Update on COVID-19 in Hawai'i - Lee Buenconsejo-Lum, MD, FAAFP Associate Dean for Academic Affairs - John A. Burns School of ...

Update on COVID-19 in
         Hawai‘i
                   February 13, 2021

           Lee Buenconsejo-Lum, MD, FAAFP
          Associate Dean for Academic Affairs
            John A. Burns School of Medicine
        JABSOM Liaison to HI EMA S ESF-8 and
several State Vaccine Implementation Plan committees

Topics to be discussed:

    1. Overview of the virus that causes
       COVID-19 (SARS-CoV-2) and major
       consequences of getting moderate to
       severe COVID-19 disease
    2. COVID-19 vaccine overview
    3. Highlights of the Hawai‘i COVID-19
       vaccine implementation plan
    4. Reminders about keeping you and your
       family safe (even if you are vaccinated)

Key timelines in the pandemic
• New virus in December 2019
• WHO declared a Global Health emergency
  January 30, 2020
• White House declares National Public Health
  Emergency February 1, 2020
• WHO declares pandemic March 11, 2020
•   Disruption of services in March 2020
•   Hawai‘i surge in Aug-Sept 2020
•   Hawai‘i starts vaccine planning Oct 2020
•   First doses of vaccine December 15, 2020
•   Started vaccinating kupuna in mid-January 2021
•   Second surge in January 2021
•   Variant strain identified in Hawai‘i January 25,
    2021

Coronavirus basics
   • The name comes from the crown-like
     appearance
   • The “spikes” on the surface are the spike
     proteins, which are the target of the
     vaccines
   • This family of viruses causes many
     diseases in humans and animals,
     including the common cold
   • Can cross species from bats into other
     animals (found in the live-animal
     markets) into humans, and humans to
     other animals (rare)

Transmission of the Novel 2019
Coronavirus (SARS-CoV-2)                         CLUSTERS
• Person to person                               • Family transmission
• Respiratory droplets from coughing,            • Bars, carpools, break rooms,
  sneezing, talking, shouting, singing             churches, funerals, nursing home,
• Contact with surfaces (low risk)                 prisons
• Health care workers not wearing proper         • Weekly cluster reports on the
  personal protective equipment (PPE)              Department of Health (DOH)
                                                   website

Incubation Period and Asymptomatic
Transmission
• Range 2-14 days, average 5-6 days
• Long pre-symptomatic period (12 days)
• ⅓ to ½ of cases are asymptoma c transmission (up to 21 days)

                                                        The time periods of infectivity
                                                        are the basis for:
                                                        • Contact tracing
                                                        • Quarantine
                                                        • Isolation

Clinical signs and symptoms
 • If more severe and need oxygen hospitalization

                                                     Chest x-rays, illness day 10, hospital day 6
                                                      White areas in the lung = inflammation

Common clinical features
• Loss of smell or taste (early)
• In hospitalized patients
   •   Prolonged fever
   •   Cough
   •   Body aches or fatigue
   •   Shortness of breath
Less common clinical features
• Oral rash
• Myocarditis (weak heart)
• Blood clots and stroke
• COVID toes (more common in kids)
• Multisystem Inflammatory Syndrome in
  Children (MIS-C) – heart, lungs, kidneys,
  brain, skin, eyes, GI tract

COVID-19 disease tends to be worse in elderly and those with
    multiple chronic conditions
    • Death: 60-69 years: 3.6%; 70-79 years: 8%; ≥80 years: 14.8%
    • Death is higher for some:
       • 10.5% for those with cardiovascular disease
       • 7% for diabetes
       • 6% each for chronic respiratory disease, hypertension, and cancer
    • 49% for patients who developed respiratory failure, septic shock, or
      multiple organ dysfunction
    • Prevention is critical!!
    • And now, getting vaccinated!
    • Treatment is mostly supportive
    • Recommendations are evolving

Testing is important if you have any symptoms
•   PCR detects presence of viral nucleic acid
•   Does not distinguish between living and dead virus
•   Presence does not necessarily imply transmissibility
•   Tests designed to detect disease in symptomatic persons
•   Asymptomatic may test positive

Yeah for Vaccines!

Questions
• How did we get the vaccines so quickly?               • COVID is not like the
   • $$
                                                          flu!
   • Pre-approval production                               • Much worse
   • Combined Phase 1/Phase 2 trials                    • Common symptoms
• Are they safe?                                          after the vaccine are
   • Held to a very high (higher than usual) standard     part of the normal
   • Close monitoring and for 1-2 years                   immune response

mRNA Vaccines
 •   Pfizer and Moderna
 •   Cannot get infected from these
 •   Similar safety profile
 •   Efficacy 94-95%
 •   Effective in preventing severe COVID-19

