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Posted on: November 23, 2020

COVID-19 Advisory: November 23, 2020

On 11/16/20 Gov. Murphy issued EO 196 reducing the allowable number of people for indoor and outdoor gatherings & on 11/22/20 he issued EO 200 extending the public health emergency. Read on for more on these orders and up to date information on COVID-19.

The rate of transmission in NJ is fluctuating in recent weeks between 1.16 and 1.60.  Anything above 1.0 is considered concerning. The higher the number, the greater the risk of viral spread throughout the community. This rate has consistently averaged above 1.0 over the last several weeks. 

In October, the entire State, region by region,  gradually moved from low COVID activity (green) to moderate COVID activity (yellow). COVID activity is now increasing at a much higher rate, including in Morris County. In early November, five of the six regions of NJ are now classified as HIGH (Orange) COVID Activity. It should be noted that out of New Jersey’s twenty-one counties, Morris County is ranked twelfth in COVID activity, this week. This ranking will fluctuate. Within all of the Pequannock Health Department’s jurisdictions, the number of new COVID cases has been rising sharply. 

Reviewing the Numbers

Please note, the daily cumulative numbers of infected individuals displayed by municipality in the Morris County link below are subject to fluctuate. At times, a percentage of cases are assigned to the wrong municipalities. Also, labs sometimes mistakenly enter the healthcare provider’s address rather than the patients’ addresses, which may skew the numbers. Corrections are made over time, as these inaccuracies are discovered. However, the trends illustrated by this data is generally accurate. 

Please see the links below for the NJDOH COVID Activity Dashboard, the NJ Regional COVID Activity Report through November 14th  and the links to the Morris County Health Department COVID Websites. The County links include daily updates of cumulative numbers of cases by municipality and COVID Testing availability:

NJ Regional COVID Activity Report

Morris County Health Department COVID Website

Government Funded COVID-19 Testing:

The County of Morris has finally received funding to conduct COVID-19 testing. This will include at-home testing and possibly, mobile test sites. At-Home testing can be done through a website where kits can be requested. The kits are sent to the requestor’s address with instructions. All tests offered will be lab confirmed PCR tests rather than the viable, but less accurate, rapid antigen tests that have become very popular over the last few of months. The cost for these tests will be paid through medical insurance. However, patients will not be responsible for the cost of the test if they are uninsured, or if they are insured, will not be responsible to pay any uncovered portion. Passaic County had been funded to offer COVID testing in this same manner since last May. Morris and ten other counties were not eligible for this federal funding at that time, however funding is now available. The testing program is expected to be initiated in Morris County before the end of this month. More details will follow, as they become available. 

Contact Tracing and Disease Investigation

The NJ Department of Health (NJDOH) has provided additional contact tracers to our local Health Department from the State work force. They support the operation while under the direction of the Pequannock Health Department’s nurse supervisors. The Department has recently requested additional contact tracers be assigned to our jurisdiction. 

Revised Definition of Close Contact to a COVID Positive Individual

Effective as of  October 22, 2020, the New Jersey Department of Health (NJDOH) updated their criteria for what is now considered a “Close Contact” in regards to someone’s exposure to a COVID-19 positive individual. As you were made aware in past communications, the previous definition of a “Close Contact” by the NJDOH  was any individual 6 feet or closer to a COVID-19 positive individual for 10 consecutive minutes. This definition has now been changed by the NJDOH to read - “a total of 15 minutes or more of close contact exposure (6 feet or closer) to an infected person during a 24-hour period. Those determined to be a close contact to a COVID -19 positive individual must quarantine or a period of not less than 14 days. This remains unchanged. 

School Operations and COVID while addressing outbreaks  

Now that schools and universities are in operation, the Pequannock Health Department is working closely with these institutions to contact trace, isolate and quarantine individuals to quickly contain any spread of the COVID-19 virus  that may be identified within these institutions. In many cases, as COVID cases have increased, classes or certain schools have suspended in-person instruction for 14 day quarantine periods when spread within the school population exceeds CDC guidelines. 

