Clinically Integrated Network Briefing

2.4.22 l Updated Treatment Guidance l Diagnostic Testing l New Variant Alert l Infection Control/PPE l Vaccines, Prevention, Boosters

A Message for the Wellforce Clinically Integrated Network, including primary and specialty care physicians, practice administrators, Network leaders (Presidents, Administrators, and Medical Directors) and Network staff

Latest COVID-19 News

Now Available: COVID-19 Webpage for Ambulatory Practices

Treatment Courses of antivirals and monoclonal antibodies are available for those who need them. Tufts Medical Center Respiratory Infection Clinic: 617-636-3164 All Gothams state funded sites are offering same day availability, and are open 8 a.m. to 7 p.m. every day. See our website for the referral form and locations. DPH has new guidance for treating patients with mild to moderate COVID-19, when supplies of sotrovimab and oral antivirals are limited. Tiers 1-3, Paxlovid preferred. If not available or feasible, sotrovimab or remdesivir is preferred. Molnupiravir may be used if other therapies not available or feasible. Tier 4, Remdesivir preferred. Molnupiravir may be used if other therapies not available or feasible.

Diagnostic Testing In paired specimens, the BinaxNOW rapid antigen test reports similar sensitivity for high viral load Omicron (typical in symptomatic patients) in comparison with PCR tests, similar to other viral strains. Click here to review a preprint, which compares SARS Co-V-2 Nasal RT- PCR and rapid antigen test (BinaxNOW) at a community testing site during an Omicron surge.

Epidemiology/Transmission New Variant Alert: Subvariant of Omicron, BA.2, is highly transmissible and has begun to circulate the U.S. Its emergence could prolong the initial Omicron wave. An editorial published in JAMA discusses significant nosocomial transmission with Omicron. Consider universal N95 use in healthcare settings. Newer soft-shell N95 models may be significantly more comfortable.

Infection Control/PPE Many consider the impact of long-term masking on children’s mental health and development. Recent articles published in The Washington Post and The New York Times discuss the idea of transitioning from mandatory mask requirements in schools to emphasizing personal choice.

Vaccines, Prevention, Boosters Timing for COVID-19 Vaccines After Treatment

COVID-19 Therapy  Suggested time to wait before vaccination

Bamlanivimab /Etesevimab No information is available regarding the safety or effectiveness of administering bamlanivimab and etesevimab after the first dose or completed series of a SARS-CoV-2 vaccine per Eli Lilly

Casirivimab /Imdevimab Passive antibody product used for post-exposure prophylaxis: Defer COVID-19 vaccination for 30 days Passive antibody product used for COVID-19 treatment: Defer COVID-19 vaccination for 90 days, source CDC “People who received passive antibody products.”

Evusheld Astrazeneca suggested in its clinical trials that patients wait 2-4 half lives of Evusheld before getting a vaccine- which is about 6-12 months.

Molnupiravir, Paxlovid, Remdesivir No waiting time needed, CDC "Considerations for Taking Medication before Getting Vaccinated."

Sotrovimab GSK suggests waiting 90 days after treatment to get a vaccine, defers to CDC.

Study finds current vaccines reduce transmission by approximately 70%. Extra dose vs booster for immunocompromised The CDC recommends immunocompromised patients receive booster shots in addition to their primary vaccine series. Pfizer and Moderna recipients are recommended to receive a third dose 28 days after the two initial 2 vaccines as part of their primary series, and then a booster is to be given 5 months after the third dose. There is currently no recommendation for healthy individuals to get a fourth vaccine dose, even if they are close to or have surpassed the 5-month window after their booster dose It is challenging to differentiate between waning immunity and differential protection against variant types when speaking about the benefits of getting an additional dose. There are new vaccines for omicron-specific variants in the works, which may or may not be recommended for everyone.

COVID-19 Answer Center for Wellforce CIN Clinicians and Staff

Wellforce CIN Clinicians and practice personnel may use this form (OR call (781) 664-5705) to ask question(s). This is NOT a resource for patients to use directly. Our Pharmacy team will do its best to answer questions as soon as received. Hours: Monday-Friday; 8:30 a.m. and 5 p.m. Weekends/holidays will be answered the next business day Click here to read the Answer Center's most frequently asked questions (FAQ).

The Wellforce Clinically Integrated Network

The Wellforce Clinically Integrated Network is a distinctively different population health enterprise and value-based care contracting entity. It comprises 2,300 primary care and specialist physicians and advanced practice clinicians, 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 our participating physicians and care teams. 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).