COVID-19 Alaska Clinical Update
Thursday, January 21, 2021

Alaska cases & vaccinations

There have been 50,732 COVID-19 cases total in AK residents, with 1,146 cumulative hospitalizations and 251 deaths. Virus transmission has declined since its peak in early December, but January has seen a leveling off in the decline in case rates. As of January 20, 59,392 Alaskans had received at least one dose of vaccine and 13,270 have completed their series.

Vaccine news

• On different dosing strategies: the UK announcement that they will delay the second dose of mRNA vaccines has prompted concern that the efficacy of the vaccine and the duration of immunity could be compromised by delaying the second dose. Other dosing strategies have not been studied and the FDA recommends against any modification to the planned dosing schedule.
• VSAFE: to use the free national reminder and safety test messaging system, anyone can text ENROLL to 1-833-VAX-TEXT when they get their vaccine and get text reminders about the second dose as well as texts asking about any side effects. Vaccine recipients can also go to the website provided on the information they get at the time of vaccination.
• Vaccine providers should report all side effects and adverse events to the national VAERS system at vaers.hhs.gov.
• Norway, which monitors health events after vaccination as the US does, reviewed 23 deaths after vaccination among very frail elderly patients. They found all patients had serious underlying illnesses causing their deaths and did not find evidence that vaccination hastened their deaths. The Norwegian Institute of Public Health, which oversaw the country’s effort to vaccinate all nursing home residents before other Norwegians, had previously recommended that severely frail patients or patients with a short remaining life expectancy be assessed individually to weigh the benefits of vaccination against the risk of any potential side effects. Side effects are substantially less common in older adults than younger people.

Distribution status: vaccination of Phase 1a, Tier 1, 2 & 3 (healthcare workers and long-term care facility residents across all regions of Alaska) continues, as does Tier 1 of Phase 1b (Alaskans age 65 and older). For more information and appointments, see covidvax.alaska.gov. New appointments will be added to the website continuously and those eligible for registration are encouraged to check the site daily. For more information on the status of the vaccination effort in Alaska, please see the DHSS vaccine home page and the DHSS vaccine dashboard. The New York Times is also tracking and comparing state vaccination efforts. Alaska currently is the  most vaccinated state per capita.

Other COVID-19 science news

A new Alaska state epidemiology bulletin found that Anchorage emergency orders, including masking requirements and gathering restrictions, appear to have contributed to decreasing SARS-CoV-2 transmission rates.

New strains reported in the UK and South Africa: the UK strain is thought to be associated with increased transmissibility, while less is known about the South Africa strain. Another variant identified in Japan in travelers from Brazil shares a mutation with the UK and South Africa strain but the significance of the mutation is not yet known. A recent MMWR warned that higher vaccination coverage might be needed to protect the public because of increased transmissibility of the UK strain and noted that universal increased compliance with mitigation strategies is warranted.

CDC said last week that there is no evidence a single variant is driving the US surge, but encouraged states to sequence more test samples. The Alaska State Public Health Laboratories sequence a subset of tests received, including all that contain the s-dropout pattern associated with the UK strain.

A Lancet study of 1,733 recovered COVID-19 patients from Wuhan found 76% reported at least one symptom 6 months after their recovery. Persistent symptoms like fatigue, difficulty sleeping, hair loss, anxiety, depression or pain were more common among those who had severe disease. Although the study included only patients who had been hospitalized with COVID-19, 439 of the 1,733 never required supplemental oxygen and 81% of this group reported one or more symptom at six months.

A letter in BMJ discusses similarities between SARS-CoV-2 pneumonia and its clinical, radiologic and pathologic parallels with secondary or acute fibrinous organizing pneumonia, proposing that the characteristic silent hypoxemia and subacute respiratory illness followed by rapid onset progression to fulminant respiratory failure involving extensive fibrosis seen in severe respiratory COVID-19 may be clinically related to a secondary organizing pneumonia. This parallel has also been drawn elsewhere, from early case reports to radiology and pathology literature, and was also reported in MERS based on radiologic findings.

Ivermectin, an antiparasitic medication used against onchocerciasis and strongyloidiasis, has been discussed as a possible treatment for COVID-19 as it is theorized to reduce inflammation. However, data remain sparse and mixed and most studies have had significant methodological limitations and incomplete data, as the NIH notes when making their recommendation that more evidence is needed to provide guidance on the role of ivermectin for treatment, in a revision to their previous statement recommending against the use of ivermectin except in a clinical trial. IDSA does not mention ivermectin at all in their treatment or prevention guidelines.