The McLennan County Medical Society in partnership with physicians from the Family Health Center, Baylor Scott and White Hillcrest, Ascension Providence and representatives from the McLennan County Health District met virtually on Thursday evening to discuss the “Current Status and Future Strategies” regarding COVID-19 in Waco, Texas.  This physician oriented lecture covered a variety of topics including local data and testing, how contact tracing works, developing a unified testing strategy and prediction models for the coming months and years.  

Please see the attached presentation if you would like to listen again or share with colleagues unable to attend.

As the acuity and incidence of cases increase locally, we continue to need to work together to communicate and care for our community.  
 

Situation Update as of 4/2/20

• Worldwide Cases – 1,007,997 confirmed cases.  52,771 deaths. US, Italy, Spain, China and Germany have the highest confirmed cases. US now ranks 1st worldwide in total cases.
• US Cases – 238,820 confirmed cases. 5,758 deaths. New York, New Jersey, California, Michigan and Louisiana have the highest confirmed cases. Texas ranks 12th nationally in total cases. 
• Texas Cases – 4,669 confirmed cases. 70 deaths. Harris, Dallas, Tarrant and Travis counties have the highest confirmed cases. McLennan County ranks 18/254 counties. 50,679 tests completed in Texas at state and private labs with 9.2. 

               https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/ed483ecd702b4298ab01e8b9cafc8b83  

• McLennan  – 49 confirmed cases. 1 death. 6 cases hospitalized. 12 recovered.

*Note for case counts – We are reporting case counts from the CDC website. Due to increasing testing capacity at State and local labs around the country, the count may be lower than the numbers reported by media. 

Message from Dr. Verner:

“Locally our epidemic curve is still fairly linear.  Of note is that the number of cases without an identifiable exposure risk is definitely increasing indicating community spread.  Containment efforts with case finding and contact tracing can still be of real benefit.  While still important to test those with history of travel to high incidence areas as well as those with high risk comorbidities, if testing availability will allow, we would want to identify as many cases of community spread as possible.  This means testing more symptomatic patients without high risk factors hoping to identify cases occurring despite social distancing, hygiene and shelter in place efforts.  The message to symptomatic patients unable to be tested would be to act as if their test were positive and home isolate.

There is now data showing that the pre-symptomatic infectious period is probably around 2 days.  This makes social distancing especially important. Experience from other countries indicates that a significant portion of infections are transmitted by those unaware that they have it.”

Local Update

• PPE – Visit covidwaco.comor email logistics@wacotx.govto request PPE for your clinic or facility.   Facilitation of resources is coordinated by the EOC in collaboration with multiple local entities including the McLennan County Medical Society.  MCMS will not be making final determinations regarding who receives which supplies nor storing any supplies; however, we will advocate for you if needed and please let us know of any special circumstances or critical needs in PPE. CDC has adapted some guidelines for reuse of PPE in certain circumstances.  https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
• Plans have been made to accommodate surge capacity up to 130% in the coming days and weeks at both hospitals.  
• Providence, Hillcrest and the Family Health Center have all adapted and are offering specially dedicated clinics for drive through testing and/or “Fever/URI” clinics.
• Testing availability remains limited, but improved and is now being offered for more symptomatic patients.  
• Telehealth continues to perform well and is being adapted by several local physicians and patients to see some chronic and acute care illnesses. Multiple resources are available online.
• We are pushing for more transparency in testing data and epidemiological information available for physicians.
• The MCMS is actively working to prepare confidential, local psychological support for our physicians via telehealth. We all realize that this is a stressful time and want to help provide a valuable resource for our members.  More information and details will be forthcoming.
• The Waco City Council has voted to extend the local state disaster order to April 21 and postpone local elections until as late as November. 
• Governor Abbott has announced that Texas schools will remain closed until May 4 and social distancing guidelines have been extended until April 30.  

See the CDC website for more information:
https://www.cdc.gov/coronavirus/2019-nCoV/summary.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html  
 
Again, this is a consolidation of physician specific information from the Waco-McLennan County Public Health District, CDC, BS&W Hillcrest, Ascension Providence and DSHS communications.  We advise following the guidelines distributed from your hospital system if applicable. More information and updates will follow as the situation continues to evolve.
 
