Calvert County Health Department

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Coronavirus (COVID-19)

September 27, 2021
Covid Booster Q+A

The FDA and CDC recently authorized Covid vaccine boosters. The following is an attempt to clarify who is eligible for boosters and explain how you can get your dose in Calvert County. The goals and rationale of the CDC are followed, but there are a few differences between CDC guidance and our local protocol. These differences simplify the process and improve access to booster doses against a disease that took the lives of 5 Calvert residents last week. Since the beginning of the pandemic, 84 of the 86 Calvert residents who have died from Covid were unvaccinated. We cannot emphasize strongly enough how important it is for every eligible person to get vaccinated against this disease.
 
More recent studies have shown a gradual decline in protection from the original vaccination series. Booster doses have improved protection back to the original levels of nearly 95%. Those eligible for booster doses should consider taking advantage of the additional protection for themselves and vulnerable people close to them.

In order to receive a Covid booster through the Calvert Health Department, individuals must meet the following criteria:

1) The initial vaccinations received were either Pfizer or Moderna.
 *For those who received Johnson & Johnson (J&J), please see below.
2) At least 4 months have passed since receiving your second vaccine dose
3) All members of the general public age 50 or older are eligible for booster doses
4) Anyone 16 and older who works in a prioritized job classification is eligible, including

• Nursing home and assisted living staff
• Healthcare workers
• First responders
• People who work or live in congregate residential facilities such as ARC housing, the Domestic Violence Shelter, Substance Use Treatment facilities, or the County Detention Center
• Public transit and school bus drivers
• Teachers/classroom staff and daycare staff. Boosters are especially recommended for those who work with children unable to wear face coverings due to developmental reasons.

 *People under 50 years-old who qualify as a result of their job will need to bring your work ID or a note from your employer to show that your job qualifies you for a booster dose.

Those in the groups below must have a note from their personal physician or nurse practitioner recommending a booster dose. This includes:

1) J&J recipients. Please understand that supplies of J&J vaccines are very limited. You should talk to your healthcare provider about the possibility of receiving a Pfizer or Moderna booster if Johnson & Johnson vaccines are not available.
2) People under age 50 with chronic health conditions that place them at high-risk of Covid complications.
3) People under age 50 who live with severely immunocompromised household members.

To emphasize: The Health Department will not give boosters to those who had their second dose (or single dose of J&J) less than 4 months ago.

Vaccine boosters can be obtained through many primary care providers and pharmacies. You can also schedule an appointment to be vaccinated by Calvert County Health Department nurses using the following link. Once you click on the link, scroll down the page to find the date and brand of vaccine that is best for you:
https://www.calvertcountycovid19.com/vaccination

If you choose to get your booster through the Health Department, you must bring proof of your previous vaccinations. You can bring your CDC Vaccination Card or download a record of your vaccinations to your smartphone or home computer via the secure Maryland database: https://md.myir.net/rorl?next=/

The following will hopefully address questions you may have about booster doses:

Please explain why booster doses are important and why the Health Department is offering them to everyone 50 and older who received their second dose at least 4 months ago.
Since the delta variant appeared in Southern Maryland in mid-July, an increasing number of breakthrough infections, and in some cases, hospitalizations, have occurred. Although fully vaccinated people (2 doses of Pfizer or Moderna or 1 dose of Johnson & Johnson) remain 10-times less likely to become severely ill from Covid than those who remain unvaccinated, over 20 fully vaccinated Calvert residents have required hospitalization since early August.
The best available studies are currently from Israel. The data show that a booster dose eliminates almost all breakthrough hospitalizations with 7-10 days of inoculation. (https://www.nejm.org/doi/pdf/10.1056/NEJMoa2114255?articleTools=true)
Boosters also dramatically reduce milder infections that can result in long-term health problems or lead to spread within households. The science behind Covid boosters is complex. The recent explanation posted on our Covid-19 website provides a detailed explanation about the reasoning behind boosters and the protection they offer. You can find the post at: https://www.calvertcountycovid19.com/post/booster-vaccinations-in-calvert

The CDC guidance recommends that people 50-64 should have underlying health conditions to qualify for a booster. Why does the local protocol allow everyone in this age group to get a booster?
The CDC’s definition of high-risk health conditions includes well over 80% of people in this age range. It is unnecessarily confusing to put limitations on access when so many people qualify for vaccination. For example, everyone who is overweight or obese (BMI >25), everyone with high blood pressure or diabetes, every current or former smoker, everyone who is African American, Hispanic, or Native American, everyone with cancer, and everyone with dozens of other chronic health conditions qualify for boosters.
For anyone interested, the CDC’s list of qualifying conditions can be found here, but again, anyone 50 or older is eligible for a booster through our Health Department: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

The FDA and CDC guidance for boosters is limited to those who previously received Pfizer vaccines. Why does the local protocol allow those vaccinated with Moderna to receive a booster?
Pfizer submitted its booster data several weeks ago, and Moderna is still finalizing its study. The FDA is only allowed to act on medications and vaccines after the manufacturer submits their final study data. As a result, they cannot formally approve Moderna boosters at this time.
Since the clinical trials for Pfizer and Moderna began in July 2020 and the Emergency Use Authorizations were approved by the FDA in December, over 200,000,000 Americans have received these vaccines. Study after study have shown the effectiveness and safety of these two vaccines mirror each other. There is every reason to expect the effectiveness and safety of Moderna boosters will be comparable to Pfizer.
Given the significant increase in breakthrough infection since the arrival of the delta variant, including an average of 4 hospitalizations each week among our vaccinated county residents, delay in access to boosters leaves Moderna recipients at unnecessary risk. Most people did not have a choice of which vaccine brand they would receive, and no one could have foreseen that getting Moderna would later leave them at increased risk of breakthrough infections due to federal regulatory restrictions. Healthcare providers have a professional duty to protect. Denying people access to booster protection under these circumstances could arguably be seen as unethical.
This decision, as with other components of our local booster protocol, was part of a consensus agreement among physicians representing all of the primary care practices in Calvert. Anyone who received Moderna and wants to wait for FDA/CDC guidance has that option. But for those who want to move ahead with a booster, the cumulative evidence of the last 14 months supports this decision.

Why do people under 50 need a note from their personal healthcare provider in order to receive a booster?
The CDC Advisory panel was clear that people under 50 who have already received the standard Covid vaccination series are at considerably lower risk of severe illness than those over 50. However, there are people with specific health problems that are at substantial risk. The CDC panel recommended that such people should have a conversation with their personal healthcare provider to see if a booster is in their best interest. Our local physicians also determined that this is the best course of action. In addition to discussing booster doses, such conversations with your healthcare provider give you an opportunity to optimize control of your underlying health conditions so you’re less susceptible harms from other infections, including influenza.
If your doctor or nurse practitioner provides Covid vaccinations, you should be able to get your booster there. If not, you only need a brief note from your provider stating that she/he recommends you receive a booster, and the Health Department will provide the vaccination.

What if I am not at personal risk of severe illness, but someone in my household is at very high-risk?
If you live with a person who is severely immunocompromised, for example someone currently receiving chemotherapy, it is very important that you don’t inadvertently pick up the virus. Even when a severely immunocompromised person is vaccinated, their protection is unpredictable and their potential for severe illness if they do become infected is much greater than for the average person. Once a person brings Covid into a household, the delta variant spreads very quickly. If it’s been at least 4 months since you completed your vaccination series, a booster will further decrease the potential that you will end up catching even a mild case of the virus. The Israeli studies show that a booster makes someone 11-times less likely to become infected if it’s been 5 or more months since their initial vaccination.

Will I need to get a booster every 6 months?
That is unlikely, but a definitive answer cannot be given. Many established vaccines require a booster close to 6 months after the first dose is administered. Examples include vaccines to prevent hepatitis, HPV, and polio. In general, once the 6-month booster is given, much longer lasting protection is provided than the protection obtained from the very early dose(s). The potential for future boosters is more likely to be the result new variants emerging than as a result of the current booster wearing off over the next 6-12 months.

Can I get a flu vaccine at the same time as my Covid vaccine?
Yes. You can safely receive a flu vaccine at the same time as either an initial Covid vaccination or a booster. For those who wish to separate the two vaccinations, that is not a problem. It’s mostly a matter of personal preference. Influenza vaccines are optimally administered in September or October.
If Covid continues to mutate in ways that periodically reduce vaccine effectiveness, it’s possible that a combined Influenza-Covid vaccine could be produced each year. For the moment, flu vaccines remain a separate inoculation from Covid.

September 10, 2021
Booster Vaccinations in Calvert

Calvert County Health Department began administering COVID vaccine boosters on Monday September 13, 2021. This is a lengthy post because it contains a lot of important evidence and guidance for those considering booster doses. This is an important decision for many in our community and you deserve a thorough overview of current information.

Over the past two weeks, there have been a series of discussions and communications between the physicians at the Calvert Health Department and >60 local clinicians, including representatives from every Calvert primary care practice and many medical specialists, to determine the best course of action regarding booster doses. Since the Delta variant began to cause hospitalizations in early August, 12 breakthrough hospitalizations have occurred in Calvert County. It is important to note that although some hospitalizations have occurred in people who received vaccination, data demonstrate that approximately 100 additional hospitalizations were prevented as a result of vaccine effectiveness. Of the breakthrough cases, ages ranged from early 50s to 80s, and 75% occurred 4-5 months after receiving a 2nd dose. None of these people met the CDC criteria for moderately-severely immunocompromised conditions, although all had at least one chronic health condition that placed them at increased risk for severe COVID illness. Of the five Calvert residents who have died from COVID since early August, one was vaccinated.

After thoroughly reviewing current vaccine research, results from early Israeli booster efforts, and local data on breakthrough cases that have resulted in hospitalizations, consensus recommendations were reached by our local physicians and nurse practitioners. The booster protocol developed by the Health Department is based on these recommendations. It is the goal of the Health Department and local healthcare providers to have a standard based on the best interests of Calvert residents and to provide clear communication and justification for this protocol. Everyone considering booster doses should be aware that protocols have not yet been officially approved by the FDA or CDC. 

There is countywide consensus to offer booster doses to everyone 50 and older who received their 2nd vaccination dose at least 4 months ago. (Those who received Johnson & Johnson should see below). Physicians felt that our local empirical evidence, although a small sample size, did not justify a waiting period of 8 months after a second dose. Our chosen timing also places the booster dose at approximately 5 months after the first dose, which is close to the standard 6-month boosters for other vaccines such as hepatitis B, HPV, and polio that have shown long-lasting immunity. 

1) The age 50 cutoff does not apply to frontline healthcare workers, nursing home or assisted living facility staff, or first responders. These people have much greater exposure risks than the general public and even if they don't get severely ill, we can't afford to lose this critical workforce for 10 days while they recover. And we certainly don't want sick people trying to work while they are providing healthcare or emergency services. Classroom staff who work with developmentally challenged students who are unable to wear face coverings are also welcomed to receive a booster dose once they reach 4 months from their second vaccination.
The age cutoff also doesn't apply to people who live or work in congregate residential settings, including the ARC of Southern MD housing, the domestic violence shelter, county jail, etc. The potential for outbreaks among vulnerable populations is too great.

2) Any licensed clinician is welcome to recommend boosters to any of their patients whom they deem in need. The age 50 cutoff only applies to the general population. If they are caring for a 32 year-old with multiple underlying health problems, licensed clinicians are encouraged to manage her/him as they see fit.

The rationale for this protocol is as follows:

Two weeks ago, the White House announced their intention to allow booster doses, starting 9/20/21, for anyone 16 or older, who had received their second mRNA vaccine at least 8 months prior. Those who received J&J remain in booster limbo. The announcement stated that the Sept. 20th date was chosen to give vaccinators time to prepare. No rationale or data were provided to justify the 8-month interval between second and third dose nor the decision to boost anyone 16 or older as opposed to limiting boosters to age groups more likely to develop severe disease and require hospitalization. 

The CDC Advisory Committee on Immunization Practices (ACIP) met shortly after the White House announcement. There was a brief presentation on boosters, but there was minimal discussion and no recommendations were made. In the meantime, people are going to pharmacies and other locations where no practice standards are being applied. The CDC estimates that >1 million Americans have already received boosters. Some medical practices have also begun to boost patients. It is our intention to develop an educated, coherent policy for boosters that provides quality guidance to our community instead of having a patchwork access system or having patients act out of fear or based on questionable information gleaned from the internet. 

Local clinicians and Health Department staff reviewed available information on the lasting effectiveness of the standard 2-dose vaccine regiment to prevent breakthrough infections and serious illness as well as current evidence on booster doses in those who do not meet the CDC definition of immunocompromised. During the past week, the Maryland Department of Health laboratory reported that 100% of Maryland COVID specimens genotyped were Delta variant, so everything mentioned in this communication will focus on that variant. This week, the ACIP reported that for seniors, full vaccination is 60% effective against infection with Delta, 75% protective against symptomatic infection, and 83% protective against hospitalization. In other words, 1 out of 6 vaccinated seniors is no longer getting protection against severe illness from COVID.

There are three primary reasons that likely account for higher rates of breakthrough infections with Delta. First, the circulating neutralizing antibodies triggered by vaccination wane over time. The rate at which antibodies diminish is likely an age-related phenomenon if evidence from other vaccines can be extrapolated. Second, one of the Delta mutation sites results in stronger covalent bonds between the virus’s spike protein and the ACE receptors on our cells. Another mutation allows more efficient entry through our cell membranes and delivery of viral RNA into our cells. This combination accounts for higher transmission rates, faster onset of illness, and higher virus counts in infected individuals than was seen with earlier strains of COVID. Third, a separate site mutation in Delta has led to conformational changes in the spike protein that decreases attachment of vaccine-derived neutralizing antibodies. Translation: Think of virus proteins like a piece of paper. You can fold the same piece of paper in thousands of different ways resulting in thousands of different shapes. Envision an origami swan or a butterfly. An antibody designed to match the shape of a swan will not align or attach well with the contours of a butterfly. The relative contribution of each of these factors to reduced vaccine efficacy is uncertain at this time.

The same principles apply to decreasing immunity following natural infection. As we’ve all seen by the sky-high infection rates and overflowing hospital wards in states with low vaccination rates, protection from pre-Delta strains of COVID is much less protective than vaccination. The recommendation holds that people who have had previous COVID infections should be vaccinated within 90-days of their illness.

A lecture this past week hosted by the American Public Health Association (APHA) with vaccine experts from UCSF, Duke, and Baylor Schools of Medicine, emphasized that giving two vaccine doses within 1 month is not an ideal way to produce lasting immunity. This regiment made sense to quickly boost immunity when hospitals are overwhelmed last winter and healthcare experts were desperately trying to protect high-risk individuals from dying, but two narrowly spaced doses are not the best long-term strategy. The experts on the national call echoed the thoughts of our local clinicians that many tried and true vaccines for both children and adults boost around 6 months after the initial dose and that's often the last dose needed for many years. We all acknowledge that there is no way to predict whether COVID vaccines will follow the pattern of hepatitis B, HPV, and polio vaccines and provide long-lasting immunity. Long-term immunity will likely hinge more than anything else on the potential evolution of additional COVID mutations.

Our local hospital data since August 1st showed 12 admissions of fully vaccinated people. 10 of the 12 received 2 doses of mRNA vaccines and the others had a single dose of J&J. Given that 93% of vaccinated Calvert residents received Moderna or Pfizer, this ratio is expected. Chart reviews confirmed that none of these people met the CDC criteria for moderate to severe immunocompromising conditions. All, however, had other underlying chronic health conditions.

