It’s a Two-Way Street

When we all wear masks and take COVID-19 precautions, we take care of each other. After several months of rising cases, hospitalizations and deaths, Alaska, is starting to see a decline in virus spread in many regions of Alaska, including Sitka. This shows that the sacrifices we are making are working. Our actions to protect ourselves and others make a difference. However, now is not the time to let our guard down – not yet. There is much reason for hope, between this news and the first shipments of COVID-19 vaccine last week, but we need to stay strong! “When we let up on the brakes, then we start to see cases rise quickly,” says Dr. Anne Zink. The end of this pandemic is in sight – let’s get there together!

COVID-19 Alaska Clinical Update: December 21, 2020

COVID-19 Alaska Weekly Update
COVID-19 Alaska Clinical Update COVID-19 Alaska Clinical Update
Monday, December 21, 2020   COVID-19 Alaska Weekly Update
Alaska Cases
42,413 COVID-19 cases total in AK residents, with 917 cumulative hospitalizations and 183 deaths. Cases continue to rise across the state, but acceleration has slowed and shown signs of reversing in recent weeks.

Vaccine News
The first doses of the Pfizer COVID-19 mRNA vaccine arrived in Alaska last week.
The FDA issued an emergency use authorization for Pfizer’s mRNA vaccine just over one week ago. The EUA authorizes the vaccine for use in individuals age 16 and older. Dosing is two doses 3 weeks apart. The EUA requires Pfizer to report every month on safety, including by age groups and by special populations such as pregnant women, and on any adverse events. Vaccination providers must report any administration errors, serious adverse events, cases of multisystem inflammatory syndrome in children and adults who have received the vaccine, and cases of COVID-19 that result in hospitalization or death in people who have received the vaccine. Reporting is via phone or online to the Vaccine Adverse Event Reporting System (VAERS).

The FDA’s recommendation is based on their analysis of the raw data from Pfizer trials, which they published in an extensive document. ASTHO’s summary of that document includes:

Safety and Side Effects

The study demonstrates the vaccine was safe and well-tolerated in participants ≥16 years of age. Reactogenicity and adverse events were generally milder and less frequent in older participants (≥56 years of age) compared with the younger group (≤55 years of age). Reactogenicity was considered mostly mild to moderate and short-lived, and the adverse events profile did not suggest any serious safety concerns. There is a significant occurrence of side effects, including injection site reactions (84.1%), fatigue (62.9%), headache (55.1%), muscle pain (38.3%), chills (31.9%), joint pain (23.6%), and fever (14.2%). Median onset of symptoms is 0-2 days after vaccination and duration was 1-2 days. There were four cases of Bell’s palsy in the vaccine group, which is not outside the parameters of the general population, but is something to watch. A total of six people died during the study period: four in the placebo and two in the vaccination group (heart attack and arteriosclerosis). All deaths were determined not to be vaccine/study related. Pregnant and breastfeeding women were not included in the study.

Efficacy

Study results show the vaccine provided protection against COVID-19 in participants who had no evidence of prior infection, with more severe cases observed in the placebo group. The vaccine was >90% effective in preventing confirmed COVID-19 occurring at least seven days after the second dose. The vaccine shows some protection after the first dose, but the study does not validate that it can be administered as one dose. There is a slight decrease in vaccine efficacy in older populations, but not a significant change. The vaccine is effective across gender, race and ethnicity demographics, and persons with comorbidities. However, there were not enough racial minorities enrolled in the study to make specific statements about the vaccine effectiveness broken down by race/ethnicity. There is limited data surrounding the vaccine efficacy against asymptomatic disease and transmission.

An analysis of Pfizer’s Phase 2/3 trial was published last week in the NEJM, with similar conclusions as to safety and efficacy.

The FDA issued an EUA for a similar mRNA vaccine made by Moderna late last week; shipment of the Moderna vaccine is expected to begin shortly.

