FUMC Paris and Connections COVID Updates
Dear Faith Leaders,
So sorry it has been a while since the last update.
Our community COVID cases continue to decrease with hospital patient cases in the mid teens and local active cases in the high 100s to low 200s.
As we trend back to a steady state of caring for endemic COVID along with all our other community needs, people are encouraged to feel confident about returning to the hospital for elective heart catheterizations, surgeries, and other procedures. When we have a COVID patient surge, we are cautious with elective cases in patients for example that might have difficulty with coming off a breathing machine, as we had maximized ICU beds and ventilator resources. We are now in a better position and have resources to provide for those community health needs. We are committed to accept transfers from our partners as much as possible to avoid patients having to travel out of town.
Vaccinations continue to be the path to avoiding future surges of hospitalized, very ill patients. FDA committees met last week and made recommendations for Moderna boosters for patients over 65 or with medical issues or high risk jobs (health care), but recommended a ½ dose for the booster. Johnson and Johnson vaccination booster was recommended for all who received that vaccination 2 months or more ago. Final recommendations have not come from the CDC on the boosters but that is anticipated this week.
Other interesting information is that recommendations for mixing types of boosters is being discussed in patients who received one J&J vaccine. The J&J booster increased antibodies, but Pfizer as a second shot after J&J created 35x antibodies, and Moderna second shot 76x antibodies. The antibodies are just one part of the immune response, but these studies suggested that mixing the vaccines might create a more robust immune response.
With community cases decreasing, PJC has free testing on Monday and Tuesday only now, but Monday through Friday 9-4 the COVID Health District clinic is still available for free antigen COVID testing as well as all 3 COVID vaccinations. Please continue to encourage the hesitant to improve both their health and community health with vaccination. I have had several earnest late adopters open to discussion and seeking vaccination as the safety of vaccines has been confirmed, and as we know the risk of the disease is so much higher than any risk from vaccination.
In terms of masking indoors, while things are better, we still have a fairly high prevalence of cases in Lamar County. Masking indoors is still recommended, as is continued hand hygiene and social distancing. I appreciate the churches that have worked so hard to keep their congregations and community safe by continuing these precautions, though we all get tired of them.
Stay well, enjoy this pretty Autumn weather, and please let me know if you need anything!
Amanda Green, MD, FACP, HMDC, CPPS
Paris Lamar County Health District Medical Director
The hospital continues to admit multiple COVID patients daily, and has many more calls for transfers (particularly ICU) that we are unable to accept as our beds are full. We have been in the high 30s to low 40s for our COVID census this week.
We have about 80 team members that elected to get vaccinated during this Fourth Wave as we continue to see younger sicker patients admitted. The majority (more than 90%) of the COVID patients admitted continue to be unvaccinated. Steve Hyde had a good editorial with numbers in the paper last week:
There are national reports, and some local incidents of oxygen shortages, but we have been stable and have good supply chain for keeping the oxygen tanks full.
We continue to see some breakthrough cases (people fully vaccinated but are positive for COVID infection) in the community, but the symptoms are typically mild. No new plans for boosters yet as we await final guidance on September 20 booster recommendations – these should come out after a September 17th CDC meeting.
Testing sites were expanded with the help of PRMC and Scott Avery working with the County. Testing hours for this week are listed on this website:
The Health District COVID clinic is still open for testing and vaccines from 9-4 Monday through Friday and Paris Junior College has added back hours 11-6 on Monday and Thursday and 9-3 on Tuesday and Friday.
Other notes from my reading this week:
-Data has come out for patients who received a first vaccination of J&J that a booster with J&J does show excellent immunity improvement, so having a booster of same vaccine appears to be protective for that vaccine as well.
-Regeneron monoclonals continue to be advocated for high risk people within the first 10 days of COVID infection.
-Vaccines for under 12 kids are in development, but are taking longer as they also have performed a dosing study before they could do the final safety studies.
-The percent vaccinated to give us herd immunity has increased from 65% to 90% due to the increased infectiousness of the circulating variants.
-Deaths are not as high this wave as the oldest decades have 80% vaccination rates, and they were the highest death risk. The epidemiology of those who are dying has shifted down a decade.
