WSHA COVID-19 Meeting with State Leaders - December 13, 2021 This meeting is being recorded
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WSHA COVID-19 Meeting with State Leaders
December 13, 2021
This meeting is being recorded
Agenda • Reflections from Peer Meetings – Cassie Sauer & Taya Briley, WSHA • Epi Report & COVID-19 Update – Dr. Bob Lutz, DOH • Difficult to Discharge – Zosia Stanley, WSHA • mAb Update – Ezra Stark, DOH • Vaccine Update – SheAnne Allen, DOH • COVID-19 and the 2022 Legislative Session – Ashlen Strong & Cassie Sauer, WSHA
Reflections from Peer Meetings Cassie Sauer, WSHA Taya Briley, WSHA
Epi Report & COVID-19 Update Dr. Bob Lutz, DOH
WSHA LEADERSHIP 12.13.2021 Bob Lutz, MD, MPH
https://www.nytimes.com/interactive/2021/us/covid-cases.html?name=styln- coronavirus®ion=TOP_BANNER&block=storyline_menu_recirc&action=click&pgtype=LegacyCollection&variant=0_Control&is_new =false
https://www.nytimes.com/interactive/2021/us/covid-cases.html?name=styln- coronavirus®ion=TOP_BANNER&block=storyline_menu_recirc&action=click&pgtype=LegacyCollection&variant=0_Control&is_new=false
https://www.nytimes.com/interactive/2021/us/covid-cases.html?name=styln- coronavirus®ion=TOP_BANNER&block=storyline_menu_recirc&action=click&pgtype=LegacyCollection&variant=0_Control&is_new=false
https://www.nytimes.com/interactive/2021/us/covid-cases.html?name=styln- coronavirus®ion=TOP_BANNER&block=storyline_menu_recirc&action=click&pgtype=LegacyCollection&variant=0_Control&is_new=false
0.83
0.32% 1/312
Statewide trends
Week 48 November 28 – December 04, 2021
During week 48, 0.4% of specimens tested by WHO/NREVSS collaborating
laboratories in Washington were positive for influenza.
https://www.doh.wa.gov/Portals/1/Documents/5100/420-100-FluUpdate.pdftotal cases (confirmed & probable) – 788,877; Δ9961; 1423/d (1345/d) total hospitalizations – 43,599; Δ382; ~55/d total deaths – 9535; Δ155 *IR – 244/100,000/2wks (280/100,000/2wks) *as of 12.09.2021
7d day avg. – 1571 (1349)
244/100,000/2wks (280)
data as of 12.09.2021Data as of 12.09.2021
Data as of 12.09.2021
data as of 12.09.2021
Eastern WA
7d rolling avg. – 406 (366)
272/100,000/2wks (369)
data as of 12.09.2021Eastern WA
data as of 12.09.2021Eastern WA
data as of 12.09.2021Western WA
7 d rolling avg. – 1168 (959)
235/100,000/2wks (281)
data as of 12.09.2021Western WA
data as of 12.09.2021Western WA
data as of 12.09.2021healthcare
7d rolling avg. – 92 (99)
7d rolling avg.-120
data as of 12.09.202120.6
7d rolling avg. – 92 (99)
7d rolling avg.-120
data as of 12.09.202125%
data as of 12.09.2021data as of 12.09.2021
7d rolling avg. – 92 (99)
7d rolling avg.-120
data as of 12.09.20217d rolling avg. – 92 (99)
7d rolling avg.-120
data as of 12.09.2021WA Health – 11.27.2021
WA Health – 12.03.2021
WA Health – 12.12.2021
vaccinations
https://www.gisaid.org/hcov19-variants/
https://theconversation.com/south-africa-early-data-suggest-omicron-is-more-transmissible-but-less-severe-173517
Phylogenetic tree of Nextstrain Clade 21K (Omicron)
transmission advantage
transmission advantage -
increased transmissibility
increased immune escape
might see different patterns of immune escape in
different settings
Omicron appears to be rapidly out-competing
Delta in South Africa
Washington State Department of Health | 43transmission advantage
Number of
sequences
% of
sequences
Delta Omicron
Time in weeks (2021)
South Africa National Institute for Communicable Diseases: Tracking SARS-CoV-2 variants, 12/8/21 report.
