NOVEL CORONAVIRUS (COVID-19) - Provider and Partner Medical Update Randall Culpepper, MD, MPH - Frederick County ...
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NOVEL CORONAVIRUS (COVID-19)
Provider and Partner Medical Update
Randall Culpepper, MD, MPH
Frederick County Deputy Health Officer
November 4, 2021
646 days Jan. 28, 2020 – Nov. 4, 2021
Worldwide COVID Weekly Cases and Deaths (Nov 4, 2021)
https://covid19.who.int/ accessed November 4, 2021
Global 7-Day Rolling Average Cases (Nov 3, 2021)
7 day ∆
7,000,000
3,062,352 cases/week
6,000,000
2,913,271 last week
2,934,149 two weeks ago
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 1-Sep 1-Oct 1-Nov
Global 7-Day Rolling Average Deaths (Nov 3, 2021)
7 day ∆
120,000
50,558 deaths/week
100,000
49,423 last week
48,280 two 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 1-Sep 1-Oct 1-Nov
COVID-19 situation in the WHO European Region
United States COVID-19 Cases and Deaths (Oct 27 and Nov 3, 2021) Last week This week
U.S. 7-Day Rolling Average Cases (Nov 3, 2021)
7 day ∆
2,000,000
1,800,000
632,043 cases/week
1,600,000
496,229 last week
1,400,000
625,396 two weeks ago
1,200,000
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 1-Sep 1-Oct 1-Nov
U.S. 7-Day Rolling Average Deaths (Nov 3, 2021)
7 day ∆
25,000
10,657 deaths/week
20,000
9,159 last week
12,463 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-Aug 1-Sep 1-Oct 1-Nov
Maryland Daily Trends in Number of COVID-19 Deaths (Oct 27 and Nov 4, 2021) Last week This week
Maryland 7-Day Rolling Average Cases (Nov 4, 2021)
7 day ∆
25,000
4,844 cases/week
20,000
5,259 last week
6,368 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-Aug 1-Sep 1-Oct 1-NovMD 10-year Age Breakdown New Cases (Oct 26 and Nov 3, 2021)
Oct 26 (731) Ages Nov 3 (800)
98 13% 0-9 125 16%
101 14% 10-19 112 14%
88 12% 20-29 111 14%
116 16% 30-39 140 18%
98 13% 40-49 109 14%
91 12% 50-59 82 10%
68 9% 60-69 75 9%
45 6% 70-79 36 5%
26 4% 80+ 10 1%Frederick County daily COVID cases by age group percentages
20
18
16
14
12
10
8
6
4
0-9 % 10-19 %
2
0Frederick County daily COVID cases by age group percentages
Chart Title
20
18
16
14
12
10
8
6
4
0-9 % 10-19 %
2
0Maryland 7-Day Rolling Average Deaths (Nov 4, 2021)
7 day ∆
400
350
85 deaths/week
300
83 last week
113 two weeks ago
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-Jul 1-Aug 1-Sep 1-Oct 1-NovMaryland : COVID Vaccinations (Nov 4, 2021)
Maryland – ICU and Acute Hospital Beds for COVID-19 (Nov 3, 2021)
Last week
Total - 587
Acute - 434
ICU - 153Maryland Active COVID-19 Outbreaks and Cases (Nov 3, 2021)
Last week
• 373 outbreaks
• 1,072 active casesMaryland COVID-19 Outbreaks Summary (Nov. 3, 2021)
Last week
• 116 school outbreaks
• 450 active casesFrederick County (Nov 4, 2021)
Case rate/100K = 14.8
12-17 year olds are 68.4% Fully Vaccinated Frederick County residents
fully vaccinated (Nov 4, 2021)
% population >= 12 years
79.5% (#4 in MD)
% population >= 18 years
80.7% (#4 in MD)
% population >= 65 years
92.9% (#5 in MD)Frederick County 7-Day Rolling Average Cases (Nov 4, 2021)
7 day ∆
1,600
1,400 268 cases/week
1,200
280 last week
285 two weeks ago
1,000
800
600
400
200
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 1-Sep 1-Oct 1-NovMaryland COVID-19 Case Rates by County (Oct 27 and Nov 4, 2021)
Frederick County Cumulative Deaths (Nov 4, 2021)
25
7 day ∆
37 deaths last 125 days
20
• June: 4
• July: 3
15
• Aug: 6
• Sept: 15
10
• Oct: 11
• Nov: 2
5
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 1-Sep 1-Oct 1-NovJuly 21-27 Oct 27-Nov 2
FHH All ICU Acute FHH All ICU Acute
Frederick Health Hospital 3 0 3 25 5 20
Bed Census 3
1
0
0
3
1
23
21
5
5
18
16
2 0 2 24 5 19
2 0 2 18 5 13
2 0 2 26 6 20
Frederick County, MD COVID-19 Hospital Statistics:
Acute Beds, ICU Beds of COVID+ 3
Patients 0 3 29 6 23
COVID-19 Patients in Acute Beds COVID-19 Patients in ICU Beds
70
60
# of Patients with COVID-19
50
40
30
20
10
0Frederick County Summary (Nov 4, 2021)
• Community transmission of COVID-19 remains HIGH!
