COVID-19 Update for Virginia
January 11, 2022
Dear Colleague:
Thank you for your continued partnership in responding to the COVID-19 pandemic. Please visit the Virginia Department of Health (VDH) website for current clinical and public health guidance, epidemiologic data, and other information. Updates on the following topics are included in this correspondence:
- New Declaration of Limited State of Emergency in Virginia and Executive Order 84
- Updated Recommendations for COVID-19 Vaccines and Staying Up to Date
- Update on Omicron Surge and Therapeutics
- CDC Shortens Isolation and Quarantine Periods
New Declaration of Limited State of Emergency in Virginia and Executive Order 84
On January 10, 2022 Governor Northam declared that a limited state of emergency exists in the Commonwealth of Virginia because of COVID-19 and issued Executive Order 84 to provide relief for hospitals and healthcare workers. This Order immediately went into effect until February 11, unless amended or rescinded sooner. The Order directs the State Health Commissioner to waive normal bed licensing requirements, allows hospitals to increase their licensed bed capacity, and mandates increased coordination between hospitals and Emergency Medical Services (EMS) agencies. It also allows healthcare providers, pharmacists, pharmacy interns, and pharmacy interns with active licenses in other states to practice in Virginia. Physician Assistants licensed in Virginia with two or more years of experience may practice without a written electronic practice agreement. A licensed practical nurse may administer COVID-19 vaccine without the supervision of a registered nurse or licensed medical practitioner. The Order provides certain liability protections to providers who act in good faith to protect patients and it increases flexibility in the transfer of patients to state-operated psychiatric hospitals.
Updated Recommendations for COVID-19 Vaccines and Staying Up to Date
Following the U.S. Food and Drug Administration’s (FDA) updated emergency use authorization (EUA) of the Pfizer-BioNTech COVID-19 Vaccine on January 3 and the Centers for Disease Control and Prevention’s (CDC) revised recommendations on January 4 and January 5, there are three key changes to the recommendations for the Pfizer-BioNTech COVID-19 Vaccine:
- All people aged 12–17 years should get a COVID-19 booster dose when they are eligible. Previously, only those aged 16 years and older were eligible for a booster dose, and CDC had recommended that all individuals 18 years of age and older should receive a booster and individuals 16–17 years of age may receive a booster. Currently, the Pfizer-BioNTech vaccine is the only vaccine available for those aged <18 years.
- The interval between completing the primary Pfizer-BioNTech COVID-19 Vaccine series and getting boosted was shortened from at least six months to at least five months for all eligible individuals (i.e., those 12 years and older).
- For moderately and severely immunocompromised children aged 5–11 years, a third primary series dose of the Pfizer-BioNTech COVID-19 Vaccine is now authorized and recommended for this population. This dose should be administered at least 28 days after the second dose.
On January 7, FDA authorized and CDC recommended that the interval between completing the primary series of the Moderna COVID-19 vaccine and administering a booster dose be shortened from at least six months to at least five months for all individuals aged 18 years or older.
In response to all these changes, FDA updated the Pfizer-BioNTech and Moderna fact sheets for providers and for recipients and caregivers and developed a summary table of booster eligibility and timing. CDC revised the Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States to reflect their new recommendations.
Although the definition of “fully vaccinated” (two doses of an mRNA vaccine or one dose of the Johnson & Johnson/Janssen vaccine) has not changed, CDC is now using the term “stay up to date” when talking about COVID-19 vaccines. This is a standard term used for other vaccinations. In the context of COVID-19 vaccinations, it means the primary series and any additional doses and boosters that are recommended for optimal protection.
Update on Omicron Surge and Therapeutics
Virginia is experiencing a major COVID-19 surge across the entire Commonwealth, largely driven by the highly transmissible Omicron variant. Nearly all data metrics are elevated, including record-high daily case rates, increased hospitalization rates, 7-day test positivity rate (which currently exceeds 30%), and increases in reported outbreaks, especially among long-term care facilities. Modeling data for Virginia predict the surge to peak on or around January 23.
We continue to learn new information about Omicron. According to CDC, the Omicron variant appears to have a shorter incubation period (2–4 days) than other variants. Lower hospitalization rates have been observed with Omicron infections in South Africa and the United Kingdom compared with those associated with previous variants. Vaccine effectiveness (VE) against symptomatic infection appears to be lower than that with other variants, but a booster dose does improve VE. People who are eligible to receive a booster are encouraged to get one as soon as possible, preferably with an mRNA vaccine. FDA continues to monitor the impact of Omicron on COVID-19 tests; in their latest update on December 28, FDA reported that antigen tests do detect Omicron infections, but the tests might have reduced sensitivity.
For therapeutics, the National Institutes of Health (NIH) clinical guidelines were updated on December 30 and CDC released a Health Alert Network (HAN) health advisory on December 31 summarizing available therapeutics. Of the available monoclonal antibodies, sotrovimab remains effective against Omicron and should be prioritized for nonhospitalized patients with risk factors for severe COVID-19. Among the antivirals, remdesivir, which has been approved for the treatment of hospitalized patients, is expected to be effective against Omicron and there is a new, off-label indication for the treatment of nonhospitalized patients. Paxlovid, an oral antiviral authorized for the treatment of nonhospitalized patients with mild to moderate disease, is effective against Omicron, but it is in short supply and is associated with possible drug to drug interactions. Molnupiravir, another oral antiviral recently authorized for outpatient treatment, can be considered when other treatment options are not accessible or clinically appropriate. Providers should refer to the NIH guidelines for the most up-to-date recommendations and VDH’s Therapeutics website for Virginia-specific information.
CDC Shortens Isolation and Quarantine Periods
On January 4, CDC released additional guidance about shorter isolation and quarantine periods for the general public. This guidance also applies to K-12 schools, institutes of higher education, and workplaces, but not to healthcare settings or high-risk congregate settings, such as correctional and detention facilities, homeless shelters, or cruise ships. For people infected with COVID-19, CDC shortened the isolation period to stay at home from 10 days to at least five days with an additional five days of wearing a well-fitting mask when around others at home or in public if symptoms have resolved. Getting tested with an antigen test at least five days after symptom onset (or five days after the initial positive test if asymptomatic) is recommended to determine if isolation at home should be continued, but it is not required. People with severe COVID-19 or immunosuppressed patients are advised to isolate for at least 10 days and follow the recommendations from their healthcare provider.
People who have close contact exposure to someone infected with COVID-19 and are asymptomatic are advised to wear a well-fitting mask and monitor their health for 10 days after the exposure. Certain exposed people, based on their vaccination and booster status, also need to quarantine at home. The period of quarantine at home was shortened from 14 days to at least five days after exposure, with an additional five days of wearing a well-fitting mask when around others at home or in public. For anyone who is exposed, getting tested with an antigen or PCR test at least five days after exposure is recommended, but it is not required. VDH adopted these isolation and quarantine updates and is revising our websites and resources as quickly as possible.
Thank you again for your continued partnership as we respond to the COVID-19 pandemic. My appointment as Virginia’s State Health Commissioner ends on January 14. It has been a true honor to work alongside you and serve all Virginians in this role since 2018 and throughout this pandemic.
Sincerely,
M. Norman Oliver, MD, MA
State Health Commissioner