-Mortality in children from COVID has risen, thought in part due to higher numbers infected, but that does not completely explain the increased morbidity due to COVID in kids this round. Higher COVID child hospitalizations are highest in states with lowest COVID vaccination rates. Of children and adolescents admitted with COVID between June 20 and July 31, 23.2% ended up in the ICU, 9.8% required intubation, and 1.8% died.
-One study predicted deaths will peak October 10th (deaths have several week lag to infection peaks).
Please keep advocating for vaccines and masks. I appreciate your work to keep your Church family and communities as healthy as possible.
Amanda Green, MD, FACP, HMDC
Chief Medical Officer, Paris Regional Medical Center
August 26, 2021
Dear Ministers and other leaders of Faith in our community,
We continued to see a rise in COVID cases over the weekend at PRMC, with our current COVID inpatient census in the 40s this week. The health district has seen around 60 new cases reported a day. Cases in the US have surpassed 130,000 a day on average after we had dropped in June to 12,000 cases a day. Very few admissions are in fully vaccinated people, and we have had no fully vaccinated people die in this most recent surge.
The Emergency Use Authorization (EUA) for the Pfizer BioNTech vaccine was converted to full FDA approval for people 16 and older. It is still EUA for boosters for immunocompromised people and for children 12-15. Moderna is thought to have full approval granted soon. Vaccines are still free and available 9-4, Monday-Friday at the Health District COVID clinic at 1128 Clarksville Street.
Immunocompromised people are eligible for boosters if 28 days out from last vaccine, and it is predicted that September 20 is when boosters will be recommended for those who got their last vaccine 8 months prior.
Hospitals do not have control over their bed capacity right now. The community does. If the community masks and gets vaccinated, this creates hospital beds. It is hard to compare when we might plateau in this fourth wave to England or India, as the level of infection prevention (masking, avoiding indoor events) does matter. The less people wear masks, the more they gather indoors together, the less they respect quarantines when they or a first degree exposure are positive for COVID, the more severe this will be. The health district will be reaching out again to schools, as they are not appropriately quarantining exposed children to positive cases, which will exacerbate the rate of spread. Just as a reminder, an exposure to an infected person if unvaccinated and either person unmasked for 15 minutes inside requires a 10 day quarantine.
We are discussing ways to provide monoclonal antibody treatments locally despite our very tight staffing. Paris Apothecary is offering this service - it can be ordered by a physician in the appropriate clinical situation.
Visitation at the hospital is still available, and patients with COVID infections can be visited after discussion with nursing for 10 minutes wearing full infection prevention covering.
Thanks and stay well!
Amanda Green, MD, FACP, HMDC
Lamar County Health Authority
Chief Medical Officer, Paris Regional Medical Center
FUMC Downtown and Connections Community,
Your staff and pastors want to thank you for the way you have come together as a faith community in the wake of the continued COVID-19 pandemic and the arrival of the Delta Variant in our community.
A couple of weeks ago we began to strongly encourage you to wear masks in worship and at church events and you have done so! We know it’s inconvenient; we know that we’re all tired of this pandemic, but you have come together as the Body of Christ to keep our community safer from this disease.
Thank you, church family, for doing what you can to be ministers of healing in a hurting community. As the writer of the Letter to the Hebrews said to the ancient church in struggle, we must run our race with perseverance in this moment. And it’s not a sprint, it’s a marathon. For now, our policy to strongly encourage masking remains in place in order for us to meet as a faith family.
Dr. Amanda Green (Chief Medical Officer, Paris Regional Medical Center; Paris Lamar County Health District Medical Director) shared a note with local pastors on the status of COVID-19 levels at Paris Regional Medical Center and the county. Here’s a bit of what she had to say (emphasis ours):
“The fourth wave is unfortunately going strong. We had decreased from 30 COVID patients to 21 last week and felt hopeful – however we again hit 30 again this weekend and ran out of ventilators Monday. We received 5 extra ventilators from the state warehouse that same day to help support our need. Community numbers of active tested individuals is up as well, reported as over 300. We have 8 ICU nurses approved from the state to come help care for patients during this surge.
