What's Up With The Virus? Masks Recommended, Unvaccinated Medical Staff, Children Losing Parents...

  COVID-19 Alaska Clinical Update  Monday, August 2, 2021 CDC recommends vaccinated persons should resume wearing masks in public indoor spa...

 

DHSS Clinical Update

COVID-19 Alaska Clinical Update 
Monday, August 2, 2021

CDC recommends vaccinated persons should resume wearing masks in public indoor spaces in regions where COVID-19 is highly prevalent

On July 27, the CDC updated its guidance on mask wearing for individuals who have been fully vaccinatedagainst COVID-19. They now recommend fully vaccinated individuals should wear a mask in public indoor spaces if it is an area with substantial or high transmission, defined as areas where there are more than 50 new cases per 100,000 residents over the previous seven days, or more than 8% of tests are positive for COVID-19 infection over that period.

CDC updates school guidance to recommend universal masking for teachers, staff, students, and visitors in schools, regardless of vaccination status and community transmission levels

Incorporating new evidence for the Delta variant, the CDC updated its guidance for schools to recommend that all teachers, staff, students, and visitors should wear a mask at all times in schools regardless of vaccination status. This was a change from the CDC’s previous guidance for schools that was released earlier this month and recommends more stringent mask wearing.

Veterans Affairs mandates COVID-19 vaccines among medical employees including Veterans Health Administration facilities staff

On July 26, Department of Veterans Affairs Secretary Denis McDonough announced that COVID-19 vaccines will be mandatory for VA health care personnel — including physicians, dentists, podiatrists, optometrists, registered nurses, physician assistants, expanded-function dental auxiliaries and chiropractors — who work in Veterans Health Administration facilities, visit VHA facilities or provide direct care to those VA serves. All VA employees are eligible to be vaccinated at no expense at any VHA facility and employees will also receive four hours of paid administrative leave after demonstrating they have been vaccinated.

Israeli data shows Pfizer-BioNTech vaccine continues to be highly effective at preventing severe COVID-19 infection but efficacy for preventing any COVID-19 infection may wane after four months

On July 22, Israel’s Ministry of Health released data showing that while the Pfizer-BioNTech COVID-19 vaccine continued to be highly effective preventing severe COVID-19 infection and hospitalization, the vaccine was only 39% effective at preventing infection. The newly released data show that overall, the Pfizer vaccine has been 88% effective at preventing COVID-19 hospitalization and 91% effective at preventing severe COVID-19. Vaccine efficacy appears to have waned over time with 75% efficacy at preventing any COVID-19 infection in persons who received their second vaccine in April 2021 compared to only 16% effective at preventing infection in persons who received their second vaccine in January 2021. 

*This presentation was released directly by the Israeli Ministry of Health and was not published in a peer-reviewed medical or scientific journal.  

Delta variant accounts for nearly 83% of new sequenced cases in US

On July 20, CDC Director Dr. Rochelle Walensky testified before the Senate Health Committee that the Delta variant now represents almost 83% of sequenced COVID cases. From July 4-17, the Delta variant accounted for 82.2%            of all sequenced samples (95% PI 78.3-86.0%). The most rapid rise has been occurring in areas with lower vaccination rates.

From March 2020-April 2021, an estimated 1.134 million children experienced the death of a primary caregiver as a result of COVID-19 infection

Using mortality and fertility data to model COVID-19-associated deaths of primary or secondary caregivers for children younger than 18 in 21 countries, researchers estimate that 1.134 million children (95% CI 884,000-1,185,000) experienced the death of a primary caregiver (at least one parent or custodial grandparent) as a result of COVID-19 infection. For adults aged 15–50 years, the estimated number of children orphaned was greater than the number of adult deaths.

Treating hospitalized COVID-19 patients with SGLT2 inhibitor did not result in significant risk reduction in organ dysfunction or death

Patients who are hospitalized with COVID-19 and have cardiometabolic risk factors (i.e. hypertension, type 2 diabetes, cardiovascular disease, kidney disease) are at high risk for multiorgan failure and death. SGLT2 inhibitors have shown benefit in reducing cardiovascular or kidney events in large trials of predominantly ambulatory patients with cardiometabolic risk factors. In this double-blind placebo-controlled randomized control trial of 1250 patients with at least one cardiometabolic risk factor (i.e. hypertension, type 2 diabetes) who were hospitalized for COVID-19 infection, half of the patients received dapagliflozin (SGLT2 inhibitor) and half received placebo. At thirty days there was no statistically significant risk reduction in organ dysfunction or death between the two groups of patients (11.2% in SGLT2 group and 13.8% in placebo group).