A recent analysis from Israel took an early look at booster doses given to those 60 and older. This paper is an initial report, so it should not be viewed as conclusive, but Israel has an excellent national health database, and as a result, is able to collect much more comprehensive outcomes than we can ever hope to in the U.S. Their bottom line was as follows, "Twelve days or more after the booster dose we found an 11.4-fold (95% CI: [10.0,12.9]) decrease in the relative risk of confirmed infection, and a >10-fold decrease in the relative risk of severe illness." The authors estimate that a booster dose results in, "protection against severe infection of 95%, similar to the original ‘fresh’ vaccine efficacy reported against the Alpha strain."

Maryland health officials are working on statewide Delta-specific data. It is unlikely they will be able to provide statistical breakdowns (ages, time since last vaccination, immunocompromised status, and chronic conditions) that we have achieved locally. On the APHA call they lamented that there are many areas of the country that are not reporting any COVID data, much less breakthrough hospitalizations. This may in part explain the lack of supporting rationale for an 8-month window between 2nd and 3rd doses and broad-brush recommendation to vaccinate everyone 16 and older.

Available evidence from U.S. and international studies indicate that booster doses have similar safety profiles to earlier doses. mRNA vaccines have been extremely safe. Other than relatively rare allergic reactions, there have been no dangerous side effects in mRNA vaccine recipients 50 and older.

Local healthcare providers also noted that offering COVID boosters in September and October will allow co-administration with flu vaccines. We know that in lots of medical contexts, requiring people to make multiple visits to complete treatment results in missed opportunities to receive important healthcare. Setting an interval of 8 months for boosters will require some high-risk patients to make separate trips to get their COVID and flu vaccinations with the ultimate result of inadequate protection against life-threatening infection. If boosters are available 4 months or more after second doses, patients can get their flu vaccine when they come in for a COVID booster or their COVID booster when they present for a flu vaccine. Either way, this should result in higher vaccination rates against both diseases.

There was significant discussion during a local web conference regarding the age cutoff. No one thought that teens or young adults need boosters at this point. Opinions ranged from age 40 to age 60. Ultimately, unanimous agreement on age 50 was achieved.

We also discussed booster doses following Johnson & Johnson (J&J) vaccination. We all acknowledged that there is insufficient evidence to make strong recommendations. There is evidence indicating safety with either another dose of J&J (as well as safety data from multiple doses of the AstraZeneca adenovirus vaccine) or a supplemental dose of an mRNA vaccine, although this evidence is limited. The FDA is currently evaluating the effectiveness and safety of boosters after J&J. For the moment, decisions on booster doses for those who initially received J&J will need to be made between individuals and their personal healthcare provider. The Health Department will not provide a booster dose to J&J recipients unless they have a note from their doctor or nurse practitioner.

COVID cases have risen dramatically in Calvert since late July. Although case counts in those 65 and older are still lower than in younger age groups thanks to high vaccination rates among seniors, we've gone from 8 diagnosed cases in seniors three weeks ago to 22 cases this past week. Diagnosed cases in those from 0-19 have gone from 35 three weeks ago to 55 this past week. As cases likely continue to increase in school-age children and teens now that they are back in classrooms, cafeterias, and school buses, there is concern that grandchild-to-grandparent transmission may fuel further increases in Calvert residents 50 and older in the coming months.

The best way to get COVID infections under control is to increase the number of Calvert residents who get initial vaccinations. For those who are at higher risk of breakthrough infections, you now have guidelines and rationale to help you decide whether a booster dose is appropriate for you. Again, the information above is based on recommendations from local physicians and nurse practitioners, not the CDC or FDA. You should always consult with your personal healthcare provider if you have additional questions. If you decide to proceed with a booster dose or if you are ready to get your first COVID vaccination, many local medical practices are providing inoculation. You may also schedule a vaccination with the Calvert Health Department. Anyone 12 and older is eligible for initial vaccination.

For booster doses, you must meet the following criteria:
1) Members of the general population must be at least 50 years-old
2) Anyone 16 and older who work in a prioritized job classification, including nursing home staff and others who work in congregate living facilities, frontline healthcare workers, first responders, and teachers and other school staff who work with students unable to wear face coverings due to developmental conditions.
3) Have received either Pfizer or Moderna for their first two doses
4) Must be at least 4 months since their second dose

Anyone not meeting these criteria must have a note from their personal healthcare provider indicating the recommendation of a booster dose. This includes:

1) J&J recipients. Since we have a limited number of J&J doses with no idea when we will receive more, if someone is recommended for a booster, they will receive an mRNA dose if they opt to get it through the Health Department. Their other option is to try to find a local pharmacy with available J&J.

2) People under age 50 unless they have a job that prioritizes them for a booster (see above).

We will not give boosters to those who had their second dose (or single dose of J&J) less than 4 months ago. People who meet CDC criteria for moderate-severe immunocompromising conditions (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html) and are at least 16 years-old may receive an 3rd dose, as long as their previous dose was administered at least 28-days earlier. 3rd doses are considered distinct from booster doses.

Registration for vaccination through the Health Department can be done via web portal https://www.calvertcountycovid19.com/vaccination or calling 410 535-5400 x388.

You must bring your CDC vaccination card so we can record your booster dose. If you can’t locate your CDC card, please bring proof of your previous vaccination dates. This can be done through the Maryland vaccination database: https://md.myir.net/rorl?next=/

If you are under age 50 and work in a prioritized setting, you must bring proof of your employment (work badge or a note from your employer that verifies you qualify based on your job).

August 16, 2021:
More Questions and Answers: 3rd Vaccination Dose Edition

Who is eligible for a 3rd dose?

The CDC has authorized Pfizer and Moderna vaccine recipients for a 3rd dose if they have a health condition that severely weakens their immune system. 2.7% of the adult population and a small number of adolescents will qualify. These conditions include the following:

• Organ transplant recipients
• Current treatment for blood and lymph cancers (leukemias and lymphomas) and most other types of cancers requiring chemotherapy
• Stem cell transplant recipients
• Advanced HIV infection
• Active treatment with medications that weaken components of the immune system, including 20 or more milligrams/day of prednisone or comparable steroid medications, TNF blockers, and other medications that impair response of the immune system
• Primary immunodeficiency diseases (e.g., DiGeorge, Wiskott-Aldrich syndromes)
• Severe renal disease

Anyone qualifying for a third dose should already be under the care of a physician. It is best for you to have a discussion with your personal doctor to decide: 1) if a 3rd dose is appropriate for you, and 2) if any temporary modifications in your treatments are needed to get the greatest benefit from a 3rd vaccine dose.

What if I received the Johnson & Johnson vaccine?

For the moment, there is no authorization to provide recipients of the J&J vaccine with an additional dose. Questions that need to be answered include the amount of benefit people will get from an additional vaccination and which brand of vaccine will give the greatest benefit. For every 1 American who received a J&J vaccine, 12 others received an mRNA vaccine. As a result, evidence has accumulated more quickly regarding the benefits of a supplemental dose in Pfizer and Moderna recipients than for those who received J&J.

The CDC knows that people who have received the J&J vaccine and have high-risk underlying health problems are anxiously awaiting guidance. Research to answer these questions is currently underway. The doctors on the CDC Vaccine Advisory Panel have said that they will provide the public with an answer as soon as possible.

I have diabetes or another health condition not listed above that I’ve been told puts me at higher risk of COVID complications. Why don’t I qualify for a 3rd dose?

The evidence at this point shows that for people with diabetes, chronic hypertension, obesity, severe asthma, etc., 2 doses of Pfizer or Moderna continues to dramatically minimize severe disease from the Delta variant of COVID. There is no evidence that a third dose will further decrease hospitalizations or risk of death. Anyone who has only received 1 dose of Pfizer or Moderna should get their 2nd dose as soon as possible. A single dose of mRNA vaccine does not provide adequate protection against Delta.

I’m 65 or over. Do I qualify for an additional vaccine dose?

At this time, there is no approval of a 3rd dose solely on the basis of age. This is another area of active research. The CDC experts point to continuing evidence of extremely good protection for seniors against severe illness, hospitalizations, and death after 2 doses of Pfizer or Moderna vaccines. They acknowledge that with the Delta variant, more seniors have been infected, but those infections have rarely led to hospitalizations unless the individual also had one of the health conditions listed above. Before they recommend additional doses, they want more evidence of significant benefit for those 65 and older.

Our local experience supports this position. Since the Delta variant began to dominate 1 month ago, all hospitalized Calvert residents have been unvaccinated.

My 14 year-old is undergoing treatment for leukemia. Can she receive a 3rd dose?

Yes. Anyone 12 and over who weighs at least 88 lbs (40 kg) is eligible for a 3rd dose. The qualifications for adolescents is the same as for adults (see medical conditions listed above). Just as we recommend for adults, it’s best to contact your child’s doctor to see if any medical treatment modifications are needed to maximize benefits from a 3rd dose.

What is the timing for a 3rd dose?

The 3rd dose should be administered no sooner than 28-days after you received your second dose, regardless of whether you have been vaccinated with Pfizer or Moderna. A 3rd dose given 1 month or 6 months after your 2nd dose works equally well, so there is no need to restart your vaccination series.

If I have one of the immunocompromising conditions listed above, does that mean I don’t have to worry about becoming severely ill from COVID if I receive a 3rd dose?

People with severely immunocompromising conditions are likely to be better protected after a 3rd dose than after the standard 2-dose series, but even a 3rd dose, they are still more susceptible to severe illness than the general population. Infectious disease experts recommend layered protection for everyone who is immunocompromised. That includes full vaccination, avoiding crowded venues, wearing a mask when out in public, and doing your best to maintain social distancing. The other key protection is to have everyone in your household receive their vaccines against COVID. The most common source of transmission is within households. Once one person has COVID, everyone else in the house will soon be exposed. Please keep in mind that people are contagious 1-2 days before they develop any symptoms, if they develop symptoms. The better we protect ourselves, the better we protect others.

I have an immunocompromising health condition. How do I get a 3rd dose?

If your personal doctor (primary care or specialist) provides vaccines, you can contact her/his office for your dose. Even if they don’t provide COVID vaccinations, it’s still recommended that you contact them to ensure that a 3rd dose is right for you and whether your treatment protocol needs to be temporarily adjusted to get maximum benefit from the vaccination.

If your doctor doesn’t provide vaccinations, the Calvert Health Department and local pharmacies should be able to help you. Our health department anticipated the need for some people to receive 3rd doses, but we never receive advanced notice about policy changes at the federal level or the state level. As a result, we did not know who would be eligible for 3rd doses or what the timing for approval would be until late last week. We are making modifications to our electronic health record to properly record vaccinations and updating patient education material. We should be ready to offer vaccines for eligible people later this week.

If you want your 3rd dose documented on your CDC card, please bring that card with you. New cards will not be issued. Your vaccination will be recorded in the Maryland electronic health database so your doctor can verify that you received the supplemental dose.

May 15, 2021: Revised Recommendations for Religious Congregations

May 15, 2021
Dear Congregation Leaders,
As of May 15, 2021, Religious Leaders should consider the following guidance in response to the ongoing COVID pandemic. Perception has shifted among many that COVID is no longer a significant threat to the health and safety of Americans. However, this past week 85 cases were diagnosed in Calvert County. Across the state, close to 700 people are hospitalized, including 200 in ICUs. Almost every one of these hospitalizations have occurred in unvaccinated people.

Fatality rates remain concerning. Although deaths have decreased compared to this past winter, twice the number of Marylanders have died of COVID this month than typically die from breast, colon, and prostate cancers combined. Those 60 and older, younger individuals with chronic health conditions, and members of minority races and ethnicities continue to suffer more severe consequences. The newer variants are infecting children and young teens more often than the original strain. 2% of hospitalizations are in this age group.

Many of the recommendations from March continue to apply. State mask mandates have been lifted for those who are fully vaccinated in indoor settings. At this point, 88% of seniors in Calvert have received at least their first COVID vaccine dose. Among all adults, only 59% have received at least one dose and 47% have completed their vaccinations. Very few teens and no children have been vaccinated at this point. This means that many of your parishioners remain susceptible to illness and can spread COVID. Depending on the makeup of your congregation, more than half of those attending services may be unvaccinated at this time.

All of the currently approved vaccines have proven to be extremely effective at preventing serious infection, hospitalization, and death. Congregation leaders should encourage their parishioners to get inoculated. Vaccination is the most effective way for each person to stay safe at home, work, and in worship with their fellow congregation members. Vaccines are now available for everyone age 12 and up at multiple locations across the county, including through the health department and many pharmacies and physician offices.

Although we are getting closer to a “return to normal”, not enough people have been fully vaccinated and virus transmission rates are not low enough to rescind all COVID precautions. Although the Governor has lifted restrictions on occupancy and face coverings (for those who are fully vaccinated), consideration should be given to continued measures that decrease potential for virus transmission. This is particularly important, especially in indoor settings, as long as COVID transmission rates and hospitalizations remain substantial.

All changes from earlier guidance or particularly important passages are in bold, italic font:

1. Encourage congregants who are at high-risk of COVID complications to continue to worship in their homes

(possibly viewing or listening to a live stream or recorded service) if they have not completed their vaccination series. Those who have completed their vaccination series can attend services in-person.
People at high-risk include anyone age 60 or older and those with chronic medical conditions including diabetes, long-standing high blood pressure, COPD, kidney disease, sickle cell disease (sickle cell trait isnot a high-risk condition), congestive heart failure, a recent history of chemotherapy, and any condition that requires immunosuppressant medications.

2) If services are held indoors, face coverings should be worn by everyone over age 2 who is not fully vaccinated. Fully vaccinated is defined as at least 2 weeks since receiving the final dose of a vaccine series. Consideration should be given to a continued requirement for all attendees to wear face coverings if it is not feasible to distinguish members remain unvaccinated.

Congregations can consider a “vaccinated” section that does not require face coverings or social distancing between families, but this may not be practical. This would automatically exclude families with children under age 12 until the FDA approves vaccinations for this age group.

3) It is extremely important that word be sent to congregation members that anyone with any illness or anyone with a sick member in their household should not attend service for at least 10 days. Even if a person feels well, they could have contracted COVID from an ill family member and be capable of infecting others. Anyone with travel to areas that put them at higher risk for virus exposure should not attend services for 10-days after return to Calvert. Eating inside restaurants and attending events with large numbers of people are particular concerns.

4) Singing by soloists or choirs should only include those who are fully vaccinated. Fully vaccinated is defined as more than 2 weeks after the final dose of someone’s inoculation series. Because vaccinations are not 100% effective, it is still safest for singers to be a distance away from the general congregation.

Due to the projection of respiratory particles while singing, a 25-foot separation between the vocalists and the general congregation is recommended. It is also important to maximize ventilation in the congregation hall by opening windows and doors and/or having the HVAC system on continual fan setting (see section 8).

Congregations can consider having a separate section for fully vaccinated members who wish to sing as part of their general worship. Those who have not yet become vaccinated should not sing in communal settings.

Humming for brief periods may be considered as an alternative.Face masks should be worn at all times.
Singing dramatically increases the risk of transmitting COVID. If someone is an asymptomatic carrier of the virus, singing increases the amount of virus they exhale and at least doubles the distance the virus carries through the air.

If the service takes place outside, the singers should ideally be downwind from the congregation.

5) If possible, services should still be held outside. This helps dissipate viral particles much more effectively than indoor settings. I realize that the weather in Southern Maryland is not always conducive to outdoor events and some congregations may not have the physical space or equipment to hold services outdoors. If outdoor services are feasible, members of the congregation should be encouraged to bring their own fold-up chairs.

Several professional sports leagues have set an 85% vaccination threshold for eliminating mask wearing and allowing contact closer than 6 feet. 85% vaccination is also a very reasonable level of immunity for congregations to aspire. Until vaccinations are approved for children and depending on the attendees at services, this may mean close to 100% of adults and teens need to be vaccinated prior to safely eliminating face masks and social distancing between families.

