Most Recent Updates Related to Covid-19
Governor Scott Offers Special Session During Thanksgiving Week for Mask Mandate Compromise and Press Conference Notes
Yesterday, Governor Scott issued a letter providing Vermont’s legislative leadership with an opportunity to call a special legislative session for lawmakers to vote on whether individual municipalities in the State should have the authority to mandate the use of facial coverings indoors within their jurisdictions. The letter comes after repeated calls by Senate President Pro Tem Becca Balint and House Speaker Jill Krowinski for Governor Scott to provide broader protection for Vermonters from the COVID-19 Delta surge through a statewide mask mandate. The Governor cited "differences of opinion" on both how to the end the pandemic and the uses of gubernatorial power and stated that the authority to adopt a mask mandate would be time-limited, would not include schools and would need to be voted on whether to rescind on a month-by-month basis. The Senate President and House Speaker were disappointed that the Governor was not willing to take statewide action, but indicated they would be willing to call lawmakers into special session on Monday, Nov. 22nd. Read more in VTDigger. To read the notes from today's press conference, please click here.
Updated Information Regarding COVID-19 Monoclonal Antibodies
This update is to remind providers of the NIH COVID-19 Treatment Guidelines Panel’s recommendations regarding the use of monoclonal antibodies, and to encourage their use for patients who could benefit from them. This is of special relevance at this time of Delta surge in light of this treatment’s potential to prevent hospitalization and protect healthcare system capacity. Three prior health updates regarding COVID-19 monoclonal antibodies (mAbs) have been issued: The March 3, 2021 Health Update provided links to two sets of national guidelines regarding the use of COVID-19 mAbs for the treatment of COVID-19 (from the Infectious Disease Society of America (IDSA) and from the National Institutes of Health (NIH) ). These guidelines are updated regularly. The April 5, 2021 Health Update gave further information from the national guidelines regarding the use of mAbs for treatment of COVID-19. The August 9, 2021 Health Update addressed the use of COVID-19 mAbs for post-exposure prophylaxis. Administration via the intravenous route was addressed (as used for treatment of COVID-19) along with subcutaneous administration. To read the full update, click here.
Health Care and Large Employer Vaccine Mandate Rules Released - Compliance Required by Jan. 4
On Thursday, Nov. 4th the Centers for Medicare & Medicaid Services (CMS) released emergency regulations requiring COVID-19 vaccination of eligible staff at health care facilities that participate in the Medicare and Medicaid programs. Facilities covered by the regulation must establish a policy ensuring all eligible staff have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care, treatment, or other services by December 5, 2021. Staff must have received the necessary shots to be fully vaccinated by January 4, 2022. The regulation also provides for exemptions based on recognized medical conditions or religious beliefs but the regulation requires staff vaccination only and does not provide for a testing alternative. The regulation applies to Medicare and Medicaid-certified provider and supplier types that are subject to CMS health and safety regulations such as hospitals, nursing homes, dialysis centers and ambulatory surgical centers but not to independent physician practices. CMS will enforce the mandate through routine inspections, or surveys, of the facilities that participate in the federal insurance programs. See the press release, FAQs and the full rule here.
Also on November 4th, the Occupational Safety and Health Administration (OSHA) finalized Emergency Temporary Standard (ETS) rules that include binding requirements for all employers with a total of 100 or more employees to implement a mandatory COVID-19 vaccination policy, with an exception for unvaccinated employees who undergo regular COVID-19 testing and wear a face covering at work. Click here for the full rule, factsheets, webinars and employee information. The mandate will take effect January 4th.
These latest regulations are in addition to the Health Care ETS released in June for health care settings “where suspected or confirmed COVID-19 patients are treated.” This regulation requires COVID-19 mitigation steps to be taken by many health care entities, such as implementing a COVID-19 plan, patient screening and record keeping requirements. For more information see the “Is your workplace covered by the COVID-19 Healthcare ETS?” flow chart and the fact sheets, sample check lists and other materials here.
Vermont COVID-19 Updates - Pediatric Pfizer Vaccine Registration to Open 11/3
The FDA expanded emergency use authorization of the Pfizer-BioNTech COVID-19 Vaccine to include children 5 through 11 years of age on Friday, October 29th. The Pfizer-BioNTech COVID-19 vaccine for 5 through 11 years of age will be a new product with new packaging. The CDC is meeting today to issue its recommendations regarding administration. Vermont expects to open registration to 5-11 year olds tomorrow, November 3rd
at 8 am, with clinics beginning as soon as Thursday or Friday.
