NOVEL CORONAVIRUS (COVID-19) - FCHD Providers-Partners Update Randall Culpepper, MD, MPH Frederick County Deputy Health Officer August 26, 2021 ...
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NOVEL CORONAVIRUS (COVID-19)
FCHD Providers-Partners Update
Randall Culpepper, MD, MPH
Frederick County Deputy Health Officer
August 26, 2021
Worldwide COVID Cases and Deaths (weekly) August 26, 2021)
https://covid19.who.int/ accessed August 26, 2021
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
1-Aug 7,000,000
8-Aug
15-Aug
22-Aug
29-Aug
5-Sep
12-Sep
19-Sep
26-Sep
3-Oct
10-Oct
17-Oct
24-Oct
31-Oct
7-Nov
14-Nov
21-Nov
28-Nov
5-Dec
12-Dec
19-Dec
26-Dec
2-Jan
9-Jan
16-Jan
23-Jan
30-Jan
6-Feb
7 day ∆
13-Feb
20-Feb
27-Feb
6-Mar
13-Mar
20-Mar
27-Mar
3-Apr
10-Apr
17-Apr
24-Apr
1-May
8-May
15-May
22-May
29-May
5-Jun
12-Jun
19-Jun
26-Jun
3-Jul
10-Jul
17-Jul
24-Jul
31-Jul
Global 7-Day Rolling Average Cases (August 25, 2021)
7-Aug
14-Aug
21-Aug
4,508,886 last week
4,557,699 cases/week
Global 7-Day Rolling Average Deaths (August 25, 2021)
7 day ∆
120,000
69,705 deaths/week
100,000
68,883 last week
68,324 2 weeks ago
80,000
60,000
40,000
20,000
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-Jul 1-Aug
United States COVID-19 Cases and Deaths (Aug 19 and Aug 26, 2021) Last week This week
U.S. 7-Day Rolling Average Cases (August 25, 2021)
7 day ∆
2,000,000
1,800,000
1,600,000
1,053,061 cases/week
1,400,000
991,829 last week
798,806 two weeks ago
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-Jul 1-Aug
U.S. 7-Day Rolling Average Deaths (August 25, 2021)
7 day ∆
25,000
20,000
7,795 deaths/week
5,907 last week
15,000 3,234 two weeks ago
10,000
5,000
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-Jul 1-Aug
U.S. COVID-19 Case Rate per 100K Last 7 Days (August 26, 2021)
Maryland is 102 cases/100K
Maryland Daily Trends in Number of COVID-19 Deaths (Aug 19 & Aug 26, 2021) Last week This week
Maryland 7-Day Rolling Average Cases (August 25, 2021)
7 day ∆
25,000
7,349 cases/week
20,000
6,524 last week
5,465 two weeks ago
15,000
10,000
5,000
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-Jul 1-AugMaryland Cases 10-year Age Breakdown (Aug 18 & Aug 26, 2021)
Last week This weekMaryland 7-Day Rolling Average Deaths (August 25, 2021)
7 day ∆
400
350
300
59 deaths/week
250
43 last week
200 29 two weeks ago
150
100
50
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-Jul 1-AugMaryland : COVID Vaccinations (August 26, 2021)
Maryland – ICU and Acute Hospital Beds for COVID-19 (August 26, 2021)
Frederick County (August 26, 2021)
Frederick County residents fully vaccinated
% population >= 12 years % population >= 18 years % population >= 65 years
73% 75% 90%Frederick County 7-Day Rolling Average Cases (August 25, 2021)
7 day ∆
1,600
1,400
1,200
1,000
800
413 cases/week
355 last week
600 263 two week ago
400
200
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-Jul 1-AugFrederick County Cumulative Deaths (August 25, 2021)
FC Deaths
400
350
300
250
17 deaths last 100 days
200
150
100
50
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-Jul 1-AugJuly 21-27 August 19–25
FHH All ICU Acute FHH All ICU Acute
Frederick Health Hospital 3 0 3 20 5 15
3 0 3 25 5 20
Bed Census 1 0 1 20 4 16
2 0 2 27 4 23
2 0 2 30 7 23
COVID-19 Patients in Acute Beds COVID-19 Patients in ICU Beds 2 0 2 30 7 23
3 0 3 31 7 24
70
60
# of Patients with COVID-19
50
40
30
20
10
0Clinical Updates
FDA approved and licensed Pfizer COVID Vaccine (Comirnaty)
• Comirnaty = COVID + mRNA + immunity/community
• FDA approved (licensed) August 23, 2021, for 16 years or older
• Providers must adhere to CDC COVID19 Vaccination Program Provider
Agreement.
