Johns Hopkins: ‘This virus is not going away’

WINDOW ROCK

Despite reports of daily diminishing numbers of coronavirus cases overall on the Navajo Nation, that does not mean the virus is not still with us Laura Hammitt, M.D., told the Health, Education and Human Services Committee last week.

What is important to note, she said, is that prevention measures and restrictions put into effect on the Navajo Nation, including stay-at-home orders, curfews, wearing of masks, hand washing and social distancing, have been successful.

Hammitt, director of Infectious Disease Programs at the Center for American Indian Health and associate professor at the Johns Hopkins Bloomberg School of Public Health, is working with the Navajo COVID-19 Health Command Operations Center as lead testing coordinator.

While Hammitt says the Nation has done a “great job” in “flattening the curve” the changes have to be sustainable.

“This virus is going to be with us for a while,” she said.

“We have to get on board with the fact that we’re going to be wearing masks, we need to be doing physical distancing, and we’re not going to be able to gather in the ways that we want to or that we used to,” she said. “We’re going to have to make new ways to remain connected with our culture, traditions and family so that we can avoid having another peak of spread.”

Hammit said what is happening in neighboring states is important and influences what happens on Navajo.

“We have to continue to get the message out that this virus is not going away,” she said.

She said people have to understand when you stop taking preventative measures cases will start to rise again.

“When we let up on those measures that we’ve been taking to slow the spread, the virus will just reemerge,” said Hammitt. “That’s what you see happening in Florida, Arizona and Texas.”

Pandemic ‘not going anywhere’

“This pandemic is not going anywhere,” concurred HCOC Director Jill Jim. “We don’t know when the surges will hit again.”

Jim said the way the disease moves across the Nation is “really unpredictable.”

“What we learned from this pandemic is our people are very mobile,” she said.

Jim concurred that there are still a lot of unknowns about the disease and its after-effects.

“Individuals are experiencing COVID-19 differently,” she said. “Some have to go through rehab, physical therapy.”

Jim said there are also the mental health aspects of recovery that are important to address.

“COVID-19 has hit every point of how we function every single day,” she said.

Jim shared the HCOC strategy has included distributing basic supplies such as food, water, and personal protective equipment, encouraging high-risk people to stay at home, and helping to quarantine those who are sick.

The HCOC has been distributing “healing kits” and “isolation kits” as a way to help COVID-19-positive and exposed individuals stay isolated. They have also worked to provide hotel rooms for those who don’t want to risk going back into their household and infecting their families.

Jim confirmed lack of running water and has put many Navajo families at a disadvantage during the pandemic.

“Preliminary findings that communities that don’t have access to water have higher rates of sickness,” she said.

Jim reported that the alternate dare sites in Chinle and Shiprock have had some challenges and beds never filled up.

Originally, the ACS were intended to be “step-down” facilities for COVID-19 patients who did not need to be hospitalized.

“The reason the ACS is there is to relieve beds in hospitals for patients who don’t need high level of care,” explained Jim.

However, there has been ongoing confusion among the public as to what the purpose of the ACS facilities is, including whether they are for patient care or isolation, which might have contributed to the underutilization.

Jim said now the federal funds used to operate the ACS have expired and they are looking at the remaining balance of the CARES Act monies to continue operations, which costs $4.7 million a month.

Meanwhile, she said the sites are still open with volunteers and supplies available.

Jim said the president’s office wants to keep the ACS facilities open in case there is another surge on Navajo and hospital beds are limited in nearby metropolitan areas such as Phoenix, Flagstaff and Albuquerque.

All of the states surrounding the Navajo Nation are surging in the number of COVID-19 cases and hospital occupancy.

For that reason, Jim said the ACS are still on “warm status,” meaning they can gear back up to full operation in 48 hours.

“If we don’t have the ACS option, we will definitely not be in a position to provide care to our own people if we have an inability to transfer externally,” she said.
However, Jim clarified that ACS cannot be scaled up to provide higher level acute care, which would still need to be referred out.

Testing strategy

Hammitt said Navajo’s testing strategy is based on state and Centers for Disease Control guidelines, and testing is now widely available.

She explained that the COVID-19 tests are viral diagnostic that detect genetic material, and can be administered through a swab to the nose, throat or saliva.
“They are used to identify current COVID-19 infections,” she said.

The test is not recommended to determine if someone has recovered from COVID-19, she explained.

