CMO Update November 17, 2021 |
In the spirit of Thanksgiving and expressing gratitude, I want to send a sincere thank you to all of you, our QDP teammates, for the exceptional care you’ve provided to our patients and each other. We are stronger together and despite the challenges of this pandemic, I believe we have forged stronger bonds as a result.
I’d like to especially acknowledge those providers who are finding opportunities to improve access to care through evening and Saturday clinic hours. We all know how busy our work lives are and many patients appreciate flexibility to be seen outside of typical 8-5 weekdays. Dr. Turrentine and his staff recently worked a Saturday shift in Hickory NC during which he identified several skin cancers, including a serious lymphoma. The patient told him that without the weekend clinic he would have ignored it much longer, with potentially life-threatening consequences.
This is just one of many examples of why QualDerm is such a great company and why I am very proud to be associated with all of you. The ‘QualDerm way’ holds us all to a higher standard and differentiates us.
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Vaccine Mandate
Last Friday Nov.12, a U.S. appeals court upheld its decision to put on hold an order by President Biden for OSHA to require COVID-19 vaccinations of all employees for companies with 100 workers or more. Except for locations that have ASC’s, QualDerm falls under the proposed OSHA rule.
We anticipate more legal challenges and QualDerm is closely monitoring these rules and regulations, which may vary by state. Next week HR will begin voluntary submission of vaccine status through the Paylocity portal in preparation for any potential future mandate whether by federal government or specific state.
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Vaccines
For anyone interested in understanding more detail about how the COVID-19 vaccines work within the body and the immune system, I highly recommend these incredibly cool 2 minute animated videos from the highly respected Children’s Hospital of Pennsylvania:
Since CDC Director Dr. Rochelle Walensky authorized use of the Pfizer-BioNTech vaccine in children aged 5 to 11 years, > 1 million elementary-age kids have already received their first dose
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For teammates and their families with questions or concerns about vaccinating their children, I encourage you to read this excellent review article from the Journal of the American Medical Association entitled Pediatric COVID-19 Vaccines: What Parents, Practitioners, and Policy Makers Need to Know (click HERE to read).
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People with overweight or obesity (OWOB) who become infected with SARS-CoV-2 are at a higher risk of severe COVID-19 and long-term symptoms, according to research published recently in the journal Influenza and Other Respiratory Viruses. Notably, adolescents with OWOB had longer-lasting respiratory symptoms (7 vs 4 days) and were more likely to be symptomatic than adolescents without OWOB (67% vs 34%).
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Delta Surge
Delta variant continues to spread regionally; the summer surge was highest in the Southeast; current fall surge concentrated in upper Midwest, Rockies, Northeast with more indoor exposure; almost exclusively infecting small pockets of the unvaccinated.
Our QDP markets are less impacted now, except for Western PA and NJ
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- Cases and positive tests rising in 20 states; hospitalizations and deaths are down.
- Holiday surge expected but should be manageable given improving vaccination rate; natural immunity is better this year than last, and there are more treatment options.
- Two-thirds of COVID-19 hospitalizations in the US are estimated to be related to obesity, diabetes, hypertension, or heart failure. Less attention is being given to the association between OWOB (overweight and obesity) and more severe COVID-19 in the US, where nearly 75% of adults and about 20% of children have OWOB.
- Another recent study published in JAMA showed that people with prior COVID-19 infection had a lower risk of second infection if vaccinated than those with only natural immunity
"This delta virus is going to play out through the country," Dr. Scott Gottlieb, former FDA Director said. "There's not much we're going to be able to do at this point to interrupt it. We've seen the South be engulfed with the infection and it's recovered. The reality is this delta infection is going to capture most people who remain unvaccinated at this point."
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"We've always said that two of the events that would demarcate the end of this pandemic was being able to vaccinate our children," Dr. Gottlieb said. "We're now able to do that down to age 5, and also having a widely available or orally accessible drug that could treat coronavirus at home to prevent people from being hospitalized or dying," he said, referring to Merck and Pfizer's experimental antiviral pills.