https://www.nicd.ac.za/diseases-a-z-index/disease-index-covid-19/sars-cov-2-genomic-surveillance-update/
Washington State Department of Health | 44virulence
potential reduced clinical severity in South Africa -
true decrease in virulence
testing/bias, confounding
time lag for hospitalizations/deaths
protection from severe illness/death - immunity from prior
infection or vaccination
South African Medical Research Council, Tshwane District Omicron Variant Patient Profile - Early Features. 12/4/21.
https://www.samrc.ac.za/news/tshwane-district-omicron-variant-patient-profile-early-features
Twitter, John Burn-Murdoch, 12/8/21. https://twitter.com/jburnmurdoch/status/1468310555844874257
Washington State Department of Health | 45immune escape - two lines of evidence
risk of reinfection appears to be increasing in South Africa*
early results from neutralization assays - decreased neutralization of
Omicron by sera for various combinations of vaccines and prior infection
better neutralization with prior infection + vaccination or 3 mRNA doses
*MedRxiv, Pulliam et al., Increased risk of SARS-CoV-2 reinfection associated with emergence of the Omicron variant in South Africa, 12/2/21.
https://www.medrxiv.org/content/10.1101/2021.11.11.21266068v2
tSee “Immune escape references” slide for remaining references
Washington State Department of Health | 46immune escape - neutralization results
Pfizer and BioNTech, 12/8/21. https://investors.biontech.de/static-files/47b4131a-0545-4a0b-a353-49b3a1d01789
Washington State Department of Health | 47impact on diagnostics
almost all NAAT and antigen tests will continue to
detect Omicron
one PCR test will fail to detect Omicron entirely (Tide
Laboratories DTPM COVID-19 RT-PCR Test)
some PCR tests will have S-gene target failure (SGTF),
which can help identify possible Omicron cases
one lineage of Omicron does not have SGTF - absence of SGTF
will not rule out Omicron
FDA, SARS-CoV-2 Viral Mutations: Impact on COVID-19 Tests, 12/7/21. https://www.fda.gov/medical-
devices/coronavirus-covid-19-and-medical-devices/sars-cov-2-viral-mutations-impact-covid-19-tests
Washington State Department of Health | 48prioritizing Omicron for sequencing
DOH - proactively request specimens for all cases
marked with international travel
query cases with travel information in WDRS
view in CREST to identify cases
DOH has contacted all laboratories known to run the
TaqPath assay and asked them to submit S-dropout
specimens to PHL
working with LHJs to request specimens for cases epi-
linked to confirmed Omicron cases
Washington State Department of Health | 49Washington State Department of Health is committed to providing customers with forms
and publications in appropriate alternate formats. Requests can be made by calling
800-525-0127 or by email at civil.rights@doh.wa.gov. TTY users dial 711.Difficult to Discharge Zosia Stanley, WSHA
Difficult to discharge/Long length of stay patients
• Increasing capacity concerns due directly to difficult to place patients
• Impacting nonurgent procedures and exacerbating workforce challenges
• WSHA pursuing legislative priorities to address top barriers and establish sustainable
solutions:
– Consent to long term care placement
– DSHS staffing increase
– Fund public guardianships for low-income patients
– Maintain LTC incentives for patients discharging from hospitals
– Maintain capacity for COVID+ SNF units
– Presumptive eligibility for Medicaid LTC
– Increase Medicaid rates for LTC facilitiesmAb Update Ezra Stark, DOH
COVID-19 Therapeutics distribution Updates for Washington Hospitals Ezra Stark – DOH Medical Countermeasures Coordinator December 12th, 2021
mAb Allocations for Washington State
Date HHS Allocation to Casirivimab Bamlanivimab Sotrovimab EVESHELD
Washington /Imdevimab /Etesevimab
Copyright Notice
©2020, Washington State
November 15th, 3,460
Hospital Association.
1,740
All Rights Reserved.
1,030 690 0
2021
November 29th, 2,664 1,464 1,200 0 0
2021
December 13th, 2,234 1,224 1,010 0 1,080(anticipated)
2021
Notes:
- 2-week allocation cycles
- Recent decrease in REGEN-COV availability(EUA expanded)
- Steady availability of bamlanivimab/etesevimab(EUA expanded)
- Sotrovimab not available in state allocation
- EVUSHELD allocation available this week(EUA authorized)Challenges/Issues:
Copyright Notice
©2020, Washington State Hospital Association. All Rights Reserved.