Vaccine began being shipped to Vermont in the days following issuance of the EUA decision.
The Vermont Department of Health is receiving vaccine between 11/01 and 11/5 in three waves of shipments.
This first allocation of 15,900 doses of vaccine is meant to act as a bolus of supply to the state and has already been prepositioned for community and school-located clinics.
Weekly ordering of pediatric Pfizer vaccine for all other COVID-19 enrolled providers will commence Wednesday, 11/10 using VDH’s standard vaccine ordering process.
Children will be able to obtain vaccine in the same locations as adults (community vaccine clinics, pharmacies) as well as school-based clinics and pediatric offices. Families will be able to learn about registration from the VDH COVID-19 vaccine webpage.
On November 9, from 1:00 – 1:45, the VDH Immunization Program will hold a training for 5 through 11-year-old approval. This training will be recorded and summarize recommendations, ordering and inventory management, storage and handling, with time for Q+A. If you would like an invitation or more information, please reach out to AHS.VDHImmunizationProgram@vermont.gov.
The American Academy of Pediatrics Vermont Chapter, in collaboration with the VDH Immunization Program, is providing funding to support expanded influenza and/or COVID vaccination by healthcare practitioners or organizations. AAP-VT is also hosting community forums for caregivers to ask questions from local, trusted pediatric health care professionals about COVID vaccination. Visit www.aapvt.org for more information about grant funding and community educational opportunities. AAP-VT president, Rebecca Bell, MD, spoke at the Administration’s press conference today and stated that pediatricians unequivocally recommend vaccine for every Vermont child. It is safe and effective and side effects have been mild, primarily pain at injection side, swelling & redness, seeing fewer systemic side effects in this age group (fever, chills, headache). The DFR Modeling report from Tuesday can be found here.
State of Vermont Strengthens School Testing Program - From 10.5.21
The State of Vermont last week distributed resources and information to all Vermont public and independent schools to enable them to establish COVID-19 response testing in every school across Vermont. The State is bolstering existing testing tools with rapid testing to help keep more kids in school.The COVID-19 response testing program consists of three complementary testing tools, each used for different scenarios, giving schools flexibility to respond directly to specific cases in their learning community:Test to Stay ? allows unvaccinated students who are close contacts of a positive COVID-19 case to take a daily antigen test at the beginning of the school day, rather than remaining at home. Students who test negative go to class and in-school extracurricular activities as normal, as long as they have no symptoms. Students test until seven days have passed since they were last exposed to the case. This program is modeled after successful programs in Massachusetts and Utah and has been supported by Vermont’s pediatric community and infectious disease experts at the University of Vermont.PCR Response Testing ? allows schools to conduct a wide range of PCR testing in response to case(s) in their learning community. This includes testing unvaccinated close contacts out of quarantine, testing vaccinated close contacts three (3) to five (5) days after exposure, and testing symptomatic students who test negative with an antigen test. Schools administer the testing on site.Take Home PCR Testing ? allows schools to distribute kits to students, staff and family members who need a test. Families can follow simple instructions to register the kit using a smartphone or web browser, collect the sample, and either send back to the lab themselves with a pre-paid shipping label, or return to the school for shipping. These kits are intended for students quarantining at home, family members of COVID-19 positive students, or anyone in the learning community who needs a test.Families will hear directly from their school about testing programs in their community. Schools will receive additional resources and information next week. Information can be found on the Agency of Education’s COVID-19 Testing Family Resources webpage and COVID-19 Response Testing At-A-Glance.
White House Releases Vaccine Mandate for Health Care Facilities, Updated COVID-19 Action Plan
The Biden-Harris Administration announced last Thursday that it will require COVID-19 vaccination of staff within all Medicare and Medicaid-certified facilities to protect both them and patients from the virus and its more contagious Delta variant. Facilities across the country should make efforts now to get health care staff vaccinated to make sure they are in compliance when the rule takes effect. The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), announced that emergency regulations requiring vaccinations for nursing home workers will be expanded to include hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies, among others, as a condition for participating in the Medicare and Medicaid programs. The decision was based on the continued and growing spread of the virus in health care settings, especially in parts of the U.S. with higher incidence of COVID-19. CMS is developing an Interim Final Rule with Comment Period that will be issued in October. Facilities are urged to use all available resources to support employee vaccinations, including employee education and clinics, as they work to meet new federal requirements.
