COVID-19 Recommendations for Nurse Practitioners

U.S. Food and Drug Administration (FDA) Approves First COVID-19 Vaccine

The FDA has approved the first COVID-19 vaccine: the Pfizer-BioNTech COVID-19 vaccine, which will now be marketed as Comirnaty, for the prevention of COVID-19 disease in individuals 16 years of age and older. Previously available under emergency use authorization (EUA), this Pfizer-BioNTech COVID-19 vaccine remains available for individuals 12 through 15 years of age and for the administration of a third dose in certain immunocompromised individuals under that EUA.

Previously, the FDA issued three EAUs to:

• The Pfizer-BioNTech COVID-19 vaccine.
  • Available data supports the use of two specified doses, with 21 days between the first and second dose, as well as an additional dose in certain immunocompromised individuals.
  • On May 10, the FDA expanded the EUA to include adolescents 12 through 15 years of age.
• The Moderna COVID-19 vaccine.
  • Available data supports the use of two specified doses, with 28 days between the first and second dose, as well as an additional dose in certain immunocompromised individuals.
• The Janssen COVID-19 vaccine.
  • Only one dose is currently required.
  • The FDA and Centers for Disease Control and Prevention (CDC) released a statement on the Janssen (Johnson & Johnson) COVID-19 vaccine following a thorough safety review, including two meetings of the CDC’s Advisory Committee on Immunization Practices (ACIP). The FDA and CDC determined that the previously recommended pause regarding the use of the Janssen COVID-19 vaccine in the U.S. should be lifted and use of the vaccine has resumed.
  • On July 13, revisions to the vaccine recipient and vaccination provider fact sheets for the Janssen Vaccine were made to include information pertaining to an observed increased risk of Guillain-Barré Syndrome (GBS) following vaccination.

A joint statement was released on August 18 to add additional information on COVID-19 booster shots:

"The available data make very clear that protection against SARS-CoV-2 infection begins to decrease over time following the initial doses of vaccination, and in association with the dominance of the Delta variant, we are starting to see evidence of reduced protection against mild and moderate disease. Based on our latest assessment, the current protection against severe disease, hospitalization and death could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout. For that reason, we conclude that a booster shot will be needed to maximize vaccine-induced protection and prolong its durability.

“We have developed a plan to begin offering these booster shots this fall, subject to FDA conducting an independent evaluation and determination of the safety and effectiveness of a third dose of the Pfizer and Moderna mRNA vaccines and CDC’s ACIP issuing booster dose recommendations based on a thorough review of the evidence. We are prepared to offer booster shots for all Americans beginning the week of September 20 and starting 8 months after an individual’s second dose [...] We also anticipate booster shots will likely be needed for people who received the Johnson & Johnson (J&J) vaccine. Administration of the J&J vaccine did not begin in the U.S. until March 2021, and we expect more data on J&J in the next few weeks. With those data in hand, we will keep the public informed with a timely plan for J&J booster shots as well."

Read the Statement

AANP is committed to ensuring that NPs have access to the latest COVID-19 vaccine information so they can educate patients on the importance of vaccination, and the association urges the public to get vaccinated at the earliest opportunity.

Learn More From the FDA

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CDC

The CDC released a statement on the Janssen (Johnson & Johnson) COVID-19 vaccine following a thorough safety review related to six cases of a rare and severe type of blood clot that were reported in individuals who received the vaccine. The previously recommended pause regarding the use of the Janssen COVID-19 vaccine in the U.S. has been lifted and use of the vaccine has resumed.

The CDC is tracking the latest COVID-19 vaccine news and offers information about vaccine recommendations, how researchers are ensuring the safety of vaccines, how COVID-19 vaccines work and other details. The CDC also stresses the importance of COVID-19 vaccination for health care workers. A number of COVID-19 vaccine resources are now available, including:

• Vaccine Storage and Handling Toolkit.
• COVID-19 Vaccination Communication Toolkit.
• Vaccine Recipient Education Toolkit.
• COVID-19 Vaccines While Pregnant or Breastfeeding.
• COVID-19 Vaccination Planning and Partnerships.
• Advisory Committee on Immunization Practices (ACIP) COVID-19 Vaccine Recommendations.
• Clinical Considerations for COVID-19 Vaccination.
• Clinical Considerations for Myocarditis and Pericarditis After Receipt of mRNA COVID-19 Vaccines Among Adolescents and Young Adults.
• COVID-19 Vaccination Program Provider Requirements.
• COVID-19 Vaccine Training and Education.
• COVID-19 Vaccination Reporting Data Systems.
• V-safe After Vaccination Health Checker.
  