6) Keep services as short as you reasonably can. Virus transmission is a result of the proximity and duration of exposure to an infected person. The longer someone is near an infected person, the more likely they are to get sick. Given the potential for severe illness with COVID-19, it is very important to limit the time people spend in group settings.

7) When possible, consider outdoor settings for children’s gatherings. Children’s services or daycare areas should have no more than 15 people in a room, including supervising adults. If the room is small, please adjust
the number of occupants accordingly. Children should wash their hands with soap and water(preferable) or apply hand sanitizer before entering the room. The newer variants such as the UK variant are just as likely to infect children as adults. Not only are some children susceptible to serious illness, but they can pass the virus to immunocompromised adults. Currently, the UK variant is the most commonly transmitted virus strain in Maryland. Children over the age of two should wear face masks whenever they are indoors. Of note, the vaccines protect against the UK variant.

Consider a craft day that allows children to design or make their own masks with the help of adult volunteers. There are many online guides to making face masks for COVID prevention.

Instead of grouping strictly by age, please consider assigning children from the same household to the same room. Children should attend the same room with the same adult supervisors from week-to-week. Grouping by household and keeping the same assigned rooms each week will decrease the number of children who are potentially exposed to a carrier of COVID. Space children apart as much as reasonable. Children from the same household may sit or play together.

If there are several services in a day, the books, toys, or other materials used should be different for each group of children so virus isn’t transmitted via objects. Common touch surfaces should be thoroughly wiped with disinfectant after each group of children leave the room. Please give at least 15 minutes between groups to allow for cleaning and air circulation. If windows or doors can be opened between groups, please do this.

8) Regardless of how indoor services are conducted, efforts should be made to maximize the flow of fresh air into buildings, improve air circulation, and use the best quality filters that your budget can accommodate. Please consult your HVAC contractor to see what adjustments can be made to your system so that optimal air flow is circulating prior to the start of services and other activities. If windows open, take advantage the fresh air to the extent that the weather permits.
Portable HEPA filter units are reasonable in smaller rooms, such as those used for children’s activities, but they are not practical for main congregation halls. Consult Consumer Reports or your HVAC consultant for brands that have proven reliable and effective.

9) Common touch surfaces in bathrooms should be cleaned with a basic disinfectant after each service is completed. Please factor this into the timing of services.

10) Consider taping a weekly message, sermon, or service for those who can't safely attend in-person services. This can be placed ahead of time on a Facebook or other social media outlet. For those without internet access, it could be placed on a phone recording.

11) No physical contact should occur between religious leaders and congregants unless all participants have been fully vaccinated. COVID-19 is more easily spread than the flu. Physical contact of any kind puts you at risk as well as those in your ministry. The exception to this is baptism of children. In this situation, as long as the religious leader is fully vaccinated and the child and family members have not been in close contact with anyone ill or diagnosed with COVID in the previous 10 days, the baptism ceremony may safely take place.

12) Good, basic hygiene should be observed. Ideally, hand sanitizer should be made available at the entrance to members of the congregation or they should be encouraged to wash their hands with soap and water immediately upon entry to the facility. All common touch surfaces should be disinfected prior to each service.

13) Finally, families continue to face financial uncertainty due to COVID impacts. Pooling resources to help area foodbanks and supplies for less-fortunate children would be wonderful. Other suggestions can be forwarded to the Interfaith Council or other congregation-to-congregation channels.

God bless,

Dr. Larry Polsky, Calvert County Health Officer

April 25, 2021: J&J Vaccine Safety Data and Women’s Health

Both the CDC and FDA have examined the evidence and decided that the benefits of the Johnson & Johnson (J&J) vaccine clearly outweigh risks. As a result, the single-dose vaccine will once again be available across the U.S. After a thorough review, out of 8,000,000 Americans who received the J&J vaccine, 15 cases of rare and dangerous blood clots were linked to this one particular vaccine. That is less than 1 case in every 500,000 people receiving the J&J vaccine. No such clots have occurred in people receiving either the Moderna or Pfizer vaccines.

A more detailed look at the rare blood clots resulting from the J&J vaccine shows that all occurred in women. All except two of the women were younger than 50. There was no link with pregnancy or birth control pills. None of the 13 were pregnant and only 2 were taking birth control pills. In women under age 50, one blood clot occurred for every 143,561 vaccines administered. For women 50 and older, the rate was less than 1 in a million.

Young women, particularly those under age 40, should give thought to which vaccine they receive. Although deaths are rare in this age group, we have seen hospitalizations and long-term health problems after COVID infections. Young adults can also spread the virus to older people who are much more susceptible to severe illness and death. To put the risk in context, if every woman between 18-40 years-old were to receive a J&J vaccine, it would take a county 12 times the size of Calvert to see one blood clot. That risk isn’t zero, but it is extremely low.

For women in their 40s and older, the risk of dangerous blood clots from a COVID infection itself is many times higher than the risk of a clot from the J&J vaccine. For women in their 40s, it’s still worth opting for Moderna or Pfizer, but the amount of benefit compared to risk is much greater than for younger women, regardless of the vaccine brand. For those 50 and older and men of any age, the risk of a blood clot from the J&J vaccine is so negligible that the recent news should not impact their decision to move ahead with vaccination as soon as its available.

Women should keep in mind that neither the Moderna nor the Pfizer vaccines have shown any major side effects after >400 million doses given. The J&J vaccine offers the simplicity of a single injection vs. two shots with Moderna and Pfizer. Contrary to internet rumors, none of the three vaccines impact fertility in women or men. Fertility experts at the American College of Obstetrics and Gynecology and the American Society for Reproductive Medicine have examined the evidence and declared all three vaccines safe during pregnancy and breastfeeding. This is important because several studies have shown more severe illness from COVID when women are pregnant.
 
Human health is complex. Medical treatments are never all good or all bad. Every medication prescribed and every surgery performed carries the potential for improved health as well as some risk of harm. Every antibiotic you and your children have ever taken carried the risk of allergic reaction and organ damage. Every surgery that is performed carries risks of hemorrhage, infection, and anesthesia reactions. Vaccines have saved more lives and prevented more suffering than any other medical treatment. No parent in America worries about their child becoming paralyzed from polio, becoming blind or deaf from rubella, or dying from smallpox. Teens and young adults are now protected against the potentially devastating effects of meningitis and older adults are spared the suffering caused by shingles and the life-threatening risks of pneumonia because of available vaccines. The very small risk of blood clots caused by the J&J vaccine shouldn’t stop anyone from getting protected against COVID. However, young women should take some time to decide which vaccine is best for them so they and the people around them stay as safe and healthy as possible.

April 16, 2021 COVID Vaccine Update- Johnson & Johnson

Johnson & Johnson vaccines remain on pause as the FDA reviews evidence of rare blood clots. The Moderna and Pfizer vaccines have not been linked with any concerns and continue to be administered. During calls on 4/14 and 4/15, physicians and vaccine researchers at the CDC emphasized that the number of reported cases has been very rare (less than 1 in 1,000,000 people). The reason for the temporary halt in vaccination is to thoroughly investigate whether additional cases of clots have occurred. The goal is to allow people to make informed decisions prior to receiving a vaccination with the Johnson & Johnson (J&J) product. It is the expectation of our Health Department that within the next 2-3 weeks, vaccinations with J&J will resume.

Of the 6 cases of cerebral blood clots reported among the 6.8 million people who have received the J&J vaccine, all were women under age 50 and happened within 2 weeks of vaccination. There was no association with pregnancy or birth control (1 of the 6 women took birth control pills and none were pregnant).

The blood clots that occurred were the result of a rare immune reaction. The AstraZeneca (AZ) vaccine available in Canada and Europe is similar in design to the J&J. The AZ vaccine has also been associated with rare blood clots (1 in 250,000 people). These have occurred at a 2:1 ratio in women vs. men. In Canada and Europe, there also has been no link between birth control or pregnancy and these blood clots.

The CDC Vaccine Advisory Committee is scheduled to meet on 4/23 to discuss additional data. It remains to be determined when they will issue more guidance. It is extremely important to the Calvert County Health Department that we provide accurate information to our entire community. Our physicians and nurses view every resident of Calvert as our personal patients. We want you to be able to make the best decisions for your health and the health of your family members.

For the moment, we strongly encourage people to get vaccinated with either Moderna or Pfizer. Close to 200 million doses of these vaccines have been administered nationwide with an extraordinary safety and effectiveness record. We continue to see >100 new infections each week in our county. Currently, there are people ranging in age from their 30’s to 80’s hospitalized in Calvert with COVID complications. The youngest is in the ICU. None of these people had been vaccinated. Please take care and once we have more information on the J&J vaccine, we will let you know.

April 13, 2021: COVID Vaccine Update- Johnson & Johnson

The FDA has placed a hold on Johnson & Johnson COVID vaccinations. The FDA is investigating rare blood clots (less than 1 in 1,000,000 people) associated with this one particular vaccine. The blood clots have been seen within 2 weeks of vaccine administration. Blood clots have not been seen with the Moderna or Pfizer vaccines. At this point, Calvert County Health Department will only vaccinate people with Moderna and Pfizer vaccines until the FDA concludes its investigation of Johnson & Johnson.

The Moderna and Pfizer vaccines were developed using a completely different technology than the Johnson & Johnson vaccine. 200 million doses of Moderna and Pfizer vaccines have been administered in the U.S. without any safety concerns.

Calvert County Health Department strongly encourages people to get vaccinated. We continue to see high rates of COVID spread in our county along with hospitalizations and deaths from the virus. Currently, those hospitalized in Calvert include people in their 40’s, 50’s, 60’s, 70’s, and 80’s. Recent deaths have included people who range in age from their early 40’s to their 80’s. During the past month, close to 100 Marylanders have died each week due to COVID infections. Among those who have been vaccinated, we have not seen any hospitalizations or deaths.

For those who have recently received a Johnson & Johnson vaccine, the risk to your health is extremely low. Please keep in mind that the blood clots have occurred in less than 1 in one million people who received a dose, and it is not clear that the clots were a direct result of the vaccine. This type of clot, called cerebral venous sinus thrombosis, occurs in approximately 1 in 200,000 Americans each year. Symptoms include severe headaches that are generally accompanied by vision changes, problems with speech, and a sudden onset of muscle weakness in one area of the body. These are also symptoms of a stroke. Anyone with these symptoms should immediately seek medical care.

We will update our website as more information becomes available.

March 29, 2021: Variants, Vaccines, and a Light at the End of the Tunnel

25,401 Calvert residents have stepped up to receive COVID vaccinations. That’s 35% of the adult population of our county (27.5% of the population when you include children and teens). With vaccine supplies expected to increase over the next few weeks, it’s possible that everyone 16 and over will be able to get vaccinated by the early June. All three of the currently available vaccines have proven effective and safe. Not only has every major medical association in the U.S. strongly recommended vaccination, but I can say without hesitancy that your doctor does too.

A recent study from the University of Texas Medical Center looked at infection rates in close to 25,000 healthcare workers. There were approximately 8,000 people in each of three groups. The first had chosen not to be vaccinated. The second had received their first dose, but hadn’t completed their final dose. The third was completely vaccinated. During the study period, the number of people diagnosed with infections were 234 in the unvaccinated group, 112 in the partially vaccinated, and 4 in the fully vaccinated group. Studies at other settings across the U.S. have also shown stellar protection from vaccination.

Half of the entire population of Israel have completed their COVID vaccination series. Evidence has shown 97% protection against infection that causes people to feel sick, and 93% protection against any infection, even asymptomatic infection. That means that 93% of vaccinated people have no personal risk from COVID and pose no risk to those around them. That is critically important. We all come in contact people who are immunocompromised, even if we aren’t always aware that someone at work, church, or at the restaurant table next to us has a medical condition that leaves them at greater risk of complications from COVID.

For people who are significantly immunocompromised, it’s extremely important for them to get vaccinated, but it’s likely that the vaccine will not be as completely protective for them as for people with well-functioning immune systems. That’s why we all play a role in protecting our family members and neighbors.

There has been discussion of which vaccine is the best. The quick answer is that they have all proven to be close to 100% protective against hospitalization and death. The Johnson & Johnson vaccine is a bit less effective in preventing mild-moderate infections, but it carries the convenience of only needing one dose. Both Pfizer and Moderna are 2-dose vaccines, but as the Univ. of Texas and Israeli experiences have shown, are extremely effective at preventing even mild infections. For the moment, people aren’t able to choose which vaccine they receive, but everyone can be reassured that all three will dramatically decrease their personal risk and prevent spread through the community. Speaking of which…

Each of the past 4 weeks, the number of COVID cases in Calvert has climbed, and climbed significantly. Case counts have risen 2 ½-fold since mid-February and hospitalizations have increased. We have also seen higher incidence of infections among younger people, some with serious consequences. Last week, there were 3 people in their 30’s who were admitted to our local hospital due to complications of COVID.  There is increasing attention to people of all ages who have long-term health problems, including fatigue, neurological symptoms, pain, and respiratory problems after COVID infections.

Why are infection rates increasing despite vaccinations leaving fewer susceptible people? Two main reasons have emerged. The first are COVID variants and the second are changes in people’s behaviors. In Maryland, two variants have been spreading since mid-February. The UK and California strains are more easily transmitted from person-to-person, and they are both more likely to cause severe disease than the original strain. The good news is that the vaccines have been effective against both of these variants.

It’s understandable that people have grown increasingly frustrated with the social limitations that COVID has brought. It’s been a full year of restrictions on gatherings, changes at work, and limits on travel. Even though a lot of people are rockin’ their masks (I’ve seen some great looks and fashion statements), no one actually likes wearing them. It’s also spring, and everyone is feeling more restless. Please be very aware that as we approach the upcoming holiday weekend, your actions will go a long way to decrease further spread as we give time for more people to get vaccinated. At least for the next week, do your best to avoid situations that may expose you to infection. Continue to wear masks and kindly ask others to do the same. These simple acts will make you less likely to spread the virus to family or friends that you’ll see during the holiday.

This spring is a far cry from last year. Not only do we better understand the virus, but we can see the light at the end of the tunnel. The more people who get vaccinated, and the quicker this happens, the faster we stop widespread transmission and get back to business as usual. There’s also less opportunity for new variants to emerge. Too many things have driven us apart as a society, but one thing we can all agree on is that we’ve had it with COVID. Unfortunately, we can’t work out a deal with the virus. Our clearest path forward is to get vaccinated as soon as each of us has the chance.

For those who are hesitant or skeptical, I encourage you to talk to your personal healthcare provider and not necessarily believe what shows up on your newsfeed or social media account. A vaccination is part of your medical care and you owe it to yourself and your loved ones to make a decision based on advice from a truly trusted source. Your doctor or nurse practitioner has an ethical obligation to advise you based on what’s best for your health and safety. You can’t say the same for any website or media outlet.

I will repeat something written in early January: Seldom do our actions lead to as much potential good, with such small risk, as receiving a vaccination to protect against COVID-19. Nothing else holds as much potential to end the physical, emotional, and social harms that have been inflicted on our community and our country over this past year.

We have a chance to take a major step in restoring normalcy to our lives. We also have a chance to come together as a nation in a common cause of patriotic selflessness. Each of us has a chance to act for the good of our community and our nation.

Once you’ve made the decision to get vaccinated, where can you register? Our health department receives a limited supply of vaccines sent each week, as does the hospital. You can register on the Calvert County Government’s site to be vaccinated either by the health department or the hospital. The website is https://www.calvertcountymd.gov/2821/Vaccine. Some area pharmacies receive weekly vaccine doses. Their locations can be found at the following website https://coronavirus.maryland.gov/pages/vaccine. Each pharmacy has its own registration process. (Yes, this whole process is a bit nuts.) In addition, the previously mentioned website has registration information for the state’s mass vaccination sites at Regency Stadium in Charles County, Six Flags, and elsewhere.  Mass vaccination sites receive tens of thousands of doses each week.