• Providers must administer COVID-19 vaccines per all program
requirements and recommendations of the CDC, ACIP, and FDA
• Applies to both EUA and FDA approved COVID-19 vaccines
o Two FDA “authorized” COVID mRNA vaccines under Emergency Use
■ Pfizer-BioNTech COVID-19 and Moderna
o One FDA fully “approved” COVID mRNA vaccine “Comirnaty”FDA approved and licensed Pfizer COVID Vaccine (Comirnaty) • May still be used under the EUA to prevent COVID-19 in individuals aged 12 through 15 years • May still be used for administration of a third additional dose in certain immunocompromised individuals • Booster doses available for all U.S. adults next month • Recommend providers reach out to remaining unvaccinated patients, address lingering hesitancy issues, and recommend vaccination
“Off-label use” of COVID Vaccines • Not recommended! • Includes giving booster doses now or vaccinating under 12 years of age • Providers may not have immunity from injury claims because may not be covered under the PREP Act or the PREP Act declaration • Individuals receiving off-label dose may be ineligible for compensation under Countermeasures Injury Compensation Program after a possible AE • Providers would be in violation of CDC’s COVID-19 Vaccination Program Provider Agreement potentially impacting ability to remain in CDC program • Vaccine administration fees may not be reimbursable by payers
Three metrics to mark the end of the epidemic • Vaccination rates o 75-85% o All zip codes, not just some zip codes • Disease rates o Circulating variant (disease severity, risk of hospitalization, death) o Vaccine coverage o Vaccine efficacy • Testing rates o Case investigation o Contact tracing
Forecast Modeling – does it help? Maryland COVID Forecast
Will the Coronavirus be here forever - how do we live with it? ■ Can’t avoid SARS-COV-2 forever ■ Can minimize impact ■ Pandemic will end…..one way or another! ■ Recent surges are novel coronaviruses meeting naive immune systems ■ Maximize immunity through vaccination or infection and virus will be “endemic” ■ Virus won’t be eliminated, but won’t upend our lives anymore.
The Coronavirus will be here forever - how do we live with it? • Boosters needed to periodically re-up immunity too. • Cases may rise and fall, maybe seasonally, but worst outcomes avoided. • How did the four common-cold coronaviruses first came to infect humans? • We’ll have to adjust our thinking about COVID-19 too.
The Coronavirus will be here forever - how do we live
with it?
■ “This is something we’re going to have to
live with and so long as it’s not impacting
health care as a whole, then I think we
can.”
■ Coronavirus will no longer be novel—to our
immune systems or society
■ Endemicity seems quite clear, but how we
get there less so.
Dr. Richard Webby
Infectious-disease researcher
St. Jude Children’s Research HospitalNone of this was inevitable ■ Historically unprecedented change and disruption after 100 years ■ Change so enormous and pervasive that we’ve altered the world’s economic balance (e.g., unemployment, recessions, tourism) ■ Timing and shape of change depended on those who challenged the constraints ■ Responders celebrated here and the faraway scientists and engineers building ever more reliable tools (tests, vaccines, IT) ■ Worked against conventional wisdom about what was possible
Unrelenting demands of continuous operation
■ Challenge of continual daily operations 10-16 hours
for months and years requires very different
approaches than the short term response to most
emergencies
■ Not about the risk of deploying on weekends, it’s
about the reality that people never operate at a
truly steady state
■ Providing care to others 24/7 leads to mental stress
– Irritation, anger, denial, uncertainty,
nervousness
– Anxiousness, helplessness or powerlessness
– Lacking motivation, tired, overwhelmed,
burned out
– Sad, depressed, trouble sleeping, trouble
concentratingCOVID Variant Strains
WHO: Variants of Concern Labels
WHO: Variants of Interest Labels
SARS-CoV-2 Variants
Variants of Interest Variants of Concern
• Eta - B.1.525 (New York) (E484K) • Alpha - B.1.1.7 (United Kingdom) (some E484K)
• Iota - B.1.526 (New York) (some E484K) • Beta - B.1.351 (South Africa) (E484K)
– Includes B.1.351.2, B.1.351.3
• Iota - B.1.526.1 (New York) (L452R)
• Gamma - P.1 (Brazil) (E484K)
• Epsilon- B.1.427 (California) (L452R) – Includes P.1.1, P.1.2
• Epsilon - B.1.429 (California) (L452R) • Delta - B.1.617.2 (India) (E484Q and L452R)
• Zeta - P.2 (Brazil) – Includes Delta Plus AY1, AY2, AY3
• Kappa - B.1.617.1 (India)
L452R or E484K substitutions in the spike protein impact
• Lambda - B1.1.1.37 (Peru) susceptibility to EUA monoclonal antibody treatments.COVID Vaccine News
FCHD COVID Vaccine Clinics
Frederick County Health Department
Oak Street Vaccination Clinic
• Schedule appointments
■ http://FrederickCountyMD.gov/CovidVaccine
■ Call 301-600-7900
■ Walk-in, no appointments available
• 1st dose clinic schedule
■ Every Wednesday 4 pm – 7 pm
■ Every Thursday 4 pm – 7 pm
■ Every Friday 10 am – 1 pm
■ Every Saturday 10 am – 1 pmThank you!
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