NOVEL CORONAVIRUS (COVID-19) - Update Randall Culpepper, MD, MPH Frederick County Deputy Health Officer April 15, 2021 - Frederick County Health ...
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NOVEL CORONAVIRUS (COVID-19)
Update
Randall Culpepper, MD, MPH
Frederick County Deputy Health Officer
April 15, 2021
Worldwide: COVID-19 (April 14, 2021)
https://covid19.who.int/ accessed April 14, 2021
Global COVID-19 Update (April 14, 2021) CASES DEATHS • Global: 137,852,958 • Global: 2,965,374 • United States: 31,401,920 • United States: 564,173 • India: 13,873,825 (inc) • Brazil: 358,452 • Brazil: 13,599,994 • Mexico: 210,294 • France: 4,902,948 • India: 172,085 • Russia: 4,554,481 • United Kingdom: 127,407 • United Kingdom: 4,381,823 • Italy: 115,557 • Turkey: 4,025,557 (new) • Italy: 3,700,393
COVID Daily Cases by WHO Region (April 14, 2021)
United States COVID-19 Cases and Deaths (April 14, 2021)
United States COVID-19 Cases (April 14, 2021)
United States COVID-19 Deaths (April 14, 2021)
United States COVID-19 Case Rate per 100K Last 7 Days (April 14, 2021)
US: New COVID-19 Hospital Admissions
Regional 7-day Moving Average New Cases (DC, MD, VA, PA, WV) (April 7 and April 14, 2021)
U.S. COVID-19 Vaccinations Administered Rate per 100,000 (April 14, 2021)
April 7, 2021 April 14, 2021Maryland Daily Trends in Number of COVID-19 Deaths (April 14, 2021)
Maryland - Current Trends (April 14, 2021)
Confirmed cases Deaths (confirmed and probable)
Note: different scales on graphs.
https://coronavirus.maryland.gov/Maryland – Current ICU and Acute Hospital Beds for COVID-19 (April 14, 2021)
Maryland : COVID Vaccinations (April 14, 2021)
Frederick County (April 15, 2021)
Frederick County Test % Positivity and Case Rate (April 15, 2021)
Frederick County COVID-19 Deaths by Week (April 15, 2021)
FCPS COVID Cases in Staff and Students (April 15, 2021)
New Variant Classification Scheme
Variants – Key Points
• CDC-designated “variants of concern” and “variants of interest” now majority
of sequenced SARS-CoV-2 specimens in Maryland
o Increased infectiousness
o Increased severity of illness
o Reduced protection from acquired immunity from vaccination or previous
infection
o Reduced response to treatment
• Exponential growth, primarily driven by B.1.1.7 (“UK Variant”)
• Key points on B.1.1.7:
o Increased transmissibility
o Increased severity of illness
o Current vaccines offer comparable protectionUS COVID-19 Cases Caused by Variants (April 12, 2021) LAST REPORT FROM CDC
Circulating SARS-CoV-2 Variants, United States (Jan 3 – Mar 27)
U.K. B.1.1.7 Variant Global Distribution (April 14, 2021)
South African B.1.351 Variant Global Distribution (April 14, 2021)
Brazil P.1 Variant Global Distribution (April 14, 2021)
U.K. B.1.1.7 strain predominant SARS-COV-2 strain in U.S.
• B.1.1.7 coronavirus strain now most common
lineage of COVID-19 circulating in the U.S. (Dr.
Rochelle Walensky, CDC, April 7)
• CDC predicted this variant would predominate
by March.
• Increased cases among younger populations
(especially youth sports)
• Studies suggest B.1.1.7 is more contagious,
possibly causes more severe disease, and
associated with higher risk of death.Cerebral Venous Sinus Thrombosis (CVST)
• Blood clot forms in the brain’s venous sinuses
• Prevents blood from draining out of the brain
• Blood cells may break and leak blood into the brain
tissues, forming a hemorrhage.