• Seven-day rolling average of new cases = 14.8 (15.7) cases per 100,000 (Maryland’s is
11.5)
• > 250 new COVID cases every week for each of the past 12 weeks
• FHH ~ 29 COVID hospitalizations
• 11 deaths in October (15 in September)
• Test positivity rate higher than Maryland since Sept. 8 (5.1 % vs 2.9%)
• County facilities will remain open by appointment only until Jan. 1, 2022
• Masks must continue to be worn in all County buildings, including Public Libraries
• Residents encouraged to get vaccinated – primary series and booster doses
• Wear masks in indoor public placesFCPS COVID Cases - students and staff (2020-2022)
Clinical Updates
MD Clinical Laboratories Influenza Test Percent Positive (Oct 23, 2021)
MDH Clinical Laboratories % Positive Week Ending
October 23
■ Influenza –like illness activity = minimal
■ 3,082 (2,898) specimens - 55 positive (1.8%)
■ No influenza-associated hospitalization
■ No influenza-associated adult deaths
■ 2 RSV outbreaks reportedFrederick County COVID-19 Testing
Frederick Health Villages Drive-Through Testing (beginning Nov 8, 2021):
• FHH recommends patients arrive with a provider’s order in hand
• All others will still be accommodated and tested
• Patients without a hardcopy order in their hand will be phoned in their car by a staff member at
the hospital (likely a CNA at their urgent care center) for a “telehealth visit” who will then
forward an electronic order to the testing tent.
• FHH will bill a patient's insurance if possible but there will be no co-pay or any other out-of-
pocket expense to the patient.
• If patient has no insurance, FHH will seek compensation from the Coronavirus Aid, Relief, and
Economic Security (Cares) Act.
• Patients can call ahead of time to the FHH telehealth # to get the electronic order in place (Note:
phone number still pending)
• Patients will not be billed for the telehealth visitFrederick County COVID-19 Testing • Community including pharmacies (e.g., CVS’s, Hillcrest pharmacy) • Urgent care centers (e.g. UNI, MedSTAR Health) • Private laboratories (e.g., CTR Lab) • Private clinics (e.g., EZ Care Clinic)
Frederick County COVID-19 Testing Frederick County Health Department • Hillcrest Clinic on Route 40 • Pop-up sites around the community o Rescue Mission o Lucas Villages o Fredericktown Mall parking lot o Brunswick o Thurmont
COVID 19 Monoclonal anybody (mAb) treatment comes to FHH
■ Decreases hospitalizations, severe disease and
death for patients with mild to moderate COVID-19
■ Closest infusion centers at Meritus Health and
Baltimore (Convention Center, MedStar Harbor
Hospital and Hatzalah of Baltimore)
■ New Frederick Health COVID-19 mAb Clinic
recently opened !!!!!COVID 19 Monoclonal anybody (mAb) treatment comes to FHH
Once patient has been identified as COVID-19 positive, providers
follow these steps:
• Review the patient eligibility requirements for monoclonal
antibody therapy and assess the patient to see if they meet the
qualifications.
• Eligibility requirements can be found on the Maryland Health
Department website or by clicking this link:
https://health.maryland.gov/phpa/Documents/MdReferralFormfor
AntibodyInfusion_031221.pdf
• Educate patient on mAb infusion and discuss risks, benefits and
alternatives to treatmentCOVID 19 Monoclonal anybody (mAb) treatment comes to FHH
• Obtain and complete “Frederick Health mAb Clinic Referral Packet”
o Provider instructions
o Patient instructions
o Maryland referral form)
https://health.maryland.gov/phpa/Documents/MdReferralFormforAntibodyI
nfusion_031221.pdf
■ Referral packets soon available on FHH and FCHD websites
■ FHMG employees can go now to the Frederick Health intranet
• Fax referral form to Frederick Health at 240-566-4833
• FHH pharmacy team reviews referral and scheduling center calls patient to
secure appointment ideally within 24-48 hours
• Patients should plan to be at the appointment for approximately 2-2 ½ hours
• At this time, there is no cost to patient for the medication although there may be
a cost associated with the procedure to administer the drug. Insurance may
cover those expenses.COVID 19 Monoclonal anybody (mAb) treatment comes to FHH
• Located near FHH Entrance 2 (Red Emergency Entrance)
• Go through entrance past ambulance bay and look for reserved parking spots for
Monoclonal Antibody patients.
