NOVEL CORONAVIRUS (COVID-19) - Update Randall Culpepper, MD, MPH Frederick County Deputy Health Officer April 22, 2021
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NOVEL CORONAVIRUS (COVID-19)
Update
Randall Culpepper, MD, MPH
Frederick County Deputy Health Officer
April 22, 2021
Worldwide Cases and Deaths: COVID-19 (April 21, 2021)
Cases
Deaths
https://covid19.who.int/ accessed April 21, 2021
Global COVID-19 Update (April 21, 2021) Global Cases: 143,488,236 Global Deaths: 3,055,587 1. United States: 31,860,862 1. United States: 569,383 2. India: 15,616,130 (inc) 2. Brazil: 381,475 3. Brazil: 14,122,795 3. Mexico: 213,048 4. France: 5,436,227 4. India: 182,553 5. Russia: 4,673,699 5. United Kingdom: 127,577 6. Turkey: 4,446,591 (inc) 6. Italy: 117,997 7. United Kingdom: 4,411,059 7. Russia: 104,937 8. Italy: 3,904,899 8. France: 102,046
WHO Global Assessment (April 21, 2021) • New COVID-19 cases increased for the 8th consecutive week o Over 5.2 million new cases reported in last week o All regions reported increase cases in last week • New deaths increased for the 5th consecutive week o Increased 8% compared to last week o Over 83,000 new deaths reported • Pace of deaths is accelerating o 9 months to reach 1 million deaths o 4 months to surpass 2 million o 3 months to reach 3 million
COVID Daily Cases by WHO Region (April 21, 2021)
United States COVID-19 Cases and Deaths (April 21, 2021)
United States COVID-19 Cases (April 21, 2021)
United States COVID-19 Deaths (April 21, 2021)
United States COVID-19 Case Rate per 100K Last 7 Days (April 21, 2021)
US: New COVID-19 Hospital Admissions
Regional 7-day Moving Average New Cases (DC, MD, VA, PA, WV) (April 14 and April 21, 2021)
U.S. COVID-19 Vaccinations Administered Rate per 100,000 (April 21, 2021)
April 14, 2021 April 21, 2021Maryland Daily Trends in Number of COVID-19 Deaths (April 21, 2021)
Maryland - Current Trends (April 21, 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 21, 2021)
Maryland : COVID Vaccinations (April 21, 2021)
Maryland Competed Vaccinations Statewide by Age (April 21, 2021)
Frederick County (April 21, 2021)
https://covid.cdc.gov/covid-data-tracker/#county-view Frederick County Case and Deaths % Change (Nov 1, 2020 – April 18, 2021)
https://covid.cdc.gov/covid-data-tracker/#county-view Frederick County Test % POS and Volume (Nov 1, 2020 – April 18, 2021)
https://covid.cdc.gov/covid-data-tracker/#county-view Frederick Health Hospital New Admissions (Nov 1, 2020 – April 18, 2021)
https://covid.cdc.gov/covid-data-tracker/#county-view Frederick Health Hospital % Beds (Nov 1, 2020 – April 18, 2021)
Frederick County COVID-19 Deaths by Week (April 21, 2021)
FCPS COVID Cases in Staff and Students (April 15, 2021)
Frederick County Trends (CDC, April 21, 2021)
Characteristic County Estimate Statewide Estimate US Total Estimate
Population: 259,547 6,045,680 331,996,199
Population density (people per
392.94 622.82 94
sq. mile):
Household size: 2.67 2.69 2.52
Percent uninsured: 4.8 % 6 9.2
Percent living in poverty: 7.1 % 9.43 10.5
Percent population 65 yrs and 14.8 %
15.87 16.3
over: (28,122)Frederick County Trends, Vaccination (CDC, April 21, 2021)
People Vaccinated Fully Vaccinated
Total 75,798
% of Total Population 29.20%
Population ≥ 18 Years of Age 75,634
% of Population ≥ 18 Years of Age 37.90%
Population ≥ 65 Years of Age 28,122
73.10%
% of Population ≥ 65 Years of Age
(83.9% 1st dose)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 protectionU.K. B.1.1.7 Variant Global Distribution (April 21, 2021)
South African B.1.351 Variant Global Distribution (April 21, 2021)
Brazil P.1 Variant Global Distribution (April 21, 2021)
CDC: Post-COVID Conditions
• Health issues persist > 4 weeks after first being infected with SARS-CoV-2
• Experts don’t know why or how often some people experience post-COVID conditions.
• Can happen to anyone who has had COVID-19, even if the illness was mild, or they had no
symptoms.
