April 16, 2020

NORTHEAST TEXAS CASE COUNT    

On the bottom right of the page that comes up, select “News and Updates” which gives you’re the current C-19 count for counties to the west of Harrison County.

Caddo, Bossier coronavirus update: COVID-19 cases rise to more than 1,300 , deaths hit 71

FROM JOHNS HOPKINS 15 APRIL:

TEMPORAL DYNAMICS OF VIRAL SHEDDING A Brief Communication article published in Nature presents analysis on temporal trends in viral shedding in COVID-19 patients. The study included data from 94 laboratory-confirmed COVID-19 patients in Guangzhou, China—including 414 total throat swabs taken as long as 32 days after symptom onset—to analyze trends in SARS-CoV-2 viral load.The study also included information on 77 identified transmission events, from both inside and outside China, to analyze SARS-CoV-2 transmission dynamics. The researchers observed high viral load in COVID-19 patients immediately after symptoms presented, which tapered off over a period of approximately 21 days. The researchers concluded that the viral load could potentially peak around the time symptoms present, or possibly slightly earlier. Based on the viral load data and case data from the 77 transmission events, the researchers estimated that 44% of the transmissions occurred during the index case’s pre-symptomatic period and that COVID-19 patients become infectious 2.3 days before symptom onset, with a peak in infectiousness around 0.7 days before symptom onset. The study does not evaluate transmissibility of individuals with asymptomatic infection, and the viral load data may not directly correlate to an individual’s degree of infectiousness. Additionally, the article notes that clinical treatment could affect viral load in COVID-19 patients.

COVID-19 IMPACT ON KIDNEY FUNCTION There is growing evidence that COVID-19 can have serious effects on organs far beyond the lungs. Respiratory distress and failure is perhaps the most recognized clinical presentation in severe COVID-19 patients, but patients are also experiencing damage to the heart, kidneys, central nervous system, and other parts of the body. In particular, kidney failure among COVID-19 patients resulting in increased demand for dialysis and continuous renal replacement therapy. This could be due to a variety of factors, including the treatments used to care for COVID-19 patients or a “cytokine storm” (i.e., overwhelming immune response that can also damage organs and tissues), but there is also preliminary evidence that the damage could be caused by the disease itself. Additional data and research are needed to fully characterize the clinical progression and manifestation of COVID-19, but it appears that the SARS-CoV-2 virus can infect a variety of cells and result in a broad scope of symptoms and damage.

More than 9,000 health-care workers in the United States have tested positive for covid-19

April 13, 2020 Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19)

This is a long, detailed Journal of the American Medical Ass. (JAMA) article of more interest to medical people than civilians, but it looks like a very thorough review which, unfortunately shows no pharmacological help yet. The entire article is available:

“Conclusions and Relevance:  The COVID-19 pandemic represents the greatest global public health crisis of this generation and, potentially, since the pandemic influenza outbreak of 1918. The speed and volume of clinical trials launched to investigate potential therapies for COVID-19 highlight both the need and capability to produce high-quality evidence even in the middle of a pandemic. No therapies have been shown effective to date.”

Tech companies step up fight against bad coronavirus info

A Scientific American article about immunity. Readable.

What Immunity to COVID-19 Really Means

Prominent scientists have bad news for the White House about coronavirus antibody tests

COVID-19 poised to hit Americas nations with more force

Gen. Milley, chairman of the Joint Chiefs of Staff, directly addressed ‘rumor and speculation’ that COVID-19 is a made-in-China weapon of war.

“At this point it’s inconclusive, although the weight of evidence seems to indicate natural, but we do not know for sure…”

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April 15, 2020

MARSHALL: [Marshall News Messenger] No new cases reported for Harrison County; cases identified at Heritage House Senior nursing facility

[Marshall News Messenger] Christus Health begins testing to determine if people had COVID-19, have antibodies to fight virus 

Lesson From Singapore: Why We May Need to Think Bigger

This article is worth a careful read. Basically, Singapore, a small city-state capable of tight monitoring (testing and contacts and cell phones), has had a “relapse” and have now had to shut things down tightly. They have gone from the most envied to just another country struggling and trying to figure out what to do and how to do it while remembering:

“All this sounds expensive. But consider that the cost of a shutdown is trillions of dollars. We clearly don’t want to do this again… if it costs a couple of hundred billion to avoid it, that may still be a relatively low price to pay.”

