First, some news about the outpatient treatment of Covid 19 with Remdesivir followed by some new guidelines on the timing of the second dose of Covid 19 vaccines. Following that is an article from today’s WSJ on BA2, the new strain of Omicron circulating. Apparently, it has yet to warrant it’s own Greek letter.
The antiviral medication remdesivir is now available for outpatient use in combating COVID-19, and the Texas Department of State Health Services (DSHS) has sent a letter to COVID therapeutic administrators explaining how they can order the medication from the state’s distributor.
Remdesivir, also known by the brand name Veklury, had previously been in short supply and was available only in hospitals. In January, the Food and Drug Administration expanded the emergency use authorization for remdesivir to include outpatient settings.
“We have been assured by the federal partners on the calls that they don’t have concern about supply,” said Manda Hall, MD, DSHS associate commissioner of community health improvement.
The improved outpatient availability is important because a recent study showed a three-day course of remdesivir greatly reduces the risk of hospitalization after a COVID-19 infection, says San Antonio infectious disease specialist Jan E. Patterson, MD, a member of the Texas Medical Association’s COVID-19 Task Force.
However, other difficulties remain in getting remdesivir to the patients who need it most, according to a December 2021 editorial in the New England Journal of Medicine.
The primary difficulty is that remdesivir is an intravenous medication that has to be administered over three consecutive days, requiring “multiple health care interactions,” the editorial says. Access to and uptake of single-dose monoclonal antibodies has been challenging, so a three-day course of remdesivir is likely to be more difficult.
“The problem is that because it’s IV and because these patients have COVID, it’s not easy to give this [on an outpatient basis],” Dr. Patterson said.
Some Texas physicians and local officials have encouraged the U.S. Department of Health and Human Services (HHS) to allow regional infusion centers that provide monoclonal antibody treatments to also provide remdesivir, Dr. Patterson says. So far, HHS has not done so.
I DON’T KNOW YET WHO IS ADMINISTERING IT TO OUTPATIENTS.
Updated CDC Guidance on COVID-19 Vaccination Second Dose Intervals
Following a thorough evaluation of the latest safety and effectiveness data, the Centers for Disease Control and Prevention (CDC) has updated the mRNA COVID-19 vaccination schedule for some patients. Specifically,
- Individuals ages 12 through 64 years – who are not moderately or severely immunocompromised – may benefit from getting their second mRNA COVID-19 vaccine dose 8 weeks after their first dose, instead of after 3 to 4 weeks.
- Particularly for males ages 12 through 39 years, this extended interval may allow a stronger immune response and minimize the already rare risk of adverse events such as myocarditis and pericarditis associated with mRNA COVID-19 vaccination.
- Patients who meet these criteria and have already received their primary mRNA series at the 3-to-4-week interval do not need to repeat any doses.
There are some people who should get their second dose at the original 3-to-4-week interval, including:
- Individuals who need rapid protection due to increased concern about community transmission or risk of severe disease
- Individuals who are moderately or severely immunocompromised
- People aged 65 years or older.
Healthcare providers are a valued and trusted source of health information and play a key role in a patient’s decision to get vaccinated. This new guidance is intended to help inform clinical decision-making by giving providers additional information to tailor vaccine recommendations based on the patient.
The interval between COVID-19 mRNA vaccine doses is best determined by considering the balance of risks and benefits, based on the individual’s age and health conditions. Regardless of the interval between the first and second dose, data show mRNA vaccines remain highly effective at reducing the risk of hospitalization or serious complications from COVID-19.
Please visit the Updated CDC COVID-19 Vaccination Schedules for additional information.
Fast-Spreading Covid-19 Omicron Type Revives Questions About Opening Up
BA.2 subvariant now accounts for more than a third of global cases, according to global database
By
Peter Landers Follow
and
Miho Inada Follow
Feb. 23, 2022 6:41 am ET
A more infectious type of the Omicron variant has surged to account for more than a third of global Covid-19 cases sequenced recently, adding to the debate about whether countries are ready for full reopening.
Health authorities are examining whether the subvariant of Omicron, known as BA.2, could extend the length of Covid-19 waves that have peaked recently in Europe, Japan and some other places.
