COVID-19 Alaska Clinical Update – Friday, September 30
Graph taken from State of Alaska’s COVID-19 Cases Dashboard
September is Suicide Prevention Awareness Month
September is Suicide Prevention Awareness Month – a time for mental health advocates, prevention organizations, survivors, allies and community members to unite to promote suicide prevention awareness. To learn more about the 988 Suicide & Crisis Lifeline in Alaska, visit 988.alaska.gov. At this site you can find videos, fact sheets and other resources about 988 in Alaska, as well as information about suicide warning signs and suicide prevention resources. Since July 1, when the Suicide and Crisis Lifeline transitioned to 988, Alaska has observed a 22% increase in call volume. Careline is the Lifeline member in Alaska that answers 988 calls.
If you or someone you know is having thoughts of suicide, experiencing a mental health or substance use crisis, call or text 988, or chat 988Lifeline.org. You can also contact the Alaska Careline at 877-266-HELP.
COVID-19 Omicron-specific vaccine boosters are available
On August 31, the FDA granted EUA for 2 Omicron-specific boosters, one from Pfizer-BioNTech and one from Moderna. The former booster is authorized for aged 12 years and older, while Moderna is authorized for adults only. These vaccines are bivalent boosters that target two strains of COVID-19 – the original strain of the virus and two omicron subvariants (BA.4 and BA.5), currently the most widespread subvariants. On September 6, the AK Department of Health announced that the booster is now available throughout the state with more than 38,000 doses ordered. People aged 12 years and older are eligible if they have completed a primary series and it has been at least two months since either their primary or a booster dose. If you have questions, please call the COVID-19 vaccine helpline at 907-646-3322.
In late September, both Pfizer-BioNTech and Moderna announced that they have requested EUA from the FDA for their bivalent boosters to be available for children aged 5 years and older. The FDA may make a decision on the EUA application before the CDC’s Advisory Committee on Immunization Practices’ next meeting October 19-20.
Monkeypox vaccine available for people who self-identify as being at increased risk for infection
On September 19, the Alaska Department of Health broadened eligibility for the monkeypox vaccine to “anyone who believes they are at increased risk for infection.” The current epidemiology suggests that people with two or more sexual partners AND who are gay, bisexual, or other men who have sex with men (MSM) or transgender people are at increased risk. Others potentially at risk might include sex workers, people with intimate or household contact with MSM with multiple partners, and people with increased risk of direct occupational exposure to monkeypox including
certain health care workers. AK DOH has reported five cases of monkeypox in Alaska residents to the CDC. Four of these cases occurred in Anchorage while one case is outside of Anchorage.
Alaska Department of Health Recommendations for Influenza vaccine and Respiratory Virus Update
October 1 marks the official start of influenza season. In preparation, the Section of Epidemiology released a bulletin, “Influenza Vaccine Recommendations and Administration for the 2022-23 Season.” Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. High-dose or adjuvanted influenza vaccines are preferentially recommended for adults aged ≥65 years. In general, vaccination is ideally offered during September and October. Unlike in past years when primarily SARS-CoV-2 was circulating, there are currently multiple respiratory viruses circulating in Alaska and so a Public Health Alert was sent on September 15. In addition to COVID-19 and influenza, Enteroviruses, Rhinoviruses, Parechovirus, and Respiratory Syncytial Virus are either currently circulating or anticipated before the end of the year.
Pediatric Pfizer-BioNTech COVID-19 vaccine 73.2% effective at preventing SARS-CoV-2 infection in interim analysis
In late August, Pfizer-BioNTech announced updated efficacy results from a Phase 2/3 trial evaluating a three-dose series of the Pfizer-BioNTech COVID-19 Vaccine in children 6 months through 4 years of age, which showed vaccine efficacy of 73.2%. This analysis was based on 13 cases in the Pfizer-BioNTech COVID-19 Vaccine group (n=794) and 21 cases in the placebo group (n=351), diagnosed from March to June 2022.
Incubation period of COVID-19 has been gradually decreasing with each variant
In a systematic review and meta-analysis, researchers reviewed 142 studies that investigated the time from SARS-CoV-2 infection to the onset of symptoms. The findings suggested that COVID-19 had a mean incubation period of 6.57 days (95% CI, 6.26-6.88 days). The mean incubation period of COVID-19 was 5.00 days (95% CI, 4.94-5.06 days) for cases caused by the Alpha variant, 4.50 days (95% CI, 1.83-7.17 days) for the Beta variant, 4.41 days (95% CI, 3.76-5.05 days) for the Delta variant, and 3.42 days (95% CI, 2.88-3.96 days) for the Omicron variant.
