NOVEL CORONAVIRUS (COVID-19) - FCHD Providers-Partners Update Randall Culpepper, MD, MPH Frederick County Deputy Health Officer August 19, 2021 ...
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NOVEL CORONAVIRUS (COVID-19)
FCHD Providers-Partners Update
Randall Culpepper, MD, MPH
Frederick County Deputy Health Officer
August 19, 2021
Worldwide COVID Cases and Deaths (weekly) August 18, 2021)
https://covid19.who.int/ accessed August 18, 2021
Global 7-Day Rolling Average Cases (August 18, 2021)
7 day ∆
7,000,000
4,570,586 cases/week
(4,529,964 last week)
6,000,000
5,000,000
4,000,000
3,000,000
2,000,000
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 1-Aug
Global 7-Day Rolling Average Deaths (August 18, 2021)
7 day ∆
120,000
67,822 deaths/week
(68,324 last week)
100,000
(69,113 2 weeks ago)
80,000
60,000
40,000
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 1-Aug
Worldwide: COVID-19 (August 18, 2021)
Global cases rates per 100K (greater than 1000) in the past 30 days
https://covid.cdc.gov/covid-data-tracker/#global-counts-rates, accessed August 18, 2021)
United States COVID-19 Cases and Deaths (Aug 11 and Aug 18, 2021) Last week This week
U.S. 7-Day Rolling Average Cases (August 18, 2021)
7 day ∆
2,000,000
1,800,000
1,600,000
1,400,000
972,674cases/week
(798,806 last week)
1,200,000 (620,933 two weeks ago)
1,000,000
800,000
600,000
400,000
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-Jul 1-Aug
0
5,000
10,000
15,000
20,000
25,000
1-Aug
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
16-Jan
23-Jan
30-Jan
6-Feb
7 day ∆
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
5-Jun
12-Jun
19-Jun
26-Jun
3-Jul
10-Jul
17-Jul
U.S. 7-Day Rolling Average Deaths (August 18, 2021)
24-Jul
31-Jul
7-Aug
14-Aug
(3,234 last week)
4,637deaths/week
(2,771 two weeks ago)
U.S. COVID-19 Case Rate per 100K Last 7 Days (August 18, 2021)
U.S. percent population ≥ 12 years fully vaccinated (August 18, 2021)
Maryland Daily Trends in Number of COVID-19 Deaths (Aug 11 & Aug 18, 2021) Last week This week
Maryland 7-Day Rolling Average Cases (August 18, 2021)
7 day ∆
25,000
20,000
6,511 cases/week
(5,465 last week)
(3,396 two weeks ago)
15,000
10,000
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-Jul 1-AugMaryland Cases 10-year Age Breakdown (Aug 11 & Aug 18, 2021)
Last week This weekMaryland 7-Day Rolling Average Deaths (August 18, 2021)
7 day ∆
400
350
300
37 deaths/week
250
(29 last week)
200 (24 two weeks ago)
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-Jul 1-AugMaryland : COVID Vaccinations (August 18, 2021)
Maryland – ICU and Acute Hospital Beds for COVID-19 (August 18, 2021)
Last weekMaryland Active COVID-19 Outbreaks and Cases (August 18, 2021)
Last week
• 196 outbreaks
• 543 active casesFrederick County (August 18, 2021)
0
200
400
600
800
1,000
1,200
1,400
1,600
1-Aug
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
16-Jan
23-Jan
30-Jan
6-Feb
7 day ∆
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
5-Jun
12-Jun
19-Jun
26-Jun
3-Jul
10-Jul
17-Jul
24-Jul
31-Jul
7-Aug
14-Aug
Frederick County 7-Day Rolling Average Cases (August 18, 2021)
(263 last week)
342 cases/week
(149 two weeks ago)Frederick County Cumulative Deaths (August 18, 2021)
FC Deaths
400
350
300
250
15 deaths last 100 days
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-Jul 1-Aug21-27 July 4–10 August
FHH All ICU Acute FHH All ICU Acute
3 0 3 12 0 12
Frederick Health Hospital 3 0 3 12 0 12
Bed Census 1 0 1 16 0 16
2 0 2 18 0 18
2 0 2 17 0 17
2 0 2 15 0 15
3 0 3 12 0 12Clinical Updates
Governor Hogan Update (August 18, 2021)
• Delta variant - 100% of sequenced specimens in Maryland
• Shifted from state of emergency to long-term public health response
• MDH new vaccine protocols for all nursing home staff
o Every NH employee must submit proof of vaccination or submit to
weekly screening and testing
o Enhancing enforcement and stepping up fines
• MDH new vaccine protocols for all hospital employees
o Every hospital employee must submit proof of vaccination or submit
to weekly screening and testing
• Launched pilot antibody testing program for NH residents to ascertain
level of immunityGovernor Hogan Update (August 18, 2021) • Maryland has no plans for a vaccine passport. • Each local school system, nonpublic school, and child care program may set their own mitigation policies and procedures for their schools, students/children, teachers and staff.