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Treatment Options Available for New and Breakthrough Infections
1. Regeneron said Nov. 8 that its COVID-19 antibody cocktail reduced the risk of contracting COVID-19 by 81.6 percent for eight months after administration in a phase 3 clinical trial, which included people living in the same household as someone with a COVID-19 infection. The drug could also be particularly useful for immunocompromised people.
- There were no hospitalizations from COVID-19 infection among the people receiving the antibody cocktail compared to six in the placebo group.
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REGEN-COV is a combination of the monoclonal antibodies casirivimab and imdevimab. In November 2020, it received FDA emergency use authorization and is now also allowed as postexposure prevention for individuals at high risk for progression to severe COVID-19.
"Today's new data demonstrate how a single dose of REGEN-COV can help protect people from COVID-19 for many months after administration," Myron Cohen, MD, director of the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, said in a news release.
2. Pfizer’s new pill Paxlovid cut the risk of hospitalization or death by 89 percent when given within three days after the start of symptoms. Molnupiravir was the first FDA approved oral antiviral medication shown to reduce the risk of hospitalization and death by >50% if taken within 5 days of COVID-19 symptoms
Boosters
Booster uptake continues for adults receiving first vaccine > 6 months ago
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Mix and match approach recommended; particularly anyone receiving J&J should get mRNA booster (Pfizer or Moderna)
- Single booster vaccine recommended for those with natural immunity from prior infection
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This tweet was interesting because our internal survey also showed about 80% of QDP teammates are already vaccinated.
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Last week Pfizer requested the FDA to authorize their SARS-CoV-2 vaccine as a booster dose for all adults aged 18 years and older, based on unpublished data from a randomized, controlled clinical trial of more than 10,000 adults who previously received a primary 2-dose series of the vaccine. Among those who received a booster dose, relative vaccine efficacy reached 95.6% when compared to no booster.
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Finally, I leave you with a very informative article on how boosters in Israel have essentially eliminated COVID-19, including the Delta surge, and the people are living a completely normal life once again.
Please continue to take care of yourselves and be safe!
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Israel's Booster Gamble
Israel has been a country of Covid extremes, and a harbinger of the pandemic. It quickly vaccinated a large portion of its population early this year and saw cases drop to near zero in June. A few weeks later, it experienced a huge Delta-driven surge and had some of the highest infection rates in the world. Now, the country seems to have the virus under control once more. To catch up on the last few weeks, I spoke to Isabel Kershner, who covers Israel for The Times.
A few weeks ago Israel looked like a cautionary tale. What happened?
I think the game changer was definitely the booster shots. Israel had a huge spike in infections this summer that necessitated drastic action. The country has a very centralized and digitized health system, which is why Pfizer was using Israel as a kind of real-world lab test case. Israel was able to analyze the data and it became clear that a combination of waning immunity five or six months after the second jab, together with the highly infectious Delta strain, led to the spike.
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So Naftali Bennett, the new prime minister, went out on a limb and took a bit of a risk. He said boosters were going to be the savior and the way to combat the fourth wave. But when he started the booster campaign, there was really no science on how well it would work.
So what happened?
What we saw, over time, was a very steep reduction in infections, hospitalizations and deaths among the people that got the booster shot. We’ve gone from over 11,000 new cases a day at the peak, down to a few dozen today. Before the booster campaign started, we also saw hospitalizations tick up among vaccinated people whose immunity had waned, but now, the overwhelming majority of hospitalizations are of people who are unvaccinated.
What are the lessons from the booster campaign?
Israel was able to achieve the goal of dealing with Covid and the fourth wave, while keeping the economy open, which the government attributes to the booster campaign.
What's life like there now?
People have kind of stopped talking about the pandemic. There was a time when it was just obsessive, where you couldn’t talk about anything else. But now people have kind of accepted that it’s a part of life. They’ve gone back to hugging and kissing, and are just getting on with it.
The government did take a new tack, which was to avoid lockdowns at all costs, try to live with the virus while taking all the necessary precautions, and banking on the booster. And it seems, at least at this point in time, to have worked. But no complacency. People are fully aware that the next strain could be on its way, and they remain ready and alert and they’re not declaring victory.
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