Most school districts have implemented and are maintaining a hybrid model, which is  mix of in-person and remote learning. The Pequannock Health Department continues to provide extensive and ongoing COVID-19 guidance, along with COVID planning, surveillance, and contact tracing efforts in all five public school districts, private schools and universities within our jurisdictions. Though there has been an increase in cases among school aged children, much of the increases in new COVID infections are unrelated to the organized school, sports and classroom activities. Rather, they are more related to social interactions outside of school and travel by car pooling to these social activities. It has also been seen that activities associated with sports events like the travel to and from the events, or other peripheral activities associated with sports, where relaxed attitudes about practicing safety precautions, have been identified as a primary driver of the increases. This is also true among young and middle aged adults where travel and /or  social interactions, especially indoors, while not practicing safety precautions, have been identified as a driver of the increases.

Attendance at Crowded Gatherings, Travel and Attendance at Holiday Gatherings Increase Risk of COVID Transmission  

As we begin to move indoor as weather changes and as cold and flu season approaches, it cannot be stressed enough that large, crowded gatherings, especially indoor or in closed tents, where social distancing isn't being practiced and where face masks aren't being worn when necessary, are in part contributing to the spread of COVID-19. This is especially true at parties or large events where eating and drinking precludes the use of masks and music may be playing loudly, which causes people to get close and project themselves so they can be heard in conversation. Indoor spaces may not be as well ventilated and these spaces may make it difficult to socially distance properly. Another driver of the sharp increases is among young and middle aged adults where travel and /or  social interactions, especially indoors, while not practicing safety precautions, have been identified as a driver of the increases.

During Holidays, it is advised that travel be limited and that holiday gatherings be limited to 10 people or less.  

The public must continue to be diligent about the following, while enjoying activities:

  • Distancing six or more feet
  • Wearing masks/face coverings when appropriate
  • Practicing hand hygiene
  • Avoiding touching the eyes, nose or mouth
  • Disinfecting commonly touched surfaces
  • Staying home when symptomatic
  • Stay away from indoor gatherings or crowds, especially if at a higher risk of serious illness because of age or specific underlying health conditions
  • Following all of the requirements and advisories set forth in the Executive Orders and Executive Directives and Travel Advisories. 
  • Adhering to isolation and quarantine recommendations and orders from the Health Department’s contact tracers and disease investigators 

Anti-Viral Treatments and Vaccine Update

Anti-Viral Therapies

On October 22, 2020, the U.S. Food and Drug Administration (FDA) approved the antiviral drug Veklury (remdesivir) for use in adult and pediatric patients 12 years of age and older and weighing at least 40 kilograms (about 88 pounds) for the treatment of COVID-19 requiring hospitalization. The FDA states that Veklury should only be administered in a hospital or in a healthcare setting capable of providing acute care comparable to inpatient hospital care. Veklury is the first treatment for COVID-19 to receive FDA approval. 

On November 21, 2020, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for casirivimab and imdevimab to be administered together for the treatment of mild to moderate COVID-19 in adults and pediatric patients (12 years of age or older weighing at least 40 kilograms [about 88 pounds]) with positive results of direct SARS-CoV-2 viral testing and who are at high risk for progressing to severe COVID-19. This includes those who are 65 years of age or older or who have certain chronic medical conditions.

Casirivimab and imdevimab must be administered together by intravenous (IV) infusion. Casirivimab and imdevimab are not authorized for patients who are hospitalized due to COVID-19 or require oxygen therapy due to COVID-19. A benefit of casirivimab and imdevimab treatment has not been shown in patients hospitalized due to COVID-19. Monoclonal antibodies, such as casirivimab and imdevimab, may be associated with worse clinical outcomes when administered to hospitalized patients with COVID-19 requiring high flow oxygen or mechanical ventilation.

Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful pathogens such as viruses. Casirivimab and imdevimab are monoclonal antibodies that are specifically directed against the spike protein of SARS-CoV-2, designed to block the virus’ attachment and entry into human cells.