Governor Hogan Update (August 18, 2021)
• Pushing for FDA authorization for 5-11 age group
• Pushing for FDA full approval of all COVID vaccines
• Monoclonal Ab therapy
o Expanded eligibility to include post-exposure prophylaxis for
unvaccinated and/or fully vaccinated immunocompromised
individuals who have been exposed to COVID case
o Treatment since Nov 2020 avoided over 450 hospitalizations
o Not a substitute for vaccination
o UnderutilizedMonoclonal antibody through IV infusion
• Vaccinated people who subsequently develop COVID-19
o Prior receipt of COVID-19 vaccine should not affect treatment
decisions
o Including use of monoclonal antibodies, convalescent plasma,
antiviral treatment, or corticosteroid administration) or timing
of such treatments.
• Antiviral therapy and COVID-19 vaccination
o Administration of an antiviral drug at any interval before or
after vaccination with any of the currently FDA-authorized
COVID-19 vaccines is unlikely to impair development of a
protective antibody responseMeritus Regional Monoclonal Antibody Infusion Center
• Open for monoclonal antibody through IV infusion.
• Infusion by referral only
o Fax Meritus Medical Center referral form to 301-790-9229
o https://www.meritushealth.com/images/covid/MdReferralFormforA
ntibodyInfusion_update-for-April-2_v3.pdf
• Mild to moderate COVID-19 in adults and high risk pediatric (age 12 - 17)
patients who are at high risk for progressing to severe COVID-19.
• For questions regarding the referral process, contact your provider or call
the Infusion Center at 301-790-8842
• Patient map to the Meritus Regional Infusion Center on their websiteAdditional dose vs Booster dose of COVID vaccine
• “Additional dose”
o Third dose after initial two dose primary vaccine series with
either mRNA vaccine
o Administered when initial immune response to primary vaccine
series is likely to have been insufficient
• “Booster” dose
o Third dose after initial two dose primary vaccine series with
either mRNA vaccine
o Administered when initial immune response to primary vaccine
series was sufficient but likely waned over time.“Additional dose” of Pfizer or Moderna COVID-19 vaccine Give an additional dose following a primary series to people associated with moderate to severe immune compromise such as in these conditions: • Active or recent treatment for solid tumor and hematologic malignancies • Receipt of solid-organ transplant and taking immunosuppressive therapy • Receipt of CAR-T-cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy) • Moderate or severe primary immunodeficiency (e.g., DiGeorge, Wiskott-Aldrich syndromes) • Advanced or untreated HIV infection • Active treatment with high-dose corticosteroids (i.e., ≥20mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, TNF blockers, and other biologic agents that are immunosuppressive or immunomodulatory • Other conditions determined by providers clinical judgment
“Additional dose” of Pfizer or Moderna COVID-19 vaccine • Use the same product, when possible: People should receive a3rd dose of the same mRNA product as their first two doses when feasible. If not feasible, a different mRNA product is allowed • Third dose must be more than 28 days after second dose. • Pfizer is available for people 12 years and older and Moderna for people 18 years and older. • Proof: self-attestation of having one of the conditions listed above, no prescription or doctor's note required. • If you've received Johnson & Johnson/Janssen vaccine: Currently there are not data to support the use of an additional mRNA COVID-19 vaccine dose after a primary Janssen COVID-19 vaccine in immunocompromised people.
