Health Alerts

April 01, 2022

Advisory

CAHAN: Use of Outpatient COVID-19 Therapeutics in California

On March 30th, the California Department of Public Health (CDPH) issued this alert on the use of outpatient COVID-19 therapeutics in California. As supply of therapeutics has increased and overall COVID-19 cases have decreased across California, there is no longer a limited supply of COVID-19 therapeutic treatments in most locations. As of this writing, all outpatients with mild to moderate COVID-19 who are at risk for disease progression should be offered treatment if eligible based on the product Emergency Use Authorizations (EUAs). Treatment should be offered regardless of vaccination status and because of the predominance of the Omicron sub-variant BA.2, sotrovimab is no longer authorized for use in California. This Health Alert also includes information on the new Test to Treat Locator. 

Please see the updated Alameda County Health Advisory. You are also encouraged to view yesterday’s webinar, COVID-19 Outpatient Therapeutics + Pre-Exposure Prophylaxis, with Dr. Nicholas Moss, Alameda County Health Officer, and Dr. John Openshaw. Dr. Openshaw is an infectious disease physician and researcher who leads the COVID-19 Clinical Team at the California Department of Public Health. He is on the faculty at Stanford University School of Medicine and regularly sees adult infectious disease patients in San Mateo and Santa Clara Counties. To learn more about COVID-19 drug-drug interactions, please check out the Liverpool COVID-19 Drug Interaction Tool. 

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org. For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org  

March 31, 2022

Advisory

Outpatient Therapies for the Treatment and Prevention of COVID-19 in High-Risk Patients

The purpose of this Health Advisory is to inform clinicians in Alameda County about the availability of outpatient therapies for high-risk patients with 1) mild to moderate COVID-19 illness who are not yet hospitalized; or 2) ongoing risk of exposure to COVID-19. When resources are limited, therapy should be prioritized for patients who are at the highest risk of progressing to severe COVID-19, as described in the NIH Panel’s interim statement. As availability increases, it may be possible to offer available therapies to all eligible patients. 

Recent updates to the Health Advisory include:

• New NIH treatment guidelines released
• Change in Sotrovimab window of therapy from within 10 days to within 7 days of symptom onset
• Change in dose of Evusheld; additional dose recommended for those who got smaller first dose
• Addition of Bebtelovimab as a recommended mAB therapy
• Remdesivir available for outpatient treatment of children and adults
• Therapeutic locator websites available
• Federal Test to Treat initiative launched 

Please also visit our COVID-19 website. For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org. For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org  

February 28, 2022

Advisory

FDA Revises Evusheld Dosing in EUA

The FDA has revised the EUA for Evusheld (tixagevimab co-packaged with cilgavimab) to increase the initial dose to 300 mg of tixagevimab and 300 mg of cilgavimab. Patients who have already received the previously authorized dose (150 mg of tixagevimab and 150 mg of cilgavimab) should receive an additional dose of 150 mg of tixagevimab and 150 mg of cilgavimab as soon as possible. Evusheld is authorized for use as pre-exposure prophylaxis (PrEP) for prevention of COVID-19 in certain adult and pediatric patients (12 years of age and older weighing at least 40 kg).

Based on the most recent available data, a higher dose may be more likely to prevent infection by Omicron subvariants BA.1 and BA.1.1 than the originally authorized Evusheld dose. Please also review our recent Health Advisory, Outpatient Therapies for the Treatment and Prevention of COVID-19 in High-Risk Patients, regarding the availability of therapeutics for patients with 1) mild to moderate COVID-19 illness who are not yet hospitalized; or 2) ongoing risk of exposure to COVID-19. Information is also available on our COVID-19 website.

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org. For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org.