State officials have finally started sending small allocations of vaccines to some doctors’ offices, but availability remains very limited. There has been no announcement as to when deliveries to doctors’ offices will be expanded. As much as it would be nice for people to receive a vaccine at their personal physician’s office, it may take months before sufficient supplies are available, so please register for a vaccine as soon as you can at any site accessible to you.

Please make a difference and register as soon as you’re eligible. Currently everyone 60 and older is eligible. Starting tomorrow, March 30th, everyone 16 and over with an underlying health condition or disabilities is eligible. Starting April 13th, all Marylanders 55 and older can register, and on April 27th, everyone 16 and older is eligible. Not everyone will be able to get vaccinated immediately, but the registration lists should move much more quickly as the national supply increases through April and early May.

Thank you for your consideration and I hope everyone has a safe and happy holiday,

Dr. Polsky

March 12, 2021: Revised Letter for Religious Congregations

March 12, 2021
Dear Congregation Leaders,

As of March 12, 2021, Religious Leaders should consider the following guidance in response to the ongoing COVID pandemic. Most of the recommendations from November continue to apply. Although COVID infection rates and fatalities have dropped since their peak earlier in the winter, our current case rates are comparable to those in late November. This past week 135 cases were diagnosed in Calvert County and 8 of our residents died of COVID-related complications in the past 3 weeks. Those 60 and older, younger individuals with chronic health conditions, and members of minority races and ethnicities continue to suffer more severe consequences. > Read Entire Letter

March 1, 2021: Vaccine Update

The authorization of a third vaccine is a significant milestone in efforts to protect our community from COVID-19. While awaiting details on how the new vaccine will be distributed and what it will mean for local availability, the health department continues to put the two currently authorized vaccines to use and is working through the pre-registration list of county residents 75 and older. As vaccination of this group nears completion this month and doses of vaccine are available, we will add residents 65-74 to our priority populations.

In recent weeks, local supply has been low, but we continue to make progress. If you pre-registered on the county's website and have a confirmation email/ticket number, your name has not been taken off the health department's list. While waiting, please look online at mass vaccination sites and pharmacies for additional ways to get vaccinated if you are in Phase 1A, 1B or 1C and have not yet been vaccinated. If you have not already enrolled for the COVID-19 Vaccine, or for more information, please visit: https://massvax.maryland.gov/

February 8, 2021: Vaccine Update

According to the official Maryland Department of Health statistics as of 2/7/21, Calvert County has the 5th highest rate of vaccination among Maryland’s 24 counties. 100% of the vaccines received by the Calvert County Health Department through 2/7/21 have been administered.

For readers wondering why they aren’t among the 10,566 residents of our county who have received at least one dose of vaccine, the short answer is that we lack sufficient numbers of vaccinations to do the job that we desperately want to do. Of note, there are over 4,000 healthcare workers, first responders, and classroom educators in Calvert who have been prioritized for vaccination by the Governor. This leaves only a fraction of the number of doses needed to vaccinate the 15,000 seniors who live in our county, not to mention the tens of thousands of people age 40-64 with significant chronic health problems who have yet to be officially approved for vaccination.

Making matters worse, especially in rural counties, is the recent shift in state policy to take vaccines away from local health departments and send them to chain pharmacies and mass vaccination sites in more densely populated counties. Our county’s public health professionals were not allowed any input when the state began choosing pharmacies to stock with vaccines. It should speak volumes that the only pharmacy in Calvert that has been given vaccines (Giant in Dunkirk) is more accessible to many residents of Prince George’s and Anne Arundel counties than those who live in Prince Frederick, St. Leonard, Lusby, or Solomons.

Our health department staff have been working 7 days every week to coordinate and administer vaccine doses since we received our first shipment with less than 24-hour’s notice on December 17th. This entire process has lacked coordination at federal and state levels. As a result, we have been forced to formulate plans on the fly. And since we are coordinating medical care, this must be done precisely because there is no margin for error. The public health professionals at our health department regularly discuss policies and planning with a group of over 40 local doctors, nurse practitioners, and hospital administrators to ensure the most efficient and fair process possible given the limitations of resources and urgency of the situation.

Our health department typically isn’t notified of how many vaccine doses we are receiving for the week until Saturday. Our staff is then left to quickly plan distribution of doses on Sunday and Monday morning. Planning involves:

- Coordination of first and second doses of Moderna and Pfizer vaccines (different dosing regiments are needed for each manufacturer’s product) over multiple days each week at our drive-thru vaccination clinic
- Multiple outreach clinics each week to underserved populations
- Partnership with the hospital’s KeepWell staff and the County Government’s Office on Aging to vaccinate seniors in independent living communities
- Performing house calls to medically vulnerable residents with severe mobility problems
- Partnership with school nurses to vaccinate classroom staff and other critical school employees
- Onsite vaccinations for staff and patients at our county’s dialysis centers
- Direct communications with every medical and dental office in the county to make sure direct service healthcare providers are vaccinated
- Direct communications with every first responder agency in the county to ensure all have access to vaccination
- Direct communications with every daycare provider so working parents have more consistent services (a benefit to parents who would lose their jobs without daycare and employers who depend on those employees, including medical offices and first responder organizations)

In addition, due to the failure of CVS and Walgreens to uphold their federal contracts to vaccinate residents of nursing homes and assisted living facilities, our health department staff volunteered to jump in and make sure these extremely vulnerable populations were vaccinated as quickly as possible.

Exacerbating stresses both to health professionals and the public are the continued expansions of those deemed eligible for vaccination by the state even though we lack the doses needed to fully immunize the previously prioritized groups. For example, although as healthcare providers we wish we could vaccinate everyone, prioritizing healthy 19-year-old grocery store employees when hundreds of thousands of seniors across the state have yet to be vaccinated defies reason. Other groups included in 1A and 1B are also questionable by traditional bioethical considerations. Our health department staff have been doing our best to reserve vaccination appointments for those who are at greatest health risk or serve in truly critical employment categories.

Like local health departments across the state, we were not given any guidance on delivery of vaccines to the general population, unless you consider “put shots in arms” as guidance. Local health departments have been completely excluded from state planning. We typically learn of decisions by listening to press conferences. Health Officers across the state have raised continued objections to state officials about the lack of local input into planning and the failure of state officials to provide monthly allocation schedules so we can properly organize local vaccination efforts. Last week, many local health departments that prescheduled vaccinations on the expectation of continued deliveries had to cancel thousands of people’s appointments when their allocations were drastically cut.

Along with almost every other local health department in the state, our weekly allocation was slashed by 66% the week of February 1st as doses of vaccines were shifted to mass vaccination sites and chain pharmacies, almost all of which are outside of Calvert. Our allocation was cut again for this coming week. There are still close to 1,900 residents 75 and older who are awaiting vaccination, but we are only being provided with 500 first doses this week.

Our health department leadership have advocated on behalf of the residents of Calvert to ask both the Maryland Department of Health and the Governor to reconsider the current plan and resume more equitable distribution of vaccines across all of the counties. We understand how important it is to provide protection to our residents and essential workers. Until the time that we begin to receive more doses locally, our best advice is for people to register at pharmacies and the mass vaccination sites. We realize this means another waiting list or two or three (the state has no central registry) and vaccination will likely require travel outside of Calvert, but given the current state policies, this is the most likely means of being protected against COVID.

For those who have received your first dose through our health department, we expect that we will continue to have adequate supplies of second doses to complete your series. We will update you if any policies change.

December 20, 2020: COVID-19 Vaccines- How Do They Work? Will I Get Vaccinated?

After a year of illness, social disruption, and economic pain, Americans finally have a chance to regain control over a virus that has claimed hundreds of thousands of lives. Vaccines were once viewed by Americans as saviors over diseases that inflicted suffering and death across all corners of our country. But with the rise of social media, some people have become leery of vaccines. Let’s take a step back before discussing the current COVID-19 vaccines.

Through the mid-20th century, parents feared paralysis and death each summer as polio epidemics spiked, and at all times of the year pregnant women dreaded the horrific birth defects caused by rubella (German measles) including brain damage, deafness, blindness, and stillbirth. These are just two of the many infectious diseases (whooping cough, meningitis, measles, etc.) that caused serious illness and death across the U.S. on a regular basis. When vaccines were developed to prevent these diseases, it was seen as patriotic to voluntarily step up and receive inoculation. Americans were not only protecting their families, but their entire communities.

Vaccines traditionally worked by introducing dead or inactivated virus or bacteria into the body so the germ could be recognized by the body’s immune system with little risk of causing harm. During a natural infection, it typically takes a week or more for the body to fully mount a response to a new pathogen. By that time, severe illness can develop. A vaccine allows the body the opportunity to develop an immune response prior to the threat of actual infection. The vaccine stimulates the production of antibodies and cytotoxic (“killer”) T cells that can be quickly summoned by our bodies if we are infected by the live virus or bacteria later on. The antibodies and killer T cells prompted by the vaccine will activate within hours after exposure to an actual infection. This quick immune response prevents both illness and the potential that vaccinated people will spread the disease to others.

The two vaccines approved by the FDA use a newer technology to produce a robust immune response to the virus responsible for COVID-19. Although these are the first mRNA vaccines approved, this technology has been undergoing steady research and development for the past 30 years. Recent advances have provided the means of stabilizing the lipid nanoparticle coating that delivers the key piece of antigenic material to our cells. If that sounds like too many technical terms and you want more understanding, please read the next three paragraphs. Otherwise, feel free to skip past the second diagram.

Messenger RNA (mRNA) is a molecule produced by our cells to translate inherited genetic information from our DNA into actual proteins our bodies need to function. You couldn’t digest your food, read this article, or breathe without DNA being transcribed to mRNA which is then translated into the proteins we need to survive. The COVID vaccines use this mRNA-to-protein translational process to eliminate the need to inject whole viruses that were necessary in older generations of vaccines. Based on the genetic code of the COVID virus, researchers were able to identify the genes that code for a key protein on the virus’s surface (spike protein). This specific segment of genetic material, and only this specific segment, was transcribed into a piece of mRNA to be used for vaccination. Because the vaccine only contains this one portion of mRNA, there is no risk of COVID infection from either vaccine.

The final technical barrier to produce a successful vaccine has been to protect the fragile segments of mRNA until they can be delivered inside cells to ribosomes. Ribosomes are tiny assembly factories in our cells’ cytoplasm that translate the instructions encoded in mRNA into protein (see diagram below). Recent scientific breakthroughs have led to the development of protective envelopes (lipid nanoparticles) that transport mRNA through cell membranes and release it into the cytoplasm. Lipid nanoparticles also have a very short half-life, so within a few days of administration, all of the vaccine mRNA is gone.

The left side of the following diagram corresponds to the mRNA vaccine process (the right side is for a different type of vaccine that is still under development):

From there, the vaccine-driven cells (via antigen presenting cells and T-helper cells) deliver COVID spike proteins to the B cells and cytotoxic T cells of our immune system (see diagram below). B cells are then produced to generate specific antibodies against the COVID virus, and cytotoxic T cells are programmed to destroy any cells that are initially infected with COVID virus before the virus can spread throughout our bodies. This combination of antibody and T cell protection has shown to be 95% effective in preventing COVID infections in those who have received the recommended 2-dose mRNA inoculation.

Because the COVID vaccines only contain two critical components (mRNA and lipid nanoparticles), the potential for side effects is likely lower than for traditional vaccines. The independent panel of experts who reviewed the most recent vaccine for the FDA voted 20-0 that the benefits of the mRNA vaccine clearly outweighed risks. However, these are new products and it would be disingenuous to suggest there is no potential for adverse reactions. Each vaccine was administered to 15,000 people, along with 15,000 people receiving placebo injections, starting in July. In addition, over 200,000 frontline healthcare workers have thus far received the Pfizer vaccine. Overall, three cases of anaphylactic allergic reaction have occurred with the Pfizer vaccine. Allergic reactions have not been seen yet with the Moderna vaccine. There are no preservatives in either vaccine and neither were made with any egg products. As a precaution, people with a history of anaphylactic reactions should make sure they receive vaccination at a location that is prepared to treat a serious allergic reaction in the small chance it should occur.

A condition called Bell’s palsy developed in 4 people in the Pfizer trial and 3 people in the Moderna trial. One person who received a placebo developed Bell’s palsy. It is unclear whether the cases of Bell’s palsy are directly related to the vaccines or if those cases are coincidental since numerous infections (common cold viruses, influenza, mononucleosis, etc.) can cause this condition. Bell’s palsy results in a temporary weakening of the facial muscles that typically improves with a few weeks and resolves in a few months.

About 2% of people had significant pain at the injection site after vaccination, and 5-7% had significant fatigue and/or general muscle aches for about two days. These body-wide symptoms are due to the vaccine’s activation of the immune system, but are not the result of an actual infection. Again, it is not possible to get a COVID infection from either vaccine because neither contain any virus particles.

There is a chance that we may learn of other side effects over time, but this must be weighed against the clear harms that continue to result from ongoing COVID infections. 300 Marylanders died from COVID infections in the past week and more than 1,600 people are currently hospitalized. Leaving oneself vulnerable to the virus places you and those around you at a clear risk of chronic respiratory problems, heart muscle damage, blood clots, stroke, and death.

Studies to this point have also shown that antibody production after natural COVID infections weaken at a much faster rate than after mRNA vaccination. We need to keep in mind that the COVID virus is in the same family as many common cold viruses (adenovirus), and humans are susceptible to recurrent infections from colds year-after-year. Although we won’t know until late in 2021, it seems possible that those who are depending on their natural immunity to prevent reinfection may be at greater risk than those who receive vaccination.

The Pfizer vaccine is approved for everyone 16 and over. The Moderna vaccine is approved for those 18 and over. The difference in ages is a result of the inclusion criteria each manufacturer set during the study trials. Pfizer allowed enrollment at age 16, Moderna at 18. Neither vaccine was intentionally tested in pregnant women. Some women in both trials became pregnant shortly after vaccination. To this point, there have been no indications of miscarriages or birth defects. These women and their babies are being closely monitored. Theoretically, there is no reason to expect additional risk during pregnancy. We have decades of extensive experience with vaccines during pregnancy. Other than a few older vaccines containing live virus (not an issue for COVID vaccines), inoculations have proven safe for both mothers and developing fetuses.

We all take risks on a daily basis. Every encounter with other people brings potential exposure to infectious diseases, possible acts of violence, etc. Every car ride we take places us and our children at risk of severe injuries from crashes. Playing sports risks concussions and other injuries. Every antibiotic we take carries some risk of allergic reaction. Receiving a vaccine also carries a small, but possible risk. But seldom do our actions lead to as much potential good, with such small risk, as receiving a vaccination to protect against COVID-19. Nothing else holds as much potential to end the physical, emotional, and social harms that have been inflicted on our community and our country over this past year.

As we each consider our option to be vaccinated against COVID-19, we are doing so in the context of the time we live. 2020 has been a very difficult year for all of us. We have also seen our country become more divided. We have a chance to make 2021 much safer and to take a major step in restoring normalcy to our lives. We also have a chance to come together as a nation in a common cause of patriotic selflessness.

Yes, there is an element of risk in getting a new vaccine. But the early evidence is very reassuring, and let’s face it, life rarely provides guarantees. When my opportunity arrives in the next week or two, I feel a responsibility to my family, my patients, my coworkers, and my community to get vaccinated. When my family members have their choice, I will encourage them to do likewise. I often hear people call themselves patriotic. Here is each person’s chance to make a small personal sacrifice for the good of our community and our nation.

