NOVEL CORONAVIRUS (COVID-19) - Provider and Partner Medical Update Randall Culpepper, MD, MPH
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
NOVEL CORONAVIRUS (COVID-19)
Provider and Partner Medical Update
Randall Culpepper, MD, MPH
Frederick County Deputy Health Officer
March 31, 2022
786 days Jan. 28, 2020 – Mar. 24, 2022
COVID Update Schedule Changes • Beginning April, will move updates to first Thursdays of each month o April 7 o May 5 o June 2 o July 7 o August 4 • In case of significant changes, we will send out notice for ad hoc update briefing
Agenda
■ Epidemiology ■ COVID-19 Updates
– Globally – Treatment
– United States – Isolation and
– Maryland Quarantine
– Frederick County – Variant Strains
– Vaccines
– Masks
■ Influenza Update
– Testing
Worldwide COVID Weekly Cases and Deaths (Mar 30, 2022)
https://covid19.who.int/ accessed Mar 30, 2022
Global 7-Day Rolling Average Cases (Mar 30, 2022)
Global 7 day ∆
30,000,000 11.1M cases/week
12.3M last week
25,000,000
20,000,000
15,000,000
10,000,000
5,000,000
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 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar
Global 7-Day Rolling Average Deaths (Mar 30, 2022)
7 day ∆
120,000
100,000
34.1K deaths/week
47.0K last week
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 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar
United States COVID-19 Cases and Deaths (Mar 23 and Mar 30, 2022)
Last week Substantial community transmission
Substantial community transmission
This week
U.S. 7-Day Rolling Average Cases (Mar 30, 2022)
7,000,000
U.S. 7 day ∆
206K cases/week
203K last week
6,000,000
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
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 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar
US COVID-19 7-Day Rolling Average Case Rate per 100K (Mar 30, 2022)
Maryland Case rate = 5.1 (4.8 last week)U.S. 7-Day Rolling Average Deaths (Mar 30, 2022)
25,000
7 day ∆
4.1K deaths/wee
5.3K last week
20,000
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-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-MarMaryland Daily Trends in Number of COVID-19 Deaths (Mar 23 and Mar 30) Last week This week
Maryland 7-Day Rolling Average Cases (Mar 30, 2022)
120,000
MD Cases 7 day ∆
2.2K cases/week
1.9K last week
100,000
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 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-MarMaryland 7-Day Rolling Average Cases (Mar 30, 2022)
Chart Title
18,000
2.2K cases/week
16,000
1.9K last week
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0Maryland 7-Day Rolling Average Deaths (Mar 30, 2022)
500
MD Deaths 7 day ∆
32 deaths/week
450
34 last week
400
350
300
250
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-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-MarMaryland 7-Day Rolling Average Deaths (Mar 30, 2022)
Chart Title
350 32 deaths/week
34 last week
300
250
200
150
100
50
0
1-Feb 3-Feb 5-Feb 7-Feb 9-Feb 11- 13- 15- 17- 19- 21- 23- 25- 27- 1-Mar 3-Mar 5-Mar 7-Mar 9-Mar 11- 13- 15- 17- 19- 21- 23- 25- 27- 29-
Feb Feb Feb Feb Feb Feb Feb Feb Feb Mar Mar Mar Mar Mar Mar Mar Mar Mar MarLast week
Maryland COVID cases – 10-year age breakdowns (Mar 30, 2022)
Maryland COVID-19 Outbreaks Summary (Mar 29, 2022)
Case Rates by County
Maryland COVID Vaccinations (Mar 23 and 30, 2022) Last week This week
Maryland Summary (Mar 30, 2022) • LOW Community Level (per new CDC definition) • MODERATE Community Transmission Level • Fatalities: slowly improving, 32 last 7 days but dropped from week before (34 deaths previous 7 days) • Variants: almost all specimens sequenced are Omicron (BA.1) or sublineages including BA.2 (BA.2 increasing percentage) • Outbreaks (03/29/22): still high but decreasing (149 total, 169 last week); o School outbreaks INCREASED last week (43 total; 41 last week) o Nursing homes DECREASED this week (34 total, 39 last week) • COVID hospitalizations: decreasing o 153 total COVID inpatients (179 last week; 2904 all time high)
Frederick County (Mar 30, 2022) MODERATE TRANSMISSION!!!