Other elements of the COVID-19 Action Plan include:
- Requiring All Employers with 100+ Employees to Ensure their Workers are Vaccinated or Tested Weekly
- Requiring Employers to Provide Paid Time Off to Get Vaccinated
- Calling on All States to Adopt Vaccine Requirements for All School Employees
- Calling on Large Entertainment Venues to Require Proof of Vaccination or Testing for Entry
- Getting Students and School Staff Tested Regularly
- Providing Every Resource to the FDA to Support Timely Review of Vaccines for Individuals Under the Age of 12Making At-Home Tests More Affordable
Expanding Free, Pharmacy Testing
Back to School: Districts Look to Pediatricians for Guidance - August 24th, 2021
The American Academy of Pediatrics Vermont Chapter (AAPVT) has been working with the Agency of Education, School Nurses, Superintendents (VSA), School Boards (VSBA), and Principals (VPA) on recommendations for back to school (attached guidance). Schools were sent the following information from VSBA, VSA, VPA on Return to School COVID-19 Prevention Measures, which included the guidance from AAPVT.The chapter is now working to connect pediatric practitioners to schools to spread the message about keeping students safe and IN school! If you are interested in talking to your school board email Stephanie at email@example.com.The key points in the AAPVT guidance are:The American Academy of Pediatrics Vermont Chapter fully supports the administration’s emphasis on getting students in-person full-time this school year and with the recommendation that schools require universal masking of all students and staff regardless of vaccination status to begin the school yearVermont pediatricians continue to support universal masking regardless of vaccination status as an important mitigation strategy to prevent spread of COVID-19 in the school setting. We feel strongly that universal masking should continue for students and staff in each school building until those under 12 years of age have had the opportunity to be vaccinated and when epidemiologic data tells us it is safe to remove them.AAPVT support schools not implementing distancing measures, but strongly recommend that schools pay special attention to distancing at times when students are eating in groups unmasked. The stay home when sick guidance is imperative as outlined in the Agency of Education/Department of Health memo. Students and staff who are sick should stay home.
Vermont Now Reporting COVID Cases by Vaccination Status - July 27, 2021
At today’s press conference by the Scott Administration, Commissioner of the Department of Financial Regulation Mike Pieciak shared new slides as a part of his modeling report that track Vermont’s COVID-19 cases by vaccination status (slides 5 & 6). He stated that while the absolute number of cases per 14 days among vaccinated Vermonters looks higher in July compared to April, as a percent of the population, the case rate among vaccinated Vermonters has fallen. Commissioner of Health Mark Levine added that over the course of the pandemic the state is aware of five fully vaccinated Vermonters who have been hospitalized and one who has died and that vaccination is the best protection against hospitalization and death. In response to questions, Governor Scott and Commissioner Levine stated they do not believe the Vermont will need to reinstitute mandatory mitigation measures although Commissioner Levine stated that people who had traveled to high prevalence areas might want to be tested when they return to Vermont, regardless of vaccination status. Levine also stated that more information about requirements for schools for the fall can be expected at next week’s press conference. Notes from the press conference can be found here. Today, the CDC also announced new mask guidelines recommending indoor masking even for those who are vaccinated in “high” or “substantial” COVID-19 transmission counties – none of which are in Vermont – and for all students and staff in school.
