Weekly Summary

Highlights

For any questions related to this report, please contact Iman Bogoreh ().

Guidance Updates

Cases and Deaths

  • Seven-day cases decreased by 50% for residents (13) and 10% for staff (9). There was a total of 4 resident and 0 staff deaths reported for the week ending on 4/10/2022.

COVID-19 Outbreaks

  • Continued outbreaks in the long-term care setting. Week 14 has reported 10 outbreaks as of 04/13/2022. Please see Figure 1 on the Outbreaks tab for reference.

COVID-19 Breakthrough Cases

  • 42 resident breakthrough cases reported during the 4-week reporting period ending on April 10, 2022. Breakthrough cases are anticipated as the vaccines do not have 100% efficacy. Generally, most breakthrough cases experience mild to no symptoms.

Resident and Staff COVID-19 Vaccination

  • For the week ending on 4/10/2022, complete vaccination coverage is 86.2% for residents and 91.1% for staff. Partial vaccination coverage is 1.9% for residents and 1.3% for staff. Please see the Resident and Staff Vaccination Data tab for more details.

Alliant Health ShopTALK and BOOST Office Hours

  • Alliant Health is having a Shop Talk webinar on April 21st, 2022 at 2:00 PM EST.

  • The webinar is going to focus on updates to NHSN and technical assistance for users of the portal. Alliant Health will also be providing office hours for clinicians to share best practices and updates in clinical guidance and science for the COVID-19 booster. We encourage all facilities to join the webinar.

  • Please register here, if you’re interested

Booster Vaccination Assitance

Health Department Vaccine Scheduling Resource Line

  • Vaccination is our top priority to reduce spread of COVID-19.

  • DPH provides a resource line to assist with scheduling COVID-19 vaccine appointments. The resource line is available from 8 a.m. – 8 p.m. ET on weekdays and 8 a.m. – 5 p.m. ET on weekends. Languages other than English are available.

  • Call (888) 457-0186 or visit dph.ga.gov/covid-vaccine to schedule a vaccine appointment.

  • DPH urges COVID-19 vaccination for everyone 5 years of age and older.

Outbreaks

COVID-19 outbreaks are reported to Georgia’s State Electronic Notifiable Disease Surveillance System (SendSS) through the Outbreak Management System (OMS). All long-term care outbreaks by week are included in the graph below; the proportion of long-term care facilities include assisted-living facilities, personal care homes (25 beds or greater), and skilled-nursing homes.

Figure 1. COVID-19 Outbreaks

Community Transmission

As of 9/10/2021, CDC recommends using its County-Level Community Transmission Data Tracker to determine community transmission level: https://covid.cdc.gov/covid-data-tracker/#county-view. This transmission tracker includes county-specific transmission indicators, which include High (red), Substantial (orange), Moderate (yellow) and Low (blue).

The summary below provides community transmission levels based on data reported to the Centers for Disease Control and Prevention. Case rate is based on data from April 06, 2022 – April 12, 2022 and percent positivity is based on data from April 04, 2022 – April 10, 2022.

Table 1. Community-Level Transmission for the State of Georgia
Variable Values
Cases 3,072
% Positivity 3-4.9%
Cases per 100,000 28.9
Deaths 220
% of Population >=5 Years of Age Fully Vaccinated 58%
New Hospital Admissions (7-day Moving Average) 36.57

Figure 1. Community Transmission Map

For a more detailed report on community transmission levels please visit https://covid.cdc.gov/covid-data-tracker/#county-view|Georgia|Risk|community_transmission_level

Proportion Estimates of COVID-19 Variants

Proportion estimates of COVID-19 variants are provided to DPH by the Centers for Diseases Control and Prevention (CDC). We have included data for the nation and the Southeast region.

Figure 3. Nationwide Proportion Estimates of Variants

Figure 4. Southeast Region Proportion Estimates of Variants

  • DPH encourages the vaccination of individuals aged 5 and up to protect against COVID-19

For more details about variants proportions, please visit here

Resident and Staff Cases and Deaths

Resident and staff case and death counts are gathered from the CDC’s National Healthcare Safety Network (NHSN). All 365 skilled-nursing facilities in Georgia are required by the Centers for Medicare & Medicaid Services (CMS) to report case and death counts to NHSN. A confirmed COVID-19 case is defined as a resident or staff newly positive for COVID-19 based on a viral test result. The test result may be from a NAAT/PCR or an antigen test. A COVID-19 death is defined as a resident or staff who died from SARS-CoV-2 (COVID-19) related complications and includes resident deaths in the facility AND in other locations, such as an acute care facility, in which the resident with COVID-19 was transferred to receive treatment. Data is presented for the 7-day period with the week start date.

