Update on Omicron Surge and Therapeutic Recommendations in Orange County
January 7, 2022
Variant surveillance using whole genome sequencing shows that the proportion of Omicron variant increased from 30% for the week ending December 21, 2021, to 83% for the week ending December 28, 2021. Cases across the county, state, and country, continue to rise exponentially. Hospitalizations in Orange County have risen as well, though at a slower rate. Updated county surveillance data can be found here.
Clinical Updates
The Omicron variant is predicted to have markedly reduced susceptibility to several anti-SARS-CoV-2 monoclonal antibodies (mAbs), especially bamlanivimab plus etesevimab and casirivimab plus imdevimab. National Institutes of Health Guidance recommends that when the omicron variant represents the majority (e.g., >80%) of infections in a community, bamlanivimab plus etesevimab and casirivimab plus imdevimab should be considered unlikely to be active for treatment or post-exposure prophylaxis (PEP) of COVID-19. With the current predominance of omicron here, the California Department of Public Health (CDPH) has notified OCHCA that they will be suspending the distribution of the monoclonal therapeutic agents bamlanivimab plus etesevimab and casirivimab plus imdevimab to Orange County.
The monoclonal Sotrovimab remains an effective treatment of COVID-19 caused by Omicron. Tixagevimab plus cilgavimab (Evusheld) has been approved for pre-exposure prophylaxis. Small quantities of these products have been allocated to Orange County hospitals to treat their highest risk patients.
Remdesivir is currently approved by the FDA for use in hospitalized individuals with COVID-19. NIH guidance indicates that it can also be used for outpatient treatment on an off-label indication.
The oral therapeutic agents Paxlovid and molnupiravir have been distributed in very limited supplies to a small number of pharmacies in the county.
This week the FDA and the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended the use of booster doses of the Pfizer-BioNTech for children 12 through 17 years of age. A 3rd dose of Pfizer-BioNTech in children 5-11 years who are moderately to severely immunocompromised was also authorized by the FDA and recommended by the CDC. In addition, the FDA authorized the use of booster doses five months after completion of a primary series with the Pfizer-BioNTech vaccine. For all current vaccine guidance review the CDC Interim Clinical Considerations on the Use of COVID-19 Vaccines.
For questions or concerns, providers can contact the OCHCA Communicable Disease Control Division at 714-834-8180.