Case rate/100K = 5.8 (5.2)
5-11 year olds ~ 45.4 % Fully Vaccinated (#4 in MD) Frederick County residents fully
12-17 year olds 77.2 % Fully Vaccinated (#5 in MD) vaccinated (Mar 30, 2022)
% population >= 12 years
85.0% (#4 in MD)
% population >= 18 years
85.8% (#3 in MD)
% population >= 65 years
95.0% (tied for #1 in MD)Frederick County 7-Day Rolling Average Cases (Mar 30, 2022)
6,000
FC Cases 7 day ∆
106 cases/week
95 (last week)
5,000
74 (2 weeks ago)
4,000
3,000
2,000
1,000
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 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar0
100
200
300
400
500
600
700
800
900
1-Feb
2-Feb
3-Feb
4-Feb
5-Feb
6-Feb
7-Feb
8-Feb
9-Feb
10-Feb
11-Feb
12-Feb
13-Feb
14-Feb
15-Feb
16-Feb
17-Feb
18-Feb
19-Feb
20-Feb
21-Feb
22-Feb
23-Feb
24-Feb
25-Feb
26-Feb
27-Feb
28-Feb
1-Mar
2-Mar
Chart Title
3-Mar
4-Mar
5-Mar
6-Mar
7-Mar
8-Mar
9-Mar
10-Mar
11-Mar
12-Mar
13-Mar
14-Mar
15-Mar
16-Mar
17-Mar
18-Mar
19-Mar
20-Mar
21-Mar
22-Mar
23-Mar
24-Mar
25-Mar
26-Mar
27-Mar
28-Mar
Frederick County 7-Day Rolling Average Cases (Mar 30, 2022)
29-Mar
30-Mar
95 (last week)
106 cases/week
74 (2 weeks ago)Frederick County Weekly COVID Deaths (Mar 30, 2022)
FC Deaths 7 day ∆
30 • June: 4
• July: 3
25 • Aug: 6
• Sept: 15
20
• Oct: 11
• Nov: 16
15
• Dec: 24
• Jan: 63
10
• Feb: 24
• Mar: 14
5
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 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-MarJuly 21 - 27 Mar 23 - 29
FHH All ICU Acute 15
FHH All ICU Acute
Frederick Health Hospital 3 0 3 7 0 7
Acute and ICU Bed Stats 3
1
0
0
3
1
7
4
0
0
7
4
2 0 2 3 0 3
2 0 2 4 1 3
2 0 2 6 1 5
COVID-19 Patients in Acute Beds COVID-19 Patients in ICU Beds 3 0 3 4 0 4
120
100
# of Patients with COVID-19
80
60
40
20
0Frederick Health Daily COVID 19 Update (Mar 30, 2022, 2:15 pm)
https://www.frederickhealth.org/patients-visitors/covid-19-information/FCPS COVID Cases (2021-2022) - students and staff (Mar 30, 2022)
Frederick County COVID-19 Community Transmission Level (March 30, 2022) - MODERATE Cases (7 day rolling average) 106 Case rate per 100K Moderate Community Transmission 5.8 % Positivity Low Community Transmission 3.1% Deaths last 7 days 3 % of population > 5 years of age fully vaccinated 81% New COVID-19 admissions per 100,000 population 2 % staffed inpatient beds with COVID-19 patients 2.7%
Influenza Update
Maryland Influenza – Laboratories Test % Positive (Mar 19, 2022)
Maryland Influenza-Associated Hospitalizations by Season (Mar 19, 2022)
Maryland Influenza - Clinical Laboratories % Positive
(week ending March 19, 2022)
Overall 2021-2022 Influenza Season
■ Overall respiratory illness activity = MINIMAL
■ 15 influenza-associated hospitalizations this week
■ 9 total influenza-associated adult deaths 2021-
2022 influenza season (1 this reporting week)
■ NO influenza-associated pediatric deaths this
2021-2022 influenza season • Influenza activity increasing in most of the country, esp. central & south-central • # of hospital admissions reported has increased for the past seven weeks • Zero pediatric deaths reported this reporting week; 13 total pediatric deaths this season
COVID-19 Clinical Updates
COVID-19 Treatment Updates
COVID-19 Treatment Options
Use Name Description Procurement and Allocation
Sotrovimab IV infusion or IV injection for treatment of symptomatic
Monoclonal Antibodies for Federal Government procures
infection. Monoclonal antibodies are susceptible to losing
Treatment Betelovimab potency as the COVID-19 spike protein mutates.
and allocates product.