MMWRs
Omicron variant is more infectious but has been associated with less severe disease than previous variants
In this MMWR, CDC authors used a large hospital administrative database to assess in-hospital mortality risk overall by demographic and clinical characteristics during the Delta (July–October 2021), early Omicron (January–March 2022), and later Omicron (April–June 2022) variant periods among patients hospitalized primarily for COVID-19. Model-estimated adjusted mortality risk differences (aMRDs) (measures of absolute risk) and adjusted mortality risk ratios (aMRRs) (measures of relative risk) for in-hospital death were calculated comparing the early and later Omicron periods with the Delta period. Crude mortality risk (cMR) (deaths per 100 patients hospitalized primarily for COVID-19) was lower during the early Omicron (13.1) and later Omicron (4.9) periods than during the Delta (15.1) period (p<0.001). Adjusted mortality risk was lower during the Omicron periods than during the Delta period for patients aged ≥18 years, males and females, all racial and ethnic groups, persons with and without disabilities, and those with one or more underlying medical conditions. During the later Omicron period, 81.9% of in-hospital deaths occurred among adults aged ≥65 years and 73.4% occurred among persons with three or more underlying medical conditions. In the later Omicron period, COVID-19 patients at lower risk were hospitalized less often and hospitalized COVID-19 patients at higher risk experienced less severe disease and lower mortality.
COVID vaccinations reduce risk of COVID-related hospitalization
In this MMWR, researchers used data from COVID-NET to describe recent COVID-19–associated hospitalization rates among adults aged ≥18 years during the period coinciding with BA.2 predominance (BA.2 period [Omicron BA.2 and BA.2.12.1; March 20–May 31, 2022]). Weekly hospitalization rates (hospitalizations per 100,000 population) among adults aged ≥65 years increased threefold, from 6.9 (week ending April 2, 2022) to 27.6 (week ending May 28, 2022); hospitalization rates in adults aged 18–49 and 50–64 years both increased 1.7-fold during the same time interval. Hospitalization rates among unvaccinated adults were 3.4 times as high as those among vaccinated adults. Among hospitalized nonpregnant patients in this same period, 39.1% had received a primary vaccination series and 1 booster or additional dose; 5.0% had received a primary series and ≥2 boosters or additional doses.
RECURRENT TOPICS
Providing COVID-19 vaccinations
All Alaskans and people who work or live in Alaska who are aged 6 months and older are eligible for vaccination against COVID-19.
If you are interested in providing the COVID-19 vaccine in your office or clinic, please visit the COVID-19 Vaccination Program Provider Enrollment page. If you have additional questions, please email the vaccination program at immune@alaska.gov
Free self-paced online course available to promote COVID-19 vaccine confidence in Alaskan Communities
Two online courses are available for free through the UAA Alaska Center for Rural Health & Health Workforce in partnership with the State of Alaska Department of Health and Social Services Division of Public Health. These courses are designed to provide participants the knowledge and skills to promote COVID-19 vaccine confidence among clients, family, friends, patients and/or community members in Alaskan communities. For those who complete the online course, there is an option to attend the live practical session to apply what they learned. These will occur monthly until the end of June and the live sessions are also free.
The Provider course is designed for licensed, or license eligible healthcare providers (1 contact hour, Interprofessional Continuing Education credit [ANMC]).
The Community course is aimed at entry level healthcare professionals and the interested public (3 hours)
Oral COVID-19 Antivirals
The FDA has authorized two oral antivirals – Paxlovid and Molnupiravir - for the treatment of mild-to-moderate COVID-19 in individuals who are at high risk for progression to severe COVID-19. Both treatments must be initiated within 5 days of symptom onset. Molnupiravir is authorized for adults (18 years and older) and Paxlovid is authorized adults and adolescents (12 years and older). Learn more at covidrx.alaska.gov.
Long-Acting Monoclonal Antibodies for COVID-19 pre-exposure prophylaxis (PrEP)
Evusheld (tixagevimab/cilgavimab) is a long-acting monoclonal antibody therapy that has been authorized by the FDA under EUA for pre-exposure prophylaxis for COVID-19. This product is given by intramuscular injection every six months and may help prevent COVID-19 infection. Evusheld is authorized for adults and adolescents (aged ≥12 years) who do not have SARS-CoV-2 infection, who have not been recently exposed to an individual with SARS-CoV-2 infection, AND who are moderately to severely immunocompromised or are not able to be fully vaccinated with any available COVID-19 vaccines due to a history of severe adverse reactions to a COVID-19 vaccine.
For more information, read the NIH COVID-19 Treatment Guidelines Panel's statement on Evusheld.
JAMA Patient Page on Evusheld
Pregnancy
The CDC strongly recommends COVID-19 vaccination either before or during pregnancy because the benefits of vaccination outweigh known or potential risks.
