COVID-19 Alaska Clinical Update: Wednesday, February 17, 2021

COVID-19 Alaska Weekly Update

COVID-19 Alaska Clinical Update
Wednesday, February 17, 2021

COVID-19 Alaska Weekly Update

Alaska cases & vaccinations

There have been 54,736 COVID-19 cases total in AK residents, with 1,199 cumulative hospitalizations and 285 deaths. Virus transmission continues to decline since its peak in early December. As of February 16, 193,614 Alaskans had received at least one dose of vaccine and 65,310 had completed the series.

COVID-19 news

When breath becomes aerosol: an observational cohort study of 194 healthy humans and 8 nonhuman primates with SARS-CoV-2 infection found variations in exhaled aerosol particles by degree of COVID-19 infection, BMI and age. 18% of human subjects accounted for 80% of the exhaled bioaerosol, suggesting a ’20:80 superspreader of infection distribution’. Volunteers aged 25 and younger and those with BMIs under 22 were comparatively low spreaders of exhaled bioaerosol. Primates exhaled the most viral particles on day 7 postinfection, consistent with another study in humans. Authors suggest the BMI and age correlation with aerosols are likely related to known changes in airway lining mucus composition and structure.

Megakaryocytes found in brain capillaries of patients who died of COVID-19, 33% in one small autopsy study, suggests one possibility for an unusual ischemic pattern contributing to neurologic effects of COVID-19. Authors note that megakaryocytes have also been found in lungs and other organs of patients with COVID-19.

Tocilizumab reportedly shortened the time to discharge, reduced the need for mechanical ventilation and reduced the risk of death in an RCT of hospitalized patients with severe COVID-19. Based on trial results discussed in a press release, 25 patients with severe COVID-19 would need to receive tocilizumab to prevent one death. Data are expected to be released as a preprint soon.

Zinc, vitamin C or both together did not show improvement in outpatients with COVID-19 symptoms compared to usual care, in a randomized clinical trial that was halted early for futility. A commentary article discusses the supplement industry and the implications of this trial, and advocates for more RCTs such as this one to decrease misinformation in health discussions. began a three-month open enrollment period this week.

Asthma was not a risk factor for respiratory failure or mortality overall after adjustment for other comorbidities in 7,272 adults with COVID-19 in a retrospective review, although asthma patients with an acute exacerbation in the past year had higher COVID-19 related mortality, especially older, male adults.

Non-COVID-19 news

CDC issued a Health Advisory on extensively drug-resistant Salmonella Typhi infections among US residents without international travel, noting that nine cases in six states (NY, CA, IL, MD, NJ, TX) had no travel history. Extensively drug resistant Typhi was previously associated with an outbreak in Pakistan beginning in 2016. CDC notes that while ceftriaxone remains appropriate empiric therapy for typhoid fever in patients with a travel history to a country other than Pakistan and Iraq, clinicians may want to consider empiric treatment with a carbapenem, azithromycin or both for suspected fever in patients with no travel history or those with a history of travel to Pakistan or Iraq. 

Vaccine news

Vaccinated people who remain asymptomatic do not need to quarantine if named as a close contact to a person with SARS-CoV-2 infection, new CDC guidelines state. At this time, vaccinated persons must be at least two weeks past their second dose and within 3 months of their last dose to qualify, and the new guidance does not apply to inpatients and residents in healthcare settings. The State of Alaska testing guidelines have been updated with this change. The guideline change does not affect State travel recommendations, and minimizing travel as well as testing and strict social distancing after travel is still strongly recommended, especially with the risk of new variants entering the state. Airport testing is offered without charge for residents and nonresidents. The Health Orders around interstate and intrastate travel expired late last week when the State’s disaster declaration expired.

Testing for TB in vaccinated people: new CDC guidance states a tuberculin skin test or interferon-gamma release assay (IGRA, or quantiferon gold) should not affect vaccine safety or effectiveness and the vaccine is not expected to cause a false positive TST or IGRA; however a false negative cannot be definitively excluded. CDC recommends against delaying vaccination because of testing for TB infection and notes that an mRNA vaccination can be given at the same time as testing. CDC recommends these tests be delayed for 4 weeks after the completion of vaccination if not done at the same time as vaccination.

The NEJM maintains a FAQ for clinicians to help answer common patient questions.

The Society of Breast Imaging released a statement that COVID-19 vaccines can sometimes lead to transient axillary lymphadenopathy 2-4 days after the shot, lasting for up to 10 days, which could look like a sign of malignancy on imaging or can lead to a diagnostic workup if noted on exam. The SBI recommended that routine screening breast imaging be scheduled before the first dose or 4-6 weeks after the second dose. For all exams, ask about vaccination status, timing and side effects and consider including the statement “Vaccines of all types can result in temporary swelling of the lymph nodes, which may be a sign that the body is making antibodies in response, as intended”. After appropriate diagnostic workup for unilateral axillary adenopathy in women who were vaccinated in the ipsilateral upper extremity within four weeks prior to screening, consider a follow-up exam between four-to-12 weeks post-second dose, and consider lymph node sampling to rule out breast and non-breast malignancy if the axillary adenopathy lingers.

Israel reports in a preprint that recipients of the Pfizer vaccine who went on to test positive for SARS-CoV-2 had substantially lower viral loads if tested 12-28 days after their first vaccination than unvaccinated people or those tested in the 11 days following vaccination.

Vaccine status

Vaccination appointments for people in eligible tiers can be made at Some Alaskans may also be eligible through Tribal or military allocations.

Alaska remains the most vaccinated state per capita; follow the DHSS dashboard here.

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.

AK Clinical Reminders

COVID-19 testing guidelines and test site locator
Report any positive test to the state Section of Epidemiology using the COVID Reporting Hotline at 1-877-469-8067 or by faxing in the Infectious Disease report form. If you suspect COVID-19 in an outpatient who cannot isolate in their own home (for example they are unsheltered or from out of town) or for another urgent situation call SOE at 907-269-8000 or 800-478-0084 (after-hours).

Join us for the ECHO series for more information and discussion:
Use the links below to register beforehand for the online meeting
COVID-19 for Alaska Healthcare Providers: Every other Tuesday, 7-8:30PM
Science ECHO for the general public: Wednesdays, 12-1PM
Healthcare Specific COVID-19 Situational Awareness: Thursdays, 12-1PM
School Health ECHO: Mondays 3-4PM
Alaska Perinatal ECHO: Thursday, 6-7PM
Palliative Care in COVID-19 ECHO: Wednesday, 12-1PM
EMS ECHO: 2nd & 4th Friday, 10-11AM
Vaccine ECHO:Thursday, 2-3 PM
AK COVID-19 clinical hotline for physicians: 833-751-4212. Staffed 24/7.
8PM-8AM is for urgent/emergent questions only.
AK Responders Relief Line: 24/7 behavioral health for everyone working in healthcare
during the COVID-19 pandemic: 1-844-985-8275