The letters to the editor are also interesting, some helpful. The bottom line is that we are not well enough to leave home yet.

Fort Worth: FWISD board votes to buy thousands of computers, hot spots for students learning at home

The purchase of 3,000 Chromebooks and 6,000 hot spots will cost nearly $2.5 million. Other school districts are making similar purchases.

Longview: There were no new cases of COVID-19 reported in Gregg County on Tuesday, according to Gregg County Health Administrator A.J. Harris. The case count remains 47.

New England Journal of Medicine.ICELAND STUDY:

Spread of SARS-CoV-2 in the Icelandic Population

Part of the study involved screening the population: “Although we asked participants who had respiratory symptoms that they described as more than mild not to participate in population screening, close to half the participants reported symptoms, most commonly rhinorrhea and coughing.….. Notably, 43% of the participants who tested positive reported having no symptoms, although symptoms almost certainly developed later in some of them….. Young children and females were less likely to test positive for SARS-CoV-2 than adolescents or adults and males. Whether the lower incidence of positive results in these two groups resulted from less exposure to the virus or from biologic resistance is not known. In other studies, investigators have found that infected children and females were less likely to have severe disease than adults and males, respectively.^”

^{My Comment: The Iceland studies will be exceedingly important as they progress. The population is contained and can be controlled. Travel can be limited. Their physicians and researchers are doing some elegant genetic studies of their population which may reveal genetic variations in susceptibility to this virus. Perhaps more importantly, they can rapidly and seemingly accurately detect genetic differences in the infecting viruses. The virus’ genetic patterns differ depending on the area a patient visited and became infected. Multiple mutations in the viruses are noted frequently.}

^{The virus’s genetic sequences and mutations might have significant importance in the development of functional vaccines. I do not pretend to understand modern virology or genetics, but I will attempt to” translate” what I can. JH}

^{Drug Evaluation during the Covid-19 Pandemic}

^{A readable explanation of how to scientifically perform and evaluate drug studies and medication treatments for our current epidemic and for the future:}

^{Excerpts: During a pandemic that is causing morbidity and mortality to grow exponentially, there is an understandable temptation to make unproven therapies widely available and not wait for rigorous clinical trial data. However, well-conducted randomized, controlled trials in these acutely ill patients can actually be carried out quite rapidly. Thousands of new patients with Covid-19 present for care each day and many can be (and are) quickly enrolled in pragmatic clinical trials. The most relevant clinical outcomes for evaluating these drugs — including death, hospitalization, number of days spent in intensive care, and need for a ventilator — are readily assessed and available within days or weeks…… Rigorous premarketing evaluation of drugs’ safety and effectiveness in randomized, controlled trials remains our primary tool for protecting the public from drugs that are ineffective, unsafe, or both. It is a false dichotomy to suggest that we must choose between rapid deployment of treatments and adequate scientific scrutiny. For the Covid-19 pandemic and other pressing medical challenges, the health of individual patients and the public at large will be best served by remaining true to our time-tested approach to clinical trial evidence and drug evaluation, rather than cutting corners and resorting to appealing yet risky quick fixes. The pandemic will inevitably leave considerable morbidity, mortality, and loss in its wake. Damage to the country’s medication-assessment process — and the public’s respect for it — should not be part of its legacy….At least 25 drugs are under investigation for use in Covid-19, with 10 in active clinical trials. The first published major randomized, controlled trial of an antiviral drug combination (lopinavir–ritonavir) began enrolling patients in China just a week after the virus had been identified.5 Contrary to expectations, its results were negative, providing important clinical guidance…. From the Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston.}

MASKS FOR NY GROCERY SHOPPERS   ???

WHY ROLLING CORONAVIRUS PATIENTS ONTO THEIR STOMACHS IS SAVING LIVES

A good summary article sent by Dr. J. Vassar.

