those people in the hospital right now don’t think it’s a hoax. These people who have passed away and their families don’t think it’s a hoax. It is not a hoax. Millions of people have died and I think it’s an insult to them to say that this is anything but a very serious pandemic.”
Battling misinformation
In the age of social media, the medical community has found itself fighting back against misinformation surrounding the virus.
Dr. Chasanov said this is why Beebe has held so many town halls on Facebook, to speak directly about the virus in an attempt to “squash any misinformation and be a beacon of trusted information for the public.” The Delaware Division of Public Health has also done Facebook Live events regarding COVID-19 and its distribution plan for the vaccine.
One cause for strife is mask-wearing, which has become a hot-button topic with the rise of COVID-19. DPH officials have encouraged mask-wearing at the state’s weekly COVID-19 briefing throughout most of the pandemic, showing studies and real world examples.
“The mask is effective,” said DPH Medical Director Dr. Rick Hong. “All these measures we’re putting in, we realize it is uncomfortable, but it’s effective.”
“Initially there was equivocation around wearing a mask or not,” Gov. Carney said. “We quickly learned that it was the most important thing you could do.”
The state’s medical community is united behind masks, social distancing and hand washing/sanitizing as the best ways to prevent community spread of the virus.
“At Beebe, we always stress the three Ws — wear a mask, watch your distance, and wash your hands,” Dr. Chasanov said. “There are several other infection prevention actions you can take in your daily life, but the one that has been most important is the access to testing that has been available to Delawareans thanks to the effort of the governor’s office, DPH, and healthcare facilities like Beebe.”
‘Know your status’
Testing is widely available to Delawareans. There are more than 20 fixed community sites and a rotating list of 15-20 additional pop-up community sites during a given week. This doesn’t include tests done by hospitals, primary care physicians, commercial labs, urgent care centers, etc.
A full list of testing sites can be found at de.gov/gettested.
No matter where the test is done instate, all labs/providers are required to report results (positive and negative) to the DPH. The state is averaging over 7,000 tests processed per day, according to the DPH’s most recent data, and administered more than 100,000 tests a month several times in 2020.
The Delaware Emergency Management Agency has begun to roll out rapid antigen tests at several of its testing events. These can provide results in less than 30 minutes.
DEMA is targeting those age 65 or older and asymptomatic young adults — the two populations it has determined are the most important to curbing the spread. The 65 and older population is the most at-risk to be affected by COVID-19, while the asymptomatic younger age demographic poses the biggest threat to public health since it can spread infection without knowing it.
Dr. Hong said it’s important to take a positive test seriously, even if the person isn’t showing symptoms and expects a “false positive.”
“You can be positive without symptoms so don’t blow off that positive,” Dr. Hong said. “There’s a reason we are asking for testing in the asymptomatic population because of the asymptomatic spread threat. If it’s a positive, treat it seriously and don’t say, ‘Well it’s got to be wrong since I’m not sick.”
Anyone who tests positive during a rapid antigen test will also receive a PCR test to double check. The PCR tests, the most widely used COVID-19 tests nationally, use cycle thresholds (Ct) to determine if an individual has any COVID-19 in their system, which will then give a positive or negative result.
The fewer cycles needed to detect the virus, the larger amount of virus is in the sample. Most Ct levels for PCR tests nationally range from 37-40, according to reporting by the New York Times. In the New York Times analysis of Ct levels, the Times found if the labs it studied in New York used a Ct of 30 as a cutoff instead, 63% of positive cases would have had no virus detected, according to the Times calculations.
This doesn’t mean the tests are false positives, it’s just a measure of how much viral load is contained in the sample.
The DPH said the three different types of PCR tests run at the DPH Laboratory use a variety of instruments for the performance of PCR. The positive Ct is set by the manufacturer when applying for Emergency Use Authorization:
• TaqPath COVID-19 Combo Kit: Positive Ct values are ≤37
• CDC 2019-nCoV Real-Time PCR Diagnostic Panel: Positive Ct values are <40
• Hologic Aptima SARS-CoV-2 assay: Positive Ct values are <40.
DPH Chief Physician Dr. Rick Pescatore said these are unlikely to cause false positives.
“A higher Ct value reflects a lower viral load,” Dr. Pescatore said. “Ct values are set such that potential contaminants or trace presence of viral genetic material are unlikely to trigger a ‘false positive.’ PCR assays typically have specificity greater than sensitivity, and thus their positive predictive value is greater than their negative predictive value.”
Hope in 2021
Both Pfzier and Moderna have developed vaccines for COVID-19, which have already been approved for the public. Delaware has administered doses to 13,080 individuals so far and has received 42,975 (22,500 from Moderna and 20,475 from Pfizer) as of Friday at 6 p.m.
“The science community has pulled together to develop an effective vaccine with speed and safety that makes me confident that each time I vaccinate a Beebe team member, we are coming a step closer to being safe from this virus,” said Dr. Chasanov at Beebe.
Delaware is still in Phase 1A of its vaccination plan, with Phase 1B scheduled to begin in mid- or late January. Phase 1A includes vaccinations for health care personnel with direct contact with ill patients or infectious material, emergency medical services agencies, long-term care staff and long-term care residents.
There is no clear answer on when the vaccine will be available to the general population, but the hope from DPH officials is sometime in the spring or summer.
Government officials have said the hope is somewhere between 50% to 70% of the population needs to be vaccinated in order to provide herd immunity. Dr. Chasanov also said questions remain if the vaccines are “going to be needed to be provided annually or with an occasional booster vaccine.
“We are hoping that as more vaccine becomes available, that our communities will reach a level of herd immunity,” Dr. Chasanov said. “In turn, this herd immunity will help provide protection to all of us.
“The biggest thing that we all can do is to keep wearing a mask and trust in science,” Dr. Chasanov added. “When the vaccine is available, take that opportunity to keep you and your family safe. It is my hope that we can move past 2020 and back to some level of pre-pandemic normal in the second half of 2021.“
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