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COVID-19 Update for Virginia<\/strong><\/p>\n January 11, 2022<\/p>\n Dear Colleague:<\/p>\n Thank you for your continued partnership in responding to the COVID-19 pandemic.\u00a0 Please visit the Virginia Department of Health (VDH) website<\/a> for current clinical and public health guidance<\/a>, epidemiologic data<\/a>, and other information.\u00a0 Updates on the following topics are included in this correspondence:<\/p>\n New Declaration of Limited State of Emergency in Virginia and Executive Order 84<\/strong><\/p>\n On January 10, 2022 Governor Northam declared that a limited state of emergency exists in the Commonwealth of Virginia because of COVID-19 and issued Executive Order 84<\/a> to provide relief for hospitals and healthcare workers.\u00a0 This Order immediately went into effect until February 11, unless amended or rescinded sooner.\u00a0 The Order directs the State Health Commissioner to waive normal bed licensing requirements, allows hospitals to increase their licensed bed capacity, and mandates increased coordination between hospitals and Emergency Medical Services (EMS) agencies.\u00a0 It also allows healthcare providers, pharmacists, pharmacy interns, and pharmacy interns with active licenses in other states to practice in Virginia.\u00a0 Physician Assistants licensed in Virginia with two or more years of experience may practice without a written electronic practice agreement.\u00a0 A licensed practical nurse may administer COVID-19 vaccine without the supervision of a registered nurse or licensed medical practitioner.\u00a0\u00a0 The Order provides certain liability protections to providers who act in good faith to protect patients and it increases flexibility in the transfer of patients to state-operated psychiatric hospitals.<\/p>\n Updated Recommendations for COVID-19 Vaccines and Staying Up to Date<\/strong><\/p>\n Following the U.S. Food and Drug Administration\u2019s (FDA) updated emergency use authorization (EUA) of the Pfizer-BioNTech COVID-19 Vaccine<\/a> on January 3 and the Centers for Disease Control and Prevention\u2019s (CDC) revised recommendations on January 4<\/a> and January 5<\/a>, there are three key changes to the recommendations for the Pfizer-BioNTech COVID-19 Vaccine:<\/p>\n On January 7, FDA authorized<\/a> and CDC recommended<\/a> that the interval between completing the primary series of the Moderna COVID-19 vaccine and administering a booster dose be shortened from at least six months to at least five months for all individuals aged 18 years or older.<\/p>\n In response to all these changes, FDA updated the Pfizer-BioNTech<\/a> and Moderna<\/a> fact sheets for providers and for recipients and caregivers and developed a summary table<\/a> of booster eligibility and timing. \u00a0CDC revised the Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States<\/a> to reflect their new recommendations.<\/p>\n Although the definition of \u201cfully vaccinated\u201d (two doses of an mRNA vaccine or one dose of the Johnson & Johnson\/Janssen vaccine) has not changed, CDC is now using the term \u201cstay up to date\u201d<\/a> when talking about COVID-19 vaccines.\u00a0 This is a standard term used for other vaccinations.\u00a0 In the context of COVID-19 vaccinations, it means the primary series and any additional doses and boosters that are recommended for optimal protection.<\/p>\n Update on Omicron Surge and Therapeutics<\/strong><\/p>\n Virginia<\/a> is experiencing a major COVID-19 surge across the entire Commonwealth, largely driven by the highly transmissible Omicron variant.\u00a0 Nearly all data metrics are elevated, including record-high daily case rates, increased hospitalization rates, 7-day test positivity rate (which currently exceeds 30%), and increases in reported outbreaks, especially among long-term care facilities.\u00a0 Modeling data for Virginia<\/a> predict the surge to peak on or around January 23.<\/p>\n We continue to learn new information about Omicron.\u00a0 According to CDC<\/a>, the Omicron variant appears to have a shorter incubation period (2\u20134 days) than other variants.\u00a0 Lower hospitalization rates have been observed with Omicron infections in South Africa<\/a> and the United Kingdom<\/a> compared with those associated with previous variants.\u00a0 Vaccine effectiveness (VE) against symptomatic infection appears to be lower than that with other variants, but a booster dose does improve VE.\u00a0 People who are eligible to receive a booster<\/a> are encouraged to get one as soon as possible, preferably with an mRNA vaccine.\u00a0 FDA continues to monitor the impact of Omicron on COVID-19 tests; in their latest update on December 28, FDA reported<\/a> that antigen tests do detect Omicron infections, but the tests might have reduced sensitivity.<\/p>\n For therapeutics, the National Institutes of Health (NIH) clinical guidelines<\/a> were updated on December 30 and CDC released a Health Alert Network (HAN) health advisory<\/a> on December 31 summarizing available therapeutics.\u00a0 Of the available monoclonal antibodies, sotrovimab remains effective against Omicron and should be prioritized for nonhospitalized patients with risk factors for severe COVID-19.\u00a0 Among the antivirals, remdesivir, which has been approved for the treatment of hospitalized patients, is expected to be effective against Omicron and there is a new, off-label indication for the treatment of nonhospitalized patients.\u00a0 Paxlovid, an oral antiviral authorized for the treatment of nonhospitalized patients with mild to moderate disease, is effective against Omicron, but it is in short supply and is associated with possible drug to drug interactions.\u00a0 Molnupiravir, another oral antiviral recently authorized for outpatient treatment, can be considered when other treatment options are not accessible or clinically appropriate.\u00a0 Providers should refer to the NIH guidelines<\/a> for the most up-to-date recommendations and VDH\u2019s Therapeutics website<\/a> for Virginia-specific information.<\/p>\n\n
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