• Hours of operation:
o Monday: 0800-1630
o Wednesday: 0800-1630
o Friday: 0800-1630
• Questions or concerns:
o Alison Conway, mAb Clinic Manager, aconway@frederick.health, 240-566-3831
o Brian Stump, Clinical Pharmacy Manager, bstump@frederick.health, 240-566-3263COVID Variant Strains
WHO: Variants of Concern Labels
WHO: Variants of Interest Labels
SARS-CoV-2 Variants (Old Classification)
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.
• Mu – B.1.621 (Columbia)U.S. COVID Variants (New Classification)
Monitoring Variant Proportions, United States (Oct 23, 2021)
COVID-19 Vaccine News
Pfizer-BioNTech COVID-19 Vaccine in Children 5-11 Years of Age
• Over 1.9 million infections, 8,300 hospitalizations (~ 1/3 required
ICU care), 2,500 cases of multisystem inflammatory disorder, ~
100 deaths
• October 26 (FDA):
o FDA’s Vaccines and Related Biological Products Advisory
Committee recommends authorizing Pfizer COVID-19 vaccine in
children 5 through 11 years of age
o “Access, personal choice, and equity question; not a mandate
for all in this age”
• October 29 (FDA):
o FDA Acting Commissioner authorized the emergency use of the
Pfizer vaccine for the prevention of COVID-19 to include
children 5 through 11 years of age.Pfizer-BioNTech COVID-19 Vaccine in Children 5-11 Years of Age
• November 2 (CDC):
o CDC’s Advisory Committee on Immunization Practices
unanimously recommended to the CDC Director the use of
the Pfizer vaccine in children 5-11 years of age
• November 2 (CDC):
o CDC Director endorsed her advisory committee’s
recommendation that children 5 to 11 years old be
vaccinated against COVID-19 with the Pfizer-
BioNTech pediatric vaccineFCHD COVID Vaccine Clinic for Children 5-11 years of age • CDC recommends children between ages of 5 and 11 years receive the Pfizer-BioNTech pediatric COVID-19 Vaccine • Due to different pediatric dose, FCHD will hold separate clinics for this group • A parent or guardian must accompany child to the vaccination clinic
FCHD COVID Vaccine Clinic for Children 5-11 years of age
• Links to schedule appointments at FCHD Oak Street Clinic
provided below and at:
https://health.frederickcountymd.gov/629/COVID-19-Vaccine
•
Date Time Location Link to schedule
• child 5-11 years
11/13/2021 2-5pm 800 Oak Street, Frederick, MD 21703 Pfizer, 5-11,
(entrance off Himes Ave. directions). appointment required
11/20/2021 2-5pm 800 Oak Street, Frederick, MD 21703 Pfizer, 5-
(entrance off Himes Ave. directions). 11, appointment
requiredCOVID Vaccine Clinics for Children 5-11 years of age • Frederick County Public Schools will also be holding vaccination clinics in schools beginning next week • Check Find Out First for the school schedules • For local pharmacies and other locations offering vaccine for children 5-11, check out http://covidvax.maryland.gov/
How can I schedule an appointment to get a COVID vaccine?
• Schedule by calling 1-855-MDGoVax (855-634-6829)
• Pharmacy websites such as CVS, Safeway, Walgreens etc.
• Other vaccination events through Frederick County webpage:
• FrederickCountyMD.gov/CovidVaccine
39FCHD COVID Vaccine Clinics Nov 4 – Nov 12
Frederick County Health Department
Oak Street Vaccination Clinic
• Schedule all COVID vaccine appointments
■ FrederickCountyMD.gov/CovidVaccine
■ Call 1-855-MDGoVax (855-634-6829)
■ Appointments strongly preferred for planning but walk-ins ok
• Adult and adolescent Vaccine Clinic Schedule (all three COVID-19
vaccines are available)
■ 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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