It has been two months since the last COVID-19 update and once again, the landscape is very different compared to where we once were. Much of the United States passed through a large Omicron surge in December ’21 and January ’22 and is now experiencing low levels of COVID-19 activity. Before diving into a discussion of sub-variant Omicron BA.2, let’s take a quick look at current conditions:
Hospital Capacity
The U.S. Department of Health & Human Services is reporting 18,479 inpatient beds in use for COVID-19 compared to over 150,000 in January. Total bed occupancy remains steady between 70-80% while the percent in use for COVID-19 has dropped from 21% in January to 2.44% in March. This is a positive sign for our healthcare system as most places return to “normal operations”.
Cases
Trends in reported cases are generally not as reassuring. Cases in the US remain low, though some areas (NY City and NY State) have seen increases in the past two weeks. Additionally, the CDC wastewater surveillance system is reporting increased activity in certain urban centers throughout the US, which typically precedes an increase in cases by 5-7 days. Meanwhile, cases throughout European countries have seen a rise. France, Germany, Italy, U.K., and Israel have all seen an increase in the past few weeks. Of those countries, only the U.K. has seen a rise in hospitalizations.
Image Source: Our World In Data
According to the World Health Organization, 18 countries in Europe are seeing an increase in cases and the BA.2 subvariant of Omicron is responsible for them. In the U.S., the CDC estimates that up to 35% of new cases are due to the BA.2 Omicron sub-variant. Notably, Omicron is the only variant currently circulating in the US.
Why the increase in cases if it is all Omicron? This is a good question without a clear answer form the epidemiological data. Many countries in Europe recently began easing or removing COVID restrictions. Similarly, many areas throughout the US have also removed COVID restrictions. This change may be responsible for the recent increase in cases, as the WHO regional director, Hans Kluge, suggests. However, it may also be due to the increasing BA.2 sub-variant activity.
What do we know about BA.2?
- It is believed that vaccination remains effective against the BA.2 sub-variant, as it is against the original form of the Omicron variant. the CDC data shows that among all age groups eligible for vaccination, rates of hospitalization correlate with vaccination. The lowest rates of hospitalization were among those vaccinated and boosted. Next was the vaccinated only group. Highest, was the unvaccinated group.
- BA.2 is believed to be more infectious (some quoting 80% more infectious), spreading more easily from person to person than the original Omicron variant. However, it is not thought to be more severe because it has not resulted in a greater number of hospitalizations, to date, except in the UK.
Of course, all the caveats given with the Delta and Omicron surges still apply. Data is preliminary and subject to interpretation. More information is still needed, but based on the currently available data, the CDC and WHO believe this BA.2 sub-variant will not result in a large surge of cases in the US.
Therapeutics
Therapeutics active against the original Omicron variant are thought to be effective against the BA.2 sub-variant. One notable exception is the monoclonal antibody Sotrovimab. Today the FDA limited its use in the US in certain areas due to evidence of reduced efficacy against the BA.2 sub-variant of Omicron.
FDA is announcing that sotrovimab is no longer authorized for use at this time in the following states and territories:
-Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont (Health and Human Services [HHS] Region 1)
-New Jersey, New York, Puerto Rico, and the Virgin Islands (HHS Region 2)
New data included in the health care provider fact sheet shows that the authorized dose of sotrovimab is unlikely to be effective against the BA.2 sub-variant. Based on Centers for Disease Control and Prevention Nowcast data, the BA.2 sub-variant is estimated to account for more than 50% of cases in the states and territories in Regions 1 and 2 listed above as of March 19, 2022.
Additionally, the Office of the Assistant Secretary for Preparedness and Response (ASPR) launched the “Test-To-Treat” program meant to provide information about locations capable of testing, prescribing and dispensing medications for COVID-19. The locator provides a list of local testing sites, treatment sites, and pharmacies participating in the Test-To-Treat program and is searchable by zip code.
For the latest in COVID-19 therapeutics, see this FOAMed Post- COVID Therapeutics
U.S. Funding For Testing And Treatment
Lastly, the U.S. Department of Health and Human Services (HHS) provides reimbursement to health care providers, for testing uninsured individuals for COVID-19, treating uninsured individuals with a COVID-19 diagnosis, and administering COVID-19 vaccines to uninsured individuals. HHS recently posted the following information detailing the end of this program:
The Uninsured Program has stopped accepting claims for testing and treatment due to lack of sufficient funds. Confirmation of receipt of your claim submission does not mean the claim will be paid. No claims submitted after March 22, 2022 at 11:59 pm ET for testing or treatment will be processed for adjudication/payment.
On April 5, 2022 at 11:59 pm ET, the Uninsured Program will also stop accepting vaccination claims due to a lack of sufficient funds.
*Submitted claims will be paid subject to the availability of funds.
For additional information, see COVID-19 Uninsured Program Claims Submission Deadline FAQs.
Health Resources and Services Administration
Last Updated on March 30, 2022
Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
Sotrovimab may not be as efficacious re BA2 go for Paxlovid Remdesivir or even Evusheld and Bebtalovimab then Molnupiravir as early as possible .
Thanks Ian. You are correct ! This afternoon, the FDA announced an update removing the EUA for Sotrovimab in certain areas of the US. I have updated the therapeutics section above and the COVID Therapeutics post.
Extremely helpful! Thank you!
Today, added the ASPR Test-To-Treat program information to the Therapeutics section above. The new locator allows patients to search for locations that provide testing, treatment, and dispense medications for COVID-19.