I wish you all a very healthy and happy New Year. Dr. Polsky

December 4, 2020: New COVID Quarantine Rules: What? Why?

The CDC revised guidance for people who have had close contact for at least 15 minutes with someone recently diagnosed with COVID. First a bit of background. Since March, the CDC has recommended that everyone with close exposure quarantine themselves for 14 days to prevent the spread of the virus to others. As researchers have learned more about the infection, we now understand that for those who do not become sick by the 7th day after exposure, the likelihood of them transmitting the infection to others is still 11%. By the 10th day after exposure, the potential is down to 1.4%.

The CDC’s new guidance decreases the length of quarantine to 10 days after exposure as long as the person has not gotten sick. There is an alternative quarantine of 7 days if someone also has a negative COVID test 1-2 days before that and stays healthy through day 7. Having a negative PCR test, which usually takes 2-4 days to come back from the lab, reduces the risk of a person transmitting the virus from 1 in 9 down to 1 in 25. Rapid tests are not nearly as accurate in detecting infections prior to the onset of symptoms. As a result, a rapid test along with no symptoms by day 7, leaves a 1 in 12 to 1 in 18 chance that a person is still infectious to others.

Let’s summarize the risk of still being infectious to others:

Day 7 with no test	1 in 9   (11%)
Day 7 with rapid test	1 in 15 (6-7%)
Day 7 with PCR test	1 in 25 (4%)
Day 10 without test	1 in 70 (1.4%)
Day 14 without test	<1 in 100 (<1%)

So why is quarantining important? Until vaccines are widely available, COVID will almost certainly continue to spread in large numbers. Currently over 2,000 Marylanders are newly diagnosed with COVID every day. Over 1,500 people are currently hospitalized across the state, 364 of whom are in ICUs. Over the past day, 48 Marylanders died as a result of COVID infections. Even more concerning is that hospitals are already reaching capacity, and we are about to be hit by the start of flu season.

As hospitals reach saturation, people with heart attacks, appendicitis, severe injuries from motor vehicle crashes, and children with severe asthma attacks will face delays in care that can lead to permanent disability or death. In other words, when hospitals fill up with COVID patients, it jeopardizes everyone’s safety. For the next few months, the best way to prevent runaway spread of infection is to quarantine as soon as you realize you’ve been exposed to someone with an active COVID infection.

The Calvert County Health Department recommends that everyone voluntarily quarantine for 10 days after the last day they were in contact with someone infected with COVID. A 1 in 15 risk of transmission with a rapid test prior to day 7 will lead to unnecessary spread of virus and further strain our local hospital. Even a 1 in 25 risk is very worrisome as we move into flu season. For the sake of 3 additional days, we hope that each person considers the importance of doing a bit more to keep everyone in our community safer.

We’ll comment more fully on the new COVID vaccines once they clear FDA authorization. We are still awaiting the release of full safety data before we make recommendations. With that said, preliminary data look very encouraging, and it’s likely that safe and effective vaccines will begin to arrive for frontline healthcare workers later this month. However, vaccine production is a precise process and it will take months until there are sufficient supplies for the general public. As a result, through the winter, the best protection against COVID is for each of us to help protect one another. If you know you’ve been exposed to someone with COVID or you receive a call from one of our nurses performing contact tracing, please help us keep Calvert safer by quarantining for 10 days. If at any point you develop symptoms of illness, contact your primary care provider or the urgent care to arrange testing.

And if you haven’t received your flu shot yet, please protect yourself by getting a vaccination this week. This simple act further reduces the chances of filling our hospital with patients infected with preventable disease. Let’s all pull together as we approach the holiday season and keep Calvert Healthy.

November 14, 2020: A Revised Letter to Religious Congregation Leaders

November 7, 2020: Back to School

Back to school outfits in November? It’s certainly been that kind of year. Parents of preK- 2nd graders know that public schools in Calvert are opening for in-person learning this Monday. For some parents, kids, and school staff, this is a day to celebrate. For others, it triggers another 2020 moment of stress. For most, there are mixed emotions.

It’s important for everyone to understand that the administrators and staff at the Calvert County Public School System (CCPS), along with the Calvert County Board of Education (BOE) have had an ongoing series of planning discussions with the Calvert Health Department since late spring. Safety measures for students, classroom teachers, and other school staff are paramount to CCPS, the BOE, and the Health Department.

Accumulating evidence from the four Calvert private schools that have had in-person classes since Labor Day, other counties in Maryland that brought students back in early October, and from other states and countries that have had kids in school for months, is that the risk of COVID transmission in school settings is very low. To this point, there have been no outbreaks in Calvert’s private schools.

To best ensure the safety of all those on school buses and in school buildings, CCPS is instituting a host of prevention strategies. Perhaps the most important is the use of a hybrid learning model for each grade level. We now have evidence showing that cohorting students in each grade level into two alternating groups reduces the potential for transmission of COVID four-fold. This is the result of two complementary factors:

Most obviously, decreasing the number of students in a classroom by half reduces the number of potential virus carriers by half. In addition, fewer students allows much greater spacing of individuals both in classrooms and on buses. This significantly reduces risks for teachers and bus drivers, as well as students. A lower number of students mean that the first row of seats in each classroom and bus can remain unoccupied, providing a greater cushion between staff and students. Coupled with mask wearing, transmission of virus via respiratory droplets is dramatically lowered. In addition, students will be cohorted during lunchtime and recess to prevent spread of virus between classrooms.

Each cohort will attend in-person classes Monday-Thursday on alternating weeks. This provides an automatic 10-day isolation period for students prior to their return to school building to observe for any symptoms of viral illness. School nurses have been educated to assess students and staff for symptoms that may indicate COVID infection. Anyone suspected of carrying the virus will be excluded from school until she/he is evaluated and tested for COVID by their healthcare provider. Each situation will be managed in consultation between CCPS and the health department nurses and doctors. Contact between school administrators and health department staff takes place 7-days/week since COVID test results can finalize over the weekend or on holidays. Early recognition of positive results provides the opportunity to isolate students prior to return on Monday or after a holiday and allows more timely contact tracing of those in close proximity to infected individuals. Any parent of a child who is a close contact of someone with COVID will be notified to discuss next steps.

CCPS also has been working on improvements in school ventilation and air filtration to further reduce risk of virus exposure. Sanitizing protocols are in place for common touch surfaces. Bus windows will be opened 2-3 inches to maximize ventilation. Each student will have an assigned seat on the bus so contact tracing can be effectively performed. Parents also have the option of transporting their children to school, if they prefer.

And speaking of parents, you all play a vital role in the success of in-school learning. It is imperative that parents keep their children home if they: 1) have symptoms listed below, 2) household members are sick, or 3) have been exposed to someone diagnosed with COVID:

Please keep your child home and notify the school if she/he develops any ONE of the following:

• New onset cough- This does not include a cough that is within the range of a typical asthma attack or other chronic respiratory condition that your child may have
• New onset shortness of breath
• Loss of Taste or Smell
• Fever of 100.0 degrees or higher

Please keep your child home and notify the school if she/he develops any TWO of the following:

• Fatigue
• Muscle or body aches
• Headache
• Sore throat
• Congestion or runny nose
• Nausea, vomiting, or diarrhea- Any combination of these symptoms counts as one potential COVID symptom

If your child becomes ill or if she/he has been exposed to someone infected with COVID, please notify your child’s school and have your child evaluated by her/his primary care provider. In order for a student to return after developing any of these symptoms, COVID testing must be performed. If a parent opts not to have testing performed, at least 10 days have to pass from the start of symptoms before it’s safe for the student to return to school.

If parents send children to school who are sick or are known to have been exposed to someone with COVID, it increases risks to everyone’s health. It also increases the chances that classrooms or entire schools may need to be closed. The same requirements hold for CCPS employees. Many school-related cases of COVID elsewhere in the country have been the result of infected staff and not students.

Parents and school staff should also make sure everyone in their household is vaccinated against influenza. Although the flu vaccine won’t prevent COVID, it will decrease serious illness and prevent further confusion and unnecessary exclusions from school while your doctor is trying to determine if an infection is due to COVID or influenza.

Finally, the Health Department, along with CCPS, is tracking infection data that are both specific to schools and more broadly across the county population. You can see charts on our health department's COVID website:
https://www.calvertcountycovid19.com/ccps-covid. Data is broken down by students, in-classroom teachers, and other CCPS staff. We are also displaying data by region of the county. The dividing line between south and central portions of Calvert is St. Leonard, and north is defined as everything above of Huntingtown. General county data is also broken down by age groups.

There has been lots of discussion about specific metrics to determine if schools should remain open. The CDC (https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/indicators.html#thresholds) and some local jurisdictions have come up with charts to guide decisions. To date, none of these schemes have taken into account infections among children and adolescents or COVID cases that directly impact school settings. To this point, Calvert County has been able to keep COVID case rates and positivity percentages relatively low compared to most of the rest of the state and the country. But when we apply our numbers to the different indicators in the CDC chart, Calvert’s metrics swing anywhere from “lowest risk of transmission in schools” to “moderate” or even “higher risk of transmission in schools”. None of the currently published metrics yield consistent guidance regarding school closures. It is also important to note that none of these metrics have been validated as appropriate indicators of risks within school facilities. As a result, it would be disingenuous to propose a set of measures at this time with the expectation that they would properly account for all of the circumstances that factor into decisions needed to determine the point at which schools should be closed.

The reality is that ongoing surveillance of trends within individual schools, portions of the county, and more broadly across our region of the state will factor into decisions regarding closures. Hemming ourselves in by setting predetermined metrics may lead us to overlook concerning changes in specific buildings or regions, or potentially force us to unnecessarily close facilities due to factors that do not directly impact schools. If closures are necessary, there may be little advanced notice. If this is the case, it’s not due to a lack of planning, but due to the unpredictable transmission patterns of COVID.

We want to assure parents and CCPS staff that the Health Department’s primary responsibility is to provide the best advice possible to CCPS Administration and the Calvert County Board of Education with the clear goal of keeping everyone as safe and healthy as possible. Our staff has put in untold hours to work with the School Superintendent, his staff, and BOE members to provide an environment that we feel comfortable letting our children attend. And, in fact, many health department employees have children in our county’s school system.

As we’ve said throughout the pandemic, we have to look out for each other and respect the well-being of everyone in our community. Parents need to do their part by keeping sick children home. School staff need to do the same. Until a safe and effective COVID vaccine is available, we all need to continue wearing masks, avoiding high-risk settings, and socially distance. Here is to a safe and successful step toward getting students back in the classroom with their teachers and friends!

October 13, 2020: Don’t Trust Anyone Under 60

As schools continue to debate in-person instruction and businesses continue to modify their staffing and customer services, it’s a good time to reexamine the prevalence and impact of COVID infections on our county. After relatively low positivity rates through much of the summer, somewhere in the range of 2.5%, we have seen rates moving back above 4.0% the last two weeks. As a reminder, rates above 5.0% are generally viewed as an indicator of concerning levels of virus transmission. Many of our recent cases are the result of one family member spreading the virus to multiple household members. We’ve also seen clusters of cases resulting from weddings. One recent wedding in Calvert lead to over a dozen infections.

On a positive note, there have not been any COVID-related deaths in Calvert in more than 2 months. And the latest CDC estimate is that the case fatality rate (the percentage of people diagnosed with COVID who will die as a result of the infection) has decreased to 0.65%. This is appreciably lower than the 2-3% case fatality rate cited in April and May.

However, one shouldn’t take this to mean that COVID doesn’t remain a serious threat across the U.S. Typical case fatality rates from influenza are 0.1%, so even with the recent reduction in deaths, COVID remains are more lethal infection than seasonal flu. Since August, we’ve continued to see 5-12 Marylanders die per day as the result of COVID infections. Over that time, dozens of Calvert residents have been hospitalized, and some will suffer long-term lung, heart, and kidney problems as a result of their infections.

Although COVID remains are major risk to Americans, we have seen a clear drop in the number of severe illnesses since late spring. One can reasonably ask why are we seeing such a significant drop in hospitalizations and deaths if COVID remains such a dangerous virus?

To this point, we can eliminate genetic mutations in the virus as a contributing factor. Although several different strains of the virus have evolved, none show signs of reduced virulence.
There are likely three key causes of the reduction in severe illness and death:

1. Doctors and nurses are getting better at caring for very sick patients
2. Social distancing and mask wearing reduce the numbers of infections and decrease the inoculum (number of virus particles) infecting those who do get sick (read more below)
3. Older individuals and those of any age with significant underlying health conditions are staying the heck away from younger people who continue to place themselves in situations that lead to transmission of the virus

Improved medical care for the very ill is truly lifesaving for some people, but it’s almost certainly not the driving factor behind the significant decrease in mortality. For the most part, medications are limited to those sick enough to require hospitalization. They can’t explain why we’ve seen such a big drop in the number of people requiring hospitalization in the first place. Although treatments for COVID have improved over the past 6 months, we still lack anything approximating a cure. Researchers continue to look for better therapies and optimize the benefits of the treatments that are currently available. Every treatment for COVID is properly labeled “experimental” at this point. And as we learned from the President’s recent illness, some of the most promising medications are currently not available to >90% of people who may benefit.

The most important factors resulting in fewer deaths are a combination of social distancing, mask wearing, and people in the highest risk categories staying away from situations that are more likely to expose them to the virus. High-risk people staying out of harm’s way is a pretty obvious contributor. This factor decreases the overall number of people who are hospitalized or die. It also decreases the case mortality rate since it doesn’t impact the number of younger, healthier people who are diagnosed with infection. Although 15.5% of our county’s population is 65 or older, during the past two months, only 5.6% of Calvert residents diagnosed with COVID were in that age bracket. Seniors have learned that you can’t trust anyone under 60.

The factors that are not completely intuitive are social distancing and mask wearing. Staying farther away from people who may be contagious is intuitive, and since mid-April, most of us have come around to accept that consistent mask wearing also decreases transmission. (Here’s a link to a post from the relatively early days of COVID. The only modification needed is that current evidence shows the percentage of people who are contagious and remain asymptomatic is closer to 40%- https://www.calvertcountycovid19.com/post/health-director-dr-polsky-on-wearing-face-masks). What’s not “common sense” is the growing evidence that social distancing and mask wearing also reduce the severity of illness in people who do get infected.

Multiple studies in the U.S. and abroad are finding that in areas where distancing and mask wearing have become adopted as social norms, the amount of virus cultured from those who do get infected is multiple times lower than was measured in the earlier days of the pandemic. There is a clear correlation between the amount of virus particles that initially infect a person and how sick they become. As a result, even though 6 feet and a mask don’t completely eliminate the transmission of virus, they decrease both the chance of spreading infection and the severity of illness in those who catch COVID despite taking precautions.

With a safe and effective vaccine still not on the visible horizon, it continues to be extremely important that we act in accordance with the best scientific evidence to minimize the lethality of COVID. The recent reduction in deaths is not a signal that the worst is behind us, it is evidence that the measures we have been taking as a community are working. The mortality rate in Calvert County is 5-times lower than the mortality rate across the rest of Maryland. Let’s keep it that way.

The other benefit of continued social distancing and mask wearing is the accompanying progressive reopening of businesses and schools. Although the pace of reopening is not a fast as some would like, a resurgence of COVID during the winter flu season will bring this to a grinding halt and may move us backwards. As we wait for the researchers to evaluate the safety and effectiveness of potential vaccines, it remains up to us to protect our friends and neighbors. COVID won’t alter our lives forever, but for the next 6+ months, our actions as individuals and as a community will alter our collective fate.

If you haven’t already, get your influenza vaccine and continue to act unto others. We’re all in this together.