February 24, 2022

Advisory

UPDATE: COVID-19 CMR Reporting

COVID-19 CMR Reporting Updates

Actions: Health Care Providers in Alameda County should submit COVID-19 Confidential Morbidity Reports (CMRs) within 24 hours on patients with SARS-CoV-2 infection that have been hospitalized or have died. Providers should continue to report on patients with Multi-System Inflammatory Syndromes in Children (MIS-C).  Healthcare facilities should continue to report weekly COVID-19 cases to CDPH as per AFL 21-25. Laboratories must continue to report positive and negative results via Electronic Laboratory Reporting (ELR) or by fax within 24 hours.

ACTIONS REQUESTED OF CLINICIANS:

1. Health Care Providers in Alameda County should submit CMRs within 24 hours on patients with SARS-CoV-2 infection that have been hospitalized or have died.
2. Continue to submit CMRs on patients with MIS-C and all non-COVID-19 Title 17 reportable conditions.

Additional Resources:

Order of the State Public Health Officer: Revision of Mandatory Reporting of Covid-19 Results by Health Care Providers

Alameda County Public Health Department CMR-D (COVID) reporting:

Email: COVIDreport@acgov.org
Fax: (510) 273-3944
For non-urgent concerns, email nCoV@acgov.org

February 22, 2022

Advisory

Update on Distribution and Patient Prioritization for Evusheld

The purpose of the CAHAN is to inform clinicians that: 

1. Evusheld is now being directly allocated to local health jurisdictions similar to the other federally allocated COVID-19 therapeutics. Evusheld received an emergency use authorization (EUA) for pre-exposure prophylaxis (PrEP) against COVID-19 on December 8, 2021. Healthcare facilities that would like to acquire product should contact Cynthia Frankel (see below).
2. Overall weekly supplies of Evusheld distributed from HHS have remained relatively consistent. However, product scarcity is still possible, especially as the number of sites administering this treatment increases. In cases where supply is limited by supply or logistical constraints, providers should follow NIH treatment guidelines.  

Please also review our recent Health Advisory, Outpatient Therapies for the Treatment and Prevention of COVID-19 in High-Risk Patients, regarding the availability of therapeutics for patients with 1) mild to moderate COVID-19 illness who are not yet hospitalized; or 2) ongoing risk of exposure to COVID-19. Information is also available on our website at https://covid-19.acgov.org/antibody-treatment 

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org 

For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org  

February 14, 2022

Advisory

UPDATE! COVID-19 Vaccine Booster Eligibility

On Friday, February 11th, the CDC updated its guidance for COVID-19 vaccination for people who are moderately or severely immunocompromised:

• Immunocompromised persons who have completed a primary series of an mRNA vaccine (Pfizer or Moderna) are recommended to receive an mRNA booster dose 3 months (instead of 5 months) after the last primary dose.
• Immunocompromised persons who have received a single J&J COVID-19 vaccine should receive one additional dose of an mRNA COVID-19 vaccine and one booster dose (preferably mRNA) for a total of 3 vaccine doses.

The CDC also clarified that immunocompromised persons who have completed their primary series of 3 mRNA doses should receive an mRNA vaccine booster dose—to make a total of 4 doses.

Also, for those who previously received passive COVID-19 antibody products, the CDC no longer recommends a waiting period prior to COVID-19 vaccination.

• Summary of key messages from the CDC related to these updates
• Alameda County’s full health advisory

February 03, 2022

Advisory

Ivermectin + Therapeutics Changes for Outpatient Treatment of Mild to Moderate COVID-19

On February 1, 2022, the CDC shared the following COCA Now: Ivermectin Products are Not Approved by FDA to Prevent or Treat COVID-19. Clinicians should be aware of the symptoms associated with ivermectin overdose, including:

• Gastrointestinal symptoms such as nausea, vomiting, and diarrhea
• Low blood pressure
• Neurologic effects such as decreased consciousness, confusion, hallucinations, central nervous system depression, seizures, coma, and death

Ivermectin may also increase sedative effects of other medications such as benzodiazepines and barbiturates.

