NOVEL CORONAVIRUS (COVID-19) - Update Randall Culpepper, MD, MPH Frederick County Deputy Health Officer April 8, 2021 - Frederick County ...

NOVEL CORONAVIRUS (COVID-19)
          Update
         Randall Culpepper, MD, MPH
    Frederick County Deputy Health Officer
                April 8, 2021

Worldwide: COVID-19 (April 7, 2021)

         https://covid19.who.int/ accessed April 7, 2021

Global COVID-19 Update (April 7, 2021)
CASES                         DEATHS
• Global: 132,046,206         • Global: 2,867,242
• United States: 30,662,171   • United States: 555,231
• Brazil: 13,100,580          • Brazil: 336,947
• India: 12,801,785           • Mexico: 205,002
• France: 4,902,948           • India: 166,177
• Russia: 4,554,481           • United Kingdom: 127,171
• United Kingdom: 4,381,823   • Italy: 112,374
• Italy: 3,700,393

COVID Daily Cases by WHO Region (April 7, 2021)

United States COVID-19 Cases and Deaths (April 7, 2021)

United States COVID-19 Cases (April 7, 2021)

United States COVID-19 Deaths (April 7, 2021)

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

US: New COVID-19 Hospital Admissions

US: COVID-19 Vaccination Rate per 100,000 (April 7, 2021)

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

Maryland Daily Trends in Number of COVID-19 Deaths (April 7, 2021)

Maryland - Current Trends (April 7, 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 7, 2021)

Maryland : COVID Vaccinations (April 7, 2021)

Frederick County (April 7, 2021)

Frederick County Test % Positivity and Case Rate (April 7, 2021)

Frederick County COVID-19 Deaths by Week (April 7, 2021)

FCPS COVID Cases in Staff and Students

What happens if infected after 1st dose of mRNA vaccine

• Must wait at least 10 days after onset of symptoms or (+) test
• May delay 2nd dose up to 90 days, but NOT obligatory
• Recommend waiting 2 months after recovery
• Notify vaccine clinic if not getting 2nd doses at already scheduled
  time
• Vaccine clinic will assist when patient ready to schedule 2nd does
• Never have to restart the mRNA 2-dose series
• Don’t need to test negative to get 2nd dose of mRNA vaccine

Seasonal Allergic Rhinitis versus COVID infection

Seasonal Allergic Rhinitis versus COVID infection
• Assume COVID infection until proven otherwise
   o HCP can document alternative diagnosis
   o Patient can get PCR tested

• Have patients minimize time allergy symptoms
   o Medications
   o Seek indoor spaces with clean air
   o Minimize time outdoors
   o If outdoors, avoid activities that stir up pollen (e.g., mowing lawns,
     raking leaves)
   o When returning indoors, shower and change clothes

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
• 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 protection

Variants

• Variants of Interest and Concern: Designated SARS-Cov-2 lineages identified
  by CDC as being of elevated concern.
• Possible reasons:
   o Increased infectiousness
   o Increased severity of illness
   o Reduced protection from acquired immunity from vaccination or
      previous infection
   o Reduced response to treatment
• Current variants of concern: B.1.1.7, B.1.351, P.1, B.1.427 (CA), B.1.429 (CA)
• Current variants of interest: B.1.525 (NY), B.1.526 (NY), P.2 (Brazil)

US COVID-19 Cases Caused by Variants (April 6, 2021)

Emerging U.K. Variant Cases in the United States (April 6, 2021)
52 states/territories (+2), 167,275 cases (+4,705; +4,068 week before that)
                                   665 cases in MD (+194, +176 week before)

Emerging S. African Variant Cases in the United States (April 6, 2021)
36 states (+5), 386 cases (+74, +93 week before that)
                                  44 cases in MD (+7, +12 week before)

Emerging Brazilian Variant Cases in the United States (April 6, 2021)
25 states (+3), 356 cases (+184, +111 week before that)
                                  2 cases in MD (+1)

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.

How long will coronavirus vaccines be protective?

Antibody Persistence through 6 Months after the Second Dose of
mRNA-1273 Vaccine for Covid-19 (NEJM, April 6, 2021)
    • Studies continue to show long-term effectiveness of COVID-19
      vaccines
    • Antibodies from Moderna vaccine remained high among 33
      adults of varying ages six months after the second dose
    • Dr. Fauci said "there's every reason to believe that similar
      results will be seen with the Pfizer as well as the J&J
      (vaccines)."

