Virginia COVID-19 Vaccination Updates

• Governor Glenn Youngkin's COVID-19 Action Plan. Last week, Governor Youngkin released his COVID-19 Action Plan, which includes encouraging vaccinations among the unvaccinated and prioritizing testing guidelines to mitigate supply chain shortages. The plan calls for prioritizing vaccine education and outreach to disproportionately unvaccinated communities and hosting and attending COVID-19 vaccine events across the Commonwealth. Actions to encourage vaccination also include working with governors across the country to learn best practices on vaccine education. Testing guidelines will be updated to reflect discouraging mass testing for pre-screening purposes, discourage asymptomatic persons from testing, and urge healthy persons with mild symptoms to stay home and use discretion on testing. The plan also directs the State Health Commissioner to issue new guidelines to prioritize the use of rapid tests for key groups like students potentially exposed to COVID-19, essential healthcare professionals, essential workers, vulnerable citizens in nursing facilities, and other key groups.
• Governor Youngkin's Executive Order 11. Executive Order 11 provides support to healthcare providers to provide flexibility and battle staff shortages caused by the COVID-19 pandemic. The order replaces Executive Order 84, issued by Governor Northam on January 10. Executive Order 11 goes into effect immediately through February 21, 2022 unless it is amended or rescinded. The order names a limited state of emergency in Virginia, allows hospitals and nursing homes to rapidly expand their bed capacity by waiving regulations, provides flexibility for out-of-state nurses and healthcare professionals to practice in Virginia, creates appropriate exemptions to the scope of practice requirements to allow healthcare providers to care for patients, expands the number of providers available to offer the COVID-19 vaccine, and expands flexibility and overtime hours for personal care workers.

White House

• Free N95 Masks for Americans. On January 19, the White House announced plans to make high-quality N95 masks available to all Americans for free. The Administration is making 400 million nonsurgical N95 masks available, free of charge, at community health centers and retail pharmacies across the United States. Shipment of these masks has begun and masks will start to be available at pharmacies and community health centers in the coming days. The program will be fully up and running by early February.

Ancillary Kit Deficiency Reporting

• Vaccine providers are encouraged to report any issues with equipment in the ancillary kits that are shipped with their federal vaccine orders.
• There are four steps to reporting to ensure enough information is gathered so problem trends in packaging and shipping can be identified. Please be prepared to provide photos, lot number, order number, date ordered, and dates received when filing a report for a deficient ancillary kit.

1. Report deficiencies to McKesson directly. Their customer service desk is charged with responding to problems and identifying trends.
2. Report deficiencies to the State Department of Health or clinic/hospital leaders who may then contact the Operation Regional LNO. This helps identify trends in problem equipment.
3. If an error or injury occurs during vaccine administration, enter the information into Vaccine Adverse Event Reporting System (VAERS) at https://vaers.hhs.gov/reportevent.html
4. Because syringes are a medical device, complete FDA form 3500  https://www.accessdata.fda.gov/scripts/medwatch/

• Ancillary Kit Opt-Out Instructions 
  • You can find opt-out instructions for the Moderna and J&J Ancillary Kits in the ExIS specification guide (version D07, page 34) in the VTrckS library at: https://vtrcks-library.cdc.gov/gm/folder-1.11.17315
  • You currently cannot opt out of Pfizer ancillary kits, which contain diluent.
  • For assistance or questions regarding ancillary kits, contact:
    • Pfizer:McKesson MedSurg to report  SNSSupport@McKesson.com       
    • Moderna or J&J/Janssen: 
      • McKesson Specialty Phone #: (833) 343-2703
      • Email: COVIDVaccineSupport@McKesson.com

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

• The VDH Southwest Regional team developed a new COVID-19 Vaccine Safety and Efficacy presentation. The video resource can be found on YouTube and includes an explanation of how COVID-19 vaccines work and what people can expect from COVID-19 vaccinations in about 20-minutes

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

Upcoming Events

• Medical Updates & Immunization Site Training for All Healthcare Providers led by Pfizer Vaccines U.S. Medical Affairs. Session topics include:
  • Introduction of the DO NOT DILUTE / Gray Cap formulation for individuals 12 years of age and older.
  • Use of each vaccine presentation, including storage, handling, preparation, and administration for:
    • Ages 5 through 11 Years: DILUTE BEFORE USE/Orange Cap
    • Ages 12 Years and Older:
      • DO NOT DILUTE/Gray Cap
      • DILUTE BEFORE USE/Purple Cap
  • Recent medical updates regarding the vaccine
  • An overview of healthcare provider resources
  • Question and answer session
  • Session dates:
    • January 26 at 12:00 pm ET
      • Attendee link
      • Password: 2pSQT324TdC
    • January 27 at 12:00 pm ET
      • Attendee link
      • Password: yVDHYiaF828

• COVID-19 and Long-Term Care Facilities: A Virginia Infection Prevention Training Center Webinar - This event is hosted by VCU Health on Wednesday, January 26, 2022, 12:00 – 1:00pm. Presenters include Arjun Srinivasan, MD (CAPT, USPHS) and Michael Stevens, MD, MPH, FACP, FIDSA, FSHEA. Topics will include: workforce shortages, access to PPE, infection risks for patients and staff, care and outcomes in a vulnerable population. Please register here.