Pre-exposure prophylaxis (PrEP) is used in non-exposed,
Long-Acting Monoclonal Antibody COVID negative patients with moderate to severe immune Federal Government procures
for Pre-Exposure Prophylaxis Evusheld deficiencies and/or the patients with severe documented and allocates product.
allergy to all vaccines.
Post-exposure prophylaxis (PEP) in exposed
Bamlanivimab and Estevimab
Monoclonal Antibodies for Post- unvaccinated individuals, treatment in symptomatic cases.
Bamlanivimab (alone) –
Exposure Prophylaxis Regen-COV
As of January 2022, neither product is used due to lack of
effectiveness against Omicron.
Paxlovid Oral medication courses used in symptomatic individuals Federal Government procures
Oral Antivirals
Molnupiravir at high risk of developing severe COVID-19. and allocates product.
Commercially available via
Infusion Antivirals Remdesivir Antiviral therapy given via IV infusion.
Amerisource Bergen.Monitoring Variant Proportions, United States (Mar 19, 2022)
Sotrovimab and Omicron sublineage BA.2
• FDA limits use of Sotrovimab to treat COVID-19 in U.S. regions due to the BA.2 Omicron sub-variant
• Due to high frequency of Omicron BA.2 sub-variant and data showing that sotrovimab unlikely to be
effective against that sub-variant.
• Sotrovimab is not authorized at this time in the following states and territories:
o Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont (Region 1) (as of
3/25/2022)
o New Jersey, New York, Puerto Rico, and the Virgin Islands (Region 2) (as of 3/25/2022)
o Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin (Region 5) (as of 3/30/2022)
o Arizona, California, Hawaii, Nevada, American Samoa, Commonwealth of the Northern Mariana
Islands, Federated States of Micronesia, Guam, Marshall Islands, and Republic of Palau (Region 9) (as
of 3/30/2022)
o Alaska, Idaho, Oregon, and Washington (Region 10) (as of 3/30/2022)
• Paxlovid, Veklury (remdesivir), bebtelovimab, and Lagevrio (molnupiravir) expected to be effective against
the BA.2 sub-variant and authorized or approved to treat certain patients with mild-to-moderate COVID-
19 who are at high risk for progression to severe disease, including hospitalization or deathCOVID-19 Isolation and
Quarantine Guidance
12am - 7pm (Mon-Fri),CDC Isolation & Quarantine Update ■ CDC Guidance has updated ■ MDH adopted CDC guidance ■ If following CDC guidance, very important to follow whole guidance for days 6-10: “avoid eating around others at home and at work until a full 10 days after your first day of symptoms.”
CDC Vaccination Criteria Terminology
• Fully Vaccinated:
o Have received all doses in the primary vaccination series (2
doses of Pfizer or Moderna; 1 dose of J&J)
• Up To Date:
o Have received all vaccination doses for which someone is
eligible, including boosters.
• Asymptomatic Exposures do not have to quarantine only if
they are UP TO DATE!ISOLATION - Public Nothing new this week
Infected Everyone stays home for ≥ 5 days Ending isolation (Sx based) Take precautions until day 10
Had symptoms
end after 5 full days if:
* fever-free for 24 hours (without
the use of fever-reducing
medication), and
Wear a mask
* Sxs are improving
Wear a well-fitted mask for 10 full days
any time you are around others inside
Had symptoms or tested
your home or in public. Do not go to
positive
Isolate from others in your home. places where you are unable to wear a
Did not have symptoms
mask (restaurants, gyms, eating at work
Regardless of vaccination end after 5 full days after date of
Wear a well-fitted mask if you must be or home).
status positive test
around others in your home.
Avoid travel
If you were severely ill with
Avoid being around people who are at
COVID-19:
high risk
Isolate for at least 10 days.
Consult your doctor before endingQUARANTINE - Public
Nothing new this week
Watch for symptoms
Vaccination status Quarantine duration (Vax based) Take precautions until day 10
until day 10
Stay home at least 5 full days.
