4/14/21 - Health Advisory: COVID-19 Updates for Providers

Requested actions

Immediately pause administering Johnson & Johnson vaccine. Six people reported severe blood clots after getting Johnson & Johnson vaccine. Offer patients Moderna or Pfizer vaccine. Continue to store Johnson & Johnson vaccine and await further instructions. The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are reviewing these cases and will provide guidance for proper recognition and management of this condition.
Be aware, on March 31, the FDA changed its Emergency Use Authorization (EUA) for Moderna vaccine to help increase the number of available doses. Current 10-dose-maximum vials are now 11-dose-maximum vials. Moderna can also ship 15-dose-maximum vials.
On April 15, all people 16 years or older are eligible to get COVID-19 vaccine. Direct patients to vaccinelocator.doh.wa.gov to find vaccine providers nearby and to our COVID-19 vaccine page for vaccine events and regularly updated resources.

Johnson & Johnson vaccine

On April 13, CDC and the FDA released a joint statement recommending pausing administration of Johnson & Johnson vaccine. The pause is out of an abundance of caution after six cases of a rare and severe type of blood clot called cerebral venous sinus thrombosis (CVST) in women under 50 within 6-13 days of receiving Johnson & Johnson vaccine. Treatment of CVST is different from the treatment healthcare providers might typically administer for blood clots. In this setting, administration of heparin may be dangerous, and alternative treatments must be given.

Washington State Department of Health (DOH) immediately paused the use of Johnson & Johnson vaccine throughout the state until further notice. DOH recommends all providers reschedule Johnson & Johnson vaccine appointments or offer these patients Moderna or Pfizer vaccine. This pause will allow experts to review these cases and plan for proper recognition and management of this condition. We will provide additional information soon.

These adverse events appear to be extremely rare. For those who got Johnson & Johnson vaccine more than a month ago, the risk of this complication is very low. People who get Johnson & Johnson vaccine and develop, within 3 weeks, severe headache, abdominal pain, leg pain or shortness of breath should contact their healthcare provider. All providers should report these symptoms to the Vaccine Adverse Event Reporting System (VAERS) at vaers.hhs.gov/reportevent.html.

Continue to store Johnson & Johnson vaccine. Do not dispose of it.

Storage prior to first puncture of vaccine vial:

Store unpunctured multi-dose vials at 36°F to 46°F (2°C to 8°C) and protect from light. Do not store frozen.
You may store unpunctured vials at 47°F to 77°F (9°C to 25°C) for up to 12 hours.

Storage after first puncture of vaccine vial:

After the first dose is withdrawn, hold the vial at 36°F and 46°F (2°C to 8°C) for up to 6 hours or at room temperature (maximum 77°F/25°C) for up to 2 hours.
Discard any vials not fully used within these times.

Additional resources

CDC Health Alert with talking points for healthcare providers.
The Advisory Committee on Immunization Practices (ACIP) will hold an emergency meeting Wednesday, April 14, 1:30-4 p.m. Eastern Time.
CDC and FDA statement.

Changes to Moderna vaccine vials

On March 31, the FDA changed its EUA for Moderna vaccine to help increase the number of available doses. Current 10-dose-maximum vials are now 11-dose-maximum vials. Moderna can also ship 15-dose-maximum vials. However, depending on the syringes and needles used for each dose, there may not be enough volume to extract more than 10 doses from 11-dose-maximum vials or more than 13 doses from 15-dose-maximum vials. Do not pool excess vaccine from multiple vials. Accessory kits will not change, other than an increase in supply. Be aware, increased thaw time is required for 15-dose-maximum vials. Continue to pierce the stopper at different sites each time.

Vaccine eligibility

On April 15, all people 16 years or older will be eligible to get COVID-19 vaccine. Direct patients to vaccinelocator.doh.wa.gov to find vaccine providers nearby and to our COVID-19 vaccine page for vaccine events and regularly updated resources. Refer patients who need help navigating these resources to:

DOH COVID-19 assistance hotline at (800) 525-0127, then press #.

Build trust in the vaccine.

Studies have shown a strong endorsement from a healthcare provider is one of the most important factors in a patient’s decision whether to get vaccinated. As vaccine supply continues to increase, we want to make every effort to ensure everyone in our state understands the importance of vaccinations. Please share credible, timely, accurate COVID-19 vaccine information with your patients to help them move from vaccine hesitance to vaccine confidence.

To support you, DOH has created a provider toolkit with talking points, discussion guides, and other resources to help you have effective conversations about the COVID-19 vaccine. You can also visit the DOH Vaccine FAQ to brush up on COVID-19 vaccine information and prepare to answer the most commonly asked patient questions. Recently, DOH hosted an Expert Panel with providers across WA to discuss how they address vaccine hesitancy, tools and resources they recommend, and ways any provider can help encourage patients to get the COVID-19 vaccine using holistic, trauma-informed strategies.

Additional resources

COVID-19 test processing

Labs report varying amounts of time to process COVID-19 tests. To support faster turnaround, we encourage providers to use in-state labs. The table below shows COVID-19 test processing times for in-state private labs.

LAB	TIME TO PROCESS TEST	TESTS PROCESSED DAILY
FidaLab	24-48 hours	500
Kaiser	24 hours	600-700
LabCorp	48 hours	Unknown
Northwest Pathology	24-48 hours	20,000
Quest	24-48 hours	800
UW Virology	12-15 hours	4,000-8,000
Atlas Genomic	16 hours	10,000

Patient education

Share the following materials with patients.