“… Today, 2 of the patients with COVID in the hospital were fully vaccinated with Moderna and both are over 80 years old. Two had one shot of Moderna. The other 28 were unvaccinated.
“I think as more and more of the vaccine hesitant see people that they know get severely ill with COVID, more are willing to accept the only real preventive treatment for severe COVID illness.”
Masking not only aids the citizens of our county, but also will assist our local healthcare system. ICU beds at Paris Regional Medical Center are currently full. The doctors, nurses, and staff need your prayers, in addition to our siblings that are ill with COVID. As a new school year begins, we have a responsibility to love and serve the most vulnerable among us, children that cannot be vaccinated yet, as best as we are able to do. We pray for the PISD School Board who voted last night to make masks part of the school dress code for all students and staff.
The best tools we have at our disposal to beat back this virus together are masks and the vaccines. The vaccine clinic on Clarksville is open daily from 9 to 4. The vaccines are free and they save lives. For more information on current COVID trends and to register to receive your vaccine, follow these links:
Thank you for your continued faithfulness to the hard work God calls us to do together! As new information becomes available, we will keep you updated on how this affects our safety policies in the Downtown and Connections Communities of FUMC.
Your FUMC Paris Staff
Dear Minister and Faith Leaders,
The fourth wave is unfortunately going strong. We had decreased from 30 COVID patients to 21 last week and felt hopeful – however we again hit 30 again this weekend and ran out of ventilators Monday. We received 5 extra ventilators from the state warehouse that same day to help support our need. Community numbers of active tested individuals is up as well, reported as over 300. We have 8 ICU nurses approved from the state to come help care for patients during this surge.
In terms of visitation, non-COVID patients may have 2 visitors at a time, and COVID patients do not have visitors, except for changes in status, for 10 minutes per day in full PPE. Today, 2 of the patients with COVID in the hospital were fully vaccinated with Moderna and both are over 80 years old. Two had one shot of Moderna. The other 28 were unvaccinated.
I think as more and more of the vaccine hesitant see people that they know get severely ill with COVID, more are willing to accept the only real preventive treatment for severe COVID illness. We had a great talk on this from Dr. Creech at Vanderbilt, who is an expert in vaccine development, immunology, and is on vaccine safety boards for the FDA. I will not be able to present his information as well as he did, but wanted to share some of his points:
-the delta variant is more infectious than alpha – one person infected 3 other people with the original strain, now one infects 7. For chickenpox, one person infects 10, for the 1918 flu one infected 2, and for measles one infects 18.
-the delta variant is still well covered by the vaccines available.
-breakthrough infections are possible, but still extremely low compared to the unvaccinated population.
-at infection, the viral load of the vaccinated is just as high as the unvaccinated. However, the vaccinated patients clear the virus much more quickly, and so are infectious a shorter period of time. (This is why vaccinated people should still wear masks inside around others.)
-vaccinated individuals can still be infected with COVID, but there is an 8 fold reduction of infection, a 25 fold reduction in hospitalization, and a 25 fold reduction in death.
-the overwhelming majority of cases and hospitalizations now are among the unvaccinated, the immunocompromised, and children.
-there is no other treatment for COVID infection that is available that has shown much benefit. Therapies such as ivermectin and vitamin supplements are not recommended at this time.
He noted that as part of the FDA studies, they take pregnant animals and give them super high doses of vaccines to try to create problems, and there were no pregnancy or fertility issues in those studies (DART testing). In the many pregnant women and women who got pregnant after vaccination, there have been no safety problems with the vaccine.
In terms of if people who had COVID need to be vaccinated, he and his family had COVID, and he works in a lab that measures antibody levels. His teen with mild symptoms had antibody levels around 8,000 (over 4000 good), his wife with 4-5 days of more severe symptoms had levels in 20,000s, and he had pneumonia and was very ill several weeks and his antibody levels were 100,000s. He got the vaccine and his antibody levels 2 weeks after his vaccination was 1,200,000. He felt that vaccination after even a severe COVID illness was meaningful protection against further COVID infection.
