COVID-19 Alaska Clinical Update
Friday, July 23, 2021
Physician messaging campaigns may be effective in persuading people to seek information and adopt preventive behaviors to combat COVID-19
In this randomized control trial of 20,4640 individuals, participants were shown video messages delivered by either black or white physicians. Participants in the intervention arm were shown videos about COVID-19 symptoms, case numbers, and CDC social distancing guidelines, while the placebo arm was shown videos about general health topics. The intervention led to higher rates of COVID-19 knowledge, information-seeking, willingness to pay for a mask, and self-reported safety behavior. The effects did not differ by participants’ race.
Pfizer-BioNTech and AstraZeneca vaccines appear to be 87.9% and 59.8% effective, respectively, against Delta variant
In a test negative case control design series from the UK, the Pfizer-BioNTech mRNA vaccine was found to be 87.9% effective at preventing infection with the Delta COVID variant (B.1.617.2) in persons who completed the full 2-dose vaccination. Effectiveness was notably lower after 1 dose of the vaccine at 33.5%. The Pfizer vaccine was also found to be 93.4% effective against the Alpha COVID variant (B.1.1.7) after full vaccination and was 51.1% effective after 1 dose of the vaccine. The AstraZeneca-Oxford vaccine, which has not been authorized in the US though has a similar mechanism to the Johnson & Johnson-Janssen vaccine, was 59.8% effective at preventing infection with the Delta variant (B.1.617.2) and 66.1% effective against the Alpha variant (B.1.1.7).
*This article has not gone through peer review and is in pre-print status. It may have not been finalized by authors, might contain errors, and report information has not yet been accepted or endorsed in any way by the scientific or medical community.
Pfizer-BioNTech and Moderna vaccine effectiveness ranged from 84-93% at preventing symptomatic COVID-19 infection
In a test negative case control design series from Canada, researchers examined the vaccine efficacy of the Pfizer-BioNTech, Moderna, and AstraZeneca vaccines at both partial and full vaccine series against circulating COVID-19 variants of concern including the Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2) variants. They estimated that that partial vaccination (1 dose of vaccine) with Pfizer-BioNTech and Moderna were >55% and >70% effective, respectively, against symptomatic infection by currently circulating variants of concern in Canada. Full vaccination with mRNA vaccines substantially improves vaccine effectiveness. For the Delta variant, full vaccination with Pfizer-BioNTech was 87% effective at preventing symptomatic infection.
*This article has not gone through peer review and is in pre-print status. It may have not been finalized by authors, might contain errors, and report information has not yet been accepted or endorsed in any way by the scientific or medical community.
Johnson & Johnson vaccine fact sheet updated to include information about increased risk of Guillain-Barré syndrome.
On July 13, the FDA updated the provider fact sheet for the Johnson & Johnson-Janssen COVID-19 vaccine with information about observed increase risk of Guillain-Barré syndrome (GBS). There have been 100 preliminary reports of GBS after approximately 12.5 million doses administered with one reported death. The Moderna and Pfizer-BioNTech COVID-19 vaccines do not appear to be associated with an increased risk of GBS.
New federal funding to develop antivirals for COVID-19
On June 17, the Biden administration announced Thursday a $3.2 billion program dedicated to developing drugs that fight COVID-19 in its early stages, along with potential future pandemics.
The Antiviral Program for Pandemics will allow the National Institutes of Health to focus on antivirals for COVID-19 and other pandemic risks, including hemorrhagic fever and influenza, the way HIV and hepatitis C can be managed.
Delta variant of COVID-19 associated with nearly double the risk of hospitalization in Scotland
In a published research letter in The Lancet, researchers in Scotland found that the Delta variant of COVID-19 is associated with approximately double the risk of hospitalization compared with the Alpha variant. Vaccines were found to reduce the risk of being admitted to hospital, but strong protective effects against the Delta variant were not seen until at least 28 days after the first vaccine dose. In community cases at least 2 weeks after the second dose, the Pfizer-BioNTech vaccine was found to provide 79% protection against infection from the Delta variant, compared with 92% against the Alpha variant.
Among pregnant women, Pfizer-BioNTech vaccination was associated with a lower risk of SARS-CoV-2 infection
In this retrospective cohort study of 15,060 pregnant Israeli women, women who received the full Pfizer-BioNTech vaccine series were 78% less likely to contract the SARS-CoV-2 virus than pregnant women who were unvaccinated. There were no notable differences between the groups regarding preeclampsia, intrauterine growth restriction, infant birth weight, abortions, stillbirths, maternal death, or pulmonary embolism.
American Association of Pediatrics recommends everyone over age 2 years wear masks at school
On July 19, the American Association of Pediatrics released their COVID-19 Guidance for Safe Schools. The recommendations included COVID-19 vaccination for all eligible students age 12 years and older; all students older than 2 years and all school staff should wear face covering at school; students should remain at least 3 feet apart within classrooms when possible; and screening tests should be offered to unvaccinated students in communities with higher community levels of COVID-19.
