12/03/21 Health Advisory: COVID-19 Updates for Providers

| December 3, 2021

COVID-19 Updates for Providers

Requested actions

      • Take a travel history for all suspected or confirmed COVID-19 cases before community transmission of Omicron becomes more prevalent.
        • Notify the Health Department of a confirmed case with history of international travel within 14 days before symptom onset or positive test, if asymptomatic.
        • Notify the Health Department of all close contacts of a confirmed case of Omicron infection.
      • Continue to follow NIH treatment guidelines for COVID-19 infection. No data exists yet about the effectiveness of monoclonal antibodies or antiviral therapies against Omicron.
    • Encourage all adult patients to get booster doses and all patients 5 years or older to get fully vaccinated.
      • Remind patients how to prevent COVID-19 infection and stop its spread: wear a mask, maintain physical distance, get vaccinated, ensure good ventilation and get tested if you have symptoms.
      • Certain PCR tests can screen for Omicron because of its S gene deletion. Ask your labs if they can monitor for Omicron. Labs should send possible Omicron specimens to CDC for sequencing.
    • Be aware, Food and Drug Administration (FDA) may soon grant emergency use authorization (EUA) to Molnupiravir, the first oral antiviral developed to prevent severe COVID-19 illness in adults 18 years or older with mild to moderate illness at high risk of progressing to severe illness.
      • Be prepared, Health and Human Services (HHS) will allocate supply to each state and DOH will distribute doses to enrolled providers. HHS created Healthcare Partner Ordering Portal (HPoP) to manage COVID-19 therapeutics.
      • Register for training on HPoP. Email mcm@doh.wa.gov to become an enrolled provider. Training is given 9–10 a.m. on Tuesdays in December.
    • Be aware, reports have increased of Multisystem Inflammatory Syndrome in Children (MIS-C), a rare but severe complication that can occur weeks after symptomatic or asymptomatic COVID-19 infection. In Washington, 24 MIS-C cases were reported September–November 2021; this is 33% greater than in any 3-month period since surveillance began.
      • Be aware, Multisystem Inflammatory Syndrome in Adults (MIS-A) has been documented. CDC has developed a working case definition which includes:
        • 21 years or older.
        • Severe illness requiring hospitalization.
        • Recent positive test result for SARS-CoV-2 infection (PCR, antigen or antibody).
        • Severe extrapulmonary organ system dysfunction.
        • Markedly elevated acute inflammatory markers.
        • Absence of severe respiratory illness (to exclude patients where tissue hypoxia causes organ system dysfunction).
      • Report MIS-A cases to the Health Department at (253) 649-1412. It is likely underdiagnosed because its symptoms overlap those seen with severe COVID-19. Use MIS-C case report form.
      • Seek additional support or education from the DOH MIS-C team. Email carlson@doh.wa.gov and amanda.dodd@doh.wa.gov.

Background

Omicron Variant of Concern

A new SARS-CoV-2 variant, lineage B.1.1.529, was detected in Botswana on Nov. 11, 2021, and South Africa on Nov. 14, 2021. This new variant has many novel mutations in portions of the genome that can potentially increase infectivity and transmissibility, confer resistance to certain therapeutics and reduce neutralization by convalescent and vaccine sera. For these reasons, on Nov. 26, 2021, WHO classified B.1.1.529 as a variant of concern and named it Omicron. By Dec. 1, the Omicron variant had been detected in at least 20 countries. Evidence of community transmission has been found n some countries. On Nov. 30, 2021, Omicron was classified a Variant of Concern by U.S. SARS-CoV-2 Interagency Group (SIG), which includes CDC, NIH, FDA, Biomedical Advanced Research and Development Authority, Department of Defense, Department of Agriculture and HHS.

Currently, it is unknown how efficiently the Omicron variant can spread from person to person. It is unknown whether Omicron is more transmissible than other variants. Preliminary data from South Africa suggest the mutations to the receptor binding protein will confer increased infectivity. Currently, information is limited about the clinical manifestations of infection. Given the small number of cases identified to date, current assessment of disease severity and response to vaccines and therapeutics is difficult. Preliminary information from South Africa indicates no unusual symptoms are associated with Omicron infection and, as with other variants, some patients are asymptomatic. Symptoms may be milder in people who are vaccinated or previously infected with SARS CoV-2.

Some SARS-CoV-2 variants, including Omicron, have Δ69-70 deletion in the spike (S) gene. This mutation leads to failure of one of the polymerase chain reaction (PCR) targets (sometimes called S-gene target failure [SGTF]) when the virus is tested with assays that include an S gene target, including Thermo Fisher Scientific TaqPath™ COVID-19 Combo Kit diagnostic assay4. TaqPath™ tests for 3 proteins of SARS-CoV-2 so will still detect the virus but will fail to detect the S gene protein specifically. Such assays can be used as a screen to presumptively identify SARS-CoV-2 variants that have the Δ69-70 deletion, including Omicron. Delta, currently the predominant variant in the United States, does not have this Δ69-70 deletion; therefore, Delta infections do not produce a SGTF profile.

COVID-19 vaccine resources

COVID-19 testing resources

Patient education

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Immediately report COVID-19

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Contacting the Health Department

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Additional resources