“We’re looking not only at how quickly those peaks go up, but how they come down,” World Health Organization epidemiologist Maria Van Kerkhove said. “And as the decline in cases occurs…we also need to look at: Is there a slowing of that decline? Or will we start to see an increase again?”
BA.2 accounted for only 3.9% of Covid-19 infections in the U.S. in the week through Feb. 12, according to the most recent estimate released by the Centers for Disease Control and Prevention. After an Omicron surge in December 2021, the U.S. has experienced an equally sharp and steady fall.
Other countries have had more trouble shrugging off Omicron. In Denmark, where an estimated 92% of cases were BA.2 as of mid-February, a peak at the end of January was followed by another two weeks later.
Evidence so far suggests BA.2 is some 30% more infectious than its cousin, the BA.1 subvariant that kicked off the Omicron wave in southern Africa in November 2021. In South Africa, BA.2 has accounted for 82% of cases so far in February, according to health authorities in that country.
Overall, BA.2 accounted for 35% of Covid-19 virus samples whose genomes were recently submitted to the global Gisaid database, according to a Gisaid update released Tuesday.
Studies so far suggest that both types of Omicron pose about the same risk of severe disease in humans. That risk is lower than last year’s Delta variant, but with so many people getting infected, the death toll from Omicron is still high.
A South African analysis comparing a group with likely BA.1 Omicron against another group with likely BA.2 found both groups had roughly equal odds of being hospitalized and developing severe disease.
Early studies suggest that vaccines and booster shots work equally well in both Omicron types in preventing serious illness. A study by the U.K. Health Security Agency found both types could easily get around the immunity of people who had received their full primary course of vaccination at least six months earlier. But a booster shot restored protection against symptomatic disease from both variants, to 69% for BA.1 and 74% for BA.2.
Still, some initial research in test tubes and animals leaves room for concern that BA.2 might be more harmful. A team led by Kei Sato at the University of Tokyo found that BA.2 had an easier time invading the cells in the lungs of hamsters compared with BA.1.
Prof. Sato said BA.2 has as many differences from BA.1 as last year’s Delta variant had from the original virus detected in Wuhan, China. He said BA.2 might merit its own Greek-letter name rather than being classed as a type of Omicron.
New York University virologist Nathaniel Landau has led research suggesting that Omicron BA.2 is even better than BA.1 at evading monoclonal antibody drugs developed to fight Covid-19. Nonetheless, he said a new Greek letter wouldn’t be needed unless BA.2 turned out to be more harmful to humans.
“If it were to turn out that it has higher pathogenicity, that would then be a reason. But at this point, no,” he said.
Prof. Sato said the current co-circulation of BA.1 and BA.2 could spawn a hybrid virus that would “more easily increase and be more harmful.”
Scientists said the public-health measures to deal with Omicron were generally the same regardless of its type—vaccination, booster shots, social distancing, masks, good ventilation and so on.
The question is whether the spread of the even more infectious Omicron type should affect the loosening of restrictions. Denmark lifted all restrictions on Feb. 1, only to see a rise in deaths in people infected with Covid-19. Officials said the virus wasn’t the cause of some of the deaths.
Early data already suggest that the Omicron variant may be better at evading vaccine-generated antibodies, and a lot of that has to do with what’s happening at a molecular level. WSJ’s Daniela Hernandez explains.
WHO officials said the threat of BA.2 was a reason for caution. In Japan, where BA.2 has recently been detected, the head of the country’s doctors association, Toshio Nakagawa, said the country should keep restrictions such as encouraging restaurants to close early. “Infections might increase again, depending on how BA.2 spreads from now on,” Dr. Nakagawa said.
Some governments say that with the public weary after two years of Covid-19, it is time to open up. They observe that the population in many countries has built up considerable immunity to SARS-CoV-2 through multiple vaccination rounds, previous infection or both.
The U.K. is ending all restrictions starting Thursday, including a legal requirement to self-isolate for those who test positive. “It is a day when all the efforts of the last two years finally enable us to protect ourselves while restoring our liberties,” Prime Minister Boris Johnson said.
—Denise Roland contributed to this article.
