BCHHS Public Health Provider Alert: Updates on COVID quarantine, vaccine and MIS-C

December 9, 2020

Situation Update

  • As predicted, COVID-19 has taken advantage of the colder weather, Thanksgiving holiday and human behavior to increase its spread locally and across the state. See the state’s dashboard for updated numbers.
  • In the past week, NC’s case count has broken single-day records on three separate days, totaling more than 6,000 cases/day on two of those days. For comparison, a month ago, cases in NC were under 3,000/day. In recent days, the percent of tests returning positive statewide has increased to more than 10%. On NC’s COVID-19 County Alert System map, the number of red counties (critical community spread) has more than doubled since November 23, up to 48 red counties from 20 red counties. There are now 34 orange counties (substantial community spread), as compared to 42 orange counties from the previous report. With today’s report, more than 80% of the state’s counties fall into the red or orange tier.
  • While Buncombe County remains in the yellow tier (significant community spread) on the state’s Alert System map, we also have seen a significant rise in cases over the past week. We are consistently adding an average of 75 new cases/day, and on December 6th, we saw a record 110 new cases. Our percent positivity, which had been consistently below 5%, has now increased to 6.2%.
  • Even though we hired and trained additional staff to help with case investigation in anticipation of a rough holiday season, we currently are unable to keep up with the caseload, like many counties across the state. We have support staff calling all new cases to make sure they are aware of their test results and are isolating appropriately, and based on guidance from NCDHHS, we are now prioritizing cases for investigation.
  • Please continue to encourage everyone to follow the 3 W’s when they must leave their home – Wear a cloth face covering. Wait 6 feet apart from others. Wash hands often or use hand sanitizer. And encourage everyone to get vaccinated against COVID when they have the opportunity (more info below).

 

New Quarantine Guidance from CDC

  • Last week, the CDC released guidance outlining options to reduce the duration of quarantine for contacts to persons with COVID-19. Based on subsequent guidance from NCDHHS, Buncombe County Public Health has implemented the following protocol related to quarantine options for the general community:
    • Because a 14 day quarantine is still preferred by the CDC, we will continue to recommend a 14 day quarantine for all contacts and ask if they can/are willing to follow that guidance.
    • If they say they are unable or unwilling to quarantine for 14 days, then our staff will review the 7 and 10 day options with them.
      • Quarantine for 10 days IF no symptoms of COVID-19 for those 10 days, OR
      • Quarantine for 7 days IF no symptoms of COVID-19 for those 7 days AND a negative diagnostic test (PCR or antigen, including point-of-care versions of either) no earlier than day 5 after last contact to the person with COVID-19
    • If they end their quarantine before day 14, they must continue to check for symptoms of COVID-19, wear a mask, and keep 6 feet apart from others for all 14 days.
    • We will continue to recommend that a full 14-day quarantine be followed for staff and residents in congregate living facilities that are at higher risk for secondary clusters or where residents may be at higher risk for severe illness. This includes nursing homes, residential care facilities, and correctional facilities.
    • NCDHHS emphasizes that a test-based strategy for discontinuing quarantine should be used only if doing so does not impact diagnostic testing capacity. If a test-based strategy is used, special consideration should be given to ensure equitable access for all affected persons and communities.
  • NCDHHS is working on updating the “Steps After COVID-19 Testing” handouts to reflect these quarantine options. Once these updated handouts are available, I will share them with you.

 