US Surgeon General issues formal advisory addressing misinformation about COVID-19 as an “urgent threat to public health”
In his first advisory as President Biden’s Surgeon General, Vivek Murthy asked “all Americans to help slow the spread of health misinformation during the COVID-19 pandemic and beyond. Health misinformation is a serious threat to public health.”
Cochrane Review of rapid COVID-19 tests confirms strengths and weaknesses of molecular and antigen COVID-19 tests
A Cochrane Review from March 24, 2021 reviewed 64 studies published up to September 30, 2020 examining the accuracy of commercially available COVID-19 antigen and molecular tests compared to RT-PCR tests. For antigen tests in people with confirmed COVID-19, the tests correctly identified COVID-19 infection in an average of 72% of people with symptoms, compared to 58% of people without symptoms. In people who did not have COVID-19, antigen tests correctly ruled out infection in 99.5% of people with symptoms and 98.9% of people without symptoms. For molecular tests, also known as Nucleic Acid Amplification Tests, overall results for diagnosing and ruling out COVID-19 were good (95.1% of infections correctly diagnosed and 99% correctly ruled out). However, 69% of the studies used the tests in laboratories instead of at the point-of-care and few studies followed test manufacturer instructions. Most of the data for molecular tests referred to the Abbott ID NOW and Cepheid Xpert Xpress tests.
CDC Morbidity and Mortality Weekly Reports (MMWRs):
More than 50% of unvaccinated adolescents and parents of unvaccinated adolescents are intending to obtain COVID-19 vaccine
In April 2021, 52% of unvaccinated adolescents aged 13–17 years and 56% of parents of unvaccinated adolescents aged 12–17 years reported intent for adolescent COVID-19 vaccination. The most common factors that would increase vaccination intent were receiving more information about adolescent COVID-19 vaccine safety and efficacy. Efforts focusing on effectively communicating the benefits and safety of COVID-19 vaccination for adolescents to the public could help increase adolescent COVID-19 vaccine confidence and vaccination coverage.
RECURRENT TOPICS
Monoclonal Antibodies
Bamlanivimab+Etesevimab led to lower incidence of COVID-19-related hospitalization and death than placebo
In the latest portion of the Phase 3 BLAZE-1 trial, which included 1049 patients in a randomized double-blind placebo-controlled study funded by Eli Lilly, patients treated with a combination of bamlanivimab+etesevimab monoclonal antibodies had a 70% relative reduction in their risk of COVID-19-related hospitalization or death from any cause compared to patients in the placebo arm. These results may be limited however because prevalence of various COVID variants in the study was not known so results may not be generalizable to new variants; and more than 87% of study participants identified as white, though minority groups have been disproportionately affected by COVID-19.
For the latest recommendations, check out the CDC webpage on Monoclonal Antibodies for High-Risk COVID-19 patients and COVID-19 Resources for Healthcare Providers.
Post-acute Sequelae of COVID-19 (PASC)
Prevalence of PASC in children likely lower than in adults
In a randomly selected cohort of Swiss children assessed six months after testing positive for SARS-CoV-2, 4% of children with SARS-CoV-2 antibodies reported at least 1 symptom lasting beyond 12 weeks compared to 2% of children who were not infected with SARS-CoV-2 virus. The most commonly reported symptom was “tiredness.” The study found a low prevalence of symptoms compatible with long COVID in this cohort of children.
For the latest recommendations, check out the CDC webpage on Post-COVID-19 Syndrome and Evaluating and Caring for Patients with Post-COVID conditions
Myocarditis
For more information, check out the CDC webpage on myocarditis and COVID-19 vaccines
COVID-19 Speakers’ Bureau
Anyone can request a free presentation for a group interested in learning more about the COVID-19 vaccines available in Alaska.
Aside from COVID-19:
RSV cases appearing in Alaska
Increased interseasonal respiratory syncytial virus (RSV) activity has been identified in the US, primarily in southern states, prompting a CDC Health Advisory. During 6/21-6/29 six outpatient RSV-positives and one inpatient RSV-positive were identified in Alaska residents from Anchorage, Fairbanks and Palmer. At this time it is not clear whether RSV activity will increase in Alaska. The Alaska RSV Seasonality Workgroup met on 6/29 and is monitoring RSV activity to determine whether recommendation for interseasonal RSV prophylaxis with Synagis is warranted.
Providers are urged to notify Dr. Rosalyn Singleton (ris2@cdc.gov) if they identify RSV-positive cases.
The Asthma & Allergy Foundation of Alaska’s Annual Conference
Wheezin’, Sneezin’, and Itchin’ in Alaska, the 15th Annual Asthma and Allergy Conference is taking place on Friday-Saturday, September 10-11 in Girdwood. For more information and to register, please visit the conference website.
CDC Clinical Support: There is a Clinician On-Call Center, a 24-hour hotline with trained CDC clinicians standing by to answer COVID-19 questions. Call 1-800-CDC-INFO (800-232-4636) and ask for the Clinician On-Call Center.
All Alaskans and people who work or live in Alaska who are aged 12 years and older are eligible for vaccination against COVID-19. Appointments can be made at covidvax.alaska.gov.
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