• Timing
o Can last weeks or months after first being infected
o Can appear weeks after infection
• Symptoms
o Tiredness or fatigue, difficulty thinking or concentrating
o Headache, loss of smell or taste
o Dizziness on standing, heart palpitations, chest pain, difficulty breathing or shortness of
breath
o Cough, joint or muscle pain
o Depression or anxiety, fever, symptoms that get worse after physical or mental activitiesCDC: Post-COVID Conditions Sequelae in Adults at 6 Months After COVID-19 Infection (Logue et. al, JAMA Net Open, 2021 Feb 1) • Longitudinal prospective cohort of adults with laboratory- confirmed SARS-CoV-2 infection with a concurrent cohort of healthy patients in a control group • Reported at least 1 persistent symptom: 49/150 outpatients (32.7%), 5/16 hospitalized patients (31.3%), and 1/21 healthy participants(4.8%) • Most common persistent symptoms were fatigue and loss of sense of smell or taste
CDC: Post-COVID Conditions 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study (Huang et al., The Lancet, January 16, 2021) • Cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020 • Median follow-up time after symptom onset was 186 days. • Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients.
COVID-19 Rehabilitation Resources • https://www.hopkinsmedicine.org/physical_medicine_rehabili tation/coronavirus-rehabilitation/ • https://www.kennedykrieger.org/patient-care/centers-and- programs/pediatric-post-covid-19-rehabilitation-clinic • https://www.umms.org/rehab/coronavirus/covid-recovery- rehabilitation • https://www.gwdocs.com/specialties/primary-care/covid-19- recovery-clinic/
Tracking Variants of Concern in Maryland • Question: What is the prevalence of variants of concern and interest in Maryland? • Question: How much data do we have available to track these variants?
Data and Methods
• Source: GISAID (formerly Global Initiative for Sharing Avian Influenza Data)
• Largest public, online repository of results from SARS-CoV-2 sequencing
• What is uploaded:
o Full sequence (i.e. AATGTC…)
o Lineage, based on sequence (e.g., B.1, B.1.351…)
o Date and location of collection
• Patients are not identified
• Includes data from Maryland Public Health Laboratory, other participating private labs
• Shown here:
o Number GISAID specimens sequenced each week, by date of collection
o Percent of GISAID specimens that are variants of concern, by date of collectionPrevalence of SARS-CoV-2 Lineages on GISAID by Week – Maryland, 2021 32
Key Points
• CDC-designated “variants of concern” and “variants of
interest” now majority of sequenced SARS-CoV-2 specimens in
Maryland
• Exponential growth by three variants:
o B.1.1.7 more infectious, more severe illness, no effect
on immunity
o B.1.526 more infectious, no effect on severity, carries
gene associated with reduced protection from immunity
o B.1.526.1 carries gene associated with increased
infectiousnessRecommended pause in the use of J&J COVID-19 Vaccine • The Advisory Committee on Immunization Practices (ACIP) met on April 14, 2021. After hearing additional data on the six cases of CVST with thrombocytopenia, ACIP agreed that more information is needed. • ACIP is planning to have an emergency meeting on Friday, April 23, 2021 to review any additional scientific evidence and deliberate further. • CDC and FDA will consider the Committee’s recommendations when they are made.
Recommended pause in the use of J&J COVID-19 Vaccine Recommendations for clinicians: • Maintain a high index of suspicion for symptoms that might represent serious thrombotic events or thrombocytopenia in patients who have recently received Janssen COVID-19 vaccine, including severe headache, backache, new neurologic symptoms, severe abdominal pain, shortness of breath, leg swelling, petechiae, or new or easy bruising. • Obtain platelet counts and screen for evidence of immune thrombotic thrombocytopenia in any patients with these symptoms who have recently received Janssen COVID-19 vaccine.
Recommended pause in the use of J&J COVID-19 Vaccine Recommendations for clinicians: • In patients with a thrombotic event and/or thrombocytopenia after receiving Janssen COVID-19 vaccine, evaluate initially with a screening platelet factor-4 (PF4) enzyme-linked immunosorbent (ELISA) assay as would be performed for autoimmune heparin induced thrombocytopenia (HIT). • Consultation with a hematologist is strongly recommended.
Recommended pause in the use of J&J COVID-19 Vaccine Recommendations for clinicians: • Do not treat patients with thrombotic events and thrombocytopenia following receipt of Janssen COVID-19 vaccine with heparin unless HIT testing is negative. • If HIT testing is positive or unable to be performed in patients with thrombotic events and thrombocytopenia following receipt of Janssen COVID-19 vaccine, non-heparin anticoagulants and high-dose intravenous immune globulin should be strongly considered.
Recommended pause in the use of J&J COVID-19 Vaccine Recommendations for clinicians: • Report adverse events to the Vaccine Adverse Event Reporting System, including serious and life-threatening adverse events and deaths in patients following receipt of COVID-19 vaccines, as required under the Emergency Use Authorizations for COVID-19 vaccines.