Vaccines and allergic reactions
After vaccination started in the UK, two anaphylactoid reactions were reported in heathcare workers who had histories of anaphylaxis to other allergens. CDC addressed this in
their clinical considerations for use of the Pfizer vaccine with the following table: Please contact Debbie.McDonald@alaska.gov for ADA compliant informationPlease contact Debbie.McDonald@alaska.gov for ADA compliant information
If you watch one thing about vaccines, try EMRAP’s Deeper Dive into COVID-19, a 23 minute videocast with accurate, concise, specific information about mRNA vaccines. The host interviews Dr. Barker of This Week in Virology, a podcast where experts discuss COVID-19, virology and, recently, paper virus snowflake patterns to augment holiday decorations.
New and upcoming from DHSS

Alaska COVID-19 testing guidelines have been updated to include the new quarantine options of 7 days with a negative test or 10 days without a test. A table on page 2 outlines the new options. Antigen testing guidance is also updated.

A clinical practice guideline from ACOG and a statement from SMFM address whether pregnant and lactating people should receive the vaccine, noting that while the vaccine was not tested in these populations, it is expected to benefit and there are not specific theoretical risks to a pregnancy, fetus or breastfeeding baby. Live virus vaccines are not recommended in pregnancy because of a risk of viral reactivation if transmitted to the fetus; mRNA vaccines do not contain a live virus. Both ACOG and SMFM recommend offering the vaccine to pregnant and lactating people if they are otherwise eligible, as does the CDC, and recommend encouraging patients to have a risk-benefit discussion with their physician prior to vaccination.

The Vaccine ECHO is a chance to discuss and learn more about COVID-19 vaccines and the Alaska vaccination campaign, held each Thursday 2-3 PM.
Please help contact tracers by including full patient address and phone numbers in the patient contact section when you request COVID-19 testing at the Alaska State Public Health Lab. ASPHL now allows these to be routed directly to COVID-19 response partners. The updated form is here: http://dhss.alaska.gov/dph/Labs/Documents/SARS-CoV-2RequestForm.pdf
COVID-19 Alaska Weekly Update
New from CDC

Updated clinical guidance for management of COVID-19

Expanded quarantine guidelines to include option of 10 day quarantine or testing out of quarantine after 7 days, and a scientific brief explaining the reasoning for this change

CDC vaccine communication toolkit and key messages for patients about mRNA vaccines

VSAFE: to use the free national reminder and safety test messaging system, anyone can text ENROLL to 1-833-VAX-TEXT when they get their vaccine and get text reminders about the second dose as well as texts asking about any side effects. Vaccine recipients can also go to the website provided on the information they get at the time of vaccination.  

AK Clinical Reminders COVID-19 testing guidelines and test site locator
Report any positive test to the state Section of Epidemiology using the COVID Reporting Hotline at 1-877-469-8067 or by faxing in the Infectious Disease report form. If you suspect COVID-19 in an outpatient who cannot isolate in their own home (for example they are unsheltered or from out of town) or for another urgent situation call SOE at 907-269-8000 or 800-478-0084 (after-hours). Join us for the ECHO series for more information and discussion:
Use the links below to register beforehand for the online meeting
COVID-19 for Alaska Healthcare Providers: Every other Tuesday, 7-8:30PM
Science ECHO for the general public: Wednesdays, 12-1PM
Healthcare Specific COVID-19 Situational Awareness: Thursdays, 12-1PM
School Health ECHO: Mondays 3-4PM
Alaska Perinatal ECHO: Thursday, 6-7PM
Palliative Care in COVID-19 ECHO: Wednesday, 12-1PM
EMS ECHO: 2nd & 4th Friday, 10-11AM
Vaccine ECHO:Thursday, 2-3 PM
AK COVID-19 clinical hotline for physicians: 833-751-4212. Staffed 24/7.
8PM-8AM is for urgent/emergent questions only.
AK Responders Relief Line: 24/7 behavioral health for everyone working in healthcare
during the COVID-19 pandemic: 1-844-985-8275

DHSS Press Release: Initial allocations of Moderna vaccine arrive in Alaska; Alaska’s work to distribute, allocate and administer vaccine continues

Dec. 21, 2020 ANCHORAGE – The second COVID-19 vaccine authorized for emergency use by the U.S. Food and Drug Administration (FDA) arrived in Alaska on Monday. Distribution and administration of this vaccine, made by Moderna, will occur this week in Alaska alongside the continued roll-out of the Pfizer vaccine which started last Monday. 

As of Sunday, 5,674 doses of Pfizer vaccine have been administered in Alaska and reported to Alaska’s VacTraAK immunization information system.