Table 2. Summary of NHSN COVID-19 Case and Death Counts
Week 03/21/2022-03/27/2022 Week 03/28/2022-04/03/2022 Week 04/04/2022-04/10/2022 Cumulative Total since March 02, 2020
No. Resident Cases 11 26 13 28141
No. Resident Deaths 3 4 4 3810
No. Staff Cases 8 10 9 24102
No. Staff Deaths 0 0 0 64

Figure 4.

Figure 5.

Figure 6.

Figure 7.

Resident and Staff Vaccination Data

The data below summarizes the percentage of residents and staff vaccinated for COVID-19 in skilled-nursing facilities. Partial vaccination rate includes resident or staff that have only received dose 1 of a two-dose series (i.e., Pfizer or Moderna). Complete vaccination rate includes resident or staff that have received dose 1 AND dose 2 of a two-dose series and a dose of a one-dose series (i.e., Janssen).

To view a list of vaccination rates for all US nursing homes, go to: https://data.cms.gov/covid-19/covid-19-nursing-home-data

Figure 8.

Figure 9.

Previously, we reported the percentage of residents and staff who were eligible for a booster or additional dose and received a booster or additional dose. As of 2/14/2022, the data now reports the percentage of residents and staff who completed a two-dose series vaccine and received a booster or additional dose.

Figure 10.

Figure 11.

See CDC currents recommendations regarding booster doses: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html

Additional Vaccination Resources

Options for COVID-19 in High-risk, Non-Hospitalized Patients

1/21/22: DPH is currently evaluating the access to monoclonal antibodies within skilled nursing facilities (SNF). The State has an opportunity to provide molnupiravir to SNF through their pharmacy providers. To ensure therapeutics are available to facilities who currently do not have access to antiviral treatment, we are asking all SNF to complete the ReadyOp survey linked below. Link: https://ga.readyop.com/fs/59GN/76fe

3/2/22: The NIH COVID-19 Treatment Guidelines Panel has updated its recommendations for non-hospitalized patients with mild to moderate COVID-19 who are at high risk for disease progression: https://www.covid19treatmentguidelines.nih.gov/about-the-guidelines/whats-new/

Preferred

  • Nirmatrelvir/ritonavir (Paxlovid™)

  • Sotrovimab

  • Remdesivir

Alternatives

  • Bebtelovimab

  • Molnupiravir

The NIH also provides guidance on prioritization of patients for COVID therapeutics.https://www.covid19treatmentguidelines.nih.gov/therapies/statement-on-patient-prioritization-for-outpatient-therapies/

4/1/22: The NIH COVID-19 Treatment Guidelines Panel has updated its recommendations for non-hospitalized patients with mild to moderate COVID-19 who are at high risk for disease progression: https://www.covid19treatmentguidelines.nih.gov/management/clinical-management/nonhospitalized-adults--therapeutic-management/

3/24/22: The NIH also provides guidance on prioritization of patients for COVID therapeutics. https://www.covid19treatmentguidelines.nih.gov/overview/prioritization-of-therapeutics/

3/18/22: IDSA released, “Among ambulatory patients with mild-to-moderate COVID-19, the IDSA guideline panel suggests against inhaled corticosteroids outside of the context of a clinical trial.” https://www.idsociety.org/globalassets/idsa/practice-guidelines/covid-19/treatment/idsa-covid-19-gl-tx-and-mgmt---inhaled-corticosteroids-2022-03-14.pdf

Oral antivirals

Two oral antivirals, Paxlovid™ and molnupiravir, have been approved under EUA to be taken by mouth twice daily for five days and must be started within 5 days of symptom onset. The initial federal allocations to Georgia are very limited. DPH has partnered with Walmart, Walgreens, and Good Neighbor Pharmacy Group (a group of small independent pharmacies) to distribute product to select stores throughout the state. As production and allocations of Paxlovid™ and molnupiravir increase, we hope to include additional pharmacy locations to increase availability throughout the state. HHS has provided a therapeutics locator for Paxlovid™ and molnupiravir https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/

EUA Paxlovid™: https://www.fda.gov/media/155050/download

EUA molnupiravir: https://www.merck.com/eua/molnupiravir-hcp-fact-sheet.pdf

Monoclonal antibodies

4/5/22 The Centers for Disease Control and Prevention (CDC) estimated the proportion of COVID-19 cases caused by the Omicron BA.2 variant to be above 50% in all U.S. Department of Health and Human Services (HHS) regions. Due to these data, use of sotrovimab is not authorized in any U.S. state or territory at this time. Accordingly and effective immediately,

ASPR has paused sotrovimab distribution to all U.S. states and territories. The FDA has updated the Fact Sheet for sotrovimab to reflect product use restrictions

Monoclonal antibodies (mAb) should be considered during COVID-19 outbreaks or confirmed resident or staff exposures. For assessing staff exposure, review the CDC guidance at https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html.