Recommended pause in the use of J&J COVID-19 Vaccine
Recommendations for clinicians:
• If you are a COVID-19 vaccination provider with Janssen
vaccine:
o Mark any Janssen COVID-19 vaccine in your inventory “Do
not use. Awaiting guidance.”
o Continue to store the vaccine in the refrigerator between
2°C and 8°C (36°F and 46°F).
o Follow recommended vaccine storage practices and
continue to monitor and document storage unit
temperatures.Characteristics of patients with CVST and thrombocytopenia*
after Janssen COVID-19 vaccine, N=6
• Median age 33 years (range 18–48)
• Median time to symptom onset 8 days (range 6–13 days)
• All cases occurred in white females
• Current estrogen/progesterone use (n=1)
• Pregnant or post-partum (n=0)
• Pre-existing conditions
o Obesity (n=3)
o Hypothyroidism (n=1) * Note: Thrombosis usually does not occur in
o Hypertension (n=1) the presence of low platelets; these case
presentations are atypical and consistent with
o Asthma (n=1) cases observed after AstraZeneca COVID-19
o Coagulation disorders (none known) vaccineInitial and late signs and symptoms among CVST patients*, N=6 (patients listed in no particular order)
Locations of CVST, intracerebral hemorrhage, and other thromboses, N=6
SARS-CoV-2 test results among CVST patients, N=6
Hematology test results among CVST patients, N=6
Treatment and outcomes among CVST patients, N=6
• Treatment
o Heparin (n=4)
o Nonheparin anticoagulants (n=5)
o Platelets (n=3)
o Intravenous immunoglobulin (n=3)
• Outcomes
o Death (n=1)
o Remain hospitalized (n=3)
■ Intensive care unit (n=2)
o Discharged home (n=2)
• * All 5 of these patients received ArgatrabanCDC COVID-19 Travel Recommendations by Destination Level 4 (Very High) - avoid all travel to these destinations
CDC COVID Modeling Forecasts (April 19, 2021)
• This week, ensemble forecasts of new reported COVID-19 cases over the next 4 weeks included
forecasts from 28 modeling groups, each of which contributed a forecast for at least one
jurisdiction.
• This week’s national ensemble predicts that the number of newly reported COVID-19 cases will
remain stable or have an uncertain trend over the next 4 weeks, with 249,000 to 724,000 new
cases likely reported in the week ending May 15, 2021.
• The state- and territory-level ensemble forecasts predict that over the next 4 weeks, the number
of new reported cases per week will likely increase in 2 jurisdictions and decrease in 1
jurisdiction, which are indicated in the forecast plots below. Trends in numbers of future
reported cases are uncertain or predicted to remain stable in the other states and territories.
• The figure shows the number of new COVID-19 cases reported in the United States each week
from February 13 through April 17 and forecasted new cases over the next 4 weeks, through May
15.
• Models make various assumptions about the levels of social distancing and other interventions,
which may not reflect recent changes in behavior. See model descriptions below for details on
the assumptions and methods used to produce the forecasts.National Forecast (CDC, April 19, 2021)
Maryland (CDC, April 19, 2021)
Seeking Monoclonal antibody treatment on Maryland
• Monoclonal antibody treatment available for Marylanders who are at high risk for serious illness
from COVID-19
• Includes people who are 65 years of age or older or have certain chronic medical conditions
• Treatment includes a single, one-hour intravenous infusion, followed by at least one hour of
observation.
• Obtained at a number of hospitals and other health care providers in the state, including:
o Adventist HealthCare Takoma Park
o Atlantic General Hospital
o Baltimore Convention Center Field Hospital
o MedStar Southern Maryland Hospital Center
o Meritus Health
o Peninsula Regional-Tidal Health
o UPMC Western MarylandSeeking Monoclonal antibody treatment on Maryland • MDH has also made arrangements with nursing homes across the state for eligible residents who contract COVID-19 to have access to treatment through their long-term care pharmacy partners. • Additionally, several dialysis centers now offer the treatment • Physicians wishing to refer a patient for a monoclonal antibody treatment through CRISP’s new referral tool can find instructions and additional resources at coronavirus.maryland.gov. o https://coronavirus.maryland.gov/pages/provider-resources
Take away messages: It’s Complicated, but the Basics Still Work
• Americans being vaccinated at accelerated daily pace
o More than 125 million Americans have received at least one dose of vaccine
o More than 78 million Americans are fully vaccinated
• COVID-19 cases and hospitalizations are increasing in some areas of the country and among younger
people who have not yet been vaccinated
o Complicated reasons for increases but likely related to predominant emerging SARS-CoV-2 variants
o COVID-19-related emergency department visits, hospital admissions, and current
hospitalizations recently rising among patients ages 18 to 64 years
o ED visits and hospitalizations among people ages 65 years and older have decreased, likely
demonstrating important role vaccination
o 80% of people 65 years or older have received at least one dose of vaccine and 63.7% are fully
vaccinated.
• Hope abounds as access to vaccines for all Americans increases
o Until the U.S. population is fully vaccinated, consistent use of prevention strategies (e.g., face
coverings, social distancing, hand washing) will limit spread of COVID
o Fully vaccinated people must continue taking everyday precautions in publicThank you!
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