ACOG recommends COVID-19 vaccination for pregnant patients

The American College of Obstetrics and Gynecology (ACOG) updated its guidance to say “ACOG recommends that all eligible persons, including pregnant and lactating individuals, receive a COVID-19 vaccine or vaccine series. Obstetrician-gynecologists and other women’s health care practitioners should lead by example by being vaccinated and encouraging eligible patients to be vaccinated as well.” Previously, ACOG had only recommended that practitioners should discuss vaccine options.      

CDC Morbidity and Mortality Weekly Reports (MMWR):

Adverse events and side effects in vaccinated persons age 12-17 similar to reactions reported in preauthorization studies with the exception of rare cases of myocarditis

The FDA authorized the Pfizer-BioNTech COVID-19 vaccine for adolescents aged 12-17 years in May 2021. In this review of safety data collected from the Vaccine Adverse Event Reporting System (VAERS) through July 16, 2021, researchers reviewed 9,246 reports received following Pfizer-BioNTech vaccination. 90.7% of these were for nonserious adverse events and 9.3% were for serious adverse events, including myocarditis (4.3%). Of the approximately 129,000 U.S. adolescents aged 12–17 years enrolled in v-safe after vaccination, 63.4% reported local reactions and 48.9% reported systemic reactions with a frequency similar to that reported in preauthorization clinical trials. Among 8.9 million adolescents vaccinated during the study period, VAERS reports were received for approximately one per 1,000 vaccinees, and 90% of these reports were for nonserious conditions. Syncope was among the events most commonly reported to VAERS in this age group and is common among adolescents after any vaccination. No reports of death to VAERS were determined to be the result of myocarditis, however follow-up of myocarditis cases is ongoing.

Large COVID outbreak in one Massachusetts county driven by Delta variant despite high levels of vaccination

During July 2021, 469 cases of COVID-19 associated with multiple summer events and large public gatherings in a town in Barnstable County, Massachusetts, were identified among Massachusetts residents; vaccination coverage among eligible Massachusetts residents was 69%. Approximately three quarters (346; 74%) of cases occurred in fully vaccinated persons. Overall, 274 (79%) vaccinated patients with breakthrough infection were symptomatic. Among five COVID-19 patients who were hospitalized, four were fully vaccinated; no deaths were reported. Real-time RT-PCR Ct values in specimens from 127 fully vaccinated patients were similar to those among 84 patients who were unvaccinated, not fully vaccinated, or whose vaccination status was unknown. This might mean that the viral load of vaccinated and unvaccinated persons infected with SARS-CoV-2 is also similar. “High viral loads suggest an increased risk of transmission and raised concern that, unlike with other variants, vaccinated people infected with Delta can transmit the virus,” according to CDC Director Dr. Rochelle Walensky.

Common respiratory virus circulated at historically low levels in 2020, however virus circulation is now picking up at unusual times of the year

In 2020, the CDC’s routine surveillance of common respiratory viruses (i.e. influenza, respiratory syncytial virus [RSV], parainfluenza, respiratory adenoviruses) showed that most of these viruses were circulating at historically low levels. This was likely due to the widespread implementation of COVID-19 mitigation strategies such as mask use, physical distancing, and limited travel. As COVID-19 prevention practices are relaxed, the CDC is expecting to see a rise in rates of these other respiratory viruses and we are already seeing an increase in RSV activity both nationally and in Alaska.  

Among healthcare providers in long term care facilities, there is wide variation in vaccine coverage depending on healthcare role and social vulnerability

In March 2021, data from a convenience sample of staff at 300 long term care facilities (LTCFs) across the United States indicated a 30 percentage-point difference in COVID-19 vaccination coverage between physicians and other advanced practice providers (75.1%) and aides (45.6%). Among aides, lower vaccination coverage was observed in facilities located in more socially vulnerable zip code areas. The finding that vaccination coverage among aides was lower among those working at LTCFs located in zip code areas with higher social vulnerability is consistent with previous analysis of overall county-level vaccination coverage by indices of social vulnerability, however, similar patterns among LTCF staff members are notable because on-site vaccination removed a number of barriers to vaccination, including travel, scheduling, and need to take time off from work.


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