The Moderna vaccine received emergency use authorization from the FDA on Friday. The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) recommended Saturday that Americans aged 18 and older receive the Moderna vaccine under emergency use. CDC Director Dr. Robert Redfield signed the ACIP recommendation, which began distribution of the Moderna vaccine on Sunday.

“We want to offer this vaccine to Alaskans as quickly as possible,” said Alaska’s Chief Medical Officer Dr. Anne Zink. “This is a major step in that direction. We’re extremely grateful for the hard work that has gone into developing this vaccine and ensuring its safety. Our role is to continue to distribute vaccine according to federal and state allocation plans to Alaskans who want it.”

According to current federal government estimates, Alaska will initially receive 26,800 doses of Moderna vaccine in addition to the 35,100 doses of the Pfizer vaccine, which began to be distributed and administered last week. These numbers include the Indian Health Service allocations for Alaska, but do not include vaccine allocated to Veterans Affairs and the Department of Defense.

The initial state allocations from Pfizer and Moderna include enough doses for 61,900 people. Both vaccines require a second dose; the second doses are being held in reserve by the federal government to ensure they will be available when needed. The follow-up dose of the Pfizer vaccine should be taken three weeks after the first dose while the separation between doses is four weeks for the Moderna vaccine.

The Pfizer and Moderna vaccines are similar in that they both use messenger RNA technology (mRNA) to protect people against the virus, they are highly effective, and they require two doses spaced apart. Both vaccines must be kept cold but the Moderna vaccine must be shipped at -4° Fahrenheit and is stable after thawing at refrigerator temperatures for 30 days and at room temperature for 12 hours. The Pfizer vaccine must be shipped at -94° Fahrenheit but can only be stored at refrigerated temperature for 5 days.

“The Moderna vaccine will help us reach more communities, especially those that have less access to cold storage,” said Tessa Walker Linderman, the DHSS co-lead of Alaska’s COVID-19 Vaccine Task Force. “Having both vaccines provides us more vaccine – and more flexibility.”

Who can get vaccinated, and when? 

Vaccine availability remains limited at this time and will be allocated according to federal and state recommendations. ACIP provides recommendations about who should have the vaccine available to them first. States have the option to make further adjustments if needed. As per the Alaska Draft COVID-19 Vaccination Plan, the Alaska Department of Health and Social Services (DHSS) has convened theAlaska Vaccine Allocation Advisory Committee (AVAAC). The committee is comprised of Alaska clinicians, ethicists and other health professionals who review the ACIP guidance and scientific data and provide recommendations on the appropriate allocation of limited COVID-19 vaccine supplies in Alaska.

Over the course of several meetings, AVAAC reviewed ACIP recommendations for Phase 1a. The committee defined Phase 1a within three distinct tiers; individuals in the first two tiers are currently eligible to be vaccinated. The remaining Phase 1a tier is anticipated to be eligible Jan. 4, 2020.

Tier 1 of Phase 1a (currently being administered) includes:

  • Hospital-based front-line health care workers who are frequently exposed to COVID-19 patients. For more details on who is included in this group, visit the Alaska Guidance for Allocating COVID-19 Vaccine information web page.
  • Long-term care facility residents and staff. This includes skilled nursing facilities, assisted living homes, and Department of Corrections infirmaries providing assisted living care.

Tier 2 of Phase 1a (currently being administered) includes:

  • Front-line EMS and fire service personnel providing medical services who are frequently exposed to COVID-19 patients and whose absence from work would compromise the ability of these critical medical services to continue. This tier includes personnel in certified ground-based and air medical services. This tier also includes community health aides and health workers providing EMS services.
  • Community Health Aides/Practitioners
  • Health care workers providing vaccinations to identified populations in Phase 1a

Tier 3 of Phase 1a (expected to be administered starting as early as Jan. 4, 2020): 

  • Workers in other health care settings at highest risk of contracting COVID-19 who are essential to the health care infrastructure and who regularly provide health care services that cannot be postponed or provided remotely. These workers meet all of the following criteria:
  • They have direct patient contact, or have direct contact with infectious materials from patients; and,
  • They provide essential services in a health care setting that cannot be offered remotely or performed via telework; and,
  • They provide a service in a health care setting that cannot be postponed without detrimental impact to the patient’s short-term or long-term health outcomes; and,
  • They need to be licensed and certified – this includes direct support professionals who provide personal care or home- and community-based services, laboratory technicians, phlebotomists, and workers performing COVID-19 testing.

