BCHHS Public Health Provider Update: COVID and Influenza update

December 8, 2021

COVID-19 Update


  • As of 12/6/2021, there have been 30,384 confirmed cases of COVID-19 and 440 COVID-19-related deaths in Buncombe County residents since the start of the pandemic.
  • Unfortunately, the case rate in Buncombe County has continued to increase over the last several weeks. We are now at 208 cases per 100,000 population in the last 7 days. The 14-day percent positivity also has steadily increased to 6.6%.
    • We expect to continue to see cases rise throughout and following this holiday season as people travel and gather together (often indoors).
    • As of the week of 11/29/21, the greatest proportion of cases in Buncombe County remained the 25-49 year old age group, and the case rate in those age 0-17 years remained stable at 21.7%.
    • The Buncombe County Board of Commissioners extended the county-wide face covering requirement for all indoor public spaces through January 5, 2022. This requirement also extends to Asheville, Biltmore Forest, Black Mountain, Montreat, Weaverville and Woodfin.
  • Buncombe County is still considered to have a high level of community transmission, per the CDC.
  • COVID-related hospitalizations and ICU utilization in our region have been increasing gradually (66 inpatients with COVID-19 in the Mission System as of this morning; up from 41 this time last week and 33 two weeks ago).
  • Per the NCDHHS dashboard, 66% of the total Buncombe County population is partially vaccinated and 63% is fully vaccinated. When considering only those eligible for vaccination (5 years of age and older), 70% of this population in Buncombe County is partially vaccinated and 66% is fully vaccinated.
    • While eligible for COVID vaccination for just over a month, 25% of our county’s 5-11 year-old population has already received their 1st dose and 12% are fully vaccinated! Thanks to all the providers administering vaccine to this age group.
  • The NCDHHS weekly Respiratory Disease Surveillance Report contains a wide variety of data on COVID-19, including post-vaccination surveillance data, attack rates and mortality rates by vaccination status (starting on page 11).
    • For the week ending November 27, 2021, unvaccinated individuals in NC remain more than 5 times more likely to get COVID-19 and were 25.30 times more likely to die of COVID-19 when compared to vaccinated individuals.

Omicron variant

  • While the Omicron variant has not been identified in North Carolina at this time, it is expected that it is already circulating here. As of the most recent data, the majority of sequenced specimens in NC and the US are the delta variant.
  • There is still much to learn about this new variant of concern, include its transmissibility. To date, there are no laboratory or epidemiologic studies showing whether and to what extent omicron can evade immunity from vaccination or past infection. It is expected that COVID-19 vaccines currently authorized or approved in the US will remain effective against severe outcomes.
  • The FDA continues to evaluate the performance of diagnostic tests for SARS-CoV-2.  They have identified certain EUA-authorized molecular tests whose performance may be impacted by mutations in the omicron and other variants.   
  • The CDC has a Science Brief for Omicron here that they will continue to update as more information becomes available.

Booster update

  • Last week, the CDC expanded its recommendation on booster doses. Now everyone 18 years of age and older should get a booster shot either 6 months after completing their Pfizer or Moderna primary vaccine series or 2 months after their J&J vaccine primary series.
  • Any FDA-approved or authorized COVID-19 vaccine can be used as a booster dose, regardless of the vaccine received for the primary series.

Updated CDC resources

Expansion of EUA for monoclonal antibodies (mAb)

  • On December 3, the FDA revised the EUA of bamlanivimab and etesevimab (previously authorized for pediatric patients 12 years of age and older weighing at least 40 kilograms, or about 88 pounds) to additionally authorize the two administered together for the treatment of mild to moderate COVID-19 in all younger pediatric patients, including newborns, who have a positive COVID-19 test and are at high risk for progression to severe COVID-19, including hospitalization or death.
  • This revision also authorizes bamlanivimab and etesevimab to be administered together for post-exposure prophylaxis for prevention of COVID-19 in all pediatric patients, including newborns, at high risk of progression to severe COVID-19, including hospitalization or death.
  • Here is the updated healthcare provider fact sheet on bamlanivimab and etesevimab.
  • Click here for a side-by-side overview of mAb treatments currently allocated by the federal government.