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• VDH
  • Updated: VDH Proper Masking Tips - The webpage updates include adding clarifying language on protectiveness of mask types. Properly fitted respirators provide the highest level of protection. The following recommendations were also added for when to consider using a respirator:
    • When caring for someone who is sick with COVID-19
    • If you are at increased risk for severe illness, for example, older adults or people with certain underlying medical conditions
    • When using public transportation, especially where distancing is not possible
    • When in crowded places where physical distancing is not possible
    • When working at a job where you interact with large numbers of people (for example, bus drivers and grocery store workers)
    • If you are not up to date on your COVID-19 vaccination.
• Vaccination FAQS. The Vaccination FAQs have been updated to include Executive Order Number Two and the Order of Public Health Emergency One, getting up to date on COVID-19 vaccinations, the definition of "boosted", quarantine guidance for schools and the exception for 12-17 year olds who have completed their primary series but have not yet been boosted.
• CDC

• • • Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 - CDC updated the infographic and text in the guidance to include links to CDC’s definition of what it means to be up to date with all recommended COVID-19 vaccine doses. In general, asymptomatic healthcare personnel who have recovered from SARS-CoV-2 infection in the prior 90 days do not require work restriction following a higher-risk exposure.
    • Testing
      • Updated: Overview of Testing for SARS-CoV-2 - Revised to align with CDC’s updated recommendations on isolation and quarantine and recommendations for people who are up to date with their vaccines.
      • Updated: Antigen Testing Guidelines - This guidance incorporates considerations for people who are up to date with their vaccines and should be used in conjunction with CDC’s Stay Up to Date with Your Vaccines recommendations.

• FDA

• • FDA Takes Actions to Expand Use of Treatment for Outpatients with Mild-to-Moderate COVID-19 - On January 21, the FDA expanded the approved indication for Veklury (remdesivir) to include its use in adults and pediatric patients (12 years of age and older who weigh at least 40 kilograms, which is about 88 pounds) with positive results of direct SARS-CoV-2 viral testing, and who are not hospitalized and have mild-to-moderate COVID-19, and are at high risk for progression to severe COVID-19, including hospitalization or death. The agency also revised the Emergency Use Authorization (EUA) for Veklury to authorize the drug for treatment of pediatric patients weighing 3.5 kilograms to less than 40 kilograms or pediatric patients less than 12 years of age weighing at least 3.5 kilograms, with positive results of direct SARS-CoV-2 viral testing, and who are not hospitalized and have mild-to-moderate COVID-19, and are at high risk for progression to severe COVID-19, including hospitalization of death.
  • FDA Limits Use of Certain Monoclonal Antibodies to Treat COVID-19 Due to the Omicron Variant - On January 24, FDA revised the authorizations for two monoclonal antibody treatments – bamlanivimab and etesevimab (administered together) and REGEN-COV (casirivimab and imdevimab) – to limit their use to only when the patient is likely to have been infected with or exposed to a variant that is susceptible to these treatments. Because data show these treatments are highly unlikely to be active against the omicron variant, which is circulating at a very high frequency throughout the United States, these treatments are not authorized for use in any U.S. states, territories, and jurisdictions at this time. There are several other therapies – Paxlovid, sotrovimab, Veklury (remdesivir), and molnupiravir – that are expected to work against the omicron variant, and that are authorized or approved to treat patients with mild-to-moderate COVID-19 who are at high risk for progression to severe disease, including hospitalization or death. Healthcare providers should consult the NIH panel’s COVID-19 treatment guidelines and assess whether these treatments are right for their patients.

• New Child Vaccination Equity Web Resources 
  • The CDC recommends COVID-19 vaccination for children ages 5 and up. However, many children continue to face barriers to vaccination because of historical or other health disadvantages, such as those in racial and ethnic minority groups or who are part of households with lower incomes.CDC has created new web resources to help state and local health department officials address vaccine disparities and barriers among children in their jurisdictions.
    • Equity in Childhood COVID-19 Vaccination This web content describes what CDC is doing to ensure COVID-19  vaccination equity among children, what communities can do to improve equity in childhood vaccination, and spotlights successful community health vaccine equity initiatives focused on children.
    • Barriers to Equity In Childhood COVID-19 Vaccination This web content identifies priority groups of children who face vaccination barriers, historical disparities, and lessons learned about vaccination barriers from schools and families.