• Building Vaccine Confidence and How to Talk to Your Patients About COVID-19 Vaccination.

Learn More From the CDC

In the U.S., 984,444,295 vaccine doses have been delivered, according to the CDC, with 270,227,181 people receiving at least one dose and 230,637,348 being fully vaccinated.

Among those who are fully vaccinated, 56,478,510 people ages 5 and up have received the updated Bivalent booster dose.

Review CDC Vaccination Statistics

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COVID-19 Vaccine Education and Equity Project

AANP is a partner organization of the COVID-19 Vaccine Education and Equity Project, which raises awareness, provides education, promotes the impact of the COVID-19 vaccine and advocates for equitable access to authorized and approved vaccines. Use the #CountMeInCOVIDVx hashtag in all of your social media posts to promote the campaign and share your reason for be "counted in" for COVID-19 vaccination.

Learn More About Count Me In

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COVID-19 Community Corps

AANP is a founding member of the COVID-19 Community Corps, of which its We Can Do This campaign aims to increase COVID-19 vaccine confidence while reinforcing basic prevention measures. Learn more about how the campaign is educating the public and find resources for your community, including fact sheets, a podcast, toolkits, tip sheets, messages for social media and more.

Learn More About We Can Do This

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National Foundation for Infectious Diseases (NFID)

AANP is a supporting organization of Keep Up The Rates, a national campaign launched by NFID to encourage all individuals to receive recommended vaccines that may have been delayed during the COVID-19 pandemic. This multimedia campaign engages national experts and leading public health organizations to reach populations who are most at risk of delaying vaccinations or of experiencing complications from vaccine-preventable diseases.

NFID also released a collection of frequently asked questions (FAQs) about the COVID-19 vaccines. Health care professionals and the general public can use this resource for information about mRNA vaccines, dosing timeframes, vaccine safety and vaccine administration.

View the FAQs

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U.S. Department of Health and Human Services (HHS)

HHS Secretary Xavier Becerra sent a letter to insurers and providers clarifying that COVID-19 vaccines and testing must be free for patients.

HHS has also produced a video series detailing the history and science of vaccines. The series is designed to provide background and clarity — via expert commentary and graphic illustration — to help viewers understand how vaccines are developed and the full strength of initiatives such as Operation Warp Speed.

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White House Administrations

The Trump administration released the COVID-19 Vaccine Distribution Strategy, which includes two documents detailing the distribution strategy and a vaccine program interim playbook.

President Joe Biden released a National Strategy for the COVID-19 Response and Pandemic Preparedness and a fact sheet announcing the goal to administer at least one vaccine shot to 70% of the U.S. adult population by July 4, 2021.

The president also issued a number of executive orders, including:

• Executive Order on Organizing and Mobilizing the United States Government to Provide a Unified and Effective Response to Combat COVID-19 and to Provide United States Leadership on Global Health and Security.
  
• Executive Order on Ensuring an Equitable Pandemic Response and Recovery.
• Executive Order on Improving and Expanding Access to Care and Treatments for COVID-19.
  

In addition, President Biden, first lady Jill Biden, Vice President Kamala Karris and second gentleman Doug Emhoff have all publicly received a COVID-19 vaccine to promote the safety and efficacy of the vaccine.

Who Is Eligible for a COVID-19 Vaccine Booster Shot?

The CDC announced that booster shots are available for all Pfizer-BioNTech or Moderna COVID-19 vaccine recipients who completed their initial series at least 6 months ago.

In addition to this, booster shots are recommended for all recipients of the Janssen (Johnson & Johnson) COVID-19 vaccine who are 18 and older and who were vaccinated two or more months ago.

The latest CDC guidelines allow eligible individuals to choose which vaccine they receive as a booster dose. Some people may have a preference for the vaccine type that they originally received, and others may prefer to get a different booster.