September 2, 2020: Youth Sports

New guidelines were issued yesterday by the Calvert County Health Department for youth soccer, flag football, field hockey, and lacrosse. The guidelines were written after several discussions with representatives from the Calvert Soccer Association, and Calvert County Parks and Recreation. Our mutual goals were to allow all children and teens to play sports and do this in a way that is less likely to result in outbreaks of infection.

During the past week, COVID infections in Calvert County have doubled compared to each of the previous 3 weeks. Please keep in mind that the numbers below only account for people who have been tested and therefore are an undercount of actual infections in Calvert. Rates increased in every age group from young children to 60 year-olds. There are currently four people admitted to CalvertHealth Medical Center with severe COVID infections. Since the time from initial infection to severe illness is typically 1 ½ to 2 ½ weeks, it’s expected that hospitalizations will rise through September.

Although severe infections among children and teens are very uncommon, children can spread infection to adults, some of whom are at high-risk of medical complications. Higher rates of COVID infection among children and teens will also make it harder for schools to reopen. This is a reminder that although sports are very important, they don’t happen in a vacuum. Although in the NBA, they happen in a bubble.

Every professional sports league has modified its rules (Major League Baseball is playing in pods, it banned players from chewing sunflower seeds (spitting), shut down all farm teams, etc.). The NFL has players and staff wearing Bluetooth trackers. And every professional sports league is performing extensive COVID testing in a way that only multi-billion dollar organizations can. They all recognize there is true risk, even for people who get extensive medical screening and are among the best physically conditioned human beings on the planet. MLB, the NBA, and the NFL are sacrificing billions of dollars to make sure they can maintain reasonably safe playing environments for their players, staff, and their families.

The guidelines issued yesterday for all moderate contact youth sports build on some of the ideas of the pros. We want kids to be physically active. We want them to be around friends. We also understand that there are other important elements of team sports, including getting along with others whether you win or lose and working together for a common goal. The four representatives from the Health Department who worked on these guidelines are all parents. Three have children currently playing youth sports, and the other coached youth soccer for his child’s team not too long ago.

It’s been a very trying six months. Many families have been financially hurt. Children have been separated from schoolmates. There are current social and political forces that are emotionally stressful. All in all, 2020 has been a very rough year for almost everyone. It’s important that we keep a sense of perspective when judging youth sports guidelines. These guidelines do not prevent any children from getting on the field with friends and playing sports. At a minimum, a child will be on the field with at least 7 others their own age. Older children and teens will be able to play full-strength games with some modest adjustments. And these changes are temporary. One or more safe, effective vaccines will likely be available in the spring. If not, it’s almost a certainty that vaccines will be available before next fall.

Some parents have questioned the age 10 cutoff for full-strength games. One thing that we should be able to agree on is that 6 year-olds on a soccer field bear more resemblance to a swarm of bees buzzing around a ball than they do to an actual soccer team. Young players stay in very close contact for extended periods. 12 year-olds understand the game and are disciplined enough to properly space apart. There is no precise age when the shift from bees to soccer players occurs. Anytime a cut-off has to be determined, there is always someone just on the other side who feels slighted. If a 16 year-old can drive, why can’t a 15 year-old? If a 17 year-old can join the military, why can’t a 16 year-old? The age 10 cut-off for full-strength games was felt to be the best compromise by the three organizations mentioned above. An exception was made for 8 and 9 year-olds in travel leagues based on the selective nature of these teams. This is a temporary situation. Any young children playing microgames this fall will be back to their regular games next year.

We have also heard complaints about restrictions on spectators. Youth sports is the only type of athletic competition in Maryland allowed to have any spectators. The reality is that people from different households will see others they know and get together for prolonged conversations. Since there’s no practical way to enforce social distancing, having a uniform rule to limit spectators allows coaches to concentrate on their players. Whether COVID is spread on a playing field or sideline, it still drives up cases and the potential for serious illness.

The foundation of a civil society is compromise. As adults, we can explain to our children that life is about balancing priorities (I wouldn’t use those exact words with a 6 year-old) and looking out for others. The greatest priority in September 2020 is minimizing COVID infections to increase the chances that schools can reopen. We also need to explain to children that some older people have gotten very sick and by adjusting to some new rules, we all help keep our neighbors safer and healthier. Over this past week alone, seven families in Calvert have had to deal with infections involving two or three generations.

We are not “The Government”. The professionals at the Calvert County Health Department are members of your community. Some of us may be in your school’s PTA or have children in the same sports league as your children. We are trying our hardest to keep our community safe with as little interference as possible. In many respects, we are just as exhausted and fed up with COVID as you are. Please be understanding that although there is no perfect path with youth sports, great consideration was taken to come to a reasonable compromise during a very difficult time.

September 2, 2020 - Be Excellent To Each Other

Opening movie theaters is a bad idea. Our priority as a community should be to reduce COVID infection rates as much as possible in order to get kids back in schools and allow working parents to get back to their jobs. There are nearly one thousand movie screens across the state. Each will be allowed to seat up to 100 people in an indoor space for 2+ hours 4-5 times/day. Reopening theaters to the public is bound to drive up infection rates.

Although our health department has been supportive of business re-openings during the continuing COVID pandemic, this latest state order defies logic. Until we have an effective vaccine for COVID, placing large numbers of people in close proximity for hours at a time is a danger to those in attendance and others they live and work with.

We implore residents of Calvert to think of others who may be secondarily infected as a result of infections picked up by moviegoers. Until people have the ability to receive effective vaccines, or the rate of COVID infections drops close to zero, we can make the collective sacrifice of watching feature films on the small screen (if you consider 72 and 80-inch home monitors to be small). And the popcorn is cheaper!

We do sympathize with theater owners and their employees, but this is one instance when the risks of disease transmission, the negative impacts on the resumption of in-class learning, and the financial costs to other employers greatly exceed the benefits to one small sector of the economy.

Be excellent to each other and catch Bill and Ted, Da 5 Bloods, or Shaun the Sheep from the comfort of your home, at least for now.

August 9, 2020, Further Fallout from "Graduation/COVID" Party

Over the past 2 weeks, 40% of all COVID cases in Calvert have occurred in 15-19 year olds. This narrow age range has accounted for almost to half of all our cases! As noted in our previous post, a Graduation/“COVID-19” party in Drum Point on 7/25 served as the cauldron for many of these infections. At present, the Health Department knows of 15 attendees of that party who have tested positive. In addition, 3 parents, 1 grandparent, 1 sibling, and 4 co-workers are known to have become ill as a result of secondary infections. At least 2 adults have been hospitalized, one of whom is in the ICU.

It's likely that other 15-19 year olds who have tested positive since late July attended the same party or other similar parties. Close to a dozen teens with positive test at the end of July and early August have not answered calls from COVID contact tracers. In these cases, we only have the teens' cell numbers- no home phone numbers- so there’s no way for us to confirm whether they were in attendance. It’s also a certainty that others at the party became infected but did not get tested and/or remained asymptomatic. In either case, these people could have infected family members or other close contacts. As a result, the total number of Calvert infections that were spawned as a result of transmission at this party will never be fully known.

This should be a wake-up call to everyone. Every day, we’re all playing a game of chess. Each move we make today has repercussions down the board. The COVID risks we expose ourselves to, whether it’s at parties or any setting with large numbers of people, also leave those in our daily lives at potential risk for weeks to come.

Finally, healthcare providers should educate adults, especially those with underlying health conditions, that they need to be mindful of potential transmission from their children/grandchildren. They should include, "Do you have a 15-19 year old in your household?" to their clinical screening questions until we see numbers decline.

August 4, 2020

Over the past 10 days, we began to see a surge in COVID cases among teens and young adults. This is at least partly due to gatherings at pool parties, bars, and other social events.

Since mid-July, 54.4% of the 200+ COVID cases diagnosed in Calvert have been among those ages 15-29. Those between 15-19 years old have accounted for an astounding 30% of the diagnosed cases in the county.

At the same time, we have seen that older adults with higher medical risks are doing a better job keeping themselves out of harms way. People 55 and older have accounted for 11.7% of our positive tests during the past 3+ weeks. But despite efforts of those with greater health risks to avoid higher-risk situations, it is inevitable that teens and young adults will transmit the virus to household contacts, some of whom will develop life-threatening medical complications. Over the past week, we’ve seen COVID admissions at CalvertHealth Medical Center jump from 1-2 patients on a typical day in June and most of July to 8 patients currently needing inpatient care.

Conspiracy theories and misinformation continue to spread on social media and other outlets. COVID is no hoax. We’ve had 12 deaths in our county and many more people have been hospitalized since March. There will be people who survive their illness but will be left with permanent lung damage or long-term renal impairment and cognitive loss due to blood clots to their kidneys and brains (strokes). Professional sports leagues from NASCAR to the NBA to Major League Baseball have not forfeited billions of dollars due to a hoax. They understand the very real risks for athletes, staff, and their families.

As a nation, we have failed to act in a coordinated and decisive manner. The reality is that until we have an effective vaccine, cases of COVID will continue. Our goal at this point should be to minimize transmission of the virus in our county and prevent outbreaks. We need to act in ways that respect everyone’s health and safety. Avoid close, in-person contact with anyone outside of your household. Wear a face mask over your mouth and nose when out in public or at work. If you need to travel, avoid eating inside restaurants and going to any area where you can’t adequately space apart from others. A crowded venue in Ocean City can be just as risky as a crowded location in Florida or Arizona.

Teens need to think about the consequences of attending parties, especially where alcohol is being served. Alcohol increases the risk of virus transmission as a result of decreasing both inhibitions and good judgment. The health department just learned of a party attended by close to 100 teens in the Drum Point area that has resulted in multiple new cases of COVID infections. Parents also need to be aware that under Maryland law, if alcohol is consumed at a party on their property by people under 21, the homeowners are subject to criminal prosecution.

We all have a stake in this. Schools have been closed across the state depriving students from pre-K to high school seniors of a better education, in-person friendships and social support, and extra-curricular activities, including sports. Most businesses have been adversely impacted, costing owners dearly and depriving employees of a steady paycheck. It will be at least April before we know which vaccines are effective and until enough people are vaccinated to sufficiently reduce the risks of COVID.

Between now and then, we can’t escape reality. This virus is indifferent to what we want to believe or how we would like to live our lives. Our collective actions will result in either spikes of serious illnesses and further business and scholastic disruptions or a more moderate course that prevents our hospital from being overwhelmed and avoids the likelihood of further shutdowns. It sucks, but we can’t reset the calendar to January.

Avoid unnecessary travel. Don’t attend parties and large gatherings. Wear your face masks whenever you’re around people outside of your household. If you are older or have chronic health problems and you share a home with someone between 15-27 years old, talk to them about their potential exposures to COVID and act accordingly. Finally, support local businesses- they can use all the help they can get until we have an effective vaccine. Take care and stay safe.

July 13, 2020

Update on COVID-Related Deaths in Calvert County

As of 7/12/20, there have been 11 COVID-related deaths among Calvert residents. The mortality rate in Calvert is approximately 4.5 times lower than the mortality rate for the state of Maryland as a whole. For those who have seen a higher number of deaths on the state COVID website, it should be noted that their accounting is erroneous. A fuller explanation can be found in our earlier post: https://www.calvertcountycovid19.com/post/new-policy-to-list-covid-19-deaths-on-our-websites

It is difficult to write about this topic because each of those 11 is not a statistic, but a human being with family and friends. However, we understand that members of our community may want to understand more about the most serious consequence of COVID infections. Until this time, there has been no mention of details related to the deaths of Calvert residents because of the need for the Health Department to maintain individual confidentiality. With such few cases in the spring, almost any information could have allowed people to trace details back to a specific person’s death. This remains a concern, so the information that follows is meant to provide a reasonable understanding of trends while continuing to respect the privacy of families that have lost loved ones.

One should keep in mind that there is a limited amount of generalizable information that can be understood from very low incidence of any type of event. Eleven deaths are too few to reach definitive conclusions, but there are several things of note. Age and racial breakdowns are as follows:

55-64   3 deaths

65-74   3 deaths

75+       5 deaths

African American   7 deaths

White                         4 deaths

Four important factors emerge at this point. First, there have not been any deaths of individuals below the age of 55 in Calvert. However, throughout the rest of Maryland, close to 300 people under 55 have died of COVID-related infections.  Second, each deceased Calvert resident had at least one underlying chronic health condition. Third, the staff at each of our county’s nursing homes and assisted living facilities have done a consistently great job in protecting their residents. And fourth, we are witnessing yet another clear sign of the disproportionate health burden carried by African Americans.

Statewide, 31% of the population is African American and 40% of COVID deaths have occurred in this population. In Calvert, African Americans account for 13% of the population and 64% of COVID deaths. Although it would be unwise to draw definitive conclusions from our local sample size, national data has made it clear that greater attention is needed to chronic disease management, historic inequities, and continuing social stressors that impact African Americans.

Each of us should reflect on how we can take action to make our community a more just and equitable place for every child and adult regardless of race or ethnicity. COVID is the latest indicator of a deeper problem that we continue to grapple with as Americans. Perhaps posterity will look back at 2020 as a turning point in U.S. history. We all have an opportunity to make a difference.

July 3, 2020

This will be a 4th of July unlike any other that we have experienced. COVID has disrupted family gatherings, schools, businesses, daycares, vacations, and summer recreation in unprecedented ways.

The 1776 Declaration of, “unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness” was bound to the understanding that the new nation “lay its foundation on such principles… most likely to effect their Safety and Happiness.” “Safety” is deliberately placed before “happiness”, an acknowledgement by the Founders that without safety, happiness is diminished.

The Declaration of Independence is not a legal document. It was, and remains, an aspiration to local political autonomy, not an invitation to anarchy. The Founders clearly understood that social norms and regulations crafted by direct representatives of the governed would increase personal liberties. But with these freedoms come the need for greater personal responsibilities. The 18th century saw waves of smallpox, yellow fever, and other infectious diseases. Just as we have enacted restrictions on certain freedoms to prevent the spread of COVID and its resulting dangers, the generation of the Founders enacted quarantines and other limitations on commerce and personal liberties to protect health and lives.

But laws and regulations can’t be enforced in every location at every time. If we hope to keep the virus in check, it will ultimately be done as a result of personal decision-making. Coronavirus is indifferent to anyone’s desires or beliefs. Virus particles don’t care why someone may refuse to wear a mask, attend a large party, or travel to an area with high infection rates. Viruses do what they are genetically programmed to do. COVID latches onto cells in a person’s respiratory tract, propagates, and spreads to the next person who falls in its path. Regardless of a individual’s rationale, this virus will continue to spread through communities aided by those who choose to act in ways contrary to basic health principles.

We are currently witnessing the results of oppositional behavior (ignoring evidence of increased transmission when people fail to wear masks and continue to congregate in large numbers) in states throughout the Southern and Western U.S. Currently the average American resident is 20 times more likely to become infected than someone living in Italy. No other industrialized country in the world has infection rates and mortality rates anywhere near those in the U.S.

This July 4th, we should act with benevolence toward our fellow Americans, some of whom are vulnerable to severe health consequences of COVID and others who will be adversely impacted financially, educationally, and/or emotionally by preventable spread. If infections spike in the months ahead, it won’t matter whether government restrictions are reimposed. The 1918-19 Influenza Pandemic led to mass business closures across the country, not because of government orders, but because We The People were afraid to go to restaurants, theaters, and any retailer that was not absolutely necessary.

This Saturday, take time to reflect on the liberties that we enjoy and the sacrifices, large and small, that patriotic Americans make to protect our collective “Safety and Happiness”. COVID-19 won’t be with us forever. But until a vaccine is available, likely sometime into 2021, we need to treat each other with consideration, including wearing face masks in public, staying home when we don’t feel well, and holding off on some of the group activities that we would otherwise like to do. As James Madison enshrined in the preamble our other great document, the U.S. Constitution, we must live up to the principles to: “promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity“. Have a happy 4th and a safe summer.

