02/25/22 Health Advisory: COVID-19 Updates for Providers

Four people in scrubs and lab coats talking as seen from above.

Requested actions

Be aware, on Feb. 22, Centers for Disease Control and Prevention (CDC) revised its COVID-19 vaccine clinical considerations. An 8-week interval between first and second doses of mRNA COVID-19 vaccine (Moderna and Pfizer) may be optimal for males 12–39 years old to reduce risk of myocarditis and increase efficacy. CDC still recommends a 3-week (Pfizer) or 4-week (Moderna) interval for people who are immunocompromised, over 65 years old or need rapid protection because of risk of transmission or severe outcomes. Providers decide which interval is best for patients based on benefits and risk factors.
- See CDC Clinician Outreach and Communication Activity (COCA) call slides for more information.
Be aware, on Feb. 24, Food and Drug Administration (FDA) revised its Evusheld emergency use authorization (EUA) (tixagevimab co-packaged with cilgavimab). When used for COVID-19 pre-exposure prophylaxis, the new initial dose is 300 mg tixagevimab and 300 mg cilgavimab. Recent data shows Evusheld may be less active against some Omicron subvariants. Contact patients who received the previous initial dose (150 mg tixagevimab and 150 mg cilgavimab) and ask them to return for an additional 150 mg tixagevimab and 150 mg cilgavimab.
- See updated Evusheld EUA for more information.
Be aware, CDC updated its list of underlying medical conditions associated with higher risk of severe outcomes from COVID-19 to include primary immunodeficiency and physical inactivity. The list is not exhaustive. Do not use it to exclude people from recommended preventive measures, like booster doses or needed therapies.
- See National Institutes of Health (NIH) COVID-19 treatment guidelines for more information.
Strongly recommend patients get COVID-19 vaccine. You are patients’ most trusted source of vaccine information.
Teach patients how to access, use and interpret at-home antigen test kits. Direct patients to the many testing locations in the area.
- Teach patients with mild to moderate illness how to care for themselves at home and when to go to the emergency department.

Background

In people 18–39 years old, myocarditis occurs in an estimated 23–33 per million people following a second dose of mRNA COVID-19 vaccine. Nearly all cases are transient and can be treated on an outpatient basis. Recent research shows increasing the interval between first and second doses of mRNA COVID-19 vaccine from 3–4 weeks to 8 weeks can reduce the risk of myocarditis by over half while also substantially improving efficacy.

CDC guidance allows clinicians to decide when the benefits of the extended interval exceed the increased risk of COVID‑19 infection. Regardless of the interval between first and second doses, a booster dose should be delivered no sooner than 5 months after the second dose. These changes do not affect people with compromised immune systems or people over 65 years old, as the risk of COVID-19 infection outweighs the benefit of reduced myocarditis incidence.

Additional COVID-19 vaccine information

Clinical considerations for the use of COVID-19 vaccine, CDC.
COCA call slides, CDC.
Epidemiology of myocarditis and pericarditis following mRNA vaccines in Ontario, Canada, Buchan, et. al.
Booster dose updates, FDA.
EUA and FDA-approved vaccine information:
- Pfizer (Comirnaty).
- Moderna (Spikevax).
- 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 test processing

Labs report varying amounts of time to process COVID-19 tests. To support faster turnaround, we encourage providers to use in-state labs. The table below shows COVID-19 test processing times for in-state private labs. If you have questions about Health Department-facilitated antigen tests, contact epitesting@tpchd.org.

Lab	Time to process test	Tests processed daily
FidaLab	24 hours	500
Kaiser	24-48 hours	600
LabCorp	24–48 hours	Unknown
Northwest Pathology	24 hours	3,000
Quest	24–48 hours	700
UW Virology	12–24 hours	10,000–11,000
Atlas Genomic	24–48 hours	10,000

COVID-19 therapies

Department of Health and Human Services (HHS) allocates monoclonal antibodies and oral antivirals to each state. DOH distributes doses to enrolled providers. Providers must enroll in Healthcare Partner Ordering Portal (HPoP) to manage COVID-19 therapies. Email mcm@doh.wa.gov for support enrolling.

Once enrolled, to request a supply of monoclonal antibodies or therapeutics, complete a smart sheet.

Supplies of all therapies are currently limited. Commercial and independent pharmacies may have oral antivirals. Hospital-associated systems may have monoclonal antibodies. All therapies must be dispensed by prescription. Therapies from pharmacies may be intended for home delivery. Patients with questions about accessing their medication should call the pharmacy.

Additional information

HHS COVID-19 therapeutics locator for providers.
DOH therapeutics for providers page.
NIH COVID-19 treatment guidelines.

COVID-19 prevention

Share with patients:

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.