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June 1, 2022
A Message for the Tufts Medicine Integrated Network, including primary and specialty care physicians, practice administrators, Network leaders (Presidents, Administrators, and Medical Directors) and Network staff:
Monkeypox
Monkeypox is not expected to spread widely. If you see a case that you suspect is Monkeypox, please call the state public health epidemiologist on call, 617-983-6800. More information can be found here.
COVID-19 Update
Wastewater RNA levels in MA have started trending down again - and while cases lag from this data, they are just beginning to decrease. In addition, the unofficial start of summer and Memorial Day holiday weekend may result in increased spread. Decreasing does not mean gone; COVID-19 is still present.

Vaccines, Prevention, Boosters
  • Pfizer boosters are approved for ages 5+, at least 5 months after mRNA series or at least 2 months after J&J.
  • CDC strengthened its recommendation that those 12 and older who are immunocompromised and those 50 and older should receive a second booster dose at least 4 months after their first. 
  • Advisory committees will be meeting to discuss the following EUAs
  • June 14: Moderna COVID vaccine for age 6 to 17 years old
  • June 15: Moderna COVID vaccine for 6 months to 5 years and Pfizer vaccine for 6 months to 4 years old
  • Click here to read the latest MA DPH Bulletin.

Treatment
  • In-home therapy is available through CDR Health for individuals who meet clinical criteria for Evusheld, Remdesivir, or bebtelovimab and have difficulty accessing them in the community. See this website for more details on how to schedule an in-home treatment.
  • Paxlovid has been noted to be well tolerated and is widely available. Continue to keep in mind drug interactions and patients with renal/hepatic impairment. Refer to our website for a few different sources to help navigate these.
  • The IDSA guide is notable for its straightforwardness and relative simplicity. Including Glomerular filtration rate (GFR) on the prescription, though not legally required, should help eliminate concerns a dispensing pharmacy may have, so the patient can acquire the medication quickly. Paxlovid must be started within 5 days of symptom onset for optimal efficacy.

Clinical Course
Rebound COVID-19 symptoms are being noted both at 7-14 days after symptom onset, both in patients receiving antiviral treatment and those who don’t.  At the moment, additional treatment for this rebound is not recommended. Patients with rebound symptoms are advised to isolate again for 5 days and monitor their symptoms. It has been noted so far that these rebound symptoms remain mild and no hospitalizations have been reported.

Telehealth
The public health emergency will likely be extended past its current timeline, where it is set to expire in July. HHS reports it is committed to the 60 days notice before ending the order, and many speculate it will be extended for at least another 90 days, until mid-October. We expect this means that Medicare flexibilities around telehealth will be extended as well.

Diagnostic Testing
  • FDA authorizes first non-prescription COVID-19 test that also detects flu and respiratory syncytial virus (RSV).
  • Third round of free government funded COVID-19 tests are eligible to be ordered at COVID.gov/tests.
  • Keep in mind - as presented during the most recent webinar - antigen (rapid) tests are increasingly often not positive at symptom onset. If someone is symptomatic, a negative antigen test does not rule them out from having a COVID-19 infection, but may indicate they are not highly contagious at that moment in time. PCR tests continue to be more sensitive in detecting COVID-19.

Infection Control/PPE
Reminder: It is still important to wear a mask even after someone has had COVID-19 and has fully recovered, especially when in a densely populated location. Omicron and its subvariants are highly transmissible; natural immunity is not sufficient to protect against reinfection and it is not uncommon to see people with several COVID-19 infections within a short window of time. Continuing to wear masks, practice social distancing, and use proper hand hygiene remain the best methods to protect against reinfection.

Sequelae/Complications
  • From MMWR, 1 in 5 adults ages 18+ have a health condition that might be a result of long COVID (i.e., related to their previous COVID-19 illness), including but not limited to neurologic/mental health conditions, kidney failure, musculoskeletal conditions, cardiovascular conditions, respiratory conditions and blood clots/vascular conditions. It therefore remains urgent for clinicians to advocate for COVID-19 prevention, given the risk that 20 percent of adults will develop enduring health complications from the virus.
  • Thromboembolic prevention and anticoagulant therapy during the COVID-19 pandemic: updated clinical guidance from the anticoagulation forum.
The Tufts Medicine Integrated Network is a distinctively different population health enterprise and value-based care contracting entity. It comprises 2,300 primary care and specialist physicians and advanced practice clinicians, working as Tufts Medicine employees or in private practice, delivering care in community and hospital settings. The Network’s purpose is to build healthier communities and to create healthy, rewarding experiences for our members and care teams. The Network was launched in July 2021 by building upon the legacies of two long-standing, high-performing organizations – Lowell General Physician Hospital Organization and New England Quality Care Alliance (NEQCA).

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