Questions to be answered with additional data
from ongoing trials

 • How long will the vaccine last (duration of
   protection)?
 • Will vaccination prevent asymptomatic SARS-CoV-2
   infection?
 • Will vaccination reduce SARS-CoV-2 transmission?
 • Are two vaccine doses required for protection or can
   protection be achieved with a single vaccine dose?
 • Is the vaccine safe and effective in children 12-15
   years of age? In pregnant women?
 • Vaccine safety follow up reported by recipients
   (V-Safe and VAERS)

Who should NOT get the COVID-19 vaccine?
• A history of the following is considered by CDC to be a contraindication to
  both the Pfizer and Moderna vaccines:
   • Severe allergic reaction (e.g., anaphylaxis) after a previous dose of an mRNA COVID-19
     vaccine or any of its components
   • Immediate allergic reaction of any severity to a previous dose of an mRNA COVID-19
     vaccine or any of its components (including polyethylene glycol [PEG])*
   • Immediate allergic reaction of any severity to polysorbate (due to potential cross-
     reactive hypersensitivity with the vaccine ingredient PEG)*
• Persons with an immediate allergic reaction to the first dose of an mRNA
  COVID-19 vaccine should not receive additional doses
Anaphylaxis
• Wheezing, severe trouble breathing
• Dizzy / low blood pressure
• Requires epinephrine
• Often hospital / ER visit

Precautions

• A history of any immediate allergic reaction to any other vaccine or
  injectable therapy is a precaution but not a contraindication to vaccination
  for both the Pfizer-BioNTech and Moderna COVID-19 vaccines
    • intramuscular, intravenous, or subcutaneous vaccines or
    • therapies not related to a component of mRNA COVID-19 vaccines
• Should be counseled about the unknown risks of developing a severe
  allergic reaction and balance these risks against the benefits of vaccination
    • May defer vaccination until more information on risk of anaphylaxis is available

    Patients with these precautions or other non-severe allergies to food or
    drugs will be monitored for 30 minutes after vaccination

Not enough information but still recommended
• Pregnant or breastfeeding women
• Immunocompromised persons
   • HIV-infection or other immunocompromising conditions or taking immunosuppressive medications
       •   Might be at increased risk for severe COVID
       •   No current data to establish vaccine safety and efficacy in these groups
       •   May receive COVID-19 vaccination if they have no contraindications to vaccination
       •   Should be counseled about unknown safety profile and effectiveness in this group
       •   Need to continue to follow guidance to protect against COVID-19
• Persons with autoimmune conditions
   • No current data on safety and efficacy of mRNA COVID-19 vaccines in this group
   • May receive COVID-19 vaccination if they have no contraindications to vaccination
• If you are in a high priority category (1A, 1B, 1C), then you should consider getting the
  vaccine when it’s your turn
• Theoretical risk of vaccine is much less than the real risk of COVID-19, hospitalization
  and death

  What about ….
  • Persons with a history of Guillain-Barre syndrome
     • No cases of Guillain-Barré syndrome (GBS) reported following vaccination
       among participants in Pfizer-BioNTech or Moderna COVID-19 vaccines
       clinical trials
     • May receive COVID-19 vaccination if they have no contraindications to
       vaccination
  • Persons with a history of Bell’s palsy (temporary facial paralysis)
     • Cases of Bell’s palsy following vaccination in both trials not found to be
       causally related to vaccination
     • Post-authorization safety surveillance will further assess any possible
       causal association
     • May receive COVID-19 vaccination if they have no contraindications to
       vaccination

Prioritization and Allocation
• Less vaccine supply compared to high demand

                                                • Frontline essential workers
                                                  are 11% of Hawai‘i’s
                                                  population
                                                  •   First responders
                                                  •   Corrections officers
                                                  •   Emergency Services dispatchers
                                                  •   Critical transportation
                                                      infrastructure workers (harbor
                                                      & dock workers, public
                                                      transportation, etc.)
• 1B Essential workers (in roughly descending     •   Critical utilities (energy, water,
                                                      gas, etc.)
 priority)                                        •   Teachers and childcare and
 “workers whose duties must be                        educational support staff (incl.
 performed on-site and require being in               post-secondary)
                                                  •   Those essential for federal,
 close proximity (< 6 feet) to the public             state and local government
 or coworkers, and are essential to the               operations
 functioning of society”                          •   U.S. Postal Service employees

• Phase 1a
    • Healthcare personnel (57,351)
    • Long-term care facility residents (includes care homes, foster homes) (11,470)
 • Phase 1b
    • Age 75 or older (103,231)
       •   14,666 Hawai‘i County
       •   11,514 Maui
       •   455 Moloka‘i
       •   209 Lanai
       •   71,140 Honolulu County
       •   5,248 Kaua‘i County
    • Frontline essential workers (126,172)

 • 1a + 1b + 1c is about 73% of the population
 • Vaccine supply into Hawai‘i should be better by March 2021
 • Thank you for your patience!
 • HUGE logistical challenges are being overcome

Avoid the 3 Cs:
Closed spaces with poor
ventilation
Crowds
Close contact with people
outside your social bubble

Questions?
             • Stay safe!
             • Live aloha!