For the latest recommendations, check out the CDC webpage on COVID in Pregnant and Recently Pregnant People and recommendations from the American College of Obstetrics and Gynecology. In addition, JAMA has published a one-page patient information sheet on COVID-19 and pregnancy.
Post-acute Sequelae of COVID-19 (PASC)
For the latest recommendations, check out the CDC webpage on Post-COVID-19 Syndrome and Evaluating and Caring for Patients with Post-COVID conditions. The Alaska Department of Health also has information about PASC and local resources on its Coping with Long COVID website.
COVID-19 Speakers’ Bureau
Anyone can request a free presentation for a group interested in learning more about COVID-19 in Alaska.
Aside from COVID-19
Alaska Medical/Nursing Licensing Timeline
The Division of Corporations, Business and Professional Licensing has recently fielded inquiries about rumors of delayed medical or nursing licenses and has provided information to promote transparency and efficiency. Temporary licenses for the Medical Board are consistently being issued within our advertised 6-8 week time frame—many as quickly as within two weeks. We have been meeting or exceeding this expedited time frame since July 2022 when the board adopted emergency expedited licensing regulations. A temporary license is a full license to practice. There are no restrictions. Board of Nursing staff report that licenses are consistently being issued within 4-5 weeks. This is a vast improvement since the spring, thanks to filling vacancies, internal process reviews, and board regulations changes.
Here are a few suggestions to help expedite the licensing process:
- Applicants can ensure a faster process if they provide all required information as quickly as possible.
- Lack of required information regarding license action in other states or malpractice suits delays review and requires further investigation. The Division of Professional Licensing strongly recommends that employers engage with their prospective applicants so they know whether an investigation will be necessary ahead of time.
- Employers should also require applicants submit a written release so we can discuss applications with the employer.
Alaska Eating Disorders ECHO Series
The Alaska Eating Disorders Alliance (AKEDA) and UAA Center for Human Development Project ECHO have collaborated to deliver a six-part ECHO series designed to connect Alaska's interdisciplinary healthcare professionals with eating disorders experts. Each 90-minute session of the Alaska Eating Disorders ECHO will offer a forum for participants to explore best practices through didactic presentations, share provider and patient experiences with case studies, and to engage in peer-to-peer discussion. We are also pleased to be able to offer 1.5 contact hours per session across a variety of provider types.
All 6 sessions (from September 7 - November 16) will take place on Wednesday every two weeks, from 6:00pm-7:30pm AKST, with the exception of the Oct 6 (Thursday) session, which will take place on Thursday to accommodate Yom Kippur.
Register for Alaska Eating Disorders ECHO here
Alaska Public Health ECHO Series
The Alaska Public Health ECHO is a virtual learning network intended for the general public to interface with Alaskan scientific and medical experts and the State of Alaska Public Health Leadership Team. This series recently restarted and is held monthly on the third Wednesday of each month from 12-1pm AKST as we explore critical public health topics and current best practices.
Register for Alaska Public Health ECHO here
Project Firstline
If you or your organization are interested in learning more about infection control in health care, the CDC has a robust training collaborative and resource library under Project Firstline. If you are interested in learning more about Project Firstline or potentially arranging a training session, please contact Kelley O’Leary at kelley.oleary@alaska.gov
Public Naloxone Training
DHSS OSMAP Project HOPE are conducting public naloxone trainings as a community outreach and to increase awareness and access. Email projecthope@alaska.gov.
Harm reduction strategies and resources
The Alaska Native Tribal Health Consortium (ANTHC) HIV/STD Prevention and Substance Misuse Prevention programs host free virtual gatherings to discuss harm reduction strategies and resources in Alaska. Guest speakers are Alaska-based experts in the field of harm reduction. Recordings of harm reduction trainings can be found here.
Several useful materials specific to Alaska opioid safety are at the following webpage. Check it out and print out information to hang up in your community.
Events/Conferences/Presentations
CDC COCA Calls:
2022-2023 Influenza Vaccination Recommendations and Guidance on Coadministration with COVID-19 Vaccines
During this COCA Call, presenters provided updates on the Advisory Committee on Immunization Practices (ACIP) recommendations for the 2022-2023 influenza vaccination season, including information on a new preferential vaccine recommendation for adults ages 65 and older. In addition, presenters outlined guidance for the coadministration of the influenza and COVID-19 vaccines.
Recommendations for Bivalent COVID-19 Booster Doses in People Ages 12 Years and Older
During this COCA Call, presenters discussed the CDC’s new guidance on bivalent COVID-19 booster doses for people ages 12 years and older, including those who are moderately or severely immunocompromised.
2022–2023 Recommendations for Influenza Prevention and Treatment in Children: An Update for Pediatric Providers
During this COCA Call, presenters provided an overview of influenza prevention and treatment recommendations for the 2022–2023 season from the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC).