COVID-19 Vaccine Booster Planning Considerations

The HHS Office of Intergovernmental and External Affairs has shared the following suggestions from the HHS and the White House on how NPs can prepare for the Pfizer-BioNTech COVID-19 vaccine booster shot administration.

Stay up to Date

• Monitor the CDC COVID-19 Vaccination Provider Support webpage for updated recommendations, requirements and other guidance.
• Check in with your jurisdiction’s Immunization Program Manager for the latest information and guidance specific to your jurisdiction.

Find Your Program Manager

Update Your Tech

• Prepare data collection systems to support new requirements, including but not limited to new codes for billing and payments, survey reporting and tracking vaccine types and doses.
• Ensure you have a process to verify that patients receive the right vaccine type and dose, especially if the patient does not have a vaccination card.
• Ensure patient reminder and scheduling systems are up-to-date and have the capacity to handle increases in user traffic.

Prep Your Practice

• Prepare to increase staffing levels and extend site hours as needed and where feasible.
• Consider increasing scheduling flexibilities, including expanding capacity for walk-in appointments and planning for mobile vaccine clinics to ensure access for hard-to-reach populations.
• Ensure staff receive adequate education and training to administer booster shots.
• Confirm a plan to ensure staff are vaccinated and a plan to minimize staff-wide exposure, if staff are infected.
• Bolster partnerships with community–based organizations to prepare communication channels for potential vaccine transfers or other support such as staffing.

Communicate and Educate

• Prepare and distribute patient education materials to highlight the importance of booster shots, continuing to focus on increasing vaccine confidence.
• Ensure materials are clear, culturally competent and accessible to all literacy levels.
• Leverage community, state and federal partnerships to engage with special populations and hard-to-reach patients.
• Set up booster shot notifications using previous second dose reminders to reach back out to patients at the appropriate length of time from the second dose of their primary series.
• Take advantage of successful COVID-19 vaccination efforts and lessons learned. For example, see the report titled “Overview of Barriers and Facilitators in COVID-19 Vaccine Outreach”.

Read the Report

Keep Track of Supply and Demand

• Monitor trends in demand to anticipate changes in inventory.
• Track supplies and assess the need to adjust current ordering patterns, while avoiding stockpiling excess supply.
• Use what you have, re-stock what you need and report what you use.
• Continue to increase uptake of primary series and ensure adequate capacity for flu vaccine administration.

CDC

Masks: The CDC currently recommends that those who are not fully vaccinated continue wearing masks in public settings and in large gatherings where other social distancing measures are difficult to maintain. For those who are fully vaccinated, it's recommended to wear a mask in public if you are in an area of substantial or high transmission to maximize protection and prevent the virus from being spread.

The CDC has released interim guidance for health care professionals in the U.S. to combat the spread of this illness, including but not limited to guidance on:

• Testing for SARS-CoV-2.
• Infection prevention and control.
• Optimizing the supply of PPE.
• Clinical care.
• Pediatric clinical care.
• Risk assessment and work restrictions for clinicians with potential exposure.
• Direct service providers.

Review the Full CDC Guidance

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The Executive Administration

President Biden and Vice President Harris have released a seven-point plan to beat COVID-19. In addition, President Biden issued an Executive Order on January 21 to establish a COVID-19 Pandemic Testing Board and to ensure a sustainable public health workforce for COVID-19 and future health care emergencies.

Review the COVID-19 Plan

Pediatric COVID-19 Vaccination Operational Planning Guide

In anticipation of future approvals and authorizations on pediatric COVID-19 vaccines, the CDC COVID-19 Vaccine Task Force has released a Pediatric COVID-19 Vaccination Operational Planning Guide. This planning guide will help NPs prepare their practices for the implementation of new vaccine procedures for children younger than 12 years old by focusing on key differences between the pediatric program and the one designed to vaccinate adolescents and adults.

Read the Planning Guide

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CDC

The CDC has released a 48-page resource guide entitled COVID-19 Vaccination Field Guide: 12 Strategies for Your Community. The field guide will help NPs quickly implement intervention strategies to promote COVID-19 vaccine confidence and uptake, based on research-proven methods.