On Dec. 20, ACIP issued further recommendations for Phases 1b and 1c vaccine allocation. Balancing between two high-risk groups, ACIP recommended that people aged 75 and older and front-line essential workers such as emergency responders, teachers and grocery store employees be next in line for the vaccine.

In Alaska, a public comment meeting for Phase 1b will occur Dec. 28, 2020. More information about the meeting, and how to provide comment, is available at the Alaska Guidance for Allocating COVID-19 Vaccine information web page.

DHSS prioritizes safety

The Alaska Department of Health and Social Services (DHSS) has been communicating with the CDC, FDA and health care partners in Alaska regarding the adverse reactions reported this week during COVID-19 vaccine clinics. Investigations into what might have caused the reactions are ongoing and DHSS is assisting.

“Safety is a top priority, and these systems are closely monitored by the CDC,” said Dr. Zink. “Reporting any adverse reaction is extremely important so we can continue to ensure the safety of these vaccines. All providers are encouraged to report all adverse reactions to the VAERS system so we can continue be as transparent as possible.”

As of today, DHSS is aware of 11 reports regarding possible allergic reactions from Alaska’s hospitals to CDC: Bartlett Regional Hospital (8), Providence Alaska (2) and Fairbanks Memorial Hospital (1). Two were identified as anaphylaxis and one of those resulted in hospitalization for ongoing monitoring. In the other three cases, symptoms were mild and not considered anaphylaxis. Symptoms have resolved in all cases and the hospitalized patient has been discharged and is doing well.  The CDC said there appears to be no obvious geographic clustering of these reactions, nor was a specific production lot involved. People who experience anaphylaxis after the first dose should not receive a second dose, according to CDC recommendations.

In all of these situations, as recommended by the CDC and DHSS, symptoms were discovered during the 15-30 minute observation period following vaccination, and as required, the hospitals had medicine on hand to treat possible allergic reactions. Vaccinations are continuing as DHSS and its state and federal partners investigate these incidents and watch closely for any further allergic reactions.

“We strongly encourage anyone who experiences an adverse reaction to promptly report it to the CDC via the Vaccine Adverse Event Reporting System (VAERS),” said Alaska’s State Epidemiologist Dr. Joe McLaughlin. “Clinicians who will be administering COVID-19 vaccine should also review CDC’s guidance on anaphylaxis management to ensure that they are prepared to deal with allergic reactions should they occur.”

Vaccination providers administering a COVID-19 vaccine that is under Emergency Use Authorization are required by the Food and Drug Administration to report vaccine administration errors, serious adverse events, cases of Multisystem Inflammatory Syndrome, and cases of COVID-19 that result in hospitalization or death. Reporting is also encouraged for any other clinically significant adverse event, even if it is uncertain whether the vaccine caused the event.

For more information about VAERS visit: vaers.hhs.gov

For more information on COVID-19 vaccination in Alaska visit: covidvax.alaska.gov.

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Holiday Messages from Sitka Unified Command: Dr. Elliot Bruhl

“This is Dr. Elliot Bruhl SEARHC Chief Medical Officer and Co-Incident Commander of the Sitka Unified Command. Like you I look forward to the holidays every year for the joy, happiness, and spending time with family and friends. Like you, I am also looking for new ways to connect with those we love. Zoom and FaceTime will be part of the season this year for us. It has been a challenging year, but I am optimistic that our efforts will bring us to a better and safer time in 2021.” https://covid19.searhc.org/

Holiday Messages from Sitka Unified Command: John Holst

“This is John Holst, Superintendent of the School District and a member of Sitka’s Unified Command, urging all Sitkans to be aware of how easy the COVID-19 virus can be transmitted from person to person. Mitigations, including face masks, instituted in the School buildings have prevented the transmission of the virus within any of our buildings. Please take the extra few seconds to always be wearing a mask whenever you are near another person or in any public setting. The children in the Sitka School District are depending on you.” https://www.sitkaschools.org/