Vaccines

The NJDOH has been asked by the CDC to begin planning strategies for SARS-CoV-2 vaccination to begin as early as November 30, 2020, but it will likely begin after that time. Upon the completion of Phase Three Clinical Trials and approval from the FDA to proceed, NJ will begin receiving shipments of the vaccine and it will begin to be disseminated to the population by priority group

At this time, priority groups are being established to receive vaccines based on those who secure the health, safety and critical needs of communities and next, by those who are in the highest risk populations. The groups are broken into categories of priority. Categories 1-A and 1-B consist of healthcare workers in hospitals, long term care facilities, medi-centers, physicians, first responders, etc. and critical infrastructure workers who are responsible to provide essential services to the public. Some examples of these critical infrastructure workers would be those in utilities, water treatment, transportation, food related industries, critical supply chain workers, etc. These first two priority groups will also likely include residents at long term care facilities.  

Upon completing vaccination to the first two priority groups (1-A and 1-B as described above ), vaccine will be disseminated to those in Category 2, which consists of those who are in vulnerable populations because of age or certain medical conditions. Last, the vaccine will be disseminated to those in Category 3, which consists of the general population, 18 years of age and older.  Early planning indicates that the vaccines will initially be allocated incrementally to the States from late November through the end of January in order to initiate vaccinations to Categories 1-A and 1-B. In the months that follow, more vaccine will be delivered to States as dissemination expands to the general public. The vaccines will likely require a two shot regimen, either twenty-one or twenty-eight days apart, depending on which vaccine is given. 

There are many other logistical obstacles that must be considered in regards to mass vaccination, not the least of which is storing the vaccine at the required -70 to -100 degrees below zero. This and many other considerations are still in the early stages of planning at the Federal, State, County and local levels and involves both public health, homeland security and emergency management agencies.  

Pfizer has now updated that their vaccine has an efficacy rate of 95%, which is incredibly good news. However, it should be noted that this finding is based on the limited data that is now available. 

Moderna announced on November 16th that the Phase 3 study of mRNA-1273, its vaccine candidate against COVID-19, has a vaccine efficacy of 94.5%. 

For additional information about COVID vaccines, therapeutics and Emergency Use Authorizations (EUA) please see the FDA and CDC links below:

FDA

CDC & CDC-FAQ

Executive Orders

As the number of COVID cases increase during this second wave, the latest Executive Orders are beginning to place restrictions on business, social activities and capacity at gatherings. As numbers increase, more restrictions will likely be forthcoming:  

Executive Order No. 192  To Protect New Jersey’s Workforce During the COVID-19 Pandemic

Effective at 6:00 a.m. on Thursday, November 5, 2020, every business, non-profit, and governmental or educational entity that requires or permits its workforce, whether in part or as a whole, to be physically present at a worksite to perform work is required, at a minimum,  to abide by the requirements set forth in the Order, to protect employees, customers, and all others who come into physical contact with its operations. The Commissioner of the Department of Labor and Workforce Development (“DOLWD”), in consultation with the Commissioner of the Department of Health,  is hereby authorized to provide support for efforts to enforce the requirements set forth in the Executive Order at the local level.  

Executive Order No. 194  Additional COVID Mitigation Efforts Bars, Restaurants, Indoor Interstate Sports and Personal Care Services

All restaurants, cafeterias, dining establishments, and food courts, with or without a liquor license; bars; and all other holders of a liquor license with retail consumption privileges, collectively referred to as “food or beverage establishments,” that are open to the public:

Must close their indoor operations to the public from 10:00 p.m. until 5:00 a.m. each day. 

Food or dining establishments are permitted to operate during their full range of normal business hours for outdoor dining and food delivery and/or take-out services. 

Any retail, recreational, and entertainment business that is authorized to open its indoor premises to the public may only do so after 10:00 p.m. only where it prohibits the consumption of food or beverages in those indoor premises between the hours of 10:00 p.m. and 5:00 a.m. 

Food and beverage establishments are prohibited from seating patrons at, or allowing patrons to stand, in any indoor bar area.

The definition of “outdoor areas” in Paragraph 4 of Executive Order No. 163 (2020) is updated to include the following: a. Outdoor enclosed structures, such as plastic domes, to seat individual parties, provided they meet the criteria set forth in the Executive Order 194.

