NOVEL CORONAVIRUS (COVID-19) - FCHD Providers-Partners Update Randall Culpepper, MD, MPH Frederick County Deputy Health Officer July 8, 2021
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NOVEL CORONAVIRUS (COVID-19)
FCHD Providers-Partners Update
Randall Culpepper, MD, MPH
Frederick County Deputy Health Officer
July 8, 2021
Worldwide Cases and Deaths: COVID-19 (July 7, 2021)
https://covid19.who.int/ accessed July 7, 2021
Global 7-Day Rolling Average Cases (July 8, 2021)
7,000,000
6,000,000
5,000,000
4,000,000
3,000,000
2,000,000
2,799,382 cases/week
(2,698,521 last week)
1,000,000
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-Jul
Global 7-Day Rolling Average Deaths (July 8, 2021)
7 day ∆
120,000
100,000
80,000
60,000
40,000
55,484 deaths/week
(57,500 last week)
(59,000 2 weeks ago)
20,000
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-Jul
Cumulative confirmed COVID-19 deaths per million people (July 8, 2021)
Share of the population fully vaccinated against COVID-19
United States COVID-19 Cases and Deaths (July 7, 2021)
U.S. 7-Day Rolling Average Cases (July 8, 2021)
7 day ∆
2,000,000
1,800,000
Last 14 days
1,600,000 120,000
100,000
1,400,000 80,000
60,000
1,200,000 40,000
20,000
1,000,000 0
24-Jun
25-Jun
26-Jun
27-Jun
28-Jun
29-Jun
30-Jun
1-Jul
2-Jul
3-Jul
4-Jul
5-Jul
6-Jul
7-Jul
800,000
600,000
400,000 104K cases/week
( 79K last week)
200,000
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-JulU.S. 7-Day Rolling Average Deaths (July 8, 2021)
7 day ∆
25,000
20,000
15,000
10,000 1,655 deaths/week
(1,934 last week)
(2,157 two weeks ago)
5,000
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-JulU.S. COVID-19 Case Rate per 100K Last 7 Days (July 8,2021)
Highest % Delta Variants
• Missouri
• Arkansas
• Nevada
• Colorado
• Utah
• ConnecticutUS: New COVID-19 Hospital Admissions (July 5, 2021)
U.S. percent population ≥ 12 years given ≥ one dose (July 8, 2021)
Maryland Daily Trends in Number of COVID-19 Deaths (July 8, 2021)
Maryland 7-Day Rolling Average Cases = 457 cases (July 8, 2021)
7 day ∆
25,000
20,000
15,000
10,000
5,000
457 cases/week
(389 last week)
(436 two weeks ago)
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-Jul0
50
100
150
200
250
300
350
1-Aug 400
8-Aug
15-Aug
22-Aug
29-Aug
5-Sep
12-Sep
19-Sep
26-Sep
3-Oct
10-Oct
17-Oct
24-Oct
31-Oct
7-Nov
14-Nov
21-Nov
28-Nov
5-Dec
12-Dec
19-Dec
26-Dec
2-Jan
9-Jan
7 day ∆
16-Jan
23-Jan
30-Jan
6-Feb
13-Feb
20-Feb
27-Feb
6-Mar
13-Mar
20-Mar
27-Mar
3-Apr
10-Apr
17-Apr
24-Apr
1-May
8-May
15-May
22-May
29-May
(25 last week)
5-Jun
14 deaths/week
12-Jun
(26 two weeks ago)
19-Jun
Maryland 7-Day Rolling Average Deaths = 26 deaths (July 8, 2021)Maryland – ICU and Acute Hospital Beds for COVID-19 (July 7, 2021)
Last week • 50 outbreaks • 270 active cases
Maryland : COVID Vaccinations (July 8, 2021)
Frederick County (July 8, 2021)
Frederick County 7-Day Rolling Average Cases = 17 (July 8, 2021)
7 day ∆
1,600
Last 21 days
1,400 25
20
1,200 15
10
1,000 5
0
800
600
400
17 cases/week
( 7 last week)
200
(12 two weeks ago)
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-JulFrederick County Cumulative Deaths (July 8, 2021)
FC Deaths
350
300
11 deaths last 70 days
250
200
150
100
50
0
1-Aug 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-JulFrederick County COVID-19 Deaths by Week
11 deaths last 70 days!!Clinical Updates
FDA: Don't Use Antibody Tests to Check if COVID Vaccine Worked
• Key Takeaways
o Antibody tests should not be used to check COVID-19 protection at any time
o Antibody tests are used in these clinical settings
■ Understanding the health impacts of COVID-19
■ Detect if someone previously was infected with SARS-CoV-2
■ Determining a person’s eligibility for convalescent plasma therapy
• Antibody testing is NOT recommended:
o To check if COVID vaccine worked
o To assess need for vaccination in unvaccinated person
o To establish presence or absence of a active SARS-CoV-2 infection
• If fully vaccinated, likely adequately protected from COVID-19.