We actually did this in back in the dark ages at Parkland Memorial Hosp. and tried other positions if needed (postural drainage) along with physical therapy (chest clapping) if indicated. JHarris

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[Marshall, Texas, April 1, 2020]

[Harrison County and Marshall, Texas] In response to inquiries from our community regarding the Shelter in Place Orders issued on March 31, 2020, Harrison County Judge Chad Sims and City of Marshall Mayor Terri Brown have defined essential vs. nonessential businesses and/or services in Harrison County, including the City of Marshall.

Essential Businesses / Services

Healthcare Operations

•             Hospitals, Clinics and Pharmacies

•             Veterinarians

Grocery Stores

•             Grocery Stores, Certified Farmers’ Markets, Farm and Produce Stands, and Supermarkets

•             Food Banks

•             Convenience Stores

•             Other establishments engaged in the retail sale of canned food, dry goods, fresh fruits and vegetables, pet supply, fresh meats, fish, and poultry, and any other household consumer products (such as cleaning and personal care products)

•             Liquor Stores

•             Some Retail: Stores that also sell groceries or sell supplies necessary for operation of essential businesses, working for home, or maintenance of residences. Example: electronics, appliances, health care products, office supplies.

Food Cultivation

•             Farming

•             Livestock

•             Fishing

Social Services

•             Businesses or non-profit organizations that provide food, shelter, and social services, and other necessities of life for economically disadvantaged or otherwise needy individuals

Media

•             Newspapers, Television. Radio, and Other Media Services

Vehicles

•             Gas Stations

•             Auto Sales

•             Auto Supply

•             Auto Repair

•             Car Wash & Mobile Detailing

Financial Institutions

•             Banks

•             Other Financial Institutions/Lending

Property Maintenance

•             Hardware Stores and Construction Supply Stores

•             HVAC Repairs, Plumbers, Electricians and Exterminators

•             Lawn Maintenance

•             Pool Service

•             Other service providers who provide services that are necessary to maintaining the safety, sanitation, and essential operation of residences, Essential Activities, and Essential Businesses

Mailing

•             Mailing Services, Shipping Services, and P.O. Boxes

Clothes Cleaning

•             Laundromats, Dry Cleaners, and Laundry Service Providers

Restaurants

•             Restaurants and other facilities that prepare and serve food, but only for delivery or carry out.

•             Schools and other entities that typically provide food services to students or members of the public may continue to do so under this Order on the condition that the food is provided to students or members of the public on a pick-up or take-away basis only.

•             Schools and other entities that provide food services under this exemption shall not permit the food to be eaten at the site where it is provided, or at any other gathering site.

E-Commerce

•             Businesses that ship or deliver groceries, food, goods or services directly to residences

Supplying Essential Business support

•             Businesses that supply other Essential Businesses with the support or supplies necessary to operate

•             Printers and Promotional Products

•             Hotels, motels and RV parks

Transportation

•             Airlines

•             Taxis

•             Other private transportation providers providing transportation services necessary for Essential Activities and other purposes expressly authorized in the Order

Care Facilities

•             Home-based care for seniors, adults, or children

•             Residential facilities and shelters for seniors, adults, and children

•             Childcare facilities providing services that enable employees exempted in this Order to work as permitted

Professional Services

•             Legal

•             Bail bonds

•             Accounting

•             Insurance

•             Real Estate Services, Architectural, Appraisal, Survey, and Title Services

Vital Infrastructure

•             Utilities

•             Telecommunications

•             Trash Collection and Disposal

•             Law Enforcement, Fire, EMS/Ambulance, Corrections, Dispatch

•             Animal Shelters

•             Governmental Employees who have not been specifically deemed non-essential and sent home by the government entity

Societal Maintenance

•             Janitorial and Maintenance Services

•             Funeral Industry

•             Defense Industry

•             Space and Technology Industry

•             Technology Support

•             Scientific Research

Religious Services with Social Distancing of 6’ between individuals and gatherings of no more than 10 people

•             Provided in Residences

•             Healthcare Operations

•             Funerals

•             Provided online while being broadcast from a religious facility

Non-Essential Businesses Prohibited from Operation

All businesses not specifically listed as essential above are considered non-essential and are to be closed at all times. A partial list is shown below:

Personal Hygiene

•             Hair Salons and Barber Shops

•             Nail Salons and Spas

•             Tattoo Parlors

•             Tanning Studios

•             Massage Studios

Other Retail

•             Furniture and Home Furnishings Stores

•             Cosmetics, Beauty Supplies, and Perfume Stores

•             Clothing Stores & Boutiques

•             Shoe Stores

•             Jewelry, Luggage, and Leather Goods Stores

•             Sporting Goods Stores

•             Hobby Stores and Game Stores

•             Framing Stores

•             Book Stores

•             Florists

Entertainment

•             Movie Theaters

•             Museums

•             Indoor Recreation, Game Rooms & Children’s Gyms

•             Ranches & Camps

•             Concert and Special Event Venues

Lifestyle

•             Gyms

•             Martial Arts Studios

•             Yoga Studios

•             Restaurants (Dine in), Bars, Clubs, and Lounges

Failure to comply with any of the provisions of this Order constitutes an imminent threat to public health. In accordance with Texas Government Code §418.173, a person who knowingly or intentionally violates this Order commits a Class B Misdemeanor punishable by a fine up to $1,000.00 and/or confinement in jail for a term that does not exceed 180 days, and each day or portion of a day that such a violation continues shall constitute a separate offense.

Harrison County and the City of Marshall are following the Centers for Disease Control’s (CDC) guidelines and recommendations on the steps our community can take to help prevent catching or spreading the coronavirus (COVID-19). This is a situation that continues to evolve and we will do our best to keep our citizens informed of the latest information.

Harrison County and the City of Marshall urge our community to practice healthy habits including:

1.        Restrict physical contact and publicly used areas.

2.        Maintain Social Distancing with a safe distance of six (6’) feet between individuals.

3.       Every person in Texas shall avoid social gatherings in groups of 10 or more per Executive Order of Governor Abbott.

4.       Residents should not visit nursing homes, retirement, or long-term care facilities unless to provide critical assistance.

5.        In accordance with the CDC, residents may still utilize drive-thru, pickup, or delivery options through the Executive Order.

6.        Regularly wash hands with warm soap and water for at least 20 seconds.

7.        Avoid touching eyes, nose, or mouth.

8.        If soap is not available, use at least a 60% alcohol-based hand sanitizer.

9.        Avoid close contact with people who are sick. All persons should remain in the home if one person in the home exhibits symptoms

If you are experiencing fever, cough or difficulty breathing, been exposed to a sick traveler or been exposed to a person with COVID-19 in the last 14 days, please contact your healthcare provider immediately. Inform your physician or emergency department of your symptoms to prevent any potential spread.

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[Marshall, Texas, March 31, 2020]

Harrison County and City of Marshall Issue Mandatory Shelter in Place Orders

First Amended Declaration of Local Disaster and Public Health Emergency Related to Communicable Disease

[Harrison County and Marshall, Texas] Harrison County Judge Chad Sims and City of Marshall Mayor Terri Brown confirm a second and third positive case of the coronavirus (COVID-19) in Harrison County. In each case, the cause of COVID-19 exposure was travel-related. County and City leadership believe it to be in the best interest to be proactive and take measures to further safeguard our citizens and prevent community spread. In response, Judge Sims and Mayor Brown are both issuing Mandatory Shelter in Place orders effective at 11:59 p.m. on March 31, 2020.

                Under this Order, citizens of Harrison County and the City of Marshall are still permitted to perform essential activities for their families; including obtaining medical supplies, visiting a health care provider, obtaining supplies they need to work from home, grocery shopping, engaging in outdoor activities while maintaining social distancing, and to perform work defined as an essential service. Citizens at a high risk of illness from COVID-19 and people who are sick are urged to remain in their residence except to receive medical care.

