Healthcare Professional Newsletter

COVID-19 

• Centers for Disease Control and Prevention (CDC)
• Updated: Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic
• Updated to note that vaccination status is no longer used to inform source control, screening testing, or post-exposure recommendations.
• Updated circumstances when use of source control is recommended.
• Updated circumstances when universal use of personal protective equipment should be considered.
• Updated recommendations for testing frequency to detect potential for variants with shorter incubation periods and to address the risk for false negative antigen tests in people without symptoms.
• Clarified that screening testing of asymptomatic healthcare personnel, including those in nursing homes, is at the discretion of the healthcare facility.
• Updated to note that, in general, asymptomatic patients no longer require empiric use of Transmission-Based Precautions following close contact with someone with SARS-CoV-2 infection.
• Archived the Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes and special considerations for nursing homes not otherwise covered in Sections 1 and 2 were added to Section 3: Setting-specific considerations.
• Updated screening testing recommendations for nursing home admissions.
• Clarified the types of long-term care settings for whom the healthcare infection prevention and control recommendations apply.
• Updated: Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2
• In most circumstances, asymptomatic HCP with higher-risk exposures do not require work restriction.
• Updated recommendations for testing frequency to detect potential for variants with shorter incubation periods and to address the risk for false negative antigen tests in people without symptoms.
• Updated: Strategies to Mitigate Healthcare Personnel Staffing Shortages 
• Conventional strategies were updated to advise that, in most circumstances, asymptomatic healthcare personnel (HCP) with higher-risk exposures do not require work restriction, regardless of their vaccination status; therefore, the contingency and crisis strategies about earlier return to work for these HCP was removed.

• Centers for Medicare and Medicaid Services (CMS) 
  • Visitation is allowed for all residents at all times.
  • Updated guidance for face coverings and masks during visits.
  • Removed vaccination status from the guidance.
  • On August 25, 2020, CMS published an interim final rule with comment period .
  • Most recent revision of this document was September 23, 2022.
  • This rule establishes LTC facility testing requirements for staff and residents.
  • Specifically, facilities are required to test residents and staff, including individuals providing services under arrangement and volunteers, for COVID-19 based on parameters set forth by the HHS Secretary.
  • This memorandum provides guidance for facilities to meet the new requirements.
  • Routine testing of asymptomatic staff is no longer recommended but may be performed at the discretion of the facility.
  • Updated recommendations for testing individuals who have recovered from COVID-19.
• Nursing Home Visitation Guidance - COVID-19: CMS is issuing new guidance for visitation in nursing homes during the COVID-19 public health emergency (PHE).
• Long-Term Care (LTC) Facility Testing Requirements

COVID-19 Vaccine Updates

• For questions about VaxMaX and its functionality, please visit the VaxMaX Help website, which includes reference guides and tutorial videos.

Upcoming Events

• National Network of STD Clinical Prevention Training Centers (NNPTC): Monkeypox Clinical Update Webinar - NNPTC faculty will provide a clinical update on monkeypox with time for a facilitated Q&A session.

• October 6, 2022 1 PM - 2 PM ET 
• November 7, 2022 12 PM- 1:15 PM ET 

Helpful Resources

• Check out our complete list of COVID-19 Vaccination Clinic Best Practices and our Lightning Learnings: Best Practices for Busy Providers!

COVID-19 Therapeutics Update

Process and Logistics Updates

New! HPoP Minimum Order Quantities (MOQ) lowered for Lagevrio and Evusheld 

• Effective October 3, 2022, the United States Government (USG) allocation for Lagevrio (molnupiravir) will be reduced for Virginia and the MOQ reduced from 24 doses to 15 doses to offer smaller volume ordering to HPoP providers. 
• Additionally, the MOQ for Evusheld will be lowered from 24 doses to 12 doses. The new MOQ of 12 doses equals 6 patient courses. Please note that this change does not impact small volume ordering which still allows for providers NOT in HPoP to order 1 to 3 patient courses.

Now LIVE in HPoP! HHS Bebtelovimab Product Replacement Initiative  

The goal of this initiative is to assist with equitable access to commercial Bebtelovimab for under and uninsured patients.  As of September 23, 2022, providers that used a dose of commercially purchased Bebtelovimab for the treatment of an uninsured or underinsured patient can request a replacement dose in HPoP.

Guidelines to participate - Provider must:

• Have used all their USG supply acquired through the HHS distribution program.
• Have purchased commercial Bebtelovimab and attest to using a purchased dose for an under or uninsured patient.
• Charge a reasonable administration fee for Bebtelovimab for that patient. Providers should consider waiving or reducing administration fees to amounts similar to the CMS payment rates of $350.50 onsite/$550.50 for at home visit when treating a patient who is under or uninsured.

The replacement dose is only for commercially purchased product and will be replaced with commercial Bebtelovimab shipped directly from the supplier.  The replacement dose can be used on any patient regardless of insurance status.

Determining how to access Bebtelovimab for your administration site(s): 

• Commercially Purchased Product (direct from AmerisourceBergen)
  • For patients with Medicare or Medicaid who have insurance but are not uninsured or underinsured or for patients who can afford treatment without insurance.
• Bebtelovimab Product Replacement Initiative (request to HHS through HPoP)
  • For patients who are uninsured or underinsured, once USG supply is depleted, and administered a commercially purchased dose with consideration of administration fees waived or reduced.
• State-Allocated USG Supply (request from VDH in HPoP): 
  • For patients who are uninsured or underinsured, where USG supply is available and commercial product has not been purchased.

Test to Treat Site Locator Tool Enhancements for Pharmacy Prescribing Paxlovid

On September 14, 2022,  enhancements were made to the Test to Treat Site Locator to show sites that offer pharmacists prescribing Paxlovid. 