We still don’t know duration of immunity or if we should mix vaccine types. He thought that boosters for health care workers would be recommended by FDA mid-September.
He noted that most of the children getting hospitalized have chronic underlying conditions (such as asthma). Current testing for vaccine safety is now occurring to the age of 6 month old children, and he suspected 7 -12 year old vaccination would be approved December or January.
He did note that Emory has done a study where antibody levels and B and T memory cell behavior in patients with a COVID infection and one dose of vaccine were the same as an uninfected person who had 2 doses of vaccine.
The Emergency Use Authorization converting to regular approval status for the COVID vaccination is just waiting on the massive paperwork and plant inspections. The only change in activity for when the vaccines have the routine (not emergency) authorization is that it would allow the companies to advertise on TV, and compensation and liability models change for the vaccine company. He noted that vaccine study data really is most meaningful in what happens the first 3 months after vaccination. He noted allergic reactions are going to occur the first week after vaccination, and any weird auto immune issues (Bell’s palsy, Guillain Barre) would declare themselves in the following few weeks. He noted that any side effect to the COVID vaccines were more rare than being hit by lightning, including myocarditis and clotting issues from Johnson and Johnson. He noted that extreme vigilance in monitoring those who had been vaccinated were the only reason those case studies were noted.
He estimated based on England and mid-Western delta infection behavior, that the South has about 3-4 weeks more of illness before we plateau. It was interesting that Iceland has some of the best vaccination rates, and they are still seeing delta in their population, but with rare ICU admissions, giving further evidence that even though a person could get COVID after vaccination, that there is a very low chance of severe disease.
The Health District will be giving booster COVID vaccinations at the COVID Clinic 1128 Clarksville to people that state they are immunocompromised, and will not be taking a health history as to the cause of immunocompromise. The FDA recommendation is for people on steroids, on immunosuppressants for transplanted organs or other underlying causes, or active chemotherapy to receive a booster if they are 28 days out from their last vaccine.
I tried to look up the 9 Texas monoclonal antibody infusion sites. There is one in San Antonio, Harlingen, Corpus Christi, Lubbock, Austin, Laredo, and Dallas. Fort Worth and Irving were sites in January, so those may round out the 9. There is not a local site for monoclonal antibody infusion at this time.
Numerous leading medical organizations cosigned a statement urging all pregnant individuals, along with those who are recently pregnant, planning to become pregnant, or lactating to be vaccinated against COVID. A study published by JAMA Network Open on Aug 11 reported the effects of COVID during childbirth, comparing 18,715 women who gave birth with COVID to 850,364 without COVID and found higher rates of preterm birth (16.4% vs 11.5%) and hospital mortality (0.1% vs <0.01%) associated with COVID infection.
The safety and effectiveness of the COVID-19 vaccine have been reported in several randomized controlled trials. One of the earliest was in the New England Journal of Medicine. https://www.nejm.org/doi/10.1056/NEJMoa2035389
I have attached a good graphic of the long term effects of patients infected with the COVID virus.
As school starts, quarantines will still be required for unmasked indoor interactions with COVID positive individuals unless vaccinated. The Texas DSHS has confirmed that the TEA recommendations to school in no way changes the health rules already in place for the reduction of spread of infection in the pandemic. I am sad that if a masked child interacts with an unmasked positive child, that they will still have to quarantine if unvaccinated, even though they tried to do all that was within their control. I am proud of Clarksville ISD and Paris ISD for putting the health of their students first during this surge of infections, and requiring masks until a reassessment of community infection levels September 3.
Trusted medical literature sources show that vaccinations are working, and masks at least don’t hurt, and probably help reduce spread of airborne and droplet diseases. Thank you for sharing with your friends and congregations as we try to keep people healthy and safe.
Thank you for all you do! Stay well!
Amanda Green, MD, FACP, HMDC
Chief Medical Officer, Paris Regional Medical Center
Paris Lamar County Health District Medical Director
Lamar County Health Authority
A word from Rob about COVID protocol changes with the arrival of the DELTA variant
Things continue to change on the COVID front. I am copying two letters that we
received today. The first is from Dr. Amanda Green, Paris Lamar County Health District
Medical Director and Lamar County Health Authority and the second from our Bishop,
Please take a minute to read both. I also have a few closing words at the end.
