Can we still do asymptomatic testing. Here’s the latest guidance.

The bottom line: CLIA waived testing sites can continue to use molecular and antigen point-of-care (POC) tests on asymptomatic individuals per guidance from the Centers for Medicare & Medicaid Services (CMS).

The fine print:

• CMS will not cite Fire/EMS agencies (or other facilities) with a CLIA Certificate of Waiver when authorized SARS-CoV-2 molecular or antigen POC tests are performed on asymptomatic individuals outside of the test’s authorization.
• This guidance does not impact Fire/EMS agencies that are distributing antigen OTC tests to community members.

Testing of asymptomatic individuals or distribution of test kits to asymptomatic individuals continues to be a beneficial strategy to prevent the spread or outbreak of disease. For agencies enrolled in WA COVID-19, we recommend the continued administration or distribution of COVID-19 tests to asymptomatic community members.

Contact us if you have questions about this policy update.

A new COVID variant on the rise. Flu and RSV decline.

COVID-19

Here’s what we know so far about the so-called Kraken variant. 

• The omicron subvariant, XBB.1.5, has become the dominant strain in the US in a matter of weeks, making up 43% of all new cases as of January 14, 2023. BQ.1.1 still makes up almost 30% of all new cases, followed by BQ.1 (15.9%) and XBB (3.9%). 
• Nicknamed the Kraken because of a mutation that allows it to bind more effectively to cells, XBB.1.5 is the most transmissible and immune evading variant we have seen so far.  
• The severity of disease caused by XBB.1.5 has yet to be determined, but according to the WHO, the strain does not carry any mutation known to be associated with potential change in severity.
• In the northeast United States where the variant is most prevalent, hospitalizations and death rates do not suggest increased severity for this strain.
• Studies are ongoing to assess the effectiveness of the bivalent booster against this variant.
• Monoclonal antibodies are not effective against the omicron subvariants which are the only strains currently in circulation. In November 2022, the FDA rescinded emergency use authorization for Bebtelovimab, the last monoclonal antibody therapy available in the US. 

Related: New coronavirus variants rendered the last remaining monoclonal antibody treatment useless

COVID-19 numbers 

• At the national level, COVID-19 hospitalizations decreased by 6% over a two-week period between December 29, 2022 and January 12, 2023. 
• New deaths in the US fell by 9% over the period December 21, 2022 to January 4, 2023*. 
• *For the week ending January 11, 2023, there were 3,907 new deaths, a 44% increase from the week prior. We will see if this trend continues over the following weeks or if the jump in numbers is attributed to reporting lag. 
• New cases dropped by 4% nationwide between December 21, 2022 and January 4, 2023*. 
• *Due to an increase in at home testing, many positive cases are not reported. The official data, therefore, may not capture the full picture. It is important to consider other data such as hospitalizations to help measure the impact of COVID-19 at this point in the pandemic. 

Here are the latest COVID-19 numbers for Washington state (note: the most recent data provided by the Washington State Department of Health is for the week ending January 7, 2023).

As of January 7, 2023

Compared to last winter (January 7, 2022)

*Shows 7-day rate

** Due to an increase in at home testing, many positive cases are not reported. The official data, therefore, may not capture the full picture. It is important to consider other data such as hospitalizations to help measure the impact of COVID-19 at this point in the pandemic.

• In Washington, 95% of inpatient beds are currently in use; around 8% are in use for COVID-19 patients. 
• As of Thursday, January 12, 2023, all Washington counties have a COVID-19 community level of low, according to the CDC. 
• Only 30% of people in Washington have received the newest bivalent booster, as of Monday, January 16, 2023. 

Related: Biden administration extends Covid public health emergency as highly infectious omicron XBB.1.5 spreads

FLU

After abnormally high flu activity early in the season, hospitalizations have dropped considerably over the past several weeks. 

Here’s where we stand early in the New Year in Washington state. 

• According to the CDC, flu-like illness activity in Washington state is currently LOW dropping from VERY HIGH in mid-December.
• The number of cumulative flu deaths is still very high for this point in the season. So far there have been a total of 147 lab-confirmed flu deaths (4 children, 143 adults), an increase of 121 deaths since mid-December. In comparison, there were a total of 237 flu deaths over the past 8 years combined at this point in the season.

Outpatient visits for Influenza Like Illness (ILI) in Washington state have declined steadily over the past month, down to 1,251 total visits in the week ending January 7th, a 71% decrease over the past four weeks.

RSV

RSV rates nationwide have declined steadily since peaking in mid-November. Here are the latest updates. 

• Weekly RSV hospitalizations have plummeted since reaching record highs in mid-November, falling from 5.2 hospitalizations per 100k population for the week ending November 12, 2022 to 1.1 hospitalizations per 100k population for the week ending January 7, 2023, according to CDC surveillance network data.
• Since our last newsletter on December 15, 2022, the number of positive weekly RSV tests has dropped by 84%, from 8,547 for the week ending December 17 to 1,362 for the week ending January 14, 2023.