NOVEL CORONAVIRUS (COVID-19) - Update Randall Culpepper, MD, MPH Frederick County Deputy Health Officer March 18, 2021 - Frederick ...

NOVEL CORONAVIRUS (COVID-19)
          Update
         Randall Culpepper, MD, MPH
    Frederick County Deputy Health Officer
               March 18, 2021

Worldwide: COVID-19 (03/18/21)

         https://covid19.who.int/ accessed March 18, 2021

Global COVID-19 Update (March 11, 2021)
CASES                         DEATHS
• Global: 118,169,684         • Global: 2,622,375
• US: 29,255,279              • United States: 529,269
• India: 11,285,561           • Brazil: 270,656
• Brazil: 11,202,305          • Mexico: 192,491
• Russia: 4,311,892
• United Kingdom: 4,247,879
• France: 4,023,186

World – Case Counts, Highest Burden Countries

COVID Daily Cases by WHO Region

United States COVID-19 Cases and Deaths (March 17, 2021)

United States COVID-19 Cases (March 17, 2021)

United States COVID-19 Deaths (March 17, 2021)

United States COVID-19 Case Rate per 100K Last 7 Days (March 17, 2021)

7-day Moving Average New Cases (DC, MD, VA, PA, WV) (March 11, 2021)

Maryland Daily Trends in Number of COVID-19 Deaths (March 17, 2021)

Current Trends in Maryland (March 17, 2021)

Cases                                Deaths

                       Note: different scales on graphs.
                                                           https://coronavirus.maryland.gov/

Maryland – Current ICU and Acute Hospital Beds for COVID-19
(March 17, 2021)

Maryland – Current Hospitalizations (March 17, 2021)

• COVID Census: 805 (up 27 from last week)
• Med/Surg: 579 (no change from last week)
• ICU: 226 (up 17 from last week)
• Total Census (COVID + Non-COVID): 7,092 (up 73 from last
  week)
• New Hospitalizations last 24 hours: 98 (up 18 from last week)
• Cumulative Hospitalizations: 36,406 (up 482 from last week;
  up 772 the previous week)

Maryland Highlights - Outbreaks (March 3, 2021)

• Active Outbreaks: 349 (down 14 from last week)
• Cases Associated with All Active Outbreaks: 14,441 (down
  1,114 from last week; was down 2,381 the previous week)

Frederick County (March 17, 2021)

Frederick County (March 17, 2021)

Frederick County COVID-19 Deaths by Week (March 17, 2021)

US COVID-19 Cases Caused by Variants (March 17, 2021)

Emerging U.K. Variant Cases in the United States (March 17, 2021)
50 states (+1), 4,686 cases (+1,403)
                                209 cases in MD (+42, +78 week before)

Emerging S. African Variant Cases in the United States (March 17, 2021)
25 states (+4), 142 cases (+51, +26 week before)
                                 22 cases in MD (+5)

Emerging Brazilian Variant Cases in the United States (March 17, 2021)
12 states (+3), 27 cases (+12, +5 week before)
                                1 case in MD (+0)

COVID Variants of Interest B.1.427/B.1.429 (preliminary)

• Emerged around May 2020 in CA, increased from 0% to >50%
  of sequenced cases from Sept. 1, 2020 to Jan. 29, 2021
• 18.6-24% increase in transmissibility
• 2-fold increased viral shedding in vivo
• Antibody neutralization assays showed decreases in
  neutralizing titers
   o 4.0 to 6.7-fold decrease among convalescent patients
   o 2.0-fold decrease among vaccine recipients

COVID Variants of Interest B.1.526 (preliminary)

• Emerged in New York, with a steady increase in the detection
  rate from late December to mid-February
• Patients with this novel variant came from diverse
  neighborhoods in the metropolitan NYC area, and they were
  on average older and more frequently hospitalized.
• Unique set of spike mutations may pose an antigenic
  challenge for current interventions

Governor’s Update – effective March 12, 2021

• Capacity limits lifted on outdoor and indoor dining at
  restaurants and bars, retail businesses, religious facilities,
  fitness centers, casinos, personal services, and indoor
  recreational establishments.
• Large outdoor and indoor venues may begin operating at 50%
  capacity.
• Medical adult day care centers may reopen.
• Quarantine requirements and other restrictions on out-of-
  state travel lifted.