• https://www.fda.gov/medical-devices/safety-communications/antibody-testing-not-
currently-recommended-assess-immunity-after-covid-19-vaccination-fda-safetyCan Immunocompromised People Safely Receive the COVID-
19 Vaccine?
• Key Takeaways
o Physicians recommend immunocompromised people
receive COVID-19 vaccine
o Pfizer and Moderna COVID-19 vaccines do not contain live
traces of COVID-19
o Depending on person's immunocompromised level, some
may receive lower levels of immunity from the vaccineCOVID Variant Strains
WHO: Variants of Concern Labels
WHO: Variants of Concern Labels
SARS-CoV-2 Variants
Variants of Interest Variants of Concern
• Eta - B.1.525 (New York) (E484K) • Alpha - B.1.1.7 (United Kingdom) (some E484K)
• Iota - B.1.526 (New York) (some E484K) • Beta - B.1.351 (South Africa) (E484K)
• Iota - B.1.526.1 (New York) (L452R) • Gamma - P.1 (Brazil) (E484K)
• B.1.617 (India) (E484Q and L452R) • Delta - B.1.617.2 (India) (E484Q and L452R)
– Kappa - B.1.617.1 • Epsilon- B.1.427 (California) (L452R)
– B.1.617.3 • Epsilon - B.1.429 (California) (L452R)
• Zeta - P.2 (Brazil) (E484K)
L452R or E484K substitutions in the spike protein impact
susceptibility to EUA monoclonal antibody treatments.Variants of Concern (VOC) and other lineages United States (07/03/21) Maryland (07/08/21) ■ Alpha (B.117) 28.7% (52.2% June 24th) ■ Alpha (B.117) ~ 93% ■ Epsilon (B.1.429) 0.1% ■ Epsilon (B.1.429) < 1% ■ Delta (B.1.617.2) 51.7% (20.6% June 24th) ■ Delta (B.1.617.2) 7% ■ Beta (B.135.1) 0.2% ■ Beta (B.135.1) < 1% ■ Gamma (P.1) 8.9% (16.4% June 24th) ■ Iota (B.1.526) 3.0%
CDC Estimated Proportions of SARS-CoV-2 Lineages, United States (July 3, 2021)
What You Should Know About Delta Variant
What You Should Know About the Delta Variant (B.1.617.2)
• First emerged in India October 2020
• Didn't raise alarms until major surge Spring 2021
o B.1.617.2 (Kappa, VOI) = sub-variant of B.1.617
o B.1.617.3 (VOI)
o B.1.617.2.1 ("Delta plus“)
• Chief mutation is L452R which changes the spike protein.
• "Delta plus" acquired additional K417N mutation (also spike
protein)What You Should Know About the Delta Variant (B.1.617.2) • More than 80% of new COVID-19 cases in 4 U.S. states • Kansas, Arkansas, Missouri, and Connecticut have highest proportion of Delta cases • Missouri - causing more than 96% of new cases • Delta variant currently ~52% of all lineages sequenced in U.S.
What You Should Know About the Delta Variant (B.1.617.2)
• Is Delta more transmissible?
o Appears to be 64% more transmissible than the Alpha variant
(B.117) in household transmission (Public Health England study)
o Alpha was already estimated to be 50% more transmissible than the
wild-type virus
• Is Delta more virulent?
o Not clear if Delta causes more severe disease or leads to more
deaths
o Preliminary data from Public Health England study suggests Delta
may be more virulent.
■ Risk of hospital admission was 85% higher in patients with the Delta variant
compared with the Alpha variant (HR 1.85, 95% CI 1.39-2.47).What You Should Know About the Delta Variant (B.1.617.2)
• Do vaccines protect against Delta?
o Public Health England study suggests vaccines protect against Delta with reduced efficacy
o 10% absolute reduction in overall vaccine effectiveness (two doses) against symptomatic
disease with Delta compared with Alpha (79% vs 89%)
o Full vaccination offered similar protection against Delta (96%) and Alpha (93%) for
hospitalizations
o Pfizer's vaccine appeared more protective against symptomatic disease from Delta than
AstraZeneca's (87.9% vs 59.8%).
o The Lancet study from Public Health Scotland found better efficacy with Pfizer's vaccine
(79%) than for AstraZeneca's (60%).
o Small Moderna study showed "modest reduction" in neutralizing antibodies against Delta
o Breakthrough infections with Delta variant greater after vaccination
o Current vaccines do provide excellent protection against sickness and death compared to no
vaccinationWhat You Should Know About the Delta Variant (B.1.617.2)
• Do Monoclonal Antibodies work against Delta?
o CDC states there's a "potential reduction in neutralization" by some currently authorized Mab
treatments
o Eli Lilly's monoclonal antibody combination (bamlanivimab/etesevimab) paused due to poor
performance against the Gamma (P.1) and Beta (B.1.351) variants.
o Regeneron and GlaxoSmithKline/Vir Biotechnology's both maintain there's no reduction in
neutralization against Delta
• Are kids at greater risk from Delta?
o No data whether that's true biologically but concerned about kids' vulnerability simply because they're
not vaccinated yet.
o ~ 25% current Maryland cases in children < 18 years of age
o No indication yet that Delta is more severe in kids.