*Please reply to this email with any COVID-19 management criticisms and/or suggestions that we can bring to city and healthcare officials.*
 
William McCunniff, MD, MBA                                                Farley Verner, MD
McLennan County Medical Society                                       County Health Authority 
President                                                                               Infectious Disease Specialist

Situation Update as of 3/25/20
·  Worldwide Cases – 468,523 confirmed cases.  21,192 deaths. China, Italy, US, Spain and Germany have the highest confirmed cases. US now ranks 3rd worldwide in total cases.
·  US Cases – 66,048 confirmed cases. 944 deaths. New York, New Jersey, California, Washington and Michigan have the highest confirmed cases. Texas ranks 11th nationally in total cases. 
·  Texas Cases – 974 confirmed cases. 12 deaths. Dallas, Travis, Harris and Tarrant counties have the highest confirmed cases. McLennan County ranks 9/254 counties. 13,325 tests completed in Texas at state and private labs.
               https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/ed483ecd702b4298ab01e8b9cafc8b83  
·  McLennan  – 28 confirmed cases. 0 deaths. 3 cases have been hospitalized. 1 recovered.
*Note for case counts – We are reporting case counts from the CDC website. Due to increasing testing capacity at State and local labs around the country, the count may be lower than the numbers reported by media. 
 
·         Community spread is occurring and increasing in Texas. McLennan County announced that we do have apparent community spread.
·         This is a Critical point in this pandemic. Collective actions for preventing and mitigating infection will help slow the spread and help the healthcare system continue to treat and manage this surge.
 
Message from Dr. Verner:
 
“A week into the epidemic the curve is still linear.  Exponential growth as seen in areas with high activity can be expected unless we learn from the experience of those already being devastated.  Hopefully we are early enough on the curve here to avoid mirroring their outcome.  An early and aggressive social distancing policy has been instituted here with the current shelter in place order and a strong social distancing message.  Epidemiologists at the health district are investigating all positive cases and instructing them regarding self-isolation.  Close contacts are notified and instructed on self-isolation (quarantine) and actively monitored regarding onset of symptoms.  This capability becomes more difficult with large numbers of cases. What may have the greatest effect on the extent of person-to-person spread is reducing the time when a person with COVID-19 is contagious and not yet self-isolating.  Those that present with COVID-19-like symptoms would ideally be tested.  The availability of testing is unfortunately, currently limited.  Hopefully this time of shelter in place can significantly impact the number of new infections for a time until the anticipated increased availability of testing can happen.  For now and until rapid testing is widely available, we are recommending that those who cannot be tested act as if they tested positive.  Guidelines for self-isolation are available from the CDC website as well as the health department and are part of instructions to patients in the EMR  of the larger clinic systems. According to the current CDC recommendations, persons with COVID-19 can discontinue home isolation when all of the following conditions are met: No fever for 3 days (72 hours) without use of fever reducing medications and improvement in respiratory symptoms (e.g. cough, shortness of breath); and at least 7 days have passed since symptoms first appeared.
 
Resist requests for prescriptions for hydroxychloroquine or chloroquine for non-approved use. Hydroxychloroquine is being used to treat hospitalized patients. There is unfortunately already a shortage developing due to hoarding.
 
Onset of anosmia and aguesia as symptoms of COVID-19 is being recognized. Still very uncommon but unusual enough to dramatically raise the suspicion if present.”
 
Local Update

• PPE – You will hear tomorrow (3/26) of a centralized location for donation and requests for PPE (coordinated by the EOC in collaboration with multiple local entities including the McLennan County Medical Society).  More information will be posted on the city’s website as well.  Requests for PPE will be directed to email logistics@wacotx.gov.   Please be considerate and respectful in requests.  MCMS will not be making final determinations regarding who receives which supplies nor storing any supplies; however, we will advocate for you if needed and please let us know of any special circumstances or critical needs for PPE.
• The Medical Society has teamed with the Waco Chamber along with the Texas Medical Association to request PPE from local businesses and industries.  These unused products will be available by emailing the aforementioned email address. We have requested surgical masks, N95 masks, disposable gloves, bleach, disinfectant and cleaning supplies, disposable medical gowns and protective shoe covers.
• Telehealth continues to perform well and is being adapted by several local physicians and patients to see some chronic and acute care illnesses.
• The Family Health Center, Ascension Providence, and BS&W Hillcrest have all (in different states of adaptation) created specially dedicated clinics to either accommodate some drive through testing and/or “Fever/URI” clinics.  See each entities’ website for more information.
• Testing availability continues to be restricted.  Leaders from all levels of government are hearing our requests to increase availability.  

 
See the CDC website for more information:
https://www.cdc.gov/coronavirus/2019-nCoV/summary.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html  
 
Again, this is a consolidation of physician specific information from the Waco-McLennan County Public Health District, CDC, BS&W Hillcrest, Ascension Providence and DSHS communications.  We advise following the guidelines distributed from your hospital system if applicable. More information and updates will follow as the situation continues to evolve.
 
William McCunniff, MD, MBA                                  Farley Verner, MD
McLennan County Medical Society                        County Health Authority 
President                                                                Infectious Disease Specialist