Definitions
•   Fully vaccinated refers to a person who is:
     o ≥2 weeks following receipt of the second dose in a 2-dose series, or
     o ≥2 weeks following receipt of one dose of a single-dose vaccine
     o No longer has a time limit of 3 months

•   Healthcare settings refers to places where healthcare is delivered and includes,
    but is not limited to
     o Acute care facilities, long term acute care facilities, inpatient rehabilitation
         facilities, nursing homes, assisted living facilities
     o Home healthcare
     o Vehicles where healthcare is delivered (e.g., mobile clinics)
     o Outpatient facilities, such as dialysis centers, physician offices, and others.

Fully Vaccinated HCP Quarantine Guidance (March 10, 2021)

•   “Fully vaccinated HCP” with higher-risk exposures who are asymptomatic do
    not need to be restricted from work for 14 days following their exposure.
•   Work restrictions for the following fully vaccinated HCP populations with
    higher-risk exposures should still be considered for:
     o HCP with underlying immunocompromising conditions (e.g., organ
         transplantation, cancer treatment), which might impact level of protection
         provided by the COVID-19 vaccine.
     o Data on which immunocompromising conditions might affect response to
         the COVID-19 vaccine and the magnitude of risk are not available.
•   “Fully vaccinated HCP” who have traveled should continue to follow CDC travel
    recommendations and requirements, including restriction from work, when
    recommended for any traveler.

Fully vaccinated inpatients and residents in healthcare settings

• Should continue to quarantine following prolonged close contact with a
  COVID case; outpatients should be cared for using recommended
  Transmission-Based Precautions.
   o Recommendation based on (1) limited information about vaccine
      effectiveness in this population, (2) the higher risk of severe disease
      and death, and (3) challenges with physical distancing in healthcare
      settings
• Quarantine is no longer recommended for fully vaccinated residents who
  are being admitted to a post-acute care facility if they have not had
  prolonged close contact with a COVID case in the prior 14 days.***
• *** Note that the MDH guidance still requires 14 days of quarantine for
  new admissions.

CDC Recommendations for Fully Vaccinated People

• Fully vaccinated residents of non-healthcare congregate settings
  (e.g. correctional and detention facilities, group homes)
   o Quarantine for 14 days and be tested for SARS-CoV-2 following
      an exposure
• Fully vaccinated employees of non-healthcare congregate settings
  and other high-density workplaces (e.g. meat and poultry
  processing and manufacturing plants), with no COVID symptoms:
   o No need to quarantine following exposure
   o Testing following an exposure and through routine workplace
      screening programs (if present) is recommended

Daily Vaccine Doses, United States (March 17, 2020)

Maryland Vaccination Dashboard (March 18, 2021)

Maryland Vaccinations Statewide by Age

Governor Hogan Announcement

• WESTERN MARYLAND MASS VACCINATION SITE
  o Mass vaccination site in Hagerstown will open one week
    early on Thursday, March 25.
  o Gives the state at least one mass vaccination site in each
    region.
  o State in active discussions with jurisdictions that have
    expressed an interest in hosting a mass vaccination site

Ebola Virus Outbreak
■ EVD outbreaks still centered in remote areas of the
  Democratic Republic of the Congo (DRC) and Guinea
■ DRC (North Kivu Province)
   – Borders Uganda, Rwanda, Burundi
   – 12 EVD cases identified, including 5 deaths (1
      new in the past week)
■ Guinea (Nzérékoré Prefecture)
   – Borders Liberia and Côte d'Ivoire
   – 18 EVD cases identified, including 9 deaths (0
      new in the past week)
■ Both countries aggressively pursuing contact tracing
  and vaccination of high risk individuals and contacts

Ebola Virus Disease (EVD) Risk Levels

• Low Risk – Present in country but not in EVD outbreak area
• Moderate Risk – Present in EVD outbreak area
• High Risk – Has a risk factor for EVD
   o Percutaneous/mucous/skin contact with blood/bodily fluids
   o Direct contact with person
   o Direct contact with dead body
   o Living in the same household
   o Providing healthcare w/o PPE (or breach in infection control
      precautions)

Ebola Outbreaks – U.S. Response

• Risk of Ebola to the U.S. remains extremely low
• Travelers from DRC and Guinea funneled to 6 U.S. airports
   o Dulles, JFK, LA, Atlanta, Newark, Chicago
• Average 50-60 daily travelers from Guinea or the DRC to U.S.
• CDC sending state-specific passenger information to state
  health departments for public health follow-up and
  monitoring

Ebola Post-Arrival Management

Thank you!