This helps to identify locations where people are able to:

• Get tested and
• If they are positive and treatment is appropriate for them – receive a prescription from a health care provider, and then 
• Have their prescription filled all at one location OR at a non-traditional test to treat site where testing and assessment sites are linked with a pharmacy

In addition, the Test to Treat Site Locator shows sites that offer telehealth services and mobile sites. If you find that your site information is not up-to-date, please reach out to the therapeutics inbox at covid19therapeutics@vdh.virginia.gov, and we can assist in getting the information updated for your site.

Clinical Updates

Monoclonal antibody therapeutics activity against emerging variants

• Evusheld retains activity against most prevalent variant, BA.5; potentially loses neutralization activity against BA.4.6, BF.7
• NEW: Updated Evusheld Fact Sheet (as of October 3, 2022)
• Breakthrough infections are always possible-- advise patients, particularly those who are immunocompromised, to have a treatment plan in place and to seek timely medical attention if COVID-19 symptoms occur
• Bebtelovimab maintains potency against all currently circulating variants
• Paxlovid/Lagevrio also expected to retain activity based on preliminary data & sequence analysis; additional data pending

Read the full preprint text here.  

September 26, 2022: NIH COVID-19 Clinical Guidelines Update 

• Ritonavir-Boosted Nirmatrelvir (Paxlovid): In this revision, the Panel notes that concerns related to SARS-CoV-2 viral rebound, and the recurrence of COVID-19 symptoms should not be a reason to avoid the use of ritonavir-boosted nirmatrelvir. To date, the recurrence of symptoms following the use of ritonavir-boosted nirmatrelvir has not been associated with progression to severe COVID-19. Furthermore, viral rebound and symptom recurrence can also occur in the absence of treatment with ritonavir-boosted nirmatrelvir.
• Drug-Drug Interactions Between Ritonavir-Boosted Nirmatrelvir (Paxlovid) and Concomitant Medications: The Panel added drugs to Box 1 and Box 2, including Janus kinase inhibitors, anti-orthopoxvirus agents, and conjugated monoclonal antibody products. The Panel also reviewed the updated Emergency Use Authorization fact sheet for ritonavir-boosted nirmatrelvir and incorporated the information into this section.
• Molnupiravir: The Panel notes that there is a lack of definitive data regarding the benefit of molnupiravir in patients who are vaccinated and at high risk of progressing to severe COVID-19. Due to the fetal toxicities that have been reported in animal studies of molnupiravir, the Panel recommends against the use of molnupiravir for the treatment of COVID-19 in pregnant patients unless there are no other options and therapy is clearly indicated. It is not yet known how often SARS-CoV-2 viral rebound occurs after molnupiravir treatment.

Resources and Tools

Link to Sign Up for the Newsletter:

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VDH Therapeutics Website for Healthcare Providers

Check out the VDH Therapeutics webpage!  We have a variety of resources and tools for providers. Reach out to COVID19Therapeutics@vdh.virginia.gov for questions, comments, or feedback on information you’d like to see.

VDH Therapeutics Website for the Public

The general public can access information about COVID-19 therapeutics at VDH Protect Your Health: Available COVID-19 Treatments. 

COVID-19 Therapeutics Webinars and Open Forum Calls for Providers

VDH is continuing to facilitate webinars and open forums monthly. See below for links to register! 

• October 5 VDH Healthcare Provider COVID-19 Therapeutics Webinar: Register here.
• October 19 VDH Healthcare Provider Open Forum with Evusheld focus and guest speaker from AstraZeneca: Register here. 

Other resource links: 

HHS: ASPR Test to Treat Fact Sheet

Treatment of Monkeypox: Information for Virginia Healthcare Providers

Find where to access therapeutics here.

Topics of Public Health Interest

• Monkeypox
• On September 28,2022, the White House hosted a press briefing and announced: 
  • Data on rates of Monkeypox cases by vaccination status has been published
  • CDC's Interim Clinical Considerations for Use of JYNNEOS and ACAM2000 Vaccines during the 2022 U.S. Monkeypox Outbreak has been updated, to include:
  • Updated guidance on components of the U.S. National Vaccination Strategy Used in the U.S. Monkeypox Outbreak
  • Updated guidance on Intradermal (ID) Administration of the JYNNEOS vaccine (alternative regimen)
  • Updated guidance in vaccination schedule and dosing regimens for JYNNEOS Vaccine for those younger than age 18 years.
  • Updates to coadministration of JYNNEOS vaccine with tuberculin skin test
  • Updated contraindications and precautions for use of ACAM2000 Vaccine (Table 5)
  • Updated guidance on JYNNEOS and ACAM2000 vaccination administration
  • Considerations for specific populations (Table 6)
  • Updated vaccine administration errors and deviations (Table 7)
• 1. Severe manifestations of monkeypox have been observed in the United States in the current outbreak.
  2. People who are immunocompromised due to HIV or other conditions are at higher risk for severe manifestations of monkeypox than people who are immunocompetent.
  3. Because people with HIV-associated immunocompromise are at risk for severe manifestations of monkeypox, the HIV status of all sexually active adults and adolescents with suspected or confirmed monkeypox should be determined.
  4. There are diagnostic and clinical management strategies that may help address severe manifestations of monkeypox.NEW:  CDC Health Alert Network (HAN) Health Advisory: Severe Manifestations of Monkeypox among People who are Immunocompromised Due to HIV or Other Conditions. The purpose of this Centers for Disease Control and Prevention (CDC) Health Alert Network (HAN) Health Advisory is to inform healthcare providers that.

Virginia COVID-19 Information Center
1-877-VAX-IN-VA  |  1-877-829-4682  |  Mon-Fri 8am-5pm

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