OSHA Rule Requires COVID 19 Safety Measures in Health Care Settings
June 22, 2021
Last week, the Occupational Safety and Health Administration (OSHA) released new standards for health care settings “where suspected or confirmed COVID-19 patients are treated.” According to the OSHA fact sheet, the Emergency Temporary Standard (ETS) is aimed at protecting workers facing the highest COVID-19 hazards. This includes employees in hospitals, nursing homes, and assisted living facilities; emergency responders; home healthcare workers; and employees in ambulatory care facilities where suspected or confirmed COVID-19 patients are treated. For more information see the “Is your workplace covered by the COVID-19 Healthcare ETS?” flow chart
Some of the key requirements of the ETS are:
- COVID-19 plan: Develop and implement a COVID-19 plan (in writing if more than 10 employees)
- Patient screening and management: Limit and monitor points of entry to settings where direct patient care is provided; screen and triage patients, clients, and other visitors
- Develop and implement policies and procedures to adhere to Standard and Transmission-Based precautions based on CDC guidelines
- Personal protective equipment (PPE): Provide and ensure each employee wears a facemask when indoors*
- Physical distancing: Keep people at least 6 feet apart when indoors*
- Physical barriers: Install cleanable or disposable solid barriers at each fixed work location in non-patient care areas*
- Health screening and medical management: Screen employees before each workday and shift
- Ventilation: Requirements for employer-owned or controlled existing HVAC systems
- Vaccination: Provide reasonable time and paid leave for vaccinations and vaccine side effects
- Training: Ensure all employees receive training so they comprehend COVID-19 transmission, tasks and situations
- Recordkeeping: Establish a COVID-19 log (if more than 10 employees) of all employee instances of COVID-19
* There are exceptions to masking, distancing, and barrier requirements for fully vaccinated staff when in well-defined areas with no reasonable expectation that a COVID-19 patient will be present
The ETS is effective immediately upon publication in the Federal Register (OSHA is working to have the standard published “as soon as possible”). Employers must comply with most provisions within 14 days, and with provisions involving physical barriers, ventilation, and training within 30 days. OSHA will use its enforcement discretion for employers who are making a good faith effort to comply with the ETS.
State Has Reached 80% Vaccination Goal – Health Care Practices Still Must Follow CDC Guidance, New OSHA Rule
June 22, 2021
As has been well publicized by the media, Governor Phil Scott announced last week that 80.2% of Vermont’s eligible population - those age 12 and older - have received at least one dose of the COVID-19 vaccine, making it the first state to reach this major milestone. Governor Scott also announced he has rescinded all state COVID-19 restrictions. Additionally, Vermont’s State of Emergency, slated to expire at midnight tonight, June 15, will not be renewed.
At this time, Vermont will no longer require sector-specific guidance for health care settings, such as the Guidance for Inpatient and Outpatient Procedures and Hospital Visitor Guidance. Instead, health care settings may establish their own guidance and are expected to follow CDC guidance, including Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination. This document includes updated testing recommendations for health care workers, visitation guidance and guidance for communal gatherings/activities in the health care setting. Some sectors, such as hospitals and long-term care settings, may be required to follow CDC guidance by federal accreditation/inspection standards.
Practices should note that last week OSHA released a new Emergency Temporary Standard (ETS) for health care workers related to minimizing the risk of exposure to COVID-19. See article below for further details regarding these requirements and compliance dates.
With Vermont ending the State of Emergency related to COVID-19, members are reminded that there are some regulatory flexibilities pegged to the State of Emergency, although S. 117/Act 6 extended many to a date certain and are not dependent on the State of Emergency. A summary of Act 6 is available here. Note the following that are linked to the State of Emergency:
- Waiver of obtaining/documenting a patient’s informed consent for use of telemedicine (sunsets 60 days after the State of Emergency or August 14, 2021) (informed consent for audio-only telehealth currently required, see sample);
- Liability protections for health care providers engaged in emergency management services or response activities.
The following will continue to a date certain:
- Health insurance companies must continue to reimburse for audio-only telehealth services at parity with in-person services (through the remainder of 2021);
- Ability for out-of-state licensed health care professionals to provide services to patients located in Vermont by telehealth (through March 2022);
- Buprenorphine prescription renewals without an office visit (through March 2022); and
- Waiver of using HIPAA compliant telehealth platforms (through March 2022, if federal waiver continues to allow – dependent on Federal Public Health Emergency).
Waiver of licensure requirements for telehealth services provided to patients located in other states, such as New Hampshire or New York, are determined by those states’ laws, and in many cases are dependent on the status of a declared emergency in those states. See the charts from the Federation of State Medical Boards to confirm if you will need to seek licensure to provide services to patients located in other states when the state of emergencies end in those jurisdictions. New Hampshire announced last week that all COVID-19 Emergency Licenses issued prior to June 12, 2021, expired on that date with the expiration of the State of Emergency. All healthcare COVID-19 Emergency Licenses will automatically be converted to a temporary license that will be valid for a period not to exceed 120 days (October 20, 2021) from June 12, 2021. As of publication, New York State continues to waive licensure requirements for telehealth under and executive order. For questions or concerns regarding this transition, contact firstname.lastname@example.org.