• Why Is everyone worried?
o Only about half of the U.S. is fully vaccinated
o When fall arrives, Delta could be particularly problematic for those who still not vaccinatedSARS-CoV-2 Variants of Concern England Technical briefing 17
(June 25, 2021)
• Delta dominant variant in the U.K.
• Accounted for ~ 95% (74% 2 weeks earlier) of sequenced cases and 92% of sequenced
and genotyped cases from June 7-21, 2021
• PCR cycle threshold (Ct) values persistently lower in Delta than Alpha cases
• Secondary attack rates remain higher for Delta than Alpha in both traveler and non-
traveler cases and amongst both household and non-household contacts
• Early data demonstrate increased risk of hospitalization with Delta compared to Alpha
• Majority of outbreaks identified through contact tracing are attributed to Delta variant
• Case fatality: 1.9% for Alpha, 0.3% for Delta (only 22% of Delta cases with > 28 days f/u)
• Adjusted odds of household clustering was 1.64 (95%CI 1.26-2.13, pCumulative cases in England of variants indexed by days since the fifth reported, (June 21, 2021)
Maryland State Board of Dental Examiners
• Important notice for all Maryland licensed dentists, dental hygienists, and dental radiation
technologists
• Governor Hogan terminates various emergency executive orders
• Executive order number 21-06-15-01
• Important notice
• On June 15, 2021, Governor Larry Hogan signed the above executive order terminating a number
of previous executive orders, to become effective July 1, 2021. This order does not affect the
practice of dentistry.
• CDC guideline compliance.
o In accordance with Maryland law, dentists and their staff are still required to follow the
recommendations of the CDC in dental settings, including, but not limited to the wearing of
masks for staff, and patients who are waiting to be treated.
• As licensees, you are responsible for staying apprised of the recommendations of the CDC.
HTTPS://www.Cdc.Gov/coronavirus/2019-ncov/hcp/dental-settings.HtmlCOVID Vaccine News
FCHD COVID Vaccine Clinics
Frederick County Health Department
Oak Street Vaccination Clinic
• Schedule appointments
■ http://FrederickCountyMD.gov/CovidVaccine
■ Call 301-600-7900
■ Walk-in, no appointments available
• Permanent 1st dose clinic schedule starting July 8, 2021
■ Every Wednesday 4 pm – 7 pm
■ Every Thursday 4 pm – 7 pm
■ Every Friday 10 am – 1 pm
■ Every Saturday 10 am – 1 pmMaryland Summary
• Surveillance/Case Investigation
o Overall activity low, but some metrics up
o 464 new cases (462,681 total) last 7 days (389 weekly cases last week)
o More men than women (65% vs 35%)
o 25% of cases are less than 18 years of age
o More cases from NCR vs Baltimore region
o 95% of new COVID cases in June were unvaccinated
o 100% of all COVID deaths in June were unvaccinated
o 93% of all new COVID hospitalizations were unvaccinated
o Average case rate = 1.1 per 100K (22% increase)
o New deaths = 14 (9,538 total) in last week
o Outbreaks decreased 35% in last 7 days (29 today)Maryland Summary
• Testing
o Positivity 0.66% (this is also up slightly)
o State goal is to integrate testing and vaccination activities for
colocation partnership for on demand or popup locations.
o 32% of Positives came from antigen tests
• Vaccinations
o Average Vaccines Delivered Per Day over last 7 days = 10,855
o 18+ Vax Rate >75% for those receiving at least one dose
o Mass vaccine sites - only one site still active (6-Flags) but will
close July 10, demobilizing all other sitesMaryland Summary
• Variants
o Percentage of Delta VOC increased in the last week
o Gamma (P1) also increasing, but rate of increase is slowing
• Hospitalizations
o 119 pts in hospital; stable inpatient census over last week (up 4 compared to last week)
o 57 hospitals have no COVID patients
o Most hospitalized patients (93%) are unvaccinated
• Other
o Latest school operations guidance pending for Governor Hogan (especially mask questions)
o MAB infusions total = 8271 (14 in the last week)
■ Moving to ED (“on demand” paradigm)
■ Appears to be effective against Delta variantFrederick County Summary • Surveillance/Case Investigation o Overall activity low, but some metrics up o 7-day rolling average doubled from 7 18 cases/week o 90% of new cases are not vaccinated o Average case rate tripled last 7 days = 0.3 0.9/100K pop. o Deaths = 11 in last 70 days (1 this week) o Outbreaks = 1
Thank you!
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