June 11, 2020

COVID infections continue to decrease across Calvert. Although it’s difficult to make direct comparisons of statistics over the past three months due to vast differences in testing availability between mid-March and early June, analysis of multiple data points indicate that COVID prevalence in our county is the lowest it’s been since March. For all of you who have been taking precautions such as wearing face masks, minimizing unnecessary trips, staying home when you don’t feel well, and maintaining the all-to-familiar 6 feet of space from others, please take a bow.

Where are we going from here? First we need to remember that COVID is still in our community, and the virus is present at even higher levels in many surrounding counties. Anyone who is 60 or older, anyone with health conditions that weaken their immune system, and anyone who lives in a household with someone at high-risk of medical complications should continue to avoid public situations that carry significant risk of infection. For others, we can socialize more, but each of us should continue to make reasonable choices that won’t spark new outbreaks.

If we continue to act with consideration for our family and neighbors, it’s possible that we may see cases drop near zero this summer. This should be our goal as we think about children going through chemotherapy, first responders with diabetes, and co-workers with chronic health conditions who want to safely return to their jobs.

Our health department staff is very happy to see businesses opening their doors and recreational activities resume. Let’s continue moving forward. At this point, maintaining reasonable distances from others on the sidelines of your child’s soccer games, wearing a face mask whenever possible in public indoor settings, and staying home when you or a family member is sick are relatively small prices to pay for a summer of relative normalcy.

Discover a new and uncrowded vacation destination this summer.
Consider eating out on a weeknight to support a local restaurant and avoid the crowds.
Shop in smaller, locally owned stores.
Become a regular at the Farmers’ Market.
Come up with your own list of ways to enjoy the summer while keeping yourself, your family, and your neighbors healthy.
Keep up the great work, Calvert!

June 4, 2020

Calvert County Public Playgrounds, Parks Reopening

Calvert County playgrounds, basketball courts, and skateparks will open to the public on Friday June 5^th. The most recent surveillance data for our county shows a gradual, sustained decline in local COVID infections since mid-April. This signals a clear decrease in transmission risk as children and teens engage in outdoor activity. By the Governor’s Orders, no more than 10 people may occupy a playground or other recreational area at any given time. Social distancing should continue to be observed to the greatest extent possible.

Calvert County Health Department has worked with the County Government staff and most importantly, the residents and employers of Calvert to protect the health and safety of our community. We are proud of the decisions we’ve made since the first cases of COVID appeared in early-March. Coupled with the actions taken by individuals and businesses, the number of COVID-related deaths in Calvert has been 10-times less per capita than has been seen in Maryland as a whole. In addition, by limiting the spread of the virus, many other Calvert residents have been spared severe illnesses that may have left them chronically debilitated from lung and kidney damage.

As playgrounds and recreation facilities open, it’s extremely important for parents to keep in mind that COVID-19 is still present in Calvert County. Risks of virus transmission are significantly less than they were 4-6 weeks ago, but they are not gone. Children and teens with any health condition that compromise their immune systems should not be brought to playgrounds or athletic fields. Children and teens who live in a household with elderly relatives or others with underlying chronic health conditions, should also continue to avoid public recreation settings at this time. Hopefully, as the summer progresses, the prevalence of COVID will drop to near zero. At that time, it will be safer for these children to play in public settings. Until then, parents of these children should arrange home playdates with a small number of their children’s friends who they can verify do not have any ill members of their household.

When playgrounds, fields, and courts reopen, please continue to keep the health of your neighbors in mind. If any member of your household has been ill during the past 14 days, do not bring your children to a public space. When children do come to the playground or athletic field, parents should continue to space themselves more than 6 feet apart. Although transmission of respiratory viruses is less likely outdoors, there is still some risk. Face masks are encouraged for parents and other spectators. Children who are playing should not have face coverings. The potential for heat stroke increases with face coverings. This lack of face covering makes it even more important that children who may be carrying COVID are not brought to public facilities.

The Calvert Health Department staff understand the stress on children as we’ve all tried to balance the direct risks of the virus with the impacts of more social isolation. Most of our staff are parents who are living through this unprecedented crisis along with you. We are very happy to see more opportunities for kids to be kids. The more personal responsibility we all take, the safer it keeps the most vulnerable in our community. We also need to keep in mind that outbreaks of COVID among children during the summer will make it harder for daycares to stay open and may have unwanted consequences as decisions are made about school reopenings in September. Take care, continue to be good neighbors, and enjoy the outdoors!

May 13, 2020

New Policy to List COVID-19 Deaths on Our Websites

To this point, our health department has not posted the number of COVID-related deaths in Calvert County. This decision was not made in an attempt to hide information from the public. The concern was a potential show of disrespect to the families of the few who have died. Reducing the death of an individual to a statistic dehumanizes that loss.

When hundreds or thousands of people perish in a calamitous event, there is a degree of anonymity to a mortality count. When only two or three people have died, each of those numbers represents a specific individual.

However, as a result of a misleading state method of attributing deaths to each county, our health department has made the decision to post the current number of coronavirus deaths in Calvert County. The state COVID website now attributes 12 deaths to Calvert County. The actual number of deaths is 3.

The state assigns a death to a county based on the address listed on each death certificate. This is problematic because the address of “residence” is provided by family members and not based on the actual residence of the individual at the time they acquired the infection. Of the 9 deaths misattributed to Calvert County, it appears that all of these individuals were previous residents of Calvert, but had been living in nursing homes outside of the county at the time they became infected with COVID-19. These individuals had been living in out-of-county facilities for months to years before they died.

At least one other county, Queen Anne’s, has had a similar problem. Almost all of the deaths attributed to Queen Anne’s were also people who lived in that county at an earlier time, but had relocated to nursing homes in other counties well before they became infected and died. Discussions occurred between the Calvert and Queen Anne’s health departments and state officials to revise the method by which deaths are attributed to counties, but this has not resulted in policy changes.

The decision to post the number of deaths that have occurred in Calvert is also to reassure people that the nursing homes in our county have been doing a stellar job protecting their residents and employees. 48% of all COVID-related deaths in Maryland have occurred among nursing home residents (792 deaths). In total, 4,323 nursing home residents across Maryland have tested positive for the virus to date. In the four nursing homes in Calvert, there has been 1 diagnosed case (now recovered) and no deaths.

Our health department’s infectious disease nurses have worked closely with the administrative and nursing staffs of each of our nursing homes since early in the pandemic. Nursing home staff can call for advice any day of the week and anytime of day or night. Every nursing home has done a consistently terrific job of screening employees for signs of illness prior to every shift. Any employee displaying any potential evidence of COVID-19 are excluded from work and tested. Any resident displaying any potential symptoms are isolated from other residents and tested. Staff consistently uses appropriate personal protective equipment (PPE). Hand washing and other hygiene measures are emphasized.

How do we know this? Our nursing staff make periodic, unannounced visits to verify employee screening is occurring, proper sanitary procedures are in place, soap and hand sanitizer dispensers are stocked, PPE is being used, and social distancing occurs for both residents and staff. The health department will continue to work with our county’s nursing home professionals to safeguard both residents and staff.

Update: May 1, 2020 5:30 pm

The Calvert Coronavirus Drive-thru Test Site launched on Tuesday. Almost 100 people were tested in our first two days without any delays or problems thanks to great work by the nursing professionals at the Health Department and the Hospital. Results were available to doctors and patients 2 days after Tuesday's tests were performed.

The one frustration is the difficulty people are having as they try to schedule testing appointments. Each person needs to get an order from their doctor or nurse practitioner. The patient then receives a code to schedule her/his appointment on a centralized state website called CRISP. Currently, the appointment spots aren't opened on CRISP until a few days before each testing date. As a result, if someone's doctor places an order for a COVID test on Thursday, the patient may not be able to schedule an appointment to have the test done until the following Sunday or Monday.

On the local level, we have no control over the scheduling site. However, we had discussions with state officials and requested that appointment spots be made available a week prior to the testing dates. They are working toward this. This afternoon, they opened the appointments in CRISP for the coming week. Anyone who has already received a code from their healthcare provider can now go on the CRISP site and schedule for the Prince Frederick location.

For those who tried without success to schedule an appointment time, we share your frustration. Hopefully, the process will be smoother going forward.

April 24, 2020 12:00 pm

The Calvert Health Department has some good news to share. Starting on Tuesday April 28, a coronavirus testing site will be established at the Prince Frederick vehicle emissions inspection facility. Our local health department worked with the Maryland Department of Health to arrange for testing material and logistical support, and now we’re partnering with Calvert Hospital to operate the testing site. We will have the capacity to perform 100 tests each week. If this proves insufficient, we will expand the testing.

Tests will be performed on Tuesdays and Thursdays. In order to arrange for a test, an individual needs to contact her/his primary care provider. Your healthcare provider will then determine if it’s appropriate for you to be tested for coronavirus. If so, she/he will place an order into an electronic medical system. You will then be given information to schedule an appointment for testing. Unless you have an appointment, you cannot be tested. Anyone arriving at the test site without an appointment will be turned away.

The test will be performed while people are in their vehicle. The test kit is then shipped to a laboratory that will send a result to your healthcare provider in 3-5 days. Anyone presenting for testing is considered to be at-risk for having COVID infection. As a result, until you receive results, you should stay home in isolation so you do not unintentionally infect others.

Prince Frederick will be the first rural location in Maryland to provide drive-thru testing for coronavirus. The Calvert Health Department thanks our colleagues at the Maryland Department of Health and at CalvertHealth Medical Center for helping us to make this service available to the residents of our county.

Anyone in need of a new primary care provider can contact:
CalvertHealth Medical Group: 410 414-2778 or calverthealthmedicalgroup.org/.
Calvert Internal Medicine: 410 535-2005 or https://calvertmedicine.com/.
Urgent Care: Dunkirk 410 650-4346 or Solomons 410 394-2800.

April 15, 2020 8:40 am

We are now settling into a new normal. A normal that has greatly and uncomfortably limited our social contact. It’s gotten to the point that kids actually want to go to school, and adults want to sit in cubicles. For most, there’s not much difference between Saturday and Wednesday. And going to the grocery store has shifted from an occasional trip to get necessities to a frequent excuse for getting out of the house.

As a result of chronic overcrowding in grocery and convenience stores, as well as some other retailers, the Health Department has acted on Governor Hogan’s directive to institute new policies to decrease virus transmission. It is strongly recommended that both customers and employees wear basic face masks. People will not be denied food if they refuse to wear a mask, but we ask that everyone place the needs of medically vulnerable neighbors above their personal preferences.

A previous post has instructions and links on how to make your own reusable masks (https://www.calvertcountycovid19.com/post/health-director-dr-polsky-on-wearing-face-masks).

Starting Thursday, stores will be required to properly disinfect all shopping carts or make antiseptic wipes available to customers at the entrance. People waiting in lines at deli counters, checkouts, and other spots in and outside of stores must space at least 6 feet apart. Employees must be allowed to wear face masks and have an opportunity to wash their hands each hour.
Finally, occupancy of retailers will be limited to 5 people per 1,000 square feet.

This is consistent with current policies of Walmart, Giant, and other private corporations as they aim to protect their customers and employees from coronavirus. If people limit their trips to their pre-pandemic habits, this limitation would not be necessary.

For your health, the health of your family members, and the safety of all those in our community, the health department asks that you voluntarily limit trips for groceries to once every 5 days on the following schedule:

• Last name starting with A-C shop on dates ending with 0 and 5
• Last name starting with D-G shop on dates ending with 1 and 6
• Last name starting with H-L shop on dates ending with 2 and 7
• Last name starting with M-R shop on dates ending with 3 and 8
• Last name starting with S-Z shop on dates ending with 4 and 9
  

We all want to get back to our normal lives as soon as possible. Our actions make a difference. Sustaining those actions are the key to lowering our risk of infection and lifting social restrictions. We can’t speed up time, but we can dramatically slow the spread of the virus.

Remember the words of Hippocrates, fittingly taken from the work Of the Epidemics, “First, do no harm.” Limit your trips to the store. Wear a face mask over your mouth and nose while in public. Leave space between yourself and others. Take care of yourself. Take care of your neighbors.

April 8, 2020 10:30 pm

Your actions over these next few days may be the single most important factor in controlling coronavirus transmission for the remainder of the pandemic. Easter and Passover are traditionally times of family celebration and togetherness. This year, what are typically times of joy have the potential to cause unintentional spread of virus and a new spike in disease. The Health Department implores everyone to stay home and celebrate in-person only with people who live in your household. FaceTime, Skype, and other video platforms are the perfect way to share holidays with loved ones outside of your home.

If virus transmission increases over the next week, it will put into motion entirely new rounds of COVID outbreaks that will last through the month of May. This will lead to longer closures of businesses and recreational activities. Regardless of Executive Orders from Governor Hogan and advice from national health experts, reducing further spread of coronavirus ultimately rests on the willingness of our community to minimize contact with those outside of our households.

A faster squelching of coronavirus infections in Calvert will begin to take the burden off of overworked first responders and medical staff. These dedicated volunteers and professionals continue to risk their own health and safety to serve us. The least we can do is limit our trips to the grocery store, maintain distance between ourselves and others, and wash our hands frequently. 

The health department proposes people voluntarily limit trips for groceries to once every 5 days on the following schedule:

Last name starting with A-C shop on days ending with 0 and 5

Last name starting with D-G shop on days ending with 1 and 6

Last name starting with H-L shop on days ending with 2 and 7

Last name starting with M-R shop on days ending with 3 and 8

Last name starting with S-Z shop on days ending with 4 and 9

We all want to get back to our normal routines as soon as possible. Our actions over the next week, and sustaining those efforts through the next month, are the key to getting us there. We can’t speed up time, but we can dramatically slow the spread of the virus. Take care of yourself, your family, and your neighbors. The Health Department wishes everyone a happy and healthy holiday.

Update April 4, 2020 4:00 pm

To Mask or Not to Mask?

When this pandemic ends, most of us will be fine. But some of us won’t. Our priority as a community is to pull together to limit the number of people who will die and the number of families who will be forever altered. That means being willing to adjust our behaviors as new scientific evidence emerges. It also means supporting your neighbors and blocking out social media haters who sow seeds of fear and mistrust.

The latest shift involves facemasks. As many have heard, the CDC now recommends routine use of homemade cloth facemasks in public settings for everyone age 2 and older. Please do not put masks on children under 2 years old.

Evidence through late March indicated that only those who developed symptoms of coronavirus were spreading it to others. Over the past 10 days, increasing evidence has shown that people can transmit the virus 1-2 days before developing symptoms, and as much as 25% of the spread may be due to people who have contracted coronavirus but never develop symptoms.

With this new evidence, the goal of cloth facemasks is to prevent people who feel healthy from unknowingly spreading virus-laden respiratory droplets when they are in public. It should be emphasized that it is currently unknown how effective homemade facemasks will be, so wearing a mask is not a substitute for limiting trips outside of your home, continuing to maintain social distancing, or frequently washing your hands.

If you want to make your own cloth masks, here are some how-to instructions and videos:

First up is a 45 second video from the Surgeon General Dr. Jerome Adams, who is also a Southern Maryland native (Chopticon High School):
https://youtu.be/tPx1yqvJgf4

Next is a how-to showing 3 different facemask designs and instructions on how to wear and clean a facemask:
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

For those with a sewing machine who want to make a more durable facemask, here is a link with instructions followed by a link for the how-to video:
https://about.kaiserpermanente.org/

https://www.youtube.com/watch?v=4aMCFnK5bHk

If it seems that coronavirus recommendations change more often than your underwear, you’re right. And if you don’t, you may need to reconsider your personal hygiene habits. Expect more changes as researchers continue to discover more about the transmission and severity of coronavirus. Stay safe. We still have a way to go.

