August 3, 2021
 
A Message for the Wellforce Physician Community,
Local Care Organization Leaders and Practice Managers,
and the Wellforce Clinically Integrated Network staff
(legacy Lowell General PHO and NEQCA)
Don't Miss Our Next COVID-19 Webinar on Wednesday, August 11, from 5:30-6:30 p.m. Please click here to join the meeting. 
COVID-19: Not Out Of The Woods
Colleagues:

Those of you who are fans of The Godfather movies may remember Michael Corleone's famous quote from Part III: “Just when I thought I was out … they pull me back in!”

I believe that is the way many of us are feeling about COVID-19. Just when we thought the worst of the pandemic was behind us, the Delta variant is proving otherwise.
 
Delta is a serious threat for the unvaccinated. And although CDC data indicates that "breakthrough" infections among the vaccinated have affected just 0.098% of Americans (most with no or mild symptoms) none of us knows what the long-term impact of virus exposure may mean.
 
For 18 months your colleague Dr. Ben Kruskal has regularly updated you about COVID-19 developments. I urge you to review this most recent Briefing which summarizes what you, your practice, and your patients should know right now.
 
It is a priority for me – as the newly appointed Interim Chief Medical Officer for the Wellforce Clinically Integrated Network – to build a deeper understanding of the COVID-19 information and other resources you may need to thrive in your personal practice.
 
Please reach out to me any time by email or phone (978-726-2668). Your input is important and appreciated.
 
Frank Osborn, MD
Interim Chief Medical Officer
Delta Variant: Impact and Implications
Below are updates in light of the surging Delta variant strain of COVID-19.
Some of this language was quoted from Shira Doron, MD, Epidemiologist, Tufts Medical Center, but the content is solely the responsibility of Ben Kruskal, MD.
 
The Delta variant is very contagious, more so than other circulating COVID-19 strains.
  • Some transmission can occur both to and from healthy people who are fully vaccinated.

  • Some outdoor transmission of Delta likely occurs under conditions of prolonged close face-to-face contact, e.g. attendance at sporting events and performances.

COVID-19 cases are higher than they were a few weeks ago.
When cases are higher, we will see numerically more cases and hospitalizations in groups with proportionally lower risk, such as those who are young or those who are vaccinated.
  • The Delta strain does not appear to be more severe in infected individuals.

Vaccines are highly effective in protecting against the Delta variant.
Well-done studies show the existing mRNA vaccines are about 88% effective against any Delta infection (asymptomatic, mild or severe) and 97% effective against hospitalization, due to the Delta variant. This represents a very small decrease in protection against infection with NO decrease in protection against hospitalization. As of now, there is no recommendation for vaccine booster doses from any US public health authority or professional society.

Transmission of the Delta variant appears to be by the same routes as prior strains of COVID-19.
  • Transmission of the Delta variant appears to be primarily by respiratory droplets, with smaller contributions from short range small particle airborne transmission, and very little surface transmission. 
  • All the precautions we know how to use should still be very effective, including: 
  • Avoiding high person-density settings, especially indoors, and settings without good ventilation.
  • Masking (surgical mask, ideally with fit improved by cloth mask or mask brace over it, or by tying ear loops and tucking the pleats in the side) is highly effective when done correctly, at times and places where there is significant transmission risk.
  • N95 masks are not likely to be better than well-fitting surgical masks without knowledgeable technical support in the selection of a model that can achieve a tight seal to the wearer’s face, as well as instruction in how to don and wear the mask to avoid air leaks around the edges, which defeat the advantages.
  • Given the increased transmissibility of the Delta strain, it may be desirable to resume some of our prior precautions, e.g. avoiding high-density indoor settings especially those including eating and drinking in many bars and restaurants. It may be appropriate to add some new precautions as well—in particular, avoidance or masking in outdoors high-density settings such as performance and sports events.
Updated Local, State and National COVID-19 News
Boston ID Chiefs Vaccine Q&A in the Boston Globe
Click here to read.  
 
Effective July 30: MA DPH New Mask Advisory
The Department of Public Health has issued a new mask advisory in light of the Centers for Disease Control and Prevention’s updated guidance. Fully vaccinated individuals are advised to wear a mask or face covering when indoors (and not in your own home) if you have a weakened immune system, or if you are at increased risk for severe disease because of your age or an underlying medical condition, or if someone in your household has a weakened immune system, is at increased risk for severe disease, or is an unvaccinated adult. This advisory (not mandate) and its emphasis on personal choice, underscores how different our situation is here in Massachusetts compared to many other parts of the country, largely due to our successful vaccination campaign.

Effective July 8: MA DPH Lifts Limit on Ordering COVID-19 Vaccine
As of 7/8/21, DPH is no longer limiting which sites can order COVID-19 vaccines. Any provider who would like to order COVID-19 vaccine must be registered with the Massachusetts Immunization Information System (MIIS) and have a completed Massachusetts COVID-19 Vaccine Program (MCVP) agreement. All providers receiving COVID-19 vaccine will order vaccine directly from the MIIS and comply with MCVP guidelines and the following requirements:
  • Report doses administered to the MIIS within 24hrs of administration
  • Administer all doses within 30 days of receipt
  • Order minimum quantities of COVID-19 vaccines (450 doses of Pfizer, 100 doses of Moderna, 100 doses of Johnson & Johnson)
  • Agree to allowable vaccine wastage guidelines. 
Major Health Care Professional Organizations Call for COVID-19 Vaccine Mandates for All Health Workers
With COVID-19 case counts rising amid the spread of the Delta variant, more than 50 health care professional societies and organizations called for all health care employers to require their employees to be vaccinated against COVID-19 in a joint statement released last week. Learn more here.
 
CDC Recommends Fully Vaccinated People Wear Masks in Public Indoor Settings in areas of Substantial or High Transmission.
Wellforce Clinically Integrated Network
The Wellforce Clinically Integrated Network is a distinctively different population health enterprise and value-based care contracting entity comprising 2,300 primary care and specialist providers, in private and employed practices, working in community and hospital settings. The Network’s purpose is to build healthier communities and to create healthy, rewarding experiences for its participating physicians. The Network was launched in July 2021 by building upon the legacies of two long-standing, high-performing organizations – Lowell General Physician Hospital Organization and New England Quality Care Alliance (NEQCA).