NOT up-to-date
Mask - wear a well-fitted mask Wear a mask
whenever around others at home. Wear a well-fitted mask for 10 full days
Watch for symptoms until 10 days any time you are around others inside
after you last had close contact your home or in public. If you are unable
Get tested >= 5 days if possible after with someone with COVID-19. to wear a mask when around others, you
last close contact even if you don’t should continue to quarantine for 10
develop symptoms days.
NO Quarantine…… If you develop symptoms, Do not go to places where you are
YES up-to-date unless you develop symptoms! isolate immediately and get unable to wear a mask (restaurants,
tested on days 1 and 3 (if day 1 gyms, eating at work or home).
Get tested >= 5 days if possible after test negative). Continue to stay
last close contact even if you don’t home until you know the results.
develop symptoms Avoid travel
Avoid being around people who are at
NO Quarantine……. high risk
Confirmed COVID-19 within unless you develop symptoms!
past 90 days
No testing requiredNothing new this week CDC work restrictions for HCP with SARS infection and exposures In general, asymptomatic HCP who have recovered from SARS-CoV-2 infection in the prior 90 days do not require work restriction following a higher-risk exposure (January 21, 2022)
COVID-19 Variant Strains
Omicron family of SARS-CoV-2 variants
SARS-CoV-2 Interagency Group (SIG) Variant classification Variant Being Monitored (VBM) Variant of Interest (VOI) - none ■ Alpha (B.1.1.7 and Q lineages) ■ Beta (B.1.351 and descendent lineages) Variant of Concern (VOC) ■ Gamma (P.1 and descendent lineages) ■ Delta (B.1.617.2 and AY lineages) ■ Epsilon (B.1.427 and B.1.429) ■ Omicron (B.1.1.529) ■ Eta (B.1.525) ■ Iota (B.1.526) Variant of High Consequence (VOHC) - none ■ Kappa (B.1.617.1) ■ 1.617.3 (no name designation) ■ Mu (B.1.621, B.1.621.1) ■ Zeta (P.2)
Monitoring Variant Proportions, United States (Mar 20, 2022)
(40% 55%)U.S. BA.2 seven-day rolling average
Monitoring Variant Proportions, United States (Mar 19, 2022)
Maryland BA.2 seven-day rolling average
WHO SARS-CoV-2 Variant classification
WHO SARS-CoV-2 Variant classification
COVID-19 Vaccine Updates
COVID-19 Vaccine Update – 2nd Boosters
• FDA and CDC looked to Israel who authorized a fourth dose to people 60 and older at least 4 months
after their last shot during the omicron surge
• Preliminary data suggested some benefit
o Israeli researchers counted 92 deaths among more than 328,000 people who got the extra shot,
compared to 232 deaths among 234,000 people who skipped the fourth dose.
o Not clear how long any extra benefit from another booster would last, and thus when to get it.
o Ideally time booster doses right before surges but don’t always know when that’s going to be
o Longer intervals between doses helps immune system mount stronger, cross-reactive defense.
o Getting booster too close together not doing any harm, but may not get much benefit
• FDA advisory panel meeting next week to discuss if everyone eventually needs a fourth dose,
possibly in the fall
• Early data from current studies of omicron-targeted shots alone or in combination with the original
vaccine see no significant advantage to using a booster that targets just Omicron.COVID-19 vaccination schedule for people who are not
moderately or severely immunocompromised
Interval
Primary series Number of Number of Interval between
between 1st
vaccine Age group doses in booster primary series and
and 2nd
manufacturer primary series doses booster dose
primary doses
Pfizer-BioNTech 5–11 years 2 NA 3 weeks NA
Pfizer-BioNTech 12 years and older 2 1† 3-8 weeks ‡ At least 5 months †
Moderna 18 years and older 2 1† 4-8 weeks ‡ At least 5 months †
Janssen 18 years and older 1 1† NA At least 2 months †COVID-19 vaccination schedule for people who are not
moderately or severely immunocompromised
† All people ages 12 years and older should receive 1 booster dose of a COVID-19 vaccine. Some
adults may receive a second booster dose:
o Adults ages 18-49 years: if received J&J COVID-19 Vaccine as both primary and booster
doses may receive an mRNA COVID-19 booster dose >= 4 months after J&J booster dose.
o Adults ages 50 years and older: A second mRNA booster dose could benefit people ages 50
years and older, as they are at increased risk for severe COVID-19, and may receive a second
booster dose >= 4 months after the 1st booster.