March 31, 2020 9:00 am

The Health Department staff understands that stress levels are rising for many Calvert residents. Each day brings more reports of coronavirus infections. New restrictions on people’s lives are announced with little time to prepare. Many households are facing increased financial pressure. Kids are trapped at home and family members are sometimes a little too close for comfort.

In addition to the work the Calvert County Health Department (CCHD) does tracking coronavirus infections and providing guidance for local professionals and general members of the public, CCHD also provides mental health and substance use treatment, as well as help for those at risk of domestic violence. We also have a list of private behavioral health providers in Calvert.

If you or someone you know is struggling emotionally or could use help dealing with substance use problems, please call 410 535-3079. Even in times of office shutdowns, we continue to provide services 6 days/week. We provide both in-person and telehealth care.

We also have a 24-hour hotline for domestic violence and sexual assault victims, as well as for those needing to talk to someone at any hour if they are considering suicide. The 24-hour hotline number is 410 535-1121.

Our Health Department has also developed a new website specifically for coronavirus information. You can link to this site through our original website https://www.calverthealth.org/ (see the link in the top left corner) or directly at https://www.calvertcountycovid19.com/. The new site has updates, local, state, and national case counts, links to the CDC and other trusted sources, and an archive of past Calvert Health Department posts.

March 29, 2020 5:35 pm

Five newly confirmed cases of coronavirus have been reported in the last 24 hours among Calvert residents, bringing our confirmed number of cases to 14. For anyone checking the Maryland state website, it has frequently given incorrect numbers for Calvert and many other counties. Once again, the numbers reflect only those people with laboratory-confirmed cases and do not account for the many people who have been infected but were not tested for coronavirus.

The first person had exposures in Ocean City and the Calvert bowling alley on 3/11 (see previous post). This person is currently hospitalized. Due to the anticipated test result, contacts of this person have already been notified. Another person was at the bowling alley on 3/11 and is currently at home recovering. Contacts of this individual who are at potential risk of transmission are being personally notified.

One of the new cases resulted from travel out of state just prior to the domestic flight restrictions. This person is currently hospitalized. Other than immediate family members, this individual has not had contact with public during the time period of potential transmission.

Another person has no clear source of infection and no travel out of the county. There is no connection between this person and any other known cases. This is an example of why everyone should limit contact outside of their home to essential needs. This person also has not been in public settings since the period of potential viral transmission began. This person has not required hospitalization and is beginning to recover.

The remaining individual had previously been notified of contact with a patient diagnosed with coronavirus while he/she was on duty at a hospital OUTSIDE OF CALVERT. Further contact investigation is currently taking place.

March 27, 2020 7:15 pm

The Health Department has been notified of a 9th case of coronavirus. During an investigation this afternoon, it is likely that transmission occurred either on March 11th during the Wednesday Night Combo Bowling League at Lord Calvert Bowling Lanes in Huntingtown or at a group gathering in Ocean City two days later.
People who attended the gathering in Ocean City are being individually contacted.

For anyone who was present at the Lord Calvert Bowling alley the night of March 11th, or their close contacts, the Health Department recommends the following:
For those who currently have a cough, shortness of breath, or fevers:
Contact your primary care provider or an urgent care. 

• Please call before going to any medical office office or urgent care.

For those who had a cough, shortness of breath or fevers between 3/13-3/26, but those symptoms have resolved:

• Email the Calvert Health Department at Calvert.admin@maryland.gov with your contact information and a nurse will be in touch with you on Monday to get additional details.

Since it has been more than two weeks since the possible transmission at the bowling alley, for anyone who was present that night but has not developed any respiratory symptoms or fever, there is no ongoing risk of illness from potential exposure on March 11th

March 27, 2020 10:00 am

One additional Calvert resident was confirmed to have coronavirus, bringing the total number of confirmed cases to 8. This resident was contacted immediately after the lab result was available. Since the time this person was capable of transmitting the virus, his/her only contacts were with immediate family members and two other people. All contacts have been reached by Health Department nurses. None are ill, and all are self-isolating for 14 days.

Please keep in mind that Calvert is somewhat atypical in that 2/3 of our residents who are employed work outside of our county. This changes many factors both in exposure to infection and potential for transmission. Most of our residents work in St. Mary’s, Prince George’s County, Washington, DC, Anne Arundel, and Northern Virginia. Other than St. Mary’s, each of these jurisdictions have higher rates of infection than seen in Southern Maryland. This will likely contribute to additional cases in Calvert over the next upcoming weeks and months.

March 26, 2020 1:50 pm

The Health Department asks for patience as we do our best to update the public with statistics related to the coronavirus pandemic. Within the last 24 hours, four additional Calvert County residents were diagnosed with the virus. This brings the County’s total number of diagnosed cases to seven. None of these cases were related. No county residents have died as a result of coronavirus. Statewide, there was a 37% increase in reported cases yesterday. This increase represents a combination of greater community transmission over the past week and modest increases in the number of people being tested.

However, the true extent of virus spread remains unclear because relatively few people who should have been tested have actually been screened. This continues to be due to a nationwide shortage of testing kits and the lack of regional lab capacity to process the tests. It is very likely that hundreds of people have been infected with coronavirus in Southern Maryland this month, but most have had mild-to-moderate illnesses and gone undiagnosed.

As a result of the all but certain prevalence of coronavirus throughout the region, people should continue to take practical precautions. Avoid unnecessary public contact. Protect vulnerable family members and neighbors by offering to go to the grocery store or pharmacy for them. Keep children away from elderly relatives. Use video technology (FaceTime, Skype, etc.) to stay in touch with others.

We realize that some members of the community have been frustrated by the lack of real-time updates on cases. Please understand that our already understaffed agency has received no increase in staffing to handle all of the dramatically increased responsibilities brought on by this pandemic. Every newly diagnosed case needs to be thoroughly evaluated by our clinical staff to make sure that individual, his or her family, and potentially exposed members in the community are receiving proper care and instructions. The Health Department receives non-stop calls from healthcare providers, county agencies, and members of the public requesting advice. We have been the hub of distribution for personal protective equipment for local healthcare providers, nursing facilities, and other essential service providers. We are dealing with frequently changing state and federal mandates affecting everything from health guidance to personnel matters . Many of our staff have shifted to remote work, placing enormous burden on our IT staff. And the list could go on and on, but you get the idea.

We are in the process of revamping our website to provide quicker updates on the number of cases in Calvert and across Maryland. But please keep in mind that these are only the verified cases and do not account for the many additional infections that have gone undetected due to testing shortages. We are also working on a better method of organizing coronavirus web resources for members of the community. We hope to have this functional within the next few days. Again, thank you for your patience as we all work toward keeping our community healthier and safer.

Update March 25, 2020 8:54 pm

An extremely unusual situation has developed over the past five days. The Calvert Health Department has always been truthful with the information we provide. In the interest of transparency, we are notifying you of the following events that have occurred in relation to the 7-11 on Hallowing Point Road.

On March 21st, a person connected to the store was tested for coronavirus. This individual falsified a positive result, leading to a temporary store closure and a swirl of social media conjecture. The result from this test is still pending. The lab to which it was sent to has a current wait time of nearly 10 days. In other words, at the present time it is not know whether that person does or does not have coronavirus.

Before it was realized that the initial report was falsified, another person who works at the store was tested by their family doctor. This test went to a different lab with a much faster turnaround time. That test was reported today did show coronavirus.

Given the very unexpected turn of events, both the store owner and the 7-11 corporation have decided that it’s in the best interest of public health to close the store on Hallowing Point Road and another Calvert store, under the same ownership, located in Prince Frederick. These stores will stay closed for 14 days as per CDC guidance to prevent transmission.

The situation was discussed with the Director of Environmental and Occupational Health at the Maryland Department of Health who agreed with the decision.

Employees are being contacted individually to provide appropriate health precautions. Given the limited amount of direct contact most customers have in a convenience store, the potential for customers to have acquired coronavirus in either store is very low. However, customers who entered either store between March 12th-25th are advised to contact their personal health care provider if they develop any respiratory symptoms or fevers. For those who have no symptoms, over the next two weeks, they should take additional precautions of washing their hands frequently and they may want to avoid contact with people over age 60 and people of any age with weakened immune systems.

The Calvert Health Department will continue to monitor employees’ health over the next 14 days and provide updates if new information becomes available.

March 25, 2020

This morning (March 25) the 4th Calvert County case of coronavirus infection was confirmed. This person is currently recovering at home. As with previous cases, Calvert Health Department nurses have obtained detailed health and contact histories from this person within one hour of notification from the testing laboratory. Our nurses have already reached out to those who had sufficient contact to put them at risk of becoming infected.

The Health Department staff understands how concerning this epidemic is to everyone across Calvert. Regardless of time of day or day of the week, our staff is immediately responding to all positive test results. Our ongoing goal is to notify those at elevated risk of infection as quickly as possible, so those people take appropriate precautions to isolate themselves per CDC guidelines. Along with everyone in the general public limiting contact with others, washing their hands frequently, and staying home if they develop any respiratory symptoms or fevers, we will minimize the spread of coronavirus and prevent severe illnesses and deaths.

Social media continues to churn with posts about individuals who are supposedly infected with coronavirus and settings in which people could have been infected. Most of these posts have been wrong and are leading to unnecessary stress in our community. The Health Department is asking people not to propagate unfounded rumors.

The health and safety of everyone in Calvert is critically important to us. The Health Department staff, along with our families, are part of the Southern Maryland community. We have a professional, ethical duty to provide the most timely and accurate information to everyone. We will continue to personally contact those at increased risk as a result of exposure to confirmed cases of coronavirus infection. At the same time, we have a legal obligation to protect confidential health information. As a result, information on specific cases that is not necessary to protect those at direct risk will not be provided via our website or social media posts.

We hope everyone understands that we are all in this together. That applies to both our physical and emotional well-being. Younger, healthier people should offer to get groceries and medication for family and neighbors who are more at risk of severe illness. For those on social media, stick with verifiable information pertaining to coronavirus and look for funny or calming posts to lift people’s spirits, especially on rainy days like today with so many people are stuck at home.

Please take care of yourselves and those around you. We’d also like to give recognition to the Emergency Department staff, respiratory therapists, and others at Calvert Medical Center as well as EMS workers as they take care of patients during this pandemic. The Health Department will continue to provide updates as they become available.

March 22, 2020

A second Calvert resident has been confirmed to have coronavirus infection. This person did not have any travel outside of the Southern Maryland region over the past month, reinforcing the potential that anyone can become infected through routine contact within our state.

This person has had no contact with vulnerable populations such as those in nursing facilities or daycares. Within 1 hour of being notified of the diagnosis, the Calvert Health Department staff was able to reach each individual who could have been potentially exposed to coronavirus by this individual. Everyone who may be at risk of infection as a result of this exposure is under isolation for a full 14 days.

It is acknowledged that due to the nationwide shortage of test kits, most people who have been infected with coronavirus have gone undiagnosed. Some of these people have no symptoms but can still transmit the infection to others. As Dr. Antony Fauci of the White House Coronavirus Task Force announced yesterday, there is a major national effort to ramp up production of testing material. Once that is accomplished, plans are in place statewide for drive-through testing centers. We will keep you informed as more information becomes available.

Current test sites in Maryland have had very limited capacity to perform tests and have had to frequently shut down operations due to lack of supplies. Dr. Fauci emphasized that until more test kits are being produced, only those with significant illness should be tested.

We urge residents of Calvert to stay at home as much as possible. As this most recent case illustrates, you can become infected through routine contact in Southern Maryland. When you do go out for groceries or medication, wash your hands before leaving the house, use a sanitizing wipe on your shopping cart, and wash your hands again as soon as you return home. If possible, use a credit or debit card to avoid exchanging items with the cashier and please stand 6 feet away from the cashier. It's important to help protect grocery store and pharmacy employees. They are providing critical services for our community.

March 21, 2020

A resident from another county being treated at CalvertHealth Medical Center (CHMC) tested positive for coronavirus on 3/20/20. This patient has been transferred to a larger medical facility to receive ongoing care.

CMHC appropriately consulted with our local health department and the Director of the Maryland Infectious Disease Epidemiology and Outbreak Response Division of the Maryland Department of Health (MDH). All precautions recommended by the CDC and MDH are being followed to protect the health and safety of patients and staff at the hospital. The health department is directly notifying any members of the community who may have had contact with the infected individual.

Both CMHC and the Calvert Health Department realize the implications of the ongoing coronavirus pandemic. We are deeply vested in ensuring the best care possible for members of our community. We encourage you to do your part in minimizing further spread of the virus. Please stay home as much as possible. If you have medically frail family members or neighbors, avoid direct contact with them and offer to pick up their groceries and medications so they can avoid contact with the public.

March 19, 2020

The first diagnosed case of coronavirus (COVID-19) in Calvert County has been confirmed. The person with the infection is under medical care and is presently doing well. This person has had minimal contact with others since becoming infected. The family members of this individual are self-isolating themselves per CDC recommendations. Those few individuals outside of the immediate family who have any risk of becoming infected have been contacted by the health department are also self-isolating themselves.

The source of transmission for the Calvert resident was an out-of-state relative. Neither the Calvert resident nor the relative has had any contact with anyone in a local school, daycare, nursing facility, or any other vulnerable population.

We remind everyone to continue to take reasonable precautions against exposure including frequent handwashing, use of disinfectants on high-touch surfaces, and limiting exposure in public places as much as possible.

March 16, 2020

As responses to the coronavirus pandemic continue to evolve, we would like to be sure that owners, managers and employees of restaurants, bars, movie theatres and gyms/fitness centers are aware of Governor Hogan’s recent Executive Order calling for closure of those establishments until further notice with the following exception:

The Executive Order allows carry-out food service (only when promptly taken from the premises), drive-thru service, and delivery of food.

The order also prohibits any gathering of more than 50 people, including social events/weddings, block parties, club or civic meetings, sports events, and religious services during this unprecedented time.

Information can be found on the Governor's website:

https://governor.maryland.gov/2020/03/16/governor-hogan-orders-closure-of-bars-and-restaurants-announces-unprecedented-public-health-surge-to-combat-covid-19-crisis/

This order remains in effect until the state of emergency has been terminated by the Governor. Unfortunately, we cannot predict when this is likely to resolve. We understand that these are difficult times for many in our area. We will continue to update the situation as information becomes available.

March 16, 2020

The current recommendations from the CDC and the Maryland Board of Physicians is that anyone:
- 60 or older, or
- at any age with underlying immune system problems or chronic respiratory ailments contact your primary care provider if you have any symptoms of a respiratory infection. Together with their health care provider, they will decide if testing is needed. For those who meet current criteria, it is important to note that tests are available.

Do NOT call 911 or go to the emergency room unless there is a true health emergency.

For younger and otherwise healthy people, the recommendation for anyone with mild respiratory symptoms is to stay home until symptoms resolve. For younger, healthy people, testing is not recommended because the risk of infecting others is greater than the benefit of being tested. Regardless of age, if anyone has a respiratory infection that is getting progressively worse, they should contact their primary care provider.

Calvert County Health Department is doing everything possible to maintain full service to everyone who receives behavioral health care through our providers. We have every intention of keeping our doors open to those who depend on our services. We have been taking all necessary hygiene measures in our offices to minimize the risk of virus transmission. The Health Department asks that if any of our patients develop symptoms of a respiratory infection, they call our office so we can make sure they get proper care by phone without risking the health of others.

In the unlikely event that buildings need to temporarily close, the Calvert Health Department is planning ways to ensure people can access prescription refills and other vital needs via telehealth or phone lines.