Read the Field Guide

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National Academy of Medicine (NAM)

NAM and the American Public Health Association have launched a nonaccredited webinar series to explore the current science about COVID-19. Webinar topics include crisis standards of care during COVID-19, the science behind social distancing and the impact of COVID-19 on long-term health.

View the Webinar Series

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National Quality Forum

To address health disparities, particularly brought to light during the COVID-19 pandemic, the National Quality Forum has released The Care We Need, a roadmap to normalize high-quality health care for every person by 2030. The report focuses on opportunities to improve the health outcomes of people and communities, along with recommendations that emphasize the importance of a seamless system of comprehensive, accessible care designed to keep people healthy and well.

Learn More About The Care We Need

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Patient-Centered Outcomes Research Institute (PCORI)

PCORI has produced a six-part, nonaccredited webinar series on COVID-19, available at no cost. Topics in the series include how incident command structures can be utilized to coordinate a response to COVID-19, nurse staffing practices and issues and the changing role of telehealth.

View the Webinar Series

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Project ECHO®

In partnership with the U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response (ASPR) and in collaboration with the National Ebola and Special Pathogens Training and Education Centers (NETEC), Project ECHO has launched a series of COVID-19 Clinical Rounds. These panel discussions are designed to facilitate learning and dialog concerning COVID-19 treatment, and a number of special sessions highlight topics such as pediatrics, personal protective equipment (PPE), long-term care facilities and more.

View the Clinical Rounds

WHO

Human-to-human transmission has been confirmed in China and other countries around the world, including within the U.S. WHO has released daily situation reports monitoring the spread, treatment recommendations and response to the outbreak. It also maintains an updated situation dashboard on COVID-19 cases globally and reports that there have been 768,983,095 confirmed cases and 6,953,743 confirmed deaths worldwide.

View the WHO COVID-19 Situation Dashboard

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CDC

The CDC reports that there have been 104,618,931 total cases and 1,127,928 deaths in the U.S.

View the CDC Weekly Surveillance Report

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U.S. Census Bureau

The United States Census Bureau has created a dashboard to show states' COVID-19 impact planning reports, nationwide demographic and economic analysis and additional data on how the pandemic is impacting communities and Americans across the U.S.

View the Census Bureau Dashboard

AANP is closely tracking policy developments in response to the COVID-19 pandemic.

AANP is committed to keeping you up to date, including by providing details on federal- and state-issued waivers and flexibilities for NPs and increased access to telehealth. Information included is related to Centers for Medicare and Medicaid Services (CMS) waivers, emergency state actions and licensure information and other policy guidance.

Review COVID-19 Policy and Practice Updates

AANP conducted three surveys dedicated to understanding the impact of COVID-19 on NPs:

• 2021 Membership Survey: COVID-19 Vaccination Summary: AANP fielded its most recent member survey between March 19 and April 16, 2021, to capture general information about member satisfaction with benefits and services as well as current hot topics, including questions related to COVID-19 vaccinations and their patients' experiences. More than 1,200 NPs responded to questions related to COVID-19 vaccines.

Executive Summary — March 2021 Membership Survey COVID-19 Vaccination Results

• August 2020 Survey: AANP fielded its most recent survey between July 28 and August 9 to capture the latest information on COVID-19’s impact on NPs and NP practice. Approximately 4,000 NPs provided essential feedback to the association based on experiences in their own communities treating patients in evolving health care environments.

Executive Summary — August 2020 COVID-19 Survey

• May 2020 COVID-19 Survey: More than 4,800 NPs responded to the first COVID-19 Impact Survey between May 8 and May 18, 2020. The purpose of this survey was to gather information on how COVID-19 impacted NPs and NP practice, including testing needs, employment changes, treatment barriers and more. This information is essential as AANP works to address the challenges faced by NPs in the current environment, including advocating for the removal of practice barriers.

Executive Summary — May 2020 COVID-19 Survey

AANP is compiling educational and clinical information regarding the COVID-19 pandemic, including a look at symptoms, testing, infection control, protection for health care providers and current, approved treatment options and investigational treatments. When available, information on funding and research is also shared.

Three patient education infographics, designed to provide information on common symptoms and tips on protecting oneself and others from COVID-19, are now available for download.

Find COVID-19 Education and Clinical Information