COVID-19 Update for Virginia
June 30, 2021
Dear Colleague:
Thank you for your partnership in responding to the COVID-19 pandemic for over a year now. Please visit the Virginia Department of Health (VDH) website for current guidance, epidemiologic data, and information. The following updates are included here:
- Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination
- Monoclonal Antibody Update
- Updates on the Delta (B.1.617.2) and the Epsilon (B.1.427/B.1.429) Variants
- New CDC Viral Testing Tool
- Preparing for Heat-Related Illness
Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination
The Centers for Disease Control and Prevention (CDC) continue to recommend COVID-19 vaccination for everyone 12 years of age and older, given the risk of COVID-19 illness and related, possibly severe, complications. According to the CDC, myocarditis and pericarditis after COVID-19 vaccination are rare. CDC reports that as of June 21, the Vaccine Adverse Event Reporting System had received 616 reports of myocarditis or pericarditis among people aged 30 years and younger who received COVID-19 vaccine. Most cases were reported after mRNA COVID-19 vaccination (Pfizer-BioNTech or Moderna), particularly in male adolescents and young adults. CDC and the U.S. Food and Drug Administration (FDA) have conducted follow-up, including medical record reviews, and have confirmed 393 reports. CDC stated that most patients who received care responded well to treatment and rest and quickly felt better. CDC and its partners are investigating these reports to assess whether there is a relationship to COVID-19 vaccination. On June 25, the FDA updated its patient and provider fact sheets for the Pfizer-BioNTech and Moderna COVID-19 vaccines to include a warning about this rare potential complication. Last week, the Advisory Committee on Immunization Practices met to review the data and CDC will update its Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States.
Monoclonal Antibody Update
The combined prevalence of two SARS-CoV-2 variants, the Gamma (P.1.) and Beta (B.1.351), now exceeds 11% in the United States and is trending upward, according to CDC. In-vitro test results suggest that the combination of bamlanivimab and etesevimab is not active against these two variants. By contrast, test results indicate that casirivimab and imdevimab (REGEN-COV, Regeneron) and sotrovimab (GlaxoSmithKline or GSK) are likely to be effective against the Gamma and Beta variants.
As a result, on June 25, the U.S. Department of Health and Human Services (HHS) announced the immediate pause of all shipments nationwide of bamlanivimab and etesevimab until further notice. FDA recommends that medical practitioners stop using this regimen for treatment of COVID-19 at this time, and to use alternative mAb products such as REGEN-COV or sotrovimab.
REGEN-COV can be obtained by completing the online order form on the VDH monoclonal antibody website, and sotrovimab can be accessed through the GSK website. For more information or questions, please email VDH at respiratory@vdh.virginia.gov.
Monoclonal antibodies (mAbs) for outpatient use are authorized for treatment of COVID-19 patients, aged 12 years and older weighing at least 40 kg, with mild to moderate disease who are at high risk for progression to severe COVID-19.
Updates on the Delta (B.1.617.2) and the Epsilon (B.1.427/B.1.429) Variants
On June 15, CDC reclassified the Delta (B.1.617.2) variant from a variant of interest to a variant of concern. According to a recent risk assessment by the European Centre for Disease Prevention and Control, the Delta variant is estimated to be 40%–60% more transmissible than the Alpha (B.1.1.7) variant. Early evidence suggests that the Delta variant might be associated with a higher risk of hospitalization. Fortunately, COVID-19 vaccines protect against severe illness caused by the Delta and other variants.
According to CDC’s update on June 29, the Delta variant was predicted to account for 26.1% of circulating strains in the United States for the week ending June 19. Some U.S. states or areas, particularly those with lower vaccination rates, are experiencing a rise in cases and hospitalizations. In Virginia, 48 COVID-19 cases caused by the Delta variant were reported as of June 25. Among 41 cases with available travel history, 31 (76%) occurred in people who did not travel internationally, indicating that the Delta variant is spreading in Virginia. Please encourage your patients to get vaccinated to protect themselves and their loved ones. People who are not yet fully vaccinated should continue to follow recommendations, including wearing a mask, practicing physical distancing, avoiding crowds and poorly ventilated spaces, and washing hands often.
Today, CDC reclassified the Epsilon (B.1427/B.1429) variant from a variant of concern to a variant of interest because of decreasing detection across the United States. In Virginia, a similar decreasing trend has been observed among sequenced samples; the Epsilon variant was last detected in Virginia in mid-May.
New CDC Viral Testing Tool
The CDC recently updated its testing website with a new COVID-19 Viral Testing Tool. The interactive web and mobile-friendly tool provides recommendations for COVID-19 testing and resources based on the user’s responses. The tool can help healthcare providers quickly access the most relevant, actionable information to determine what type(s) of COVID-19 testing they should recommend to patients. It can also help people determine what type of test they should get. When test results are available, the tool can help interpret the results and guide next steps.
Preparing for Heat-Related Illness
Certain groups are particularly vulnerable to heat-related illness, including low-income households, people who do not have access to air conditioning, people with chronic medical conditions (e.g., diabetes, heart disease, hypertension, obesity, mental illness), people aged 65 years or older, infants and children, and outdoor workers. Please remind your patients about the dangers of heat-related illness and how to prevent this potentially life-threatening illness.
On behalf of VDH, I thank you for your tireless efforts and sacrifices these many months to protect Virginians from COVID-19. If you have questions about COVID-19, please contact your local health department.
Sincerely,
M. Norman Oliver, MD, MA
State Health Commissioner