Monoclonal
Antibody
Administration
Sites that have
requested
shipment in WACopyright Notice ©2020, Washington State Hospital Association. All Rights Reserved.
Copyright Notice
mAb updates
©2020, Washington State Hospital Association. All Rights Reserved.
Casirivimab / Imdevimab(REGEN-COV)
Expanded storage requirements to allow to kept kept at room temperature for up to 30 days when shielded from light.
Bamlanivimab / Etesevimab
Expanded the Emergency Use Authorization (EUA) for bamlanivimab and etesevimab administered together to
include pediatric patients under the age of 12, including neonates (infantsCopyright Notice
New Therapeutics Update - EVUSHELD
©2020, Washington State Hospital Association. All Rights Reserved.
On December 8, 2021, AstraZeneca’s EVUSHELD, a combination of two anti-SARS-COV-2 monoclonal antibodies
(tixagevimab/cilgavimab), received an EUA from the FDA.
(https://www.fda.gov/media/154701/download)
mAb for pre-exposure prophylaxis in individuals aged 12 and older (weighing ≥ 40 kg) who are either unable to mount
an adequate immune response to COVID-19 vaccination or are unable to get a COVID-19 vaccine due to concern for
severe adverse reactions.
Current authorization is for redosing every six months. The product is administrated via intramuscular injection.
EVUSHELD is supplied as a single carton containing 1 single-dose vial of tixagevimab injection and 1 single-dose
vial of cilgavimab injection.
Twenty-four cartons are packaged in a case and the case is the minimum order. EVUSHELD is stored as a
refrigerated product at 2° to 8°C.Copyright Notice New Therapeutics Update - Molnupiravir ©2020, Washington State Hospital Association. All Rights Reserved. The Antimicrobial Drugs Advisory Committee (AMDAC) met on 30 November and recommended Merck’s Molnupiravir oral antiviral for use by a narrow 13-10 vote. The FDA has not formally considered the AMDAC’s recommendation for use under an EUA but is expected to do so on 17 December. Molnupiravir is packaged in unit-of-use bottles, 40 capsules to taken 8 per day over 5 days and intended to treat outpatients with mild to moderate COVID-19. Storage is normal room temperature, 20° to 25°C. Molnupiravir could be ready to order via Healthcare Partner Order Portal the week of 20 December.
CopyrightAllocation
Antiviral Notice Prioritization
©2020, Washington State Hospital Association. All Rights Reserved.
Tier 1A
Sites (or partnerships) that can fulfill all test to treat requirements in a high SVI/region with higher cases per 100k.
Tier 1B
Sites (or partnerships) that can fulfill all test to treat requirements in a region with higher cases per 100k.
Tier 1C
Sites (or partnerships) that can fulfill all test to treat requirements in high SVI counties that do not have high cases per
100k.
Tier 2
Sites that cannot fulfill all test to treat requirements, however, are able to administer or dispense treatment based on
prescription or recommendation from a healthcare provider. This tier will be used when allocation amounts are larger.
“test to treat requirements” are defined by a site that can provide COVID-19 testing, patient evaluation and
recommendation, provide prescription for treatment, and administer or dispense treatment on its own or through
partnerships.“Test to Treatment”
Copyright Notice
©2020, Washington State Hospital Association. All Rights Reserved.
DOH will continue to identify suitable sites for distribution based on
capabilities that can expedite test-to-treatment.
Sites that can:
Administer/confirm either molecular/antigen POC COVID-19 test
Prescribe medication
Dispense medication
There is an anticipated 5-day window between symptom onset and when an
antiviral course should begin.
May be an additional requirement to test for pregnancy in some cases.Copyright
FederalNotice
Retail Pharmacy Partnerships
©2020, Washington State Hospital Association. All Rights Reserved.
Goal:
Work with retail pharmacy partners to
provide oral antiviral dispensing
capabilities statewide. Retail
pharmacies as complementary to
health care partners, not primary
Partners: Walgreens / Rite-Aid / CVS
Locations: 1-3 sites per region initially
Capability: Able to
test/prescribe/dispense
Benefit: Will allow wider, more
equitable availability statewideCopyright Notice
Other distribution partners
©2020, Washington State Hospital Association. All Rights Reserved.
