COVID-19 Updates for Providers

Requested actions

• Be aware, Centers for Disease Control and Prevention (CDC) updated its COVID-19 monoclonal antibody treatment recommendations.
  • Sotrovimab monoclonal antibody formulation retains significant efficacy against Omicron, the dominant circulating variant.
    • Other monoclonal antibody formulations under emergency use authorization (EUA)—bamlanivimab and etesevimab and casirivimab and imdevimab—lack clinical benefit against Omicron and should not be used at this time.
  • Sotrovimab supplies are currently limited. Prioritize its use for non-hospitalized people with risk factors for progressing to severe COVID-19, including:
    • Unvaccinated against COVID-19.
    • Has not received all CDC-recommended prime and booster doses of COVID-19 vaccine.
    • Clinical risk factors.
    • Older age (e.g., 65 years or older).
    • Not expected to mount an adequate immune response.
  • Use sotrovimab for the above high-risk people when oral Paxlovid is not indicated because of potential severe drug-drug interactions or if Paxlovid is unavailable.
• Be aware, a high volume of people with suspected COVID-19 are going to local emergency departments (EDs) seeking testing. Help spread the recommendation to save ED capacity for emergencies.
• Be aware, CDC updated its COVID-19 vaccination recommendations.
  • People who get Pfizer vaccine for their prime series can get a booster dose 5 months after they got their second dose (previous recommendation was 6 months).
    • Booster recommendations for Moderna and Johnson & Johnson vaccines are unchanged.
  • Immunocompromised children age 5-11 are now eligible for a third prime dose 28 days after they got their second dose. Pfizer is the only COVID-19 vaccine available to this age group.
• Recommend, before gathering indoors, people perform COVID-19 self-tests (also called home or over-the-counter tests) and encourage their guests to do the same. Along with vaccination, masking and physical distancing, self-tests reduce the chance of spreading COVID-19. Self-tests help protect unvaccinated children, older adults, those who are immunocompromised and people at risk of severe disease.
  • Teach patients how to use and interpret a self-test. Teach patients what to do if they test positive or negative. Encourage patients who test negative to retest 24 hours later.
  • Encourage all patients with COVID-like symptoms and recent exposure to stay home and away from others. If they must be around others, they should wear a mask and maintain physical distance.
  • Encourage all patients to wear well-fitted, high quality masks and improve indoor ventilation.
  • Encourage patients 5 years or older to get fully vaccinated against COVID-19.
  • Encourage patients 16 years or older to get COVID-19 vaccine booster dose at the recommended interval.
  • We are seeing heavy demand for testing. Direct people to local testing sites for free tests. Prepare patients that test turnaround times may be delayed when demand is high.

Background

As Omicron cases surge in our region and healthcare system capacity is strained, we welcome news of additional tools to combat the pandemic and reduce the burden on our healthcare systems. We are working with community partners to establish equitable and accessible distribution of these therapeutics as they become available.

In the original clinical trial, sotrovimab treatment reduced the risk of the composite endpoints of hospitalization and death in high risk patients by 85%. Based on pre-print in vitro data, CDC currently believes sotrovimab is the only monoclonal antibody under EUA that retains efficacy against Omicron variant. Because sotrovimab supplies are limited—we expect to receive 550 doses for the entire state for the next month—it is imperative that we prioritize it for the highest risk individuals. See the risk tiers in CDC’s distribution plan for details.

We hope to have availability of oral antivirals very soon via local partner pharmacies for people in the middle tier high risk group. We plan to have detailed information to help providers access these medications as soon as they become available locally.

Additional information

• Vaccine recommendation changes press release, CDC.
• Sotrovimab EUA.
• Sotrovimab EUA frequently asked questions (FAQs), Food and Drug Administration (FDA).
• Sotrovimab fact sheet for healthcare providers.
• Sotrovimab fact sheet for patients, parents and caregivers.
• Isolation and quarantine guidance for healthcare workers, CDC.
• Isolation and quarantine guidance for the general public, CDC.
• Find more resources on other therapeutics in the COVID-19 monoclonal antibody therapeutics communication toolkit.

COVID-19 vaccine

• Booster dose updates, FDA.
• EUA fact sheets for recipients and caregivers:
  • Pfizer.
  • Moderna.
  • Johnson & Johnson.

• COVID-19 vaccine locator, Washington State Department of Health (DOH).
• COVID-19 vaccine provider toolkit and resources, DOH.
• COVID-19 vaccination for providers, CDC.
• Clinical considerations for COVID-19 vaccination and guidance for managing anaphylaxis, CDC.
• COVID-19 vaccine quick reference guide for healthcare professionals, CDC.
• COVID-19 vaccine training module on best practices for providers, CDC.

COVID-19 testing

• K–12 test requirements to return to school, DOH.
• Antigen test guidance, CDC.

COVID-19 therapeutics

Department of Health and Human Services (HHS) allocates monoclonal antibody and oral antiviral supplies to each state. DOH distributes doses to enrolled providers. Providers must enroll in Healthcare Partner Ordering Portal (HPoP) to manage COVID-19 therapeutics. Email mcm@doh.wa.gov to register for HPoP training, held Tuesdays at 9 a.m.

• To request an initial supply of Evusheld monoclonal antibody for pre-exposure prophylaxis (PrEP), complete a smart sheet.
• Read more about Evusheld monoclonal antibody for PrEP.
• Find more resources in the COVID-19 monoclonal antibody therapeutics communication toolkit.

COVID-19 prevention patient education

Share the following materials with patients.

• What to do if you have COVID-19.
• What to do if you may have been exposed to COVID-19.
• What to do if you have COVID-19 symptoms and have not been tested or exposed.

Immediately report COVID-19

• Cases in the following people—call (253) 649-1412.
  • Healthcare workers (e.g., EMS, medical, nursing, any healthcare facility employee).
  • Public safety workers (e.g., law enforcement, firefighter).
  • Live or work in a long-term care facility, senior living center, permanent supportive housing or similar congregate setting (e.g., shelter, correctional facility) housing people at high risk of severe outcomes.
  • Anyone who dies with COVID-19.
  • Anyone with suspected MIS-C.
• All other cases—fax the following to (253) 649-1357 or call (253) 649-1413.
  • Patient—first name, last name, date of birth, gender, race, ethnicity, preferred language, phone number, address and zip code.
  • Specimen—collection date and type (NP, nasal swab, blood, etc.).
  • Test—type (PCR, NAAT, antigen, antibody/serology) and result (detected, not detected, inconclusive).
  • Ordering facility.
• For all cases, report the person’s race, ethnicity and preferred language.

Contacting the Health Department

• Questions?
  • For urgent issues, call (253) 649-1412.
  • For non-urgent issues, call (253) 649-1413 and leave a message.
    • Includes reporting notifiable conditions 24 hours a day, 7 days a week.
    • Leave the patient’s name, date of birth and disease.

Additional resources

• Washington COVID-19 risk assessment dashboard.
• CDC guidance for healthcare providers and facilities.
• DOH COVID-19 data dashboard.
• DOH COVID-19 page.
• CDC COVID-19 page.

SARS-CoV-2 sequencing and variants in Washington