November 13, 2023

The 2023-2024 respiratory viral season is underway and as winter approaches and we head into the holiday season, understanding the current state of COVID-19, including variants, vaccines, antiviral treatments, and masking, is prudent for protecting yourself and others. 

As of October 2023, the CDC’s Center for Forecasting and Outbreak Analytics anticipates the upcoming respiratory viral season will likely result in similar numbers of hospitalizations compared to last year. In addition to COVID-19 vaccination for protection, there are two other winter respiratory vaccines to consider: (1) Influenza (Flu), and (2) Respiratory Syncytial Virus (RSV).  The CDC/ACIP recommends both vaccines in age-appropriate individuals and are both available at no out-of-pocket cost to patients/members.

With decreased testing and reporting of positive COVID-19 results, the CDC data on hospitalizations and public wastewater surveillance have become the most reliable gauge of COVID-19 infections. State and territory ensemble forecasts predict that trends in the numbers of future hospitalizations related to COVID-19 are uncertain or predicted to remain stable over the next four weeks.  

It remains Ventegra's deep commitment to our clients to provide the most updated and relevant one-stop-shop resource on COVID-19.

COVID-19 Variants

COVID-19 variants continue to change over time. The HV.1 Omicron sub-lineage is the dominant strain in the U.S. and is responsible for 25.2% of sequenced specimens this week vs. 18.2% the previous week. The newly detected variants BA.2.86 and JN.1 are not common in the U.S. and it’s too soon to tell if these will spread more broadly. Although new variants gain attention and are monitored, the CDC states 99% of SARS-CoV-2 variants are part of the XBB group of Omicron, which is what the 2023-2024 updated vaccines are based on. The updated vaccines should work against recently identified BA.2.86 and JN.1 variants.  

Updated COVID-19 Vaccine for Fall/Winter Virus Season

In preparation for the respiratory illness season, the CDC reviewed available scientific studies and determined people may receive COVID-19, influenza, and respiratory syncytial virus vaccinations at the same time.

Vaccination remains the best protection against COVID-19 related hospitalizations and death. The CDC recommends the 2023-2024 updated COVID-19 vaccines: Pfizer-BioNTech, Moderna, or Novavax, to protect against serious outcomes of COVID-19 illness this fall and winter season. Anyone aged 5 years and older who has received one updated COVID-19 vaccine is considered up to date with COVID-19 vaccinations.  

The majority of COVID-19 related hospitalizations and deaths occur in those 65 years of age and over, and the CDC strongly recommends COVID-19 vaccinations, countermeasures to reduce transmission, and prompt outpatient antiviral treatment in this population.

Masking and Testing

At this point, masking is an individual choice. The CDC recommends checking local hospital admission rates to determine when masking is advisable. . When you are sick or caring for someone who is sick the CDC recommends masking. If you either tested positive for COVID or have been exposed to someone who tested positive, the CDC advises masking around others at home and in public for at least 10 days.

As of September 25, each household may order four free rapid COVID tests through the U.S. government to be mailed directly to the home.

Transition to Oral Antivirals Distribution

The Administration for Strategic Preparedness and Response (ASPR) Commercialization Transition Guide outlines the plan to transition COVID-19 oral antivirals away from United States Government (USG) ordering and distribution and towards commercial channels. 

Molnupiravr (Lagevrio) manufactured by Merck and Nirmatrelvir/ritonavir (Paxlovid) manufactured by Pfizer became available for commercial purchase starting November 1, 2023. 

The USG will close Lageviro ordering on November 10th and any USG issued product should be utilized until depletion or expiration, whichever comes first. Lageviro may not be returned/disposed unless expired.  On November 27th, the USG ordering for Paxlovid will close and USG product should be dispensed until commercial supply is stocked. Please visit ASPR for complete details on managing USG product and the commercial product. 

The commercially available wholesale acquisition cost (WAC) for a 5-day treatment course is $1390 for Paxlovid and $950 for Lagevrio. Commercial supplies are subject to traditional formulary benefit and utilization management criteria, such as cost-sharing tiers and quantity limits per day supply. Pfizer and Merck are providing individual support programs for their commercially available agents for the uninsured and underinsured. 

Long Covid Resources

Although the majority infected with SARS-CoV-2 recover within about a week, as many as 1 in 5 people have Long COVID, where symptoms can linger for weeks to years after diagnosis. The National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER) initiative provides a community support fact sheet on What You Need to Know About Long COVID.  

RECOVER has launched several nationwide clinical trials studying interventions for the most common Long COVID symptoms. These NIH-sponsored studies are being conducted using “platform protocols” where multiple therapies for a single disease are tested. RECOVER-VITAL is testing a longer course of Paxlovid, RECOVER-NEURO is evaluating brain training and stimulation interventions. Two additional initiatives will soon launch, RECOVER-SLEEP and RECOVER-AUTONOMIC.   

Scientists continue to study who is at greatest risk for Long COVID but data is showing those at higher risk are those (1) with severe COVID-19 that required hospitalization (2) who have other health conditions like diabetes or lung disease (3) not COVID-19 vaccinated.