10/1/21 Health Advisory: COVID-19 Updates for Providers

| October 2, 2021
Pregnant woman talking to doctor while looking at a clipboard

Requested actions

  • Promote COVID-19 vaccine among people who are pregnant, lactating or who may become pregnant. Only 31% of pregnant people in the U.S. are fully vaccinated. In 2021, 97% of pregnant people hospitalized for COVID-19 illness or labor and delivery with active infection were unvaccinated. Educate patients on the safety and effectiveness of COVID-19 vaccine during pregnancy.
  • Be aware, the U.S. is experiencing a shortage of BinaxNOW antigen test kits, straining the entire testing system. Washington State Department of Health (DOH) is working with the manufacturer, Abbott, and the federal government to increase the supply in Washington. However, supplies will likely remain low for the next month or two.
  • Help families navigate the K-12 testing requirements to return to school for students with COVID-19-like illness (CLI). Children with CLI need a PCR test before returning to school. Over-the-counter antigen tests do not offer proof of testing.

Background

COVID-19 vaccine for pregnant and lactating people

On Sept. 29, the Centers for Disease Control and Prevention (CDC) released a Health Alert Network (HAN) advisory recommending urgent action to increase COVID-19 vaccination among people who are pregnant, recently pregnant, lactating, trying to become pregnant or who may become pregnant. CDC strongly recommends COVID-19 vaccine before or during pregnancy because the benefits of vaccine outweigh known or potential risks.

As of Sept. 27, more than 125,000 lab-confirmed COVID-19 cases are in pregnant people, including more than 22,000 hospitalizations and 161 deaths. The highest number of COVID-19-related deaths in pregnant people (n=22) in one month happened August 2021. National surveillance data shows about 97% of pregnant people hospitalized for illness or labor and delivery with active infection were unvaccinated.

In addition to the risks of severe illness and death for pregnant and recently pregnant people, they are also at increased risk for adverse pregnancy and neonatal outcomes, including preterm birth and admission of their neonate(s) to an intensive care unit (ICU). Other adverse pregnancy outcomes, like stillbirth, have been reported.

Despite the known risks of COVID-19, as of Sept. 18, 31.0% of pregnant people were fully vaccinated before or during their pregnancy. Additionally, there are racial and ethnic disparities in vaccination coverage for pregnant people.

Healthcare providers should communicate the risks of COVID-19, the benefits of vaccine, and the safety and effectiveness of COVID-19 vaccine during pregnancy. Healthcare providers should strongly recommend people who are pregnant, recently pregnant, lactating, trying to become pregnant or who may become pregnant get COVID-19 vaccine as soon as possible.

Recommendations

  • Ensure all clinical staff are aware of the recommendation for vaccination of people before and during pregnancy and the serious risks of COVID-19 to pregnant and recently pregnant people and their fetuses/infants.
  • Increase outreach efforts to encourage, recommend and offer vaccination to people who are pregnant, recently pregnant, lactating, trying to become pregnant or may become pregnant. A strong recommendation from a healthcare provider is a critical factor in COVID-19 vaccine acceptance and can make a meaningful difference to protect the health of pregnant and recently pregnant people and their fetuses/infants.
  • For healthcare providers who see patients who are pregnant, recently pregnant, lactating, trying to become pregnant or who may become pregnant:
    • Review patients’ COVID-19 vaccination status at each pre- and post-natal visit and discuss COVID-19 vaccine with those who are unvaccinated.
    • Reach out to your patients with messages encouraging and recommending the critical need for vaccination.
    • Remind patients that vaccine is recommended for those with prior COVID-19 infection. Studies show vaccination provides increased protection in people who have recovered from COVID-19.
    • Support efforts to ensure people who get the first dose of an mRNA COVID-19 vaccine (i.e., Pfizer-BioNTech, Moderna) return for their second dose to complete the series as close as possible to the recommended interval.
      • Consider a booster dose for eligible pregnant people.
    • Communicate accurate information about COVID-19 vaccines and confront misinformation with evidence-based messaging from credible sources. For example, currently no evidence shows any vaccine, including COVID-19 vaccine, causes fertility problems in women or men.
  • Become a COVID-19 vaccine provider and vaccinate patients during their visit. Learn how to enroll as a COVID-19 vaccine provider.

More information

Booster doses

Following a Sept. 23 vote by the Advisory Committee on Immunization Practices (ACIP), on Sept. 24 CDC recommended a single booster dose of Pfizer-BioNTech (Comirnaty) vaccine to certain high-risk populations at least 6 months after their primary series under the FDA’s expanded EUA:

  • All Pfizer recipients 65 years or older or who live in long-term care facilities should receive a booster dose.
  • Pfizer recipients between 50 and 64 years old with underlying medical conditions should receive a booster dose.
  • Pfizer recipients between 18 and 49 years old with underlying medical conditions may receive a booster dose based on their individual risks and benefits.
  • Pfizer recipients between 18 and 64 years old in an occupational or institutional setting where the burden of disease and risk of infection are high may receive a booster dose based on their individual risks and benefits.

Recent CDC and FDA decisions about booster doses do not change the definition of full vaccination. Booster doses are not required where vaccine mandates are in place.

A Clinician Outreach and Communication Activity (COCA) call on Sept. 28, 2021 covered what clinicians needs to know about administering booster doses.

COVID-19 vaccine resources

COVID-19 test supply shortage

The U.S. is experiencing a shortage of BinaxNOW antigen test kits, straining the entire testing system. DOHis working with the manufacturer, Abbott, and the federal government to increase the supply to Washington. However, supplies will likely remain low over the next month or two. If you need test kits, we have alternative options.

Abbott Laboratories extended all BinaxNOW tests’ shelf life to 12 months. See Abbott’s BinaxNOW COVID-19 ag card product expiry update for new expiration dates by lot number.

Testing in schools

As in-person learning resumes at schools, families need help navigating the K-12 testing requirements to return to school when a student has CLI. Children with CLI need a PCR test before they return to school. Over-the-counter antigen tests do not offer proof of testing.

  • If a person with COVID-19 symptoms tests negative for SARS-CoV-2 with a molecular test, they may return to school following existing school illness management policies as long as they are not a close contact of someone with COVID-19 and subject to quarantine.
  • If a person with COVID-19 symptoms tests negative for SARS-CoV-2 with an antigen test, per CDC antigen testing guidance, a confirmatory lab-based molecular test is recommended.
  • Anyone symptomatic who receives a negative antigen test should seek a confirmatory PCR test. An alternative to confirmatory nucleic acid amplification testing (NAAT) is serial antigen testing performed every 3-7 days for 14 days.

COVID-19 test processing

Labs report varying amounts of time to process COVID-19 tests. To support faster turnaround, we encourage providers to use in-state labs. The table below shows COVID-19 test processing times for in-state private labs.

LAB TIME TO PROCESS TEST TESTS PROCESSED DAILY
FidaLab 24-72 hours 800-1,200
Kaiser 24-72 hours 800-1,000
LabCorp 24-48 hours Unknown
Northwest Pathology 24-48 hours 20,000
Quest 24-48 hours 1,300
UW Virology 24-48 hours 7,000-9,000
Atlas Genomic 24-48 hours 10,000

Patient education

Share the following materials with patients.

Additional resources