• Chain of events is part of a stroke
• Can occur in adults, children, newborns and neonates
• Less common than most other types of stroke
• Damage brain and central nervous system
• Serious and requires immediate medical attentionJanssen Vaccine and Cerebral Venous Sinus Thrombosis (CVST) • April 12: > 7M doses of Janssen vaccine administered in U.S. • CDC/FDA reviewing data on 6 reported U.S. cases of a rare and severe type of blood clot following Janssen vaccination • Cerebral venous sinus thrombosis (CVST) seen in combination with thrombocytopenia • Women between ages of 18 – 48 • Symptoms occurred 6 - 13 days after vaccination
Janssen Vaccine and Cerebral Venous Sinus Thrombosis (CVST)
Medical Management
• Warning signs and symptoms within 3 weeks post-Janssen vaccination:
o Severe headache
o Blurred vision
o Severe abdominal pain
o Leg pain or swelling
o Backache
o Onset neurologic symptoms (fainting, loss of consciousness, loss of control over
body movement)
o Shortness of breath
o Petechiae (tiny red spots on the skin)
o New or easy bruising
• HCPs should report adverse events to the Vaccine Adverse Event Reporting SystemJanssen Vaccine and Cerebral Venous Sinus Thrombosis (CVST) Medical Management • Different from treatment typically administered • Heparin usually used to treat blood clots • However, heparin may be dangerous and alternative treatments need to be given (as with heparin-induced thrombocytopenia (HIT)) • Avoid heparin in patients with potential vaccine-associated immune thrombotic thrombocytopenia (VITT), unless heparin-induced thrombocytopenia (HIT) testing is negative. • Consider non-heparin anticoagulants and high-dose intravenous immune globulin in patients who present with immune-mediated thrombotic events with thrombocytopenia after J&J COVID-19 vaccination • Strongly recommend consultation with hematology
Janssen Vaccine and Cerebral Venous Sinus Thrombosis (CVST) • Similar to thrombotic events with thrombocytopenia after receipt of the AstraZeneca COVID-19 vaccine in Europe. • Both vaccines contain replication-incompetent adenoviral vectors o Janssen vaccine: Human [Ad26.COV2.S] o AstraZeneca vaccine: Chimpanzee [ChAdOx1] • Both encode the spike glycoprotein of SARS-CoV-2
Janssen Vaccine and Cerebral Venous Sinus Thrombosis (CVST)
Pathogenesis
• Studies conducted among patients diagnosed with CVST after AstraZeneca COVID-19 vaccine in Europe
• Pathogenesis may be associated with platelet-activating antibodies against platelet factor 4 (PF4)
o IgG anti-PF4 (heparin-PF4 antibody) can activate platelets and induce thrombotic thrombocytopenia in a
small percentage of persons exposed to heparin
o However, none of the European cases had recent heparin exposure
• CVST historically (first reported in the literature >100 years ago)
o Predisposing factors mainly genetic and acquired prothrombotic states and infection
o Incidence of CVST in children and neonates ~ 7 cases per million
o Incidence of CVST in adults ~ 3–4 cases per million
o 75% of reported adult CVST cases are women (pregnancy, puerperium, usage of oral contraceptives)
o Highest frequency between 20 and 40 years of age
o Other possible predisposing factors quite extensive and includes more than 100 different causes
o Generally has a favorable prognosis if diagnosed and treated early
Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis,
and treatment, Volume 27: Issue 5 (Nov 2009): Venous Brain Circulation DisordersCerebral venous sinus thrombosis causes and risk factors
Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis,
and treatment, Volume 27: Issue 5 (Nov 2009): Venous Brain Circulation DisordersCerebral venous sinus thrombosis causes and risk factors
Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis,
and treatment, Volume 27: Issue 5 (Nov 2009): Venous Brain Circulation DisordersCerebral venous sinus thrombosis causes and risk factors
Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis,
and treatment, Volume 27: Issue 5 (Nov 2009): Venous Brain Circulation DisordersCerebral venous sinus thrombosis causes and risk factors
Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis,
and treatment, Volume 27: Issue 5 (Nov 2009): Venous Brain Circulation DisordersJanssen Vaccine and Cerebral Venous Sinus Thrombosis (CVST) Summary • Pause use of Janssen vaccine until ACIP further reviews these CVST cases • Maintain high index of suspicion for symptoms that might represent serious thrombotic events or thrombocytopenia • Obtain platelet counts and screen for evidence of immune thrombotic thrombocytopenia • Evaluate initially with anti-PF4 screening using PF4 enzyme-linked immunosorbent assay (ELISA); same as for autoimmune HIT • Consultation with hematology strongly recommended. • Do not treat patients with thrombotic events and thrombocytopenia following receipt of Janssen vaccine with heparin, unless HIT testing is negative
Date: Thursday, April 15, 2021 Time: 2:00 pm - 3:00 pm (ET) Zoom link below to join: https://www.zoomgov.com/j/ 1614336614?pwd=ZVhQUHoya G4zVFdua2czcE9EU20wUT09 Or iPhone one-tap : US: +16692545252,,1614336614#,,,,*160026# or +16468287666,,1614336614#,,,,*160026# Or Telephone: Dial (for higher quality, dial a number based on your current location): US +1 669 254 5252 or +1 646 828 7666 or +1 551 285 1373 or +1 669 216 1590 Webinar ID: 161 433 6614 Passcode: 160026
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