Indoor interstate youth sports competitions, including those operated by school-based, club, and recreational programs, are hereby suspended within the State. School-based, club, and recreational programs are also prohibited from hosting indoor interstate youth sports competitions outside of New Jersey, or  indoor youth sports competitions outside of New Jersey that would require New Jersey teams to travel to another state.

Personal care services authorized to reopen their indoor facilities to the public pursuant to Paragraph 2 of Executive Order No. 157 (2020) shall limit occupancy of any indoor premises to 25 percent of the stated maximum capacity, if applicable, at one time, excluding the facility’s employees.

Executive Order No. 195  County and Municipal Government may enact further restriction on Bars, Restaurants, Personal Care Services and Non- Essential Businesse

Municipalities and counties are permitted under this Order to impose additional restrictions, in response to COVID-19, on the hours of operation of non-essential retail businesses, food and beverage establishments, personal care service businesses, recreation and entertainment businesses, as defined by previous Executive Orders Such limitations may apply across the entire county or municipality or in targeted locations therein. Provided, however, that the limitations authorized by this paragraph cannot restrict the hours of operation of such businesses between 5:00 a.m. and 8:00 p.m. While municipalities and counties can restrict hours of operation for the aforementioned businesses between the hours of 8:00 p.m. and 5:00 a.m., they cannot prevent dining establishments from arranging for the pickup or delivery of goods or otherwise limit their scope of operations. 

Executive Order No. 196  Reduces the numbers at Indoor and Outdoor Gatherings 

Indoor Gatherings

As of 6:00 a.m. on Tuesday, November 17, 2020, the number of individuals at indoor gatherings that are not religious services or celebrations, political activities, wedding ceremonies, funerals, or memorial services shall be limited to 10 persons. The number of individuals at indoor gatherings that are religious services or celebrations, political activities, wedding ceremonies, funerals, or memorial services shall be limited to 25 percent of the capacity of the room in which it takes place, but regardless of the capacity of the room, such limit shall never be larger than 150 persons or smaller than 10 persons. For purposes of this Paragraph, any private residence or residential unit shall be treated as a single “room”. Legislative proceedings of state, county, or local government, including local Boards of Education, and state and local judicial proceedings are not subject to the capacity limits on gatherings in this or any other applicable Executive Order.

Professional and collegiate athletic competitions that are conducted indoors are subject to the current indoor gathering limit of 10 persons. Athletes, coaches, referees, and trainers, and other individuals who are necessary for the competitive professional or collegiate sporting event are not included in the number of individuals present at a gathering for purposes of the limits on gatherings. The number of individuals present inside facilities where indoor professional or collegiate athletic competitions are taking place may not exceed 25 percent of the capacity of the room in which it takes place, and such limit may not exceed 150 persons.

Outdoor Gatherings

As of 6:00 a.m. on Monday, November 23, 2020, the number of individuals at outdoor gatherings shall be limited to 150 persons or fewer. All other requirements for outdoor gatherings shall remain in effect. An outdoor gathering that is a religious service or celebration, political activity, wedding ceremony, funeral, or memorial service is not required to comply with the numerical limit on persons. Outdoor entertainment centers where performances are viewed or given, including movie theaters, performing arts centers, and other concert venues, must limit the number of patrons in any outdoor area where a performance is viewed or given to a number that ensures that all individuals can remain six feet apart, but such limit shall never be larger than 150 persons. 

Professional and collegiate athletic competitions that are conducted outdoors are subject to the outdoor gathering limit of 150 persons. Athletes, coaches, referees, and trainers, and other individuals who are necessary for the competitive professional or collegiate sporting event are not included in the number of individuals present at a gathering for purposes of the limits on gatherings. All other sports practices and competitions that are conducted outdoors are subject to the outdoor gathering limit of 150 persons, inclusive of athletes, coaches, referees, and trainers.

*NOTE- Other restrictions and requirements may be applicable for the activities and/or the authorities specified in the above mentioned Executive Orders. For additional information, please refer to the entire content of the Executive Orders and Executive Directives at the links below.

Additional Links

Governor Murphy's Executive Orders

NJ Executive Directives

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