                Essential services are defined as all first responders, emergency management personnel, individual performing government functions, healthcare operations, essential infrastructure, grocery stores, farmers’ market, food banks, pet stores, farming, livestock, fishing, social services, media, gas stations, auto supply/repair, banks, hardware, mailing services, plumbers, electricians, exterminators, laundromats, dry cleaners, restaurants, office supplies, airlines, private transportation, home-based services or shelters for seniors, adults or children, professional services (legal, accounting, insurance, real estate, appraisal, survey, and title), childcare, utilities, telecommunications, janitorial, maintenance, healthcare operations, funerals, defense industry, and educational services operating online. A full list of all essential services may be found in the Ordinance at www.marshalltexas.net.

Non-essential businesses shall shut down except for maintaining Minimum Basic Operations.  Essential Businesses exempted from shut-down are encouraged to determine staff who are essential to operations and to send non- essential staff home.

For the purposes of this Order, “Essential Travel” includes travel for any of the following purposes:

•             Any   travel   related   to   the provision of or access to Essential Activities, Essential Governmental Functions, Essential Businesses, or Minimum Basic Operations;

•             Travel to care for the elderly, minors, dependents, persons with disabilities, or other vulnerable persons;

•             Travel to or from educational institutions for purposes of receiving materials for distance learning, for receiving meals, and any other related services;

•             Travel to return to a place of residence from outside the jurisdiction;

•             Travel required by law enforcement or court order; or

•             Travel required for non-residents to return to their place of residence outside the City. Individuals are strongly encouraged to verify that their transportation out of the City remains available and functional prior to commencing such travel.

When citizens need to leave their places of residence, whether to obtain or perform vital services or to otherwise facilitate authorized activities necessary for continuity of social and commercial life, they should at all times comply with the Social Distancing Requirement.

Failure to comply with any of the provisions of this Order constitutes an imminent threat to public health. In accordance with Texas Government Code §418.173, a person who knowingly or intentionally violates this Order commits an offense punishable by a fine up to $1,000.00 and/or confinement in jail for a term that does not exceed 180 days, and each day or portion of a day that such a violation continues shall constitute a separate offense.

                The Emergency Management Team will continue to meet with leaders from Harrison County, Marshall – Harrison County Health District, CHRISTUS Good Shepherd Health System – Marshall, and City of Marshall monitoring the situation on an ongoing basis and providing notices to citizens as needed.

Harrison County and the City of Marshall are following the Centers for Disease Control’s (CDC) guidelines and recommendations on the steps our community can take to help prevent catching or spreading the coronavirus (COVID-19). This is a situation that continues to evolve and we will do our best to keep our citizens informed of the latest information.

Harrison County and the City of Marshall urge our community to practice healthy habits including:

1.        Restrict physical contact and publicly used areas.

2.        Maintain Social Distancing with a safe distance of six (6’) feet between individuals.

3.       Every person in Texas shall avoid social gatherings in groups of 10 or more per Executive Order of Governor Abbott.

4.         Residents should not visit nursing homes, retirement, or long-term care facilities unless to provide critical assistance.

5.        In accordance with the CDC, people shall avoid eating or drinking at bars, restaurants, and food courts, or visiting gyms or massage parlors. Residents may still utilize drive-thru, pickup, or delivery options through the Executive Order.

6.        Regularly wash hands with warm soap and water for at least 20 seconds.

7.        Avoid touching eyes, nose, or mouth.

8.        If soap is not available, use at least a 60% alcohol-based hand sanitizer.

9.        Avoid close contact with people who are sick. All persons should remain in the home if one person in the home exhibits symptoms

If you are experiencing fever, cough or difficulty breathing, been exposed to a sick traveler or been exposed to a person with COVID-19 in the last 14 days, please contact your healthcare provider immediately. Inform your physician or emergency department of your symptoms to prevent any potential spread.

The City of Marshall will hold City Commission meetings utilizing a video and audio conferencing tool, as well as, a standard conference call.  Instructions and direct links to view meetings or speak during Citizen Comment can be found at http://www.marshalltexas.net.

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[Marshall, Texas, March 26, 2020]

On March 26, 2020, at 11:30 a.m., City of Marshall Mayor Terri Brown issued a Declaration of Local Disaster and Public Health Emergency Related to Communicable Disease in conjunction with Harrison County Judge Chad Sims as a positive test of the coronavirus (COVID-19) has been reported in Harrison County, Texas. Additional information and data are being collected at this time. The City of Marshall Emergency Management Team composed of representatives from the City of Marshall, Harrison County, CHRISTUS Good Shepherd Health System – Marshall and the Marshall – Harrison County Health District continue to meet on a regular basis to review developments and make appropriate responses to safeguard our community.