On February 2, 2022, CDPH released the following health alert: CaHAN (Omicron Variant Update: Therapeutics Changes for Outpatient Treatment of Mild to Moderate COVID-19)

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org

For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org

For the full health advisory, please see ACPHD's Health Advisory.

January 28, 2022

Advisory

Outpatient Therapies for the Treatment and Prevention of COVID-19 in High-Risk Patients

The purpose of this Health Advisory is to inform clinicians in Alameda County about the availability of outpatient therapies for high-risk patients with 1) mild to moderate COVID-19 illness who are not yet hospitalized; or 2) ongoing risk of exposure to COVID-19. When resources are limited, therapy should be prioritized for patients who are at the highest risk of progressing to severe COVID-19, as described in the NIH Panel’s interim statement.

Please see the full health advisory full details and visit our COVID-19 website.

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org

For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org

January 19, 2022

Advisory

Prioritization of COVID-19 CMR Reporting

The increase of COVID-19 cases in Alameda County caused by the Omicron variant of SARS-CoV-2 is creating a substantial burden on communities, health care systems, and providers. Alameda County is closely monitoring the situation. Submission of Confidential Morbidity Reports (CMRs) for COVID-19 cases is required by state regulation but may be challenging during periods of high case volume.

Until further notice, clinical providers in Alameda County should prioritize submission of CMRs for patients with COVID-19 that have been hospitalized or have died. CMRs for other COVID cases should continue to be submitted as capacity allows. Multi-System Inflammatory Syndromes in Children (MIS-C) is required to be reported separately, and should continue to be prioritized for CMR submission. Laboratories must continue to report positive and negative results via Electronic Laboratory Reporting (ELR) or by fax.

Please see the full health advisory for details, including actions requested of clinicians and additional resources.

December 28, 2021

Advisory

Changes to J&J Guidance and CDPH Booster Requirements

Due to the risk of Thrombosis with Thrombocytopenia Syndrome (TTS), a rare but serious adverse event, the CDC now recommends the use of mRNA vaccines over the Janssen/J&J vaccine for all vaccine-eligible persons. Vaccine providers should start the two-dose mRNA vaccine series even if there is uncertainty about how the patient will receive their second dose; setting alone should not be a reason to offer the J&J vaccine. However, J&J may be offered in some situations as described below:

• When there is a contraindication to mRNA vaccines (e.g., severe allergic reaction after a previous dose or to a component of an mRNA vaccine)
• When a person would otherwise remain unvaccinated for COVID-19 due to limited access to vaccines.
• When a person wants to receive J&J despite the safety concerns identified

 For more information, please review the CDC’s Interim Clinical Considerations.

As Omicron spreads, it is important that providers encourage all eligible patients to get a booster, especially those over 50 or those with significant underlying health conditions.

For more information, please see PDF.

December 28, 2021

Alert

CAHAN Disease Notification - CDPH Health Alert - Authorization of Paxlovid

On December 22, 2021, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for Pfizer’s Paxlovid (nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use) for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kilograms).

The federal government will be allocating Paxlovid to states, and the California Department of Public Health (CDPH) will allocate Paxlovid to jurisdictions based on new COVID-19 cases and an equity measure. Given the limited amount of Paxlovid available, product scarcity is expected. The attached Health Alert outlines suggested prioritization of patients for Paxlovid and ethical considerations in settings of limited availability.

On December 23, 2021, the FDA issued an emergency use authorization (EUA) for Merck’s molnupiravir for the treatment of mild-to-moderate COVID-19 in adults. More information about the allocation of molnupiravir is coming soon.

For clinical questions, please contact Arnie Spanjers, MD, at arnie.spanjers@acgov.org

For allocation questions, please contact Cynthia Frankel, RN, MN at cynthia.frankel@acgov.org

• CDPH Health Alert

December 01, 2021

Alert

SARS-CoV-2 virus variant of concern B.1.1.529 (Omicron)

• ACPHD Health Alert
• CDPH Health Advisory
• CDC Health Alert