• Regional hospitals
• Local clinics
• Independent pharmacies
• Health DepartmentsOrientation for new Healthcare Partner Order
Portal (HPOP) sites
Training/Orientation are held via virtual training
on Tuesdays at 9AM through the reminder of
Questions? 2021.
Upcoming Dates:
December 14th
December 21st
Please contact mcm@doh.wa.gov to register.Vaccine Update SheAnne Allen, DOH
68
Vaccinations by age group Source https://www.doh.wa.gov/Emergencies/COVID19/DataDashboard (12/13/2021)
1 year celebration of vaccine rollout
What’s coming next?
(Things we are waiting for…)
Moderna for adolescents
Moderna for children (6-11 y)
Moderna full BLA
Smaller Pfizer/Comirnaty package size
J & J for adolescents
J & J for children (6-11 y)
J & J full BLA
Boosters for kids (?)
Vaccine recommendations 6 months+ (?)
Washington State Department of Health | 71• Booster doses of the
Booster Doses Pfizer-BioNTech vaccine are
now available for teens ages
16 and 17.
• Everyone 16 and older is
recommended to get a
booster dose:
• Six months after
receiving the
Moderna or Pfizer
vaccine, or
• Two months after
receiving the
Johnson & Johnson
vaccine.Pfizer
• Pfizer 450 –no longer available
• Pfizer has submitted an expiration date extension for peds.
• Comirnaty.
• 300 minimum dose order
• 12+ (12-15 covered under EUA)
• Will come in the Peds shipper
• Same storage as Peds
• No more diluent
• Same volume of dose (.3ml)
• Will see in threshold in mid-December. Start planning. The initial lots will be
short dated, so providers should not be stocking up.Washington State Department of Health | 74
Moderna Ordering
• Half Doses
• If you need 200 booster doses, when you order in the IIS you only need to order 100
• Ordering Cap
• There is a lot of Moderna out in the field expiring in the next few months so make
sure you are rotating stock and changing your ordering patterns accordingly
• Some Moderna is short-dated to expire in January so order as needed.
• Vaccine Advertisement page
Washington State Department of Health | 75Additional Updates Supply • Additional access points • Update vaccine locator • Manage inventory- expiring doses HRSA • HRSA is not really doing distribution anymore. They are pushing them back to the Jurisdictions to order both Peds and adult vaccine. Pfizer 2-4 year old • Feb- Mar
FEMA Opportunity • Dec 15- Jan 20 • Thurston & King County • Fixed sites • Mobile vaccine teams • Inslee announced FEMA mobile COVID-19 vaccination unit will be coming to Western Washington.
COVID Vaccine Counseling Billing
Providers who counsel patients about COVID-19 vaccine
information and availability can bill using the codes below:
Established patient office visit series: 99211 - 99215
Preventive medicine counseling, approx. 15 minutes: 99401(new
as of 12/3/21)
Telephone evaluation codes: 99441 - 99443
In the scenario the provider is already seeing the patient for
another reason, and counseling for COVID-19 vaccination
increases the time spent with the patient, the provider may
account for this additional time by choosing the appropriate
E/M level
Nurses and medical assistants who counsel patients about COVID-
19 vaccine information and availability can bill using CPT® code
99211
Policy retroactive to dates of service beginning on 6/22/21Vaccine Counseling Emergency Order
Conditions for coverage:
Consultation is by an in-network medical provider (does not include pharmacy
services providers)
Provider checks patient’s vaccination status and asks patient to confirm patient
isn’t already vaccinated. Provider has established relationship with patient
Provider/patient discussion is contemporaneous, either in-person or via voice. If
audio-only, patient must consent to health plan being billed for the service
Cap of two billings per patient
Bill using diagnosis code Z71.89 and CPT code 99401, 99441 or 98966COVID Vaccine Administration Billing
COVID-19 and the 2022 Legislative Session Ashlen Strong, WSHA Cassie Sauer, WSHA
Thank you for joining us today
Copyright Notice ©2021, Washington State Hospital Association. All Rights Reserved.
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