Declaration of Local Disaster and Public Health Emergency Related to Communicable Disease

WHEREAS, the disease Covid-19 currently poses a significant health risk to the residents of the City of Marshall and has been declared a World, National and State Health Emergency; and,

WHEREAS, the Covid-19 disease was confirmed to exist in Harrison County as of March 26, 2020; and,

WHEREAS, as City of Marshall Mayor, I have concerns regarding finite accommodations for an influx of local Covid-19 patients, personal protective equipment shortages for emergency response personnel and the potential for the escalating spread of the disease in pandemic form; and,

WHEREAS, it is necessary to preserve and protect the public health of the residents of the City of Marshall with the disease already present in the County; and,

WHEREAS, on the date of this declaration, the Harrison County Judge has also issued a declaration of a public health emergency.

NOW, THEREFORE, BE IT PROCLAIMED BY TERRI BROWN, MAYOR OF THE CITY OF MARSHALL, TEXAS:

l.          That a local state of disaster and public health emergency is hereby declared in the City of Marshall pursuant to §418. l08(a) of the Texas Government Code.

2.         Pursuant to §418.108(b) of the Texas Government Code, the local state of disaster and public health emergency shall continue for a period of not more than seven (7) days from the date of this declaration unless continued or renewed by the Marshall City Commission.

3.         Pursuant to §418.108(c) of the Texas Government Code, this declaration of a local state of disaster and public health emergency shall be given prompt and general publicity and shall be filed promptly with the City Secretary.

4.         Pursuant to §418.108(d) of the Texas Government Code, this declaration of a local state of disaster and public health emergency activates the Marshall Emergency Management Plan.

5.         Pursuant to §418.108(g) of the Texas Government Code, this declaration of a local state of disaster authorizes the Mayor to control ingress to and egress from the City of Marshall and to control the movement of persons and the occupancy of premises within the City of Marshall.

6.         All officers and employees of the City of Marshall, including without limitation all law enforcement officers employed by the City of Marshall and all emergency medical personnel employed by the City of Marshall, are hereby authorized and directed to cooperate to the fullest extent allowed by law with the health authority designated by the City of Marshall pursuant to Chapter 121 of the Texas Health and Safety Code to enforce any and all communicable disease control measure by said health authority pursuant to Chapter 81 of the Texas Health and Safety Code or other applicable law.

This declaration shall take effect immediately from and after its issuance. ORDERED and DECLARED this 26th day of March 2020.

Terri Brown
Mayor, City of Marshall

 
Citizens are urged to follow following the Centers for Disease Control’s (CDC) national guidelines and the Executive Order GA-08 by Governor Greg Abbott.
It has been expressed that our community practice Social Distancing which includes:
1.         Restrict physical contact and publicly used areas.
2.         Maintain a safe distance of six (6’) feet between individuals.
3.         Every person in Texas shall avoid social gatherings in groups of 10 or more per Executive Order of Governor Abbott.
4.         Residents should not visit nursing homes, retirement, or long-term care facilities unless to provide critical assistance.
5.        In accordance with the CDC, people shall avoid eating or drinking at bars, restaurants, and food courts, or visiting gyms or massage parlors. Residents may still utilize drive-thru, pickup, or             delivery options through the Executive Order.
6.         Regularly wash hands with warm soap and water for at least 20 seconds.
7.         Avoid touching eyes, nose, or mouth.
8.         If soap is not available, use at least a 60% alcohol-based hand sanitizer.
9.         Avoid close contact with people who are sick. All persons should remain in the home if one person in the home exhibits symptoms.

If you are experiencing fever, cough or difficulty breathing, been exposed to a sick traveler or been exposed to a person with COVID-19 in the last 14 days, contact your healthcare provider immediately. Be sure to call before going to your doctor or an emergency department to prevent any potential spread.

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