Hi! I have a short update for the group, mainly to share that numbers continue to be up in the community and in the hospital. There has been an average of 10 new active cases
reported daily to the health district, putting us in the 100s for active COVID case
numbers still. We are up to 16 patients with COVID in the hospital today after getting to
12 last weekend but being at 10 mid-week this week - I was hoping that the rise had
halted, but it continues. All COVID-infected patients in the hospital currently are
reportedly unvaccinated for COVID.
I have made school recommendations, which based on CDC and American Academy of
Pediatrician data is that all people over 2 wear masks when in public indoors. The state
has specifically stripped the schools from being able to enforce school mask mandates,
so recommendations are all that they can make. I do think that masking is appropriate in
churches as well with our rise in active cases. The delta variant is being reported to be
much more infectious than the original COVID. One case study that just came out had
70% of all attendees positive for COVID after a superspreader event on the east coast -
this included vaccinated people as well.
To highlight the downstream effects of our region and state having low vaccination
rates: Yesterday, it was reported that there were no open ICU beds in Texas. Not only
patients with COVID are in our hospitals, but neighbors with strokes and heart attacks.
We will not have beds to take care of people with non-COVID problems if COVID
continues to rise, particularly as they take so much more nursing time. We had state
nurse help during the first surges, but we do not have that resource now, and nursing is
scarce. Neighbor rural hospitals have several units closed as they have no nurses to
staff the beds. Getting vaccinated is the best way to try to stay out of the hospital with
COVID. In Missouri which has had a huge surge, their children's hospital is full of
children with COVID, meaning children with diseases such as leukemia cannot obtain
care. This disease is shifting to the young.
We continue to have free testing of symptomatic people and free vaccinations (Pfizer,
Moderna and J&J) at the COVID Clinic at 1128 Clarksville Street from 9-4 Monday
Thank you for continuing to partner for health in your church communities. Please let
me know if you need anything!
Dr. Amanda Green
Greetings in the name of our Lord Jesus Christ,
Recent news regarding the spread of COVID-19 and the Delta variant requires us to once again evaluate safety protocols for worship and other ministries. The virus has mutated, spreads faster, and is more dangerous than before. As the body of Christ, let us commit to doing no harm (putting children and health-compromised adults at risk) and doing good (wearing masks, encouraging vaccination, and practicing social distancing).
For the foreseeable future, all are encouraged while worshipping or gathering in our churches to wear masks. If one has not been vaccinated, wearing a mask is essential. The most vulnerable among us are our children, who are unable to get vaccinated. Many thought our communities were moving in a very good direction, but the Delta variant changed that, and once again, we must change how we protect others. Otherwise, too many of our friends and family members will be at even greater risk.
Getting the COVID vaccine is the best way to protect ourselves from the severity of this dangerous virus. Each year, I get the flu vaccine. On one or two occasions, I still got the flu, because the strain of flu that year was different than the vaccine. Yet, my flu symptoms were not as strong, and I suffered very little. Similarly, those who are vaccinated against COVID may experience much milder, or even asymptomatic,
cases of COVID.
As a member of the body of Christ, I have thought of what is best for our communities and those with whom we have relationships. I have not thought about what is most comfortable for me. Please join me in wearing masks, encouraging vaccination, and practicing social distancing in our churches so that our witness is a symbol of Christ’s and our compassion for all persons and their health.
Thank you for your leadership and for ensuring that our churches are safe places for all God’s children.
Bishop Michael McKee
Thank you for reading these two letters. As you can see, we are moving back into choppy waters! Several of our healthcare professionals, pastors, and chairs of our boards and committees have also been talking today about how best to move into this new place. All of those that responded were supportive of strongly encouraging all of us to begin wearing masks again for worship and other indoor church gatherings. We hope you will join us as we continue to work together to fight this virus!
Please feel free to call me if you have any questions (940-736-3008).
Grace and Peace,