Evaluating and Supporting Patients Presenting with Cardiovascular Symptoms Following COVID
During this COCA Call, presenters discussed post-COVID conditions (PCC), also referred to as Long COVID or post-acute sequelae of SARS-CoV-2 infection. Of the variety of symptoms that patients with PCC experience, cardiovascular symptoms and complications are among the most common and debilitating. Presenters also outlined the recommended clinical approach to identifying and managing cardiovascular complications in these patients based on the American Academy of Physical Medicine and Rehabilitation’s (AAPM&R) “Multi-Disciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Cardiovascular Complications in PCC”.
CDC EPIC Webinar: Monkeypox 101
This webinar will teach the basics of monkeypox and discuss CDC’s response to the current outbreak. The seminar will cover the signs and symptoms of monkeypox, how it spreads, understanding your risk, and how to prevent and treat monkeypox. It will also cover the trends for the current outbreak in the United States, how CDC is responding to and working toward reducing stigma surrounding monkeypox, and how you can help. This webinar will feature Neal Carnes, PhD, LGBTQ+ Equity Advisor for CDC’s Monkeypox Response, and Sapna B. Morris, MD, MBA, clinical consultations lead for CDC’s Monkeypox Clinical Task Force.
Register for the webinar: https://www.zoomgov.com/webinar/register/WN_8zR7JFz2SCSiylJwoFebpw
ANTHC Tribal Health Webinar Series
The ANTHC Tribal Health Webinar series occurs on Friday from 12-1pm on Zoom and is open to the public.
https://anthc.zoom.us/j/98667611681
Meeting ID: 986 6761 1681
September 30th: Ilka Decker, MD, MS. UM Nephrology. Diabetic Kidney Disease for Primary care.
October 7th: Mina Pirzadeh, MD. UM Pulmonary and Critical Care. Diagnosis and Management of Asthma in Adults.
October 14th: Jason Deen, MD. Seattle Children’s Hospital. AAP Care of American Indian and Alaska Native Children
October 19th: Research Brown Bag: Stephen O’Keefe, MD. University of Pittsburgh. Preliminary Findings from the Alaska Colon Cancer Fiber Study: High Dose Fiber Supplement Suppresses Colonic Mucosal Biomarkers of Cancer Risk in Alaska Native People at High Risk of Colon Cancer”
October 21st: Breanna Kinghorn, MD. Seattle Children’s Hospital. Pediatric Bronchiectasis.
October 28th: Jennifer Schaub, MD. UM Nephrology. Diagnosis and Management of Acute Kidney Injury.
November 4th: Areeba, Jawed, MD. UM Nephrology. Conservative Management in CKD and Palliative Care in CKD.
November 11th: Karthik Ramani. UM Nephrology. Primary Care Approach to CKD Management.
November 18th: Hallie Prescott, MD, MSc. UM Pulmonary and Critical Care. Management of Sepsis.
November 25th: Off for Thanksgiving Holiday
December 2nd: Wassim Labaki, MD, MS. UM Pulmonology. Diagnosis and Outpatient Management of COPD
December 9th: Mary Crocker, MD. Seattle Children’s Hospital. Management of Pediatric Asthma.
December 16th: James Benzschawel. Program Manager, Alaska Tribal Health System Emergency Management. Emergency Management framework within the Alaska Tribal Health System.
December 23rd: Off for the Holidays
December 30th: Off for the Holidays
January 6th: Mary Thomson, MD. UM Hepatology. Management of Decompensated Cirrhosis for Primary Care Providers.
January 13th: Shijing Jia, MD. UM Pulmonology. TBD
January 20th: Megan Acho, MD. UM Pulmonology. TBD
January 27th: Annette Marley. ANTHC Epidemiology. Firearm Safety.
February 3rd: Namory Bagayoko, MD. ANMC Orthopedics. TBD
February 10th: Bonnie Wang, MD. UM Pulmonology. Pulmonary approach to upper airway symptoms.
February 17th: Nangghaahlaangstangs. Haida People.
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.
The most up-to-date, evidence based COVID-19 treatment guidelines can be found at:
NIH COVID-19 Treatment Guidelines
IDSA Guidelines on the Treatment and Management of Patient with COVID-19
Alaska Responders Relief Line (844) 985-8275
Your well-being matters. Your behavioral health colleagues are standing by to talk 24/7: 844-985-8275
Recognizing the unique stressors that providers face, the Division of Behavioral Health has established a 24/7 support line, (844) 985-8275, for healthcare and behavioral professionals impacted by COVID personally and professionally. Staff supporting the call line recognize callers are often first responders and will allow callers to openly express their experiences and feelings serving Alaskans impacted by COVID.
This service is also available to immediate family members of first responders who may be experiencing stress, anxiety and other hard to label emotions as a result of their loved one engaging on the front lines.
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