Update on COVID-19 and the Omicron Variant: Staffing, Surgical and Procedural Volumes, Therapeutics and More

I’m writing today with several updates about how UNC Health system and local entity leaders are continuing to work to ensure we have the tools, resources and teammates available across our hospitals and clinics so that you can provide the best care for our patients during the Omicron surge.

• Staffing remains our greatest concern, with more than 1,000 teammates across UNC Health unavailable on any given day due to COVID-related absences. We are working with leaders at our hospitals, clinics and Shared Services teams to develop multiple contingency plans to redeploy teammates to critical areas if needed.
• At the same time, don’t come to work if you are sick! Contact your local Occupational/Employee Health team if you have any symptoms.

• We have already begun to reduce the number of surgeries and procedures at many entities. For those entities who have not yet taken this step, leaders are closely monitoring the situation to determine if/when they need to ramp down. Read this recent story from WRAL featuring Dr. Jessie Tucker, President and CEO at Wayne UNC Health Care, and hear how his team is managing staffing challenges at Wayne UNC.

• The Omicron variant now makes up more than 85% of COVID cases in North Carolina.
• COVID therapeutics that remain active and effective against Omicron include Sotrovimab, Paxlovid (Nirmatrelvir/Ritonavir), Remdesivir and Molnupiravir.
• However, these drugs are either in incredibly short supply or are complicated to administer, so our plans are evolving rapidly. You can read the latest update at the bottom of this message, and we will share future updates by email and on our COVID-19 Treatment Guidelines page, which is also available from the ‘References’ dropdown menu in Epic@UNC.

• Our situation isn’t unique – hospitals across North Carolina and the nation are feeling the strain of rising hospitalizations coupled with limited staffing. In an attempt to draw more attention to this situation, multiple UNC Health leaders, including Dr. Burks, signed an open letter to all North Carolinians that was published Wednesday, Jan. 12, asking for the public’s help to slow the spread of COVID-19 by getting vaccinated and boosted and practicing the 3 W’s (Wear a mask, Wash hands frequently, Wait at least 6 feet apart).
• We are also sending a message to UNC Health patients via My UNC Chart to help reinforce when it is (and isn’t) appropriate to seek testing at our Emergency Departments and other locations.
• Daily efforts are also being made through news and social media to educate and make a plea to the public to go to the appropriate place for testing, wear masks, and get vaccinated or boosted.

• I’d also encourage you to read a letter to the editor from Jay Kirby, President and CEO at Pardee UNC Health Care. Jay refers to this current surge of patients, the testing shortage, and staffing shortage as the ‘perfect storm of stress’ for our teams and I agree.
• We aren’t sure how long this ‘perfect storm’ will last, but our models predict a peak of inpatients by mid-February. As we work through these next few weeks, please be mindful of the stress and pressure our teammates are under and give each other an extra amount of support and grace. I also encourage everyone to review our resources for help and share these resources with teammates who may be struggling.
• Even if you are doing well today, I’d encourage you to reflect and be mindful of the stress we are all facing. I really like this ‘Going Home Checklist’ that our Well-Being Team shared recently. This is tough – we must all rest and recharge as much as possible.
• We all play a critical part in reaching our mission – It Starts With Me. So, if you see any situation that causes concern for patient or teammate safety, please escalate it immediately to your leader or in your Safety Huddle.

Update on Ambulatory COVID-19 Therapeutics at UNC Health 

01/12/2022

The Omicron variant of COVID-19 now makes up more than 80% of cases in North Carolina. This means UNC Health will stop administering Casirivimab/Imdevimab and Bamlanivimab/Etesevimab, as data predicts these treatments will be significantly less effective against Omicron.

COVID therapeutics that remain active and effective against Omicron include Sotrovimab, Paxlovid (Nirmatrelvir/Ritonavir), Remdesivir and Molnupiravir. At this time:

• UNC Health has an extremely limited quantity of Sotrovimab and Paxlovid and anticipates we will run out of supply on Jan. 12.
• There is a sufficient supply of Remdesivir, but this medication requires IV administration over three consecutive days.
• Several hundred courses of Molnupiravir are also available. However, the FDA has issued an Emergency Use Authorization (EUA) for this medication for use only when other therapies are not readily available, and it is not recommended for individuals who are pregnant, breastfeeding or under the age of 18.

UNC Health is taking the following measures to ensure these therapeutics are available to those most at-risk for progression to critical illness due to COVID:

• Effective today, Jan. 12, the COVID Therapeutics workflow will pause until additional supplies of Sotrovimab and Paxlovid become available.
• Patients at the highest risk of COVID progression will be prioritized for Molnupiravir.
  • View the latest prioritization criteria. The current priority is at Level 2, and clinicians should only prescribe Molnupiravir to patients who meet Level 2 criteria and are within five days of symptom onset.
  • UNC Health physicians and APPs will be able to directly prescribe this medication without using the Request for COVID Therapeutics workflow.
  • Clinicians can e-prescribe this medication to any retail or UNC Health pharmacy.
    • The following UNC Health pharmacies have a limited supply of Molnupiravir available: UNC Hillsborough Outpatient Pharmacy, Johnston Health Outpatient Pharmacy, Pardee Outpatient Pharmacy, Shared Services Center Pharmacy, UNC Pharmacy at Panther Creek and WEB Pharmacy (Wayne).
    • We recommend that clinicians view UNC Health’s real-time inventory of Molnupiravir in Epic@UNC before issuing a prescription (use this tip sheet for instructions on how to add this component to a dashboard).
    • Please be aware that there is currently a limited supply of this medication. UNC Health pharmacies will do their best to allocate supply until they run out.
• Planning is underway to administer Remdesivir at select UNC Health locations in the next week.
  • The current priority is at Level 2, as this treatment requires three consecutive days of infusion and there is limited capacity at infusion centers.
  • The government does not provide this medication, so patients may be responsible for the cost. These costs may include co-pays or deductibles, and the COVID Therapeutics team will inform patients of this possibility.
• We will continue to share regular updates.

Note: UNC Health physicians and APPs have the ability to prescribe Paxlovid and Molnupiravir at an external pharmacy. If a clinician chooses to prescribe outside of UNC Health, please ensure that you review the significant drug-drug interactions associated with Paxlovid, along with prescribing restrictions and counseling requirements for Molnupiravir.