“Additional dose” of Pfizer or Moderna COVID-19 vaccine
Importance of infection prevention measures
• Counsel all immunocompromised people (including those who
receive an additional mRNA dose) about potential for reduced
immune response to COVID-19 vaccination and need to continue
following prevention measures:
o Wear a mask
o Stay 6 feet apart from others they don’t live with
o Avoid crowds and poorly ventilated indoor spaces until advised
otherwise by their healthcare provider
• Strongly encouraged all close contacts of immunocompromised
people to be vaccinated against COVID-19“Additional dose” of Pfizer or Moderna COVID-19 vaccine
Additional clinical considerations:
• Give mRNA COVID-19 vaccination primary series and/or additional dose at least two weeks
before initiation or resumption of immunosuppressive therapies when possible
o Timing of COVID-19 vaccination should take into consideration immunosuppressive
therapies and optimization of both the patient’s medical condition and response to vaccine
• Patient’s clinical team best situated to determine degree of immune compromise and
appropriate timing of vaccination.
• Consider these factors in assessing general level of immune competence of patients:
o Disease severity, duration, clinical stability, complications, comorbidities, and any
potentially immune-suppressing treatment
• Serologic testing not indicated: use of serologic testing to determine immune response is not
recommended at this time. Providers' clinical judgement of the patient's general level of
immune competence is sufficient. Utility of serologic testing or cellular immune testing to assess
immune response to vaccination and guide clinical care (e.g., need for an additional dose) has
not been established and is not recommended at this time.Joint Statement from HHS Public Health and Medical Experts
on COVID-19 Booster Shots (August 18, 2021)
• COVID-19 vaccines authorized in the US continue to be remarkably effective in reducing risk of
severe disease, hospitalization, and death, even against the widely circulating Delta variant
• Data shows protection against SARS-CoV-2 infection begins to decrease over time following the
initial doses of vaccination
• In association with the Delta variant, evidence of reduced protection against mild and moderate
disease
• Current protection against severe disease, hospitalization, and death could diminish in the
months ahead, especially among those who are at higher risk or were vaccinated during the
earlier phases of the vaccination rollout.
• Feds conclude that booster shots needed to maximize vaccine-induced protection and prolong
durability.
• Plan to offer booster shots for all Americans beginning September 20 and starting 8 months after
an individual’s second dose.
• Subject to FDA conducting an independent evaluation and determination of the safety and
effectiveness of a third dose of the Pfizer and Moderna mRNA vaccines and CDC’s Advisory
Committee on Immunization Practices (ACIP) issuing booster dose recommendations based on a
thorough review of the evidence.CDC Myocarditis update survey after mRNA vaccination • Enhanced surveillance activity • F/u reported VAERS myocarditis cases to assess long-term outcomes • Most have recovered well but can’t assess recovery of the heart until at least 3 months have passed • CDC will contact individual patients or parents to assess functional outcomes and then contact their provider by mail and then phone to do a secondary survey • Beginning next few weeks and lasting several months
COVID-19 Vaccines While Pregnant or Breastfeeding • COVID-19 vaccination recommended for everyone >= 12 years • Includes women who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future • Pregnant and recently pregnant people are more likely to get severely ill with COVID-19 compared with non-pregnant people • Getting COVID-19 vaccine can protect against severe illness • American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant and lactating women be vaccinated against COVID-19
COVID-19 Transmission Levels by State/Territory
COVID Variant Strains
WHO: Variants of Concern Labels
WHO: Variants of Interest 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)
– Includes B.1.351.2, B.1.351.3
• Iota - B.1.526.1 (New York) (L452R)
• Gamma - P.1 (Brazil) (E484K)
• Epsilon- B.1.427 (California) (L452R) – Includes P.1.1, P.1.2
• Epsilon - B.1.429 (California) (L452R) • Delta - B.1.617.2 (India) (E484Q and L452R)
• Zeta - P.2 (Brazil) – Includes Delta Plus AY1, AY2, AY3
• Kappa - B.1.617.1 (India)
L452R or E484K substitutions in the spike protein impact
• Lambda - B1.1.1.37 (Peru) susceptibility to EUA monoclonal antibody treatments.COVID 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
• 1st dose clinic schedule
■ Every Wednesday 4 pm – 7 pm
■ Every Thursday 4 pm – 7 pm
■ Every Friday 10 am – 1 pm
■ Every Saturday 10 am – 1 pmThank you!
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