Dear USET/USET SPF Family,
After reaching a low point around the first of April, COVID-19 cases have been rising steadily. Reported cases in the USA are now about four times higher than they were 6 weeks ago, and cases among our Tribal citizens have increased as well. Reported cases are likely significantly less than actual cases due to the wide availability of home tests. Community levels are particularly high in the Northeast; county-level community data is available on the CDC’s website.
As we face this second wave of the Omicron variant, the USET Tribal Epidemiology Center would like to summarize actions that can be taken by Tribal health programs in three different areas: public health measures, prevention by vaccination, and treatment. Please share with all appropriate staff.
Public Health Measures for COVID-19
The tried-and-true public health measures to prevent the spread of COVID-19 should still be used:
- Social distancing
- Appropriate mask wearing
- Hand washing
- Covering coughs and sneezes
- Isolation of people infected with COVID-19
- Quarantine of unvaccinated people who have been in close contact with someone with COVID-19
The CDC website has excellent resources for both the public and for health care workers:
When cases are relatively low, and staffing resources are available, timely contact tracing is still an effective prevention and control strategy.
Prevention by Vaccination
After a year and a half of experience, and with over a half-billion doses of vaccine given in the USA, it has become clear that vaccination for COVID-19 is safe and effective. Even though vaccines are less effective at preventing infection by the Omicron variant than by the original viral strain, vaccines are still very effective at preventing serious disease and death.
The most effective prevention measure that we have today is vaccination (other than complete isolation from everyone at all times, which is neither practical nor desirable). Unfortunately, there is a lot of misinformation about COVID-19 vaccines. The CDC has some resources for healthcare workers to communicate with vaccine-hesitant people.
The USET TEC has also developed the Vax-A-Nation Vaccine Campaign Toolkit, which has a variety of vaccine uptake materials. The original electronic files are also available to USET member Tribal Nations for customization upon request.
It has become challenging to keep up with the complex recommendations for getting booster shots. The CDC now has a helpful tool for determining when people need boosters.
The CDC website has more information for the public about COVID-19 vaccines as well as comprehensive information for healthcare workers about vaccines.
Treatment of Patients with COVID-19
COVID-19 will probably be with us for a long time. To put things into perspective, the influenza pandemic that began in 1918 was significantly more deadly than the COVID-19 pandemic has been so far. We are still living with influenza a century later, and we must learn to live with COVID-19. Fortunately, there are now some effective treatments for COVID-19. Most young, healthy patients with COVID-19 will recover with rest, symptomatic treatment, and isolation to protect others. Older patients (50+) and people with certain medical conditions are at higher risk for more severe disease and bad outcomes, and these patients should receive early treatment with one of the following:
- Ritonavir-boosted nirmatrelvir (Paxlovid): This oral 5-day treatment course is now widely available. It was shown to be 88% effective in unvaccinated patients with at least one high-risk condition in preventing hospitalization or death. It must be used within 5 days of onset of symptoms and has a number of significant drug interactions.
- Remdesivir: This IV drug given on 3 consecutive days was shown to be 87% effective in patients with at least one high-risk condition in preventing progression of disease to require hospitalization. The major disadvantage is that it requires 3 days of an IV drug.
If neither nirmatrelvir-ritonavir (Paxlovid) or remdesivir is available, one of the following alternatives could be used:
- Bebtelovimab: This single-dose IV monoclonal antibody has been shown to be effective in vitro against the Omicron variant (there are no placebo-controlled trials yet for bebtelovimab). There are no other currently available monoclonal antibody treatments that are effective for Omicron.
- Molnupiravir: This oral 5-day treatment was shown to be 30% effective at preventing progression to severe disease. It should only be used if more effective treatments are unavailable or contraindicated.
Please remember to avoid using dexamethasone or other steroids in outpatients who do not need hospitalization and supplemental oxygen, as it may actually be harmful.
Comprehensive treatment guidelines for COVID-19 is available on the NIH website. A list of high-risk conditions is available on the CDC website.
Please do not hesitate to contact the USET TEC at usetepi@usetinc.org should you have questions or would like to access the Vax-A-Nation Vaccine Campaign Toolkit electronic files.
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