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The Virginia Department of Health’s up-to-date resources relevant for health professionals and their response to COVID-19 in Virginia. This page includes clinician’s letters, information on infection prevention, testing, and other COVID-19 topics.
Thank you for your continued work to protect the health and well-being of all Virginians.
Healthcare Professionals and Healthcare Workers
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- Long-Term & Residential Care
- Testing & Laboratory
- Variants and Their Impacts -With variants continuing to evolve and the potential impacts on available therapeutics, VDH developed this new resource to help providers stay up to date on what COVID-19 drugs are expected to be effective.
Hot Topics for Health Professionals
The clinical benefits of Paxlovid in preventing severe adult COVID-19
November 22, 2022 (CDC MMWR Early Release) - “Among U.S. adults diagnosed with COVID-19, including those with previous infection or vaccination, persons who were prescribed Paxlovid within 5 days of diagnosis had a 51% lower hospitalization rate within 30 days after diagnosis than those who were not prescribed Paxlovid. Paxlovid should be offered to eligible adults irrespective of vaccination status, especially in groups with the highest risk for severe COVID-19 outcomes, such as older adults and those with multiple underlying health conditions.”
Bivalent COVID-19 vaccine effectiveness in preventing symptomatic illness
November 22, 2022 (CDC MMWR Early Release) - “Monovalent mRNA COVID-19 vaccines were less effective against symptomatic infection during the period of SARS-CoV-2 Omicron variant predominance.” In this study of vaccine effectiveness of the U.S.-authorized bivalent mRNA booster formulations, bivalent boosters provided significant additional protection against symptomatic SARS-CoV-2 infection in persons who had previously received 2, 3, or 4 monovalent vaccine doses. Due to waning immunity of monovalent doses, the benefit of the bivalent booster increased with time since receipt of the most recent monovalent vaccine dose.
“All persons should stay up to date with recommended COVID-19 vaccinations, including bivalent booster doses for eligible persons.”
Ongoing challenges of evolving COVID-19 variants
November 19, 2022 - CDC’s Nowcast variant surveillance data set, which is updated weekly on Fridays, is indicating that the proportion of BQ.1 and BQ.1.1 sub-variants of SARS-CoV-2 continues to rise, causing 49.7% of new infections nationally and just over 50% in Region 3 (that includes Virginia). An excellent summary of the characteristics of BQ.1 and BQ.1.1 has recently appeared. One piece of bad news is that BQ.1 and BQ.1.1 are the most immune-avoidant Omicron sub-variants noted yet, which may explain, at least in part, why COVID-19 case numbers are beginning to rise in some places and why these two sub-variants are almost totally resistant to bebtelovimab, which was until now the only remaining active monoclonal antibody. The corresponding good news is that increases in clinical severity of COVID-19 disease have not been reported so far AND that the major treatment drugs, Paxlovid, molnupiravir (Lagevrio), and remdesivir are still effective against these sub-variants.
Updated Information on SARS-CoV-2 variants, sub-variants, and their susceptibility to various COVID-19 treatment and prevention drugs
November 18, 2022 – VDH has prepared and will keep updated a brief summary of information about evolving SARS-CoV-2 variants and the treatment and prevention medications to which they are susceptible. This summary includes recent developments and talking points about these variants and drugs as well as a list of sources of additional information.
Rapidly changing mix of circulating SARS-CoV-2 variants and sub-variants could affect COVID-19 treatment choices
November 11, 2022 – The ongoing decrease in the circulation of the Omicron BA.5 sub-variant virus and the corresponding increase in Omicron sub-variants BQ.1 and BQ.1.1 is likely to have an impact on the effectiveness of the one monoclonal antibody available to treat COVID-19. Specifically, the U.S. Food and Drug Administration (FDA) recently updated its guidance on the monoclonal antibody bebtelovimab to indicate that the drug is not expected to neutralize Omicron sub-variants BQ.1 or BQ.1.1 and that it is “not authorized for treatment of mild-to-moderate COVID-19 in geographic regions where infection is likely to have been caused by a non-susceptible SARS-CoV-2 variant….” As of November 12, 2022, Omicron sub-variants BQ.1 and BQ.1.1 combined were responsible for approximately 44% of SARS-CoV-2 infections in HHS Region 3 (that includes Virginia). According to the most recent CDC Nowcast projection, the proportion of infections caused by BQ.1 and BQ1.1 has been increasing steadily over the past 4 weeks. Other treatment options such as Paxlovid, Lagevrio, and Veklury are considered to still be active against these two Omicron sub-variants.
A COVID-19 prevention concern: arrival of new SARS-CoV-2 variants and sub-variants could affect Evusheld prevention options
November 10, 2022 – An ongoing increase in the frequency of the BQ.1 and BQ.1.1 sub-variants of SARS-CoV-2 could affect the benefits of using Evusheld for pre-exposure prophylaxis. Based on knowledge of mutations that confer resistance to SARS-CoV-2 antibodies, the NIH Treatment Guidelines Panel has updated its Evusheld recommendations to include a caution about the need for additional precautions to minimize COVID-19 exposures in areas where these and several other new sub-variants are common. The most recent CDC Nowcast projections indicate that the proportion of infections caused by BQ.1 and BQ1.1 nationally has increased steadily over the past 4 weeks and that, as of November 12, BQ.1 and BQ.1.1 combined were responsible for approximately 44% of SARS-CoV-2 infections in HHS Region 3 (that includes Virginia). However, the FDA still recommends the use of Evusheld as a preventive measure for those at high risk of severe COVID-19 illness who cannot get vaccinated.
COVID-19 case numbers after lifting universal masking requirements in schools
November 9, 2022 – After a time-staggered lifting of universal school masking requirements in metropolitan Boston, where COVID-19 incidence had initially been similar in early 2022 across all 72 school districts, case numbers in school staff and students (SSS) indicated that an additional 45 COVID-19 cases/1000 SSS had occurred in unmasked schools during the 15 weeks after lifting the mask mandate. The nearly 12,000 extra COVID-19 cases represented about 29% of all cases in all districts in that period. Because of isolation practices of 5+ days, these additional cases represented at least 6,500 and 17,500 missed school days for staff and students respectively. An accompanying editorial discusses the significance of these results.
Johnson and Johnson/Janssen: https://vaxcheck.jnj/
Non VDH-State Guidance
Page Last Updated: November 28, 2022
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