COVID-19 Vaccine

  • Vaccine Distribution Prioritization Groups
    • In October, NCDHHS submitted an Interim COVID-19 Vaccination Plan to the CDC. Pages 56-67 of the plan provide details on the vaccine distribution prioritization groups proposed by the state.
      • Based on recommendations from the CDC’s Advisory Committee on Immunization Practices (ACIP) earlier this month, the state has revised their COVID-19 Vaccine prioritization groups to include LTCF residents in Phase 1a of distribution. (See attached updated prioritization groups. A graphic representation can be found here.)
      • The initial phase of vaccine dissemination (Phase 1a) will include healthcare workers and medical first responders who are at high risk of exposure based on work duties or who are vital to the initial COVID-19 vaccine distribution.
        • Other healthcare workers are included in Phase 1b and Phase 2.
        • Hospitals and health departments are tasked with administering vaccine during Phase 1a.
          • Buncombe County is keeping abreast of vaccine allocation estimates and will be sharing information on vaccination site locations, times, and processes to the Phase 1a vaccine population in the coming weeks.
        • The Federal government has established a partnership with large chain pharmacies to administer vaccine at participating skilled nursing facilities and larger adult care homes (e.g., assisted living facilities) during Phase 1a. Local health departments will work with non-participating facilities to get their staff and residents vaccinated.

 

  • Vaccine Allocation to NC
    • Two very promising vaccines are nearing Emergency Use Authorization (EUA) review.
    • The Pfizer Vaccine Candidate:
      • The FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) meeting to review/discuss this vaccine’s EUA application is scheduled for 12/10.
      • If the EUA is granted, the first shipment of Pfizer vaccine is expected to arrive in North Carolina the week of 12/14.
      • The estimate provided by CDC/Operation Warp Speed is that NC will receive approximately 85,000 doses as part of this initial allocation.
      • This initial allocation will be going to hospitals. Clearly, due to the limited number of doses, hospitals will be prioritizing within their own staff who is eligible for this first round of vaccine.
    • The Moderna Vaccine Candidate:
      • The VRBPAC meeting to review/discuss this vaccine’s EUA application is scheduled for 12/17.
      • If the EUA is granted, the first shipment of Moderna vaccine is expected to arrive in North Carolina the week of 12/21.
    • Vaccine is expected to be allocated to NC on a weekly basis for both products once they become available.
    • Per NCDHHS, if the allocation for the week of 12/21 is ample, it is expected to be split between hospitals, LTCFs, and health department.

 

  • COVID Vaccine Provider Enrollment
    • NCDHHS has been reaching out to enroll COVID vaccine providers in tiers – first was hospitals and health departments, most recently has been FQHCs, community health centers. rural health clinics and free and charitable clinics.
    • NCDHHS plans to expand provider enrollment over the next few weeks to include a broader range of providers (e.g., primary and specialty care providers, pharmacies, mobile vaccination providers, occupational health for large employers, providers serving incarcerated populations). We will share more information as we receive it.

 

  • Vaccine Messaging and Resources
    • Messages and resources related to COVID vaccine are available and will continue to be rolling out on https://covid19.ncdhhs.gov/vaccines. You can find information there for communicating with your patients about the vaccine, including a COVID-19 Vaccine FAQ. I encourage you to review these resources, as they include answers to questions you are likely already getting from patients or have yourself.

 

Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

  • Please review the attached updated information and guidance for clinicians on MIS-C associated with COVID-19.
  • NCDHHS continues to request voluntary reporting of cases of this syndrome to the Communicable Disease Branch via a secure online reporting form (https://is.gd/NC_MISC_Submission).
  • If you have questions, please contact the Communicable Disease Branch epidemiologist on call at 919-733-3419.

 

Reporting Test Results to Public Health:

  • Remember that, per NC statute, providers are responsible for reporting cases of COVID-19 immediately to the local health department in the county where the patient lives.
    • Please complete the Communicable Disease Report Form (attached and available online, now as a fillable PDF) and fax it and a copy of the lab result to BCHHS Communicable Disease staff at 828-250-6169.
    • This is required even if the outside lab performing the test sends results to the state.

 

This global pandemic remains an ever-changing situation. Please continue to check the CDC and NC DHHS websites for more information.

Contact the Buncombe County Communicable Disease staff at 828-250-5109 (available 24/7) or the NC Division of Public Health epidemiologist on-call line at 919-733-3419 (available 24/7) for additional consultation about COVID-19 or other public health concerns.

Multisystem-Inflammatory-Syndrome-in-Children-Assoc-with-COVID-19-12-1-2020.pdf

NCDHHS-COVID-Vaccine-Prioritization-Groups-12-02-2020.pptx