“The test can remain positive for several weeks after somebody is recovered,” said Hammitt. “All that it’s detecting at that point is dead virus. We do not recommend that this test be used to determine if someone is recovered.”

Instead they follow the CDC guidelines that are based on symptoms or the time since the test was first positive, she said.

She explained that even though a person might test positive after they are recovered from COVID-19, it doesn’t pose a risk of transmission.

However, Hammitt said those people who have symptoms but test negative should still quarantine for 14 days, (because it could be a false negative), as should people who have been exposed to someone who has COVID-19.

“Those people need to be in quarantine even if they’ve had a negative test,” she said.

She stressed that if someone tests negative for COVID-19 that does not prevent future infections.

Hammitt described the COVID-19 antibody test as one that detects antibodies made by the body’s immune system in response to the infection.

“It is used to provide information about someone’s past exposure to the virus,” she said.

She said it is not used to diagnose someone who has a current infection.

A positive antibody test means that the person very likely had a COVID-19 infection in the past, she said.

“Whenever we get infected with something, our immune system responds and makes antibodies to try to fight off the infection,” she said.

Hammitt said it is still unknown whether the presence of COVID-19 antibodies will protect people from the virus going forward or how long that protection might last.

A negative antibody test means a person likely has not had a COVID-19 infection, she said.

Hammitt said her group is working on a protocol for antibody testing on Navajo and they plan on doing a large sample test.

“We want to roll it out across the Navajo Nation to understand how much spread of COVID-19 there has been,” she said. “We still have a lot to learn.”

While she said the antibody test is not something that is currently being made available to the general public, Hammitt expects it will become more available on Navajo in a couple of months.

‘Learn as we go’

HEHSC Chairman Daniel Tso said he is concerned about the possibility of young students going back to school in the fall, a topic which has made national headlines in the past week.
“My real concern is how to safeguard students from the pandemic within their age group,” he said.

Hammitt said she wished she had easy answers.

“I think school districts across the country are grappling with this same challenge,” said Hammitt. “How do we get kids back safely to school? We know that for many kids this is an important place where they have social support, nutritional support and their education needs being met.”

Hammitt says there has been more COVID-19 testing of children happening.

“We need to be able to analyze those data and how much of a risk transmission in the schools will pose,” she said.

She said the same types of policies that are being developed to reopen offices can be used for reopening school.

“I’m sure we can ensure adequate distancing in the schools, perhaps staggered schedules, adequate cleaning, and screening and testing for teachers and employees,” she said.

Hammitt said while they don’t have all of the answers right now, they will rely on data to help make decisions.

“As with everything with this pandemic, we will probably learn as we go,” she said.

Hammitt said systems might need to be put in place to monitor “conditions on the ground” in real time so that we can change course if what has been done does not seem to be working.

Tso asked if there was a possibility of obtaining a rapid test such as a breathalyzer test that would give an immediate result.

“I do think that there will be advances in the diagnostic testing technology that will make for better access to point of care rapid testing, but that will be a ways off,” responded Hammitt.

Delegate Otto Tso asked how they plan to handle the regular flu season on top of the COVID-19 pandemic.

Hammitt agreed that is another big area of concern as they usually start seeing cases of the flu pop up in October/November.

She said flu vaccinations will be important, and she expects that when people get sick during the upcoming flu season, they will be tested both for flu and COVID-19 at the same time.
Hammitt said under normal circumstances classrooms in the winter are a “germ factory.”

”Everyone knows those come home to the household,” she said. “That’s what we have to avoid in this situation given how severe of a disease COVID-19 is and how significantly it’s affecting elders and others across the age groups.”

Delegate Nathanial Brown asked how many different strands of COVID-19 virus there have been and if the disease might have been around before March. He also asked if Hammitt shutting down the Nation for a whole month could help.

Hammitt responded saying if the Nation shuts down for a month, the curve will flatten.

While there may have been circulation of the virus sooner than March, there probably wasn’t a significant amount given that COVID-19 does cause a fairly unique presentation of symptoms, she said.

“Whenever a virus infects a person, it starts to replicate itself,” she said. “It does this by duplicating its genes. That’s what makes us sick.”

As far as the number of strains, Hammitt estimated there may be up to three, and much research is being done in this area.

“We’re looking very carefully at all of these little differences that may pop up as the virus replicates itself,” she said.

As of right now, Hammitt said there is no concrete evidence that there are multiple lineages or distinct strains of the virus.

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