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UPMC: Several Unknowns With Omicron COVID-19 Variant

From left, Dr. Donald Yealy, UPMC chief medical officer, along with Dr. Graham Snyder, UPMC medical director of infection prevention and hospital epidemiology, and Dr. Erin McCreary, UPMC director of antimicrobial stewardship innovation and infectious diseases pharmacist, speak during a virtual news conference Thursday about the Omicron variant of COVID-19. Submitted photo

There is still a lot to learn about the latest COVID-19 variant Omicron, UPMC doctors said during a virtual news conference Thursday.

The Omicron variant of SARS-CoV-2 is the latest strain of the coronavirus to be designated a “variant of concern” by the World Health Organization as more and more countries are reporting cases.

Dr. Graham Snyder, UPMC medical director of infection prevention and hospital epidemiology, said there is still a lot to learn about the Omicron variant, but people still need to follow the same COVID-19 safety guidelines of masking when indoors around others, social distancing and being vaccinated.

“Omicron — like Delta before it — will not change what we need to do to stay safe,” he said.

Snyder said medical professionals in South Africa and other parts of the world have done a quality job of disseminating information about Omicron. He said it’s promising to hear the symptoms from Omicron seem to be less severe, but it’s concerning to hear how quickly it spreads. He added that COVID-19 and its variants aren’t going away and will be something people will be discussing for years.

“It’s not surprising to see the emergence of another variant,” he said. “We will talk about (COVID-19 and its variants) for years. (We should) plan for the foreseeable future, years to be dealing with COVID.”

When asked if there is one vaccine – Johnson & Johnson, Moderna or Pfizer – that is better to fight Omicron, Snyder said all three vaccines are “fantastic,” and they are all safe and highly effective. He said the vaccines will be effective against Omicron, but UPMC officials don’t know yet to what degree. He added again that people should receive the vaccine and a booster shot when eligible.

“It’s a good way to be prepared for Omicron,” he said.

Dr. Donald Yealy, UPMC chief medical officer, said the increase in the number of COVID-19 cases and other illnesses like the flu is a challenge to a hospital’s capacity. He said the demand for health care services has grown dramatically in the last few months. He added all communities UPMC operates in are operating near the high end of capacity, which is nothing new since the start of the COVID-19 pandemic.

“It makes this a volatile period of time,” he said.

When asked about long waiting times reported at the emergency room at UPMC Altoona, Yealy said all UPMC facilities are experiencing longer waiting times because of the need for medical services. He also said UPMC officials at all facilities are monitoring the situation and prioritizing treatment to be more efficient to reduce waiting times for patients.

“This is a difficult challenge,” he said.

Snyder said medical professionals have known since the beginning of the pandemic that there would be “ups and downs” when it comes to a hospital’s capacity. He said it’s not as “intense” as last year at this time as far as capacity. He added that the availability of vaccinations since last year has “flattened the curve.”

NEW MONOCLONAL ANTIBODIES

TREATMENT

Dr. Erin McCreary, UPMC director of antimicrobial stewardship innovation and infectious diseases pharmacist, said UPMC officials are now treating patients receiving monoclonal antibodies in a new way. She said giving monoclonal antibodies to outpatients with mild to moderate COVID-19 via a series of four injections under the skin is essentially as effective at preventing severe hospitalization and death as giving the treatment in one intravenous (IV) infusion, and is superior to not giving the treatment at all.

“When we began to see a surge in COVID-19 cases due to the Delta variant three months ago, we realized it would be impossible to accommodate the demand for monoclonal antibodies with IV infusions,” McCreary said. “We can more than double our outpatient appointments for antibodies when using the subcutaneous route, so we began administering the treatment through injections when needed to treat as many patients as possible.”

The Food and Drug Administration’s emergency use authorization of Regeneron’s combination treatment of the monoclonal antibodies casirivimab and imdevimab allows for subcutaneous injection only when IV infusion “is not feasible and would lead to delay in treatment.”

Although only the IV route of administration had been studied in randomized clinical trials, McCreary and colleagues knew that without using injections to expand capacity during the Delta surge, many patients would experience delays in treatments or not receive them at all. UPMC switched most of its outpatient infusion centers to administering the treatment by subcutaneous injection on Sept. 9.

The patients who received injections of Regeneron’s monoclonal antibodies were followed for 28 days and compared to a matched population of patients who received an IV infusion of the drug, as well as those who were eligible for treatment, but did not receive it.

The study team determined that the COVID-19 patients who received subcutaneous injections had a 3.4% likelihood of being hospitalized or dying in the following four weeks, compared to 7.8% in matched patients who were not treated. Patients who received subcutaneous injections had a similar chance of avoiding hospitalization and death compared to those who received IV infusions; the adjusted risk was within the pre-determined, clinically acceptable threshold.

The findings mean that when surging COVID-19 cases and staffing shortages make it logistically impossible to administer monoclonal antibodies through long IV infusions, health care providers can revert to quicker subcutaneous injections to equitably continue providing the treatment to as many patients as possible. Injections take less time to administer, result in shorter appointments for patients and can be administered by more health care staff than IV infusions.

To guide health care providers on best practices during the recent nationwide upswing in COVID-19 cases, the physician-scientists are publishing the findings in medRxiv, a preprint journal, and shared the results ahead of peer-reviewed publication.

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