‡ An 8-week interval may be optimal for some people ages 12 years and older, especially for males
ages 12 to 39 years.
o Shorter interval (3 weeks for Pfizer-BioNTech; 4 weeks for Moderna) between the first and
second doses remains the recommended interval for people who are moderately to severely
immunocompromised, adults ages 65 years and older; and in situations in which there is
increased concern about COVID-19 community levels or individual’s risk of severe disease.COVID-19 vaccination schedule for people who are
moderately or severely immunocompromised
Number of Number of Interval
Primary Interval between Interval between
Age group primary booster between 1st
vaccination 2nd and 3rd dose 3rd and 4th dose
vaccine doses doses and 2nd dose
Pfizer-BioNTech 5–11 years 3 NA 3 weeks At least 4 weeks NA
Pfizer-BioNTech 12 years and older 3 1* 3 weeks At least 4 weeks At least 3 months *
Moderna 18 years and older 3 1* 4 weeks At least 4 weeks At least 3 months *
1 J&J
Janssen 18 years and older followed by 1 1* 4 weeks At least 2 months NA *
mRNA
* People ages 12 years and older may choose to receive a 2nd booster dose using an mRNA COVID-19 vaccine if it has been
>= 4 months after the 1st booster dose.How can I schedule an appointment to get a COVID vaccine?
• Schedule by calling 1-855-MDGoVax (855-634-6829)
• Pharmacy websites such as CVS, Safeway, Walgreens etc.
• Frederick County webpage vaccination calendar:
• FrederickCountyMD.gov/CovidVaccine
39Frederick County Health Department
• Himes Avenue Vaccination Clinic
• Schedule all COVID vaccine appointments
o FrederickCountyMD.gov/CovidVaccine
o Call 1-855-MDGoVax (855-634-6829)
o Appointments strongly preferred for planning but walk-ins ok
• All mRNA COVID-19 vaccines are available but J&J not in inventory
• Adult and adolescent Vaccine Clinic Schedule
■ Every Wednesday 4 pm – 7 pm
■ Every Saturday 10 am – 1 pmFCHD COVID Vaccine Clinics Mar 30 –Apr 9 1st dose, 2nd dose, additional dose, and boosters at all clinics!
COVID-19 Masks Update
When should people mask in community settings? • When “Community Levels” are “High” • Based on personal preference or personal level of risk • On public transit • In healthcare settings • When people have symptoms • When people have a positive COVID test • When people have exposure to someone with COVID-19 https://www.cdc.gov/coronavirus/2019-ncov/travelers/face-masks-public-transportation.html https://www.cdc.gov/coronavirus/2019-ncov/science/community-levels.html
COVID Testing Update Frederick County
Frederick Health moves primary COVID-19 testing site
indoors at Frederick Health Village – March 28
■ Shifted drive-through to walk-in testing inside
Frederick Health Village
■ Still testing from 7 AM – 3PM, seven days a week.
■ Enter FHV south entrance - staff and signage will
direct where to go and parking is available
■ Masks required inside testing clinic
■ Order is required; if needs an order, contact
240-316-4970 from 0700-1500.
■ Testing since beginning of pandemic; remains
single largest testing location in Frederick
■ Over 223,000 tests for Frederick County residents,
as well as residents from neighboring statesFrederick County Health Department COVID-19 Testing Update
• Closing today, Thursday, March 31, 2022
o Hillcrest/Golden Mile and all community testing clinics
o Testing available throughout the county at pharmacies,
urgent care clinics, health care providers
o https://covidtest.maryland.gov/ for testing optionsCOVID-19 Test to Treat Locator
■ Faster, easier access to life-saving
COVID-19 treatments
■ Help find participating sites
■ Call center also available
– 1-800-232-0233
– TTY 1-888-720-7489
– Help in English, Spanish, and
more than 150 other languages
– 0800 to midnight, 7 days/weekFind COVID-19 guidance for your community ■ One-stop shop website to help all people in the U.S> ■ Improve access to vaccines, tests, treatments, and masks ■ Get latest updates on COVID-19
COVID Update Schedule Changes • Beginning April, will move updates to first Thursdays of each month o April 7 o May 5 o June 2 o July 7 o August 4 • In case of significant changes, we will send out notice for ad hoc update briefing
Thank you!
You can also read