                        https://www.nejm.org/doi/full/10.1056/NEJMc2103916

Receptor-Binding Domain ELIZA (Panel A)

Pseudovirus Neutralization Assay (Panel B)

Live Virus Neutralization Assay (FRNT-mNG) (Panel C)

Where are we going? (modeling runs dated March 31, 2021)

Probability of Herd Immunity for US and UK by Quarter

COVID Vaccine Administration Tips for Providers

Pfizer COVID vaccine

Pfizer = maximum of 6 doses/vial
• Per updated federal guidance, all vials of Pfizer contain 6 vaccine
• Fact Sheet for HCPs for EUA of Pfizer COVID-19 Vaccine (revised
  2/25/2021) states one vial contains 6 doses of 0.3nl.
• Providers that are unable to get a sixth dose from each vial must
  report the sixth dose as “wastage” using the process outlined in
  your agreement with the State
• https://www.cdc.gov/vaccines/covid-19/info-by-
  product/pfizer/index.html

Moderna COVID vaccine
Moderna = maximum of 10 doses/vial
•   NEW Fact Sheet for HCPs for EUA of Moderna COVID-19 Vaccine (revised 3/31/2021) states:
•   Moderna COVID-19 Vaccine supplied in two multiple-dose vial presentations:
     o Multiple-dose vial contains possible 11 doses 0.5 mL each (range 10-11 doses)
     o Multiple-dose vial containing a maximum of 15 doses 0.5 mL each (range 13-15 doses)
•   Depending on the syringes and needles used for each dose, may not be sufficient volume to
    extract more than 10 doses from the maximum of 11 doses vial or more than 13 doses from the
    maximum of 15 doses vial.
•   Irrespective of the type of syringe and needle: each dose must contain 0.5 mL of vaccine.
•   If amount of vaccine remaining in vial cannot provide a full dose of 0.5 mL, discard the vial and
    contents.
•   Do not pool excess vaccine from multiple vials.

Janssen COVID vaccine
Janssen (J&J) = maximum of 5 doses/vial
• New Fact Sheet for HCPs for EUA of Janssen COVID-19 Vaccine (revised
   3/19/2021) states a maximum of 5 doses can be withdrawn from the
   multi-dose vial.
• Hospital providers who receive J&J vaccine shall (subject to availability of
   vaccine):
    1. Offer J&J vaccine to any eligible inpatients being discharged from a
        hospital admission to a nursing home, assisted living program, or
        other post-acute care facility (e.g., rehabilitation center).
    2. Offer the J&J vaccine to eligible inpatient rehabilitation patients
        who have longer lengths of stay, but not 3-4 weeks needed for the
        Pfizer/Moderna second dose to be given before discharge.

COVID Vaccines – Second Doses
•   As vaccine first doses are administered, providers should estimate the number
    of patients that will require a second dose each week.
•   Prioritize patients requiring second doses.
•   Manage appointments for second doses based on weekly estimates.
•   Schedule individual's second dose at the time of the first dose at the
    appropriate time interval from the 1st dose (i.e., 3 or 4 weeks)
•   Individuals don’t need to create a new appointment on their own for 2nd dose.
•   Second dose should be at the same location with the same provider.
•   Second doses should not be held or saved for patients who have not returned
    after 42 days following their first dose; providers may use only those second
    doses as first doses.

COVID At-Risk Vaccines

• COVID-19 vaccine doses that are at risk of being wasted due to
  expiration or spoilage (“at-risk” vaccines)
• Previous State policy that reasonable efforts first be made to
  reallocate “at-risk vaccines” in accordance with the State’s
  prioritization requirements
• As of April 12, no longer have prioritization requirements so
  “at-risk” vaccines shall be administered to any unvaccinated
  person to avoid wastage.

COVID-19 vaccine provider updates

• Per federal guidance, must disclose vaccine type being administered to
  individuals at the time of scheduling their appointments.
• May not refuse an individual a vaccine based on citizenship or
  immigration status.
• State prefers that Marylanders are prioritized for getting a vaccine
  allocated to us by the federal government; however, Maryland providers
  will not turn away a person from out of state who needs a vaccine.
• Must not discriminate on the basis of race, color, religion or creed, sex,
  age, ancestry or national origin, marital status, physical or mental
  disability, sexual orientation and gender identity, genetic information,
  socioeconomic status, and/or any other protected status.

How to register for vaccinations in Maryland
•   Maryland Statewide Pre-Registration System for Mass Vaccination Sites
    (appointment-only)
      o Notifies the person when it's their turn to schedule an appointment
      o Six Flags America Theme Park, Regency Furniture Stadium (Blue Crabs Stadium),
        Wicomico Civic Center, Hagerstown Premium Outlets, M&T Bank Stadium.
      o Marylanders eligible in Phase 1 and Phase 2A and 2B may now pre-register
          ■   Online at covidvax.maryland.gov
          ■   By phone through the state’s COVID-19 Vaccination Support Center at 1-855-MD-GOVAX (1-
              855-634-6829) open seven days a week from 7 am to 10 pm (assist those without internet
              access or who can't use the web-based systems, including people with disabilities).
     o Once pre-registered, Marylanders will be notified once an appointment is
        available, and will be able to verify their pre-registration status and reserve an
        appointment.
•   Frederick County Health Department website
     o Frederick County COVID-19 Vaccine Interest Form

Thank you!