3/11/22: IDSA released the following update: In ambulatory patients with mild-to-moderate COVID-19 at high risk for progression to severe disease, the IDSA guideline panel recommends bebtelovimab only in the context of a clinical trial. https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/#toc-11

Bebtelovimab is a monoclonal antibody product now authorized for the treatment of mild to moderate COVID-19 in adults and certain pediatric patients who are at high risk for progression to severe COVID-19, including hospitalization or death and for whom alternative COVID-19 treatment options approved or authorized by the FDA are not accessible or clinically appropriate. It covers the Omicron variant.

New! 4/13/22: HHS releases guidance on retaining bamlanivimab plus etesevimab in storage. https://aspr.hhs.gov/COVID-19/Therapeutics/updates/Pages/important-update-13April2022.aspx

On January 24, 2022, the FDA updated the EUA for two COVID-19 monoclonal antibody treatments: Lilly’s bamlanivimab plus etesevimab and Regeneron’s casirivimab plus imdevimab (REGEN-COV). Because data show these treatments are highly unlikely to be active against the Omicron variant, which is circulating at a very high frequency throughout the United States, these treatments are not authorized for use in the U.S. at this time. Product return is not recommended. HHS has advised providers to hold REGEN-COV and bamlanivimab plus etesevimab as these products may be effective against future variants of COVID-19. For storage concerns, consider transferring product to another location/site or health system/hospital. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-limits-use-certain-monoclonal-antibodies-treat-covid-19-due-omicron

Providers should review the prevalence of the Omicron variant in their region using CDC NOWCAST data found at https://covid.cdc.gov/covid-data-tracker/#variant-proportions.

New! Bebtelovimab:

Please find the updated ReadyOp link for Bebtelovimab. The deadline is Tuesday 5PM EST. Link: https://ga.readyop.com/fs/59KT/5a6b

Visit https://combatcovid.hhs.gov/hcp/resources-clinicians for mAb EUA Fact Sheets, NIH Treatment Guidelines, ordering, administering, billing, and reporting.

CDC recently released guidance on the interval between receiving a mAb and receiving COVID vaccination. Patients no longer have to wait 90 days between the mAb and the vaccine.
https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html

Remdesivir

The FDA expanded the EUA for Remdesivir (Veklury™) to include non-hospitalized, high-risk outpatients. Remdesivir should be given within seven days of symptom onset intravenously x 3 days. https://www.fda.gov/news-events/press-announcements/fda-takes-actions-expand-use-treatment-outpatients-mild-moderate-covid-19. Remdesivir ordering is not managed through DPH. Contact your pharmacy vendor for ordering.

Convalescent Plasma

On 3/9/22 IDSA revised its recommendation for convalescent plasma for ambulatory patients with mild to moderate COVID at high risk for progression who had no other treatment options. IDSA suggests FDA-qualified high-titer coalescent plasma within 8 days of symptom onset. The FDA EUA authorizes use only in immunocompromised individuals. Ordering convalescent plasma is not managed through DPH.

Reported Staff Shortages in Skilled Nursing Facilities

In NHSN, skilled nursing homes can report additional data on resource needs. The data below summarizes staffing shortages. Definitions for the categories are below.

  • Aides: certified nursing assistants, nurse aide, medication aide, or medication technician
  • Nursing staff: registered nurse, licensed practical nurse, or vocational nurse
  • Clinical staff: physician, physician assistant, or advanced practice nurse
  • Other staff: these personnel may include, but are not limited to, environmental services, cook, dietary, pharmacists, pharmacy techs, activities director, care givers, wound care, physical therapy, shared staff, etc.

Figure 12. Skilled Nursing Facilities in Georgia Reporting Shortages in Staff, 4/04/2022 – 4/10/2022

Infection Prevention

The Department of Public Health Infection Preventionist teams are available for Administrative order review, outbreak assistance for COVID and other infections that require infection control measures. This team is also available to review policies and procedures related to infection prevention.

Table 4. IP Contacts
Region Resource Contact
North (Rome, Dalton, Gainesville, Athens) Sue Bunnell and Mary Whitaker ,
Atlanta Metro (Cobb-Douglas, Fulton, Clayton, Lawrenceville, Dekalb, LaGrange) Teresa Fox, Cyndra Bystrom, and Renee Miller , ,
Central (Dublin, Macon, Augusta) Southwest (Columbus) Theresa Metro-Lewis and Karen Williams ,
Southeast (Valdosta, Albany) Connie Stanfill
Southwest (Savannah, Waycross) Regina Howard
Backup/Nights/Weekends Jeanne Negley and JoAnna Wagner ,