Influenza Update

  • For the week ending November 27, 2021, influenza-like illness increased across NC, although it remained at low levels. No influenza-associated deaths have been reported in NC so far this flu season (through the week ending 11/27/21). Influenza data is part of the NCDHHS weekly respiratory surveillance report found here.
  • Please see this CDC Health Advisory and the attached memo from NCDHHS about increased influenza A(H3N2) activity and updated guidance on the use of antiviral post-exposure prophylaxis (PEP) in the context of co-circulation with SARS-CoV-2.
    • While it is unknown what the effectiveness of this year’s influenza vaccine will be, the A(H3N2) component was recently updated and is genetically similar to the currently circulating A(H3N2) viruses.
      • Please continue to encourage influenza vaccination to all those 6 months of age and older. Per the CDC advisory, influenza vaccination coverage is lower this season as of the week ending November 6, 2021 in certain groups at higher risk of severe influenza illness, such as pregnant persons and children, compared with the same period in 2020. Because influenza activity was low last season, the CDC anticipates a lower level of community protection that we rely on year after year to reduce the risk of a severe influenza season. Therefore, the CDC is anticipating an increase of influenza illness this winter, and both A(H3N2) and B-Victoria viruses are already co-circulating. As SARS-CoV-2 continues to circulate in the United States, illnesses associated with both viruses might stress healthcare systems.
      • Historically, influenza A(H3N2) predominant seasons have often been associated with more severe flu seasons, especially among older adults and young children.
    • PEP with influenza antiviral medications has been recommended in closed settings like LTCFs since before the COVID-19 pandemic. Given the unique considerations of influenza outbreaks in the context of co-circulation with SARS-CoV-2, it now may be considered for persons:
      • Who have had recent close contact with a person with influenza (e.g., roommates)
      • In confined quarters (e.g., dorms, shelters, prisons) with increasing incidence of influenza
      • Who are at increased risk for severe illness with influenza
      • Who have had recent close contact with a person with influenza and will be traveling for the holidays
  • Remember that all influenza-associated deaths are reportable to the local health department in the patient’s county of residence.
  • Resources:


CDC Clinician Call on Laboratory Detection of Influenza and SARS-CoV-2 Viruses


Updates on Buncombe County COVID-19 Vaccination Efforts

  • Walk-in COVID-19 Vaccine Clinic
    • BCHHS building, 40 Coxe Avenue in downtown Asheville
    • All FDA-authorized or FDA-approved COVID-19 vaccines and all doses are available here.
    • For the weeks of 12/6 and 12/13, the clinic will be open Tuesday-Friday from 9am-4pm.
      • The Buncombe County COVID Vaccine Clinic, like other non-emergency county services, will be closed Thursday 12/23, Friday 12/24, Monday 12/27 and Friday 12/31. Therefore, our hours of operation will change those weeks.
        • For the week of 12/20, the clinic will be open Monday-Wednesday from 9am-4pm.
        • For the week of 12/27, the clinic will be open Tuesday-Thursday from 9am-4pm.
        • For the week of 1/3/2022, the clinic will be open Monday-Friday.
    • No appointment is needed.
  • School-based Saturday COVID-19 Vaccine Clinics
    • We continue to have very successful school-based vaccine clinics. For more information on upcoming school-based Saturday clinics and other local vaccine clinics, please click here.
  • COVID-19 vaccines for the homebound
    • We continue to work with the Mission Health Partner CaraMedics to administer COVID-19 vaccine to those living in Buncombe County who cannot easily leave their homes to access vaccination.
    • If you know someone in need of this service, have them or their caregiver call the Buncombe County Ready Team at 828-419-0095.


If you have any concerns or questions about COVID-19, influenza or any other communicable disease, please contact the Buncombe County Communicable Disease staff at 828-250-5109 (available 24/7).