COVID-19: ARKANSAS EMPLOYER UPDATEJoe Thompson, MD, MPHPresident and CEO, ACHIProfessor, UAMS Colleges of Medicine and Public Health

04.23.2020

COVID-19: CONFIRMED CASES IN THE U.S.

Source: Washington Post, as of April 23, 8 a.m.

Confirmed Cases

842,472Reported Deaths

46,782

COVID-19: CONFIRMED CASES BY AR COUNTY

Source: Arkansas Department of Health, as of April 23, 8 a.m.

Cumulative Cases: 2,392

Hospitalized: 97

On Ventilator: 23

Deaths: 44

Recoveries: 893

ARKANSAS POLICY ACTIONS & NUMBERS OF POSITIVE CASES & TESTS PER 100K*

As of April 22

COVID-19: FLATTENING THE CURVE

Statistical Visualization: Alexander Radtke, March 9, 2020, flowingdata.com

0

500

1000

1500

2000

2500

1

Source: Arkansas Department of Health.

CONFIRMED COVID-19 CASES IN ARKANSAS

*

*As of 8 a.m. April 23

0

50

100

150

200

250

300

3/11

3/12

3/13

3/14

3/15

3/16

3/17

3/18

3/19

3/20

3/21

3/22

3/23

3/24

3/25

3/26

3/27

3/28

3/29

3/30

3/31

4/1

4/2

4/3

4/4

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4/6

4/7

4/8

4/9

4/10

4/11

4/12

4/13

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4/16

4/17

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4/19

4/20

4/21

4/22

NEW CASES OF COVID-19 PER DAY IN ARKANSAS

Sources: Arkansas Department of Health, Office of Gov. Asa Hutchinson

Community Correctional facility cases (as reported in press conferences, beginning Apr. 20)

914 12

4148 48

43

62 6456

6671 72

6774 74 76 73

86

74 77 7481 83 85

9386 88

9386

97

0

20

40

60

80

100

3/23 3/24 3/25 3/26 3/27 3/28 3/29 3/30 3/31 4/1 4/2 4/3 4/4 4/5 4/6 4/7 4/8 4/9 4/10 4/11 4/12 4/13 4/14 4/15 4/16 4/17 4/18 4/19 4/20 4/21 4/22

COVID-19 HOSPITALIZATIONS IN ARK. PER DAY

Source: Arkansas Department of Health.

Total of “currently hospitalized,” each day, beginning March 23

HOSPITAL OCCUPANCY DASHBOARD — STATEWIDE

CARES ACT: UNEVEN SPREAD OF COVID-19 AID

IMMUNOLOGY 101

COVID-19 TESTING IN ARKANSASo Two categories of testing:

o Molecular – whether someone is currently infectedo Serological – whether someone is currently or previously has been

infected; sometimes determines immunity

o To date, most tests in Arkansas have been molecularo FDA has allowed development and use of unapproved testso State health department recently relaxed testing criteriao Capacity has expanded, but remains inadequate to determine

how many infectedSource: ACHI, COVID-19 Testing: Testing Types, Recent Developments, and Policy Considerations, https://achi.net/wp-content/uploads/2020/04/200420C_COVID-Testing.pdf

COVID-19 TESTING IN ARKANSAS

VACCINE DEVELOPMENT: TRADITIONAL VS. PANDEMICTraditional ParadigmMultiple Years

Small-scale clinicaltrial material

Manufacturing scale-upcommercial scale, validation of process

Large-scaleManuf.

Target ID, dev. partner selection, and preclinicaltrial

Phase1

Phase2

Phase3 Licensure

Go/no-go decision to invest in candidate First trial in humans

Efficacy trial in humans

Evaluation trial in humans

Outbreak ParadigmOverlapping PhasesShorten DevelopmentTime

Target ID, dev. partner selection, etc

Go/no-go decision

First in humans (safety) Efficacy Regulatory path for emergency auth.

Clinical development

Safety/dose sel. Safety/eff.

Manufacturing dev., scale-up,clinical trial material, commercial scale, validation of process

Large-scale manufacturing

Access: Geographic spread of manufacturing and development sites and pursuit of emergency authorization before licensure.

Source: Developing Covid-19 Vaccines at Pandemic Speed, Nicole Lurie, M.D., M.S.P.H., Melanie Saville, M.D., Richard Hatchett, M.D., and Jane Halton, A.O., P.S.M., New England Journal of Medicine, March 30, 2020

WHITE HOUSE GUIDELINES FOR REOPENING U.S.

o 3-phases for lifting restrictions on individuals and employerso Based on up-to-date data, readinesso Mitigates risk of resurgenceo Protects most vulnerableo Implementable at states' discretion

o Basic ‘gating’ criteria for states to satisfy before proceeding to phased approach

Source: “Guidelines for Opening Up America Again,” https://www.whitehouse.gov/openingamerica/

THREE CATEGORIES OF GATING CRITERIA TO SATISFYo Symptoms (within 14-day period):

o Downward trajectory of flu-like illnesses ANDo Downward trajectory of COVID-like syndromic cases

o Cases (within 14-day period):o Downward trajectory of documented coronavirus cases ORo Downward trajectory of positive tests as percentage of total tests

o Hospitals:o Capacity to treat all patients without crisis care ANDo Robust testing for at-risk healthcare workers, including antibody testing

Source: “Guidelines for Opening Up America Again,” https://www.whitehouse.gov/openingamerica/

COVID-19 RESPONSE: ARKANSAS GOVERNOR ESTABLISHES THREE EXPERT ADVISORY GROUPSo Medical Advisory Committee for Post-Peak COVID-19

Response, Apr. 13o Make recommendations necessary to avoid resurgence

o Economic Recovery Task Force, Apr. 18o Deliver strategy and advice for economic recovery

o COVID-19 Testing Working Group, Apr. 21o Make recommendations to expand testing capacity and performance

Source: Arkansas Governor Asa Hutchinson, https://governor.arkansas.gov/news-media/press-releases/

ARKANSAS DECISION POINTS FOR REOPENINGo Gov. Hutchinson has set a May 4 target to lift restrictions

o The following announcements will determine whether a May 4 opening will be allowed:o April 22: Decision made to lift certain restrictions on elective surgerieso April 29: Decision on restaurantso April 30: Decision on gymso May 1: Decision on barber and beauty salonso May 4: Decision on places of worship and larger venues

Source: Gov. Asa Hutchinson, COVID-19 press update, April 22, 2020.

NIH TREATMENT GUIDELINES FOR COVID-19o No recommended agents for pre-exposure, post-exposure, or

treatments of COVID-19o No drug proven to be save and effective for treating COVID-19o Therapeutic categories in clinical trials under investigation

o Antivirals – may directly target viruso Host modifiers, immune-based therapies – may affect immune response

or target viruso Addresses best practices for patients at different stages

o Self-isolating outpatients – asymptomatic or mild to moderate symptomso Inpatients – with severe illness or critical disease

Source: National Institutes of Health, https://www.nih.gov/news-events/news-releases/expert-us-panel-develops-nih-treatment-guidelines-covid-19

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