Holiday Messages from Sitka Unified Command: Denise Ewing

“Seasons Greetings, this is Denise Ewing, your State Public Health Nurse and Public Health Liaison for Sitka Unified Command. With Christmas just around the corner it’s time to get those creative preparation juices flowing. Whether you are trying out virtual Christmas gatherings, or winterizing your backyard for an intimate family Christmas fire, it’s all about making it mindful this year, keeping it safe and fun at the same time. My heart, and prayers go out to each of you this holiday season as we keep kindness and grace at the forefront. Merry Christmas, Happy Holidays and a health filled New Year!” https://covid19.alaska.gov/

Holiday Messages from Sitka Unified Command: Janelle Vanasse

“Seasons Greetings, this is Janelle Vanasse, Superintendent of Mt. Edgecumbe High School and member of the Sitka Unified Command. Thank you for the warm welcome you have extended to Mt. Edgecumbe High School Students this year and the care you have taken to manage COVID. For the holidays, our students head home to every corner of Alaska; your efforts mean so much not only to Sitka, but to all the communities of Alaska and the families and Elders our students will return to. To you and your family, Happy Holidays.” http://www.mehs.us/

News Release: December 16 Unified Command Weekly Meeting

UNIFIED COMMAND DISCUSSES START OF

PHASE 1 VACCINATIONS

SITKA, December 16, 2020

Incident Commander, John Leach reported on his discussion with Southeast Alaskan communities on the 2021 cruise ship industry. Leach said the draft of a centralized Smartsheet showing specific metrics for each community has been created and will continue to be developed.  The Coast Guard is participating telephonically in the meeting today because SEARHC is looking for assistance in getting vaccines to some of the communities they serve due to inclement weather occurring within their delivery timeframe. Coast Guard Commander, Brian McLaughlin explained to Unified Command the request, authorization and execution process for assistance in delivery to these communities.

Jay Sweeney, Finance Section Chief is waiting for information from FEMA on the June project. The August project is being loaded into the portal and staff is working on getting the September project into the system.

Public Health Nurse, Denise Ewing reviewed case counts for Alaska and reminded us that our alert level remains high statewide. Vaccines have started to arrive in Sitka and today we are starting Phase I in Sitka with EMS, first responders, and healthcare workers. While the vaccine has arrived, Sitkans will still need to practice COVID-19 mitigation guidelines to keep each other safe.

Trish White, Pharmacist announced they are beginning Phase 1 vaccinations today for EMT Sitka Firehall, Sitka Police, Alaska State Troopers, Guardian Medic First Responders, and healthcare workers not covered under SEARHC from 4-8 pm at the Firehall.  White thanked EMS, Sitka Fire Hall, Public Health and SEARHC for collaboration efforts.

John Holst, Superintendent for Sitka School District shared that the Listening Session occurs live December 16 for parents at 6:30 pm in Centennial Hall. The update to the Smart Start plan is going to allow more freedom in what is possible or not possible to operate safely for instruction. The District is targeting January 11 as a possible return time for in school instruction for all school buildings. Due to a huge number of traveling staff members over Christmas break there will not be enough staff to open for in school instructions the first week of January. The last day of instruction before Christmas is Friday, December 18.

Unit Resource Leader, Amy Ainslie shared that the COVID Conscious Business Program has launched, visit cityofsitka.org to fill out an application. For any questions about the program please email covidconcious@cityofsitka.org.

Janelle Vanasse, Superintendent of Mt. Edgecumbe High School said most students have left for the holidays and fourteen students will remain on campus over the winter break. Students will be returning from break on January 9.

Unified Command urges citizens to remain diligent and practice proper hygiene measures, such as washing your hands often, avoiding close contact with others and keeping your social circle small. In addition, stay home if you feel ill, wear a face covering when around others, and clean and disinfect objects and surfaces on a regular basis.

COVID-19 symptoms are similar to the flu – fever, aching, cough, sore throat, shortness of breath, and sometimes decreased sense of taste and smell. If you are concerned you might have contracted the coronavirus contact the COVID hotline at 966.8799 from 8:00 a.m. to 5:00 p.m.  Outside of normal clinic hours, patients can contact the SEARHC 24/7 Nurse Advice Line at 1.800.613.0560 to be triaged by a registered nurse. 

The Emergency Operations Center encourages residents to prepare for any local emergency by ensuring each family member has a 14- day emergency supply kit, including any necessary medications.

For information on the local pandemic response, visit cityofsitka.org or covid19.searhc.org.

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