Yale doctor: Expect jump in hospitalizations
Dr. Albert Ko weighs in on the state’s 400,000 coronavirus cases
Last winter, 100,000 documented COVID-19 cases ago in Connecticut, most of us couldn’t have named a single epidemiologist. We’ve learned a lot since then — and so have they, about a disease they’re still struggling to predict.
This much they know: For the next few weeks at least, we will face a grimmer picture.
“We’re going to have a lot more hospitalizations in the next two, three, four weeks and especially if there’s not going to be any changes in terms of interventions that address the social contact rate,” said Dr. Albert Ko at the Yale School of Public Health.
He added, “I wouldn’t be surprised if it doubles.”
He couldn’t predict the upcoming death rates — too many moving parts — other than to say they’re going up, and not just for elderly people.
I spoke with Ko, who’s also a Yale School of Medicine professor and was co-chairman of Gov. Ned Lamont’s Reopen Connecticut committee, about the state’s morose milestone of 100,000 cases. That number, for starters, is way less than the population of state residents who have had the illness caused by the novel coronavirus.
What’s the best guess? 400,000, Ko said. Then, as he has since we all met him in the spring, he im
“It’s pretty clear from the observational studies, those countries that have universal face masks and have done it early, have lower mortality rates as well as lower case rates.” Dr. Albert Ko, Yale professor of epidemiology and infectious diseases
mediately pivoted from focusing on numbers for their own sake — we journalists like to do that — to what it tells us.
That 400,000 figure would mean about 13 percent of the Connecticut population has had COVID-19 since the first case in early March, or maybe a little before that. We’ve seen estimates as high as 25 percent in New York.
“That’s a long way from 60 percent to 70 percent to get herd immunity,” Ko said. “The number is not important, the absolute number, it’s exactly 400,000, or 500,000. I think the key issue is, the people that we’ve identified, that’s a minority of everybody that’s been infected.”
Bad news, good news
Half of all people with COVID, more or less, have no symptoms at all. And Ko said, “A lot of people are actually infected, they might be feeling something, but they may not realize it until you ask them.”
That’s how we’ve had 400,000 cases. Unfortunately it doesn’t mean we can start seeing infection rates decline just because more people have had it than we’ve tracked. Herd immunity doesn’t work that way, Ko explained, because infections can spread exponentially, meaning, 2, 4, 8, 16, 32, 64 and so on, rather than one or two at a time.
So there’s a spate of bad news before we get to the end of this. The vaccines are coming as soon as next month, if they prove effective as appears likely, but they won’t be widely available until the middle of 2021 at best.
“It’s going to take a year to roll that out across the population. That’s why it’s really important, what we do now has to rely on public health prevention, you know, face masks, social distancing, reducing gathering sizes.”
The good news, Ko said, is that those public health measures can bend the curve. We’ve seen that in other countries that are — my view here — way more disciplined than the United Toddler States of America.
The mask mistake
Can we actually be more careful on the whole? One problem is that controversy over masks and other measures to prevent spread of COVID sprouted with early advice from epidemiologists including Ko and Dr. Anthony Fauci of the National Institutes of Health. As late as March 10, Ko was quoted in a Yale interview saying most people didn’t need to rush out to buy common face masks.
They knew the masks prevented spread when worn by sick people, but the degree of protection for the whole population wasn’t clear. “We didn’t have evidence,” he said.
“I believe I was an author maybe the week afterward, saying we should be using universal cloth masking,” he said — cloth, because surgical masks were still scarce and badly needed by health care workers.
Early research came from two Yale economists who put the evidence of mask effectiveness together.
“When I saw that, I said, ‘I’m wrong.’ You know, we need to get everybody universal face masks.”
In that short hesitation, the anti-mask crowd, one of whom lives at 1600 Pennsylvania Ave. for a few more weeks, took its cues. Oh, they say, there are no double-blind, controlled trial, randomized studies that show masks save lives.
Ko explains, calmly, why such studies would be almost impossible to pull off. “It’s pretty clear from the observational studies, those countries that have universal face masks and have done it early, have lower mortality rates as well as lower case rates. So it’s really the consistency of the data.”
‘We have to be humble about COVID’
We talk about science and evidence every day now. Ko’s view — and the reason you’ve heard of him — is that doesn’t mean we abandon wisdom in favor of copious data.
“You know, you never want perfection,” Ko said, referring to the need for absolute proof that masks work, or that certain populations are more vulnerable than others. “The last thing you want to do in an epidemic is use perfection as the enemy of the good.”
The 100,000 documented case level in Connecticut, and the 250,000 U.S. death figure, came more or less as predicted.
“When we gave the recommendations on the plan to reopen Connecticut, one of the major points that we made was that we are going to have a resurgence,” Ko said. “The question is, when would it happen and how bad would it be?”
Why, then, did they advance a reopening? Ko insists the gradual way it was done prevented the sorts of rapid resurgence we saw in the South and some western states. And he says, social interactions, which were happening anyway, have been the major cause of outbreaks.
How can Connecticut claim it has managed the disease well when it still has among the highest death rates in the nation, and new cases are cropping up here rapidly despite the general mask-wearing, distancing culture?
We know Connecticut has tested at a much higher rate than most states. We also know some states have hidden COVID deaths by citing other causes such as pneumonia, according to studies.
But much of the answer is that the nursing home calamity of the spring, when about half of all residents contracted COVID and almost 3,000 died — about one in seven — was a tragic result of the early weeks of coronavirus. Nursing homes and assisted living facilities account for 71 percent of all Connecticut coronavirus deaths, most of it coming before the May 20 reopening.
There were too few staff members to go around, forcing many to work in multiple places, spreading the disease. And too little testing and protective gear. And medicine didn’t know how to keep people alive as well it does now.
“The one thing, we have to be humble about COVID,” Ko said. “We’re learning something different every week, there’s new evidence coming out.”
Young adult deaths
The best guess is the peak will come this winter.
“I wish, as all of us do, that we didn’t have these numbers. But that really is a testament to how difficult it is to control this disease which is highly transmissible, and its ability to cause super-spreading events,” Ko said. “I think beneath that, what we’re really worried about is how that translates into hospitalizations and deaths.”
His prediction of a doubling of people being treated in Connecticut hospitals with COVID-19 would bring the number to 1,700, less than 300 below the April peak, when so many people were dying, most from nursing homes.
The sharp rise in cases now, and the steeper curve of hospitalizations, means deaths may speed up — including, Ko said, among young adults.
“The bottom line is that overall fatality from this disease is high. And it’s also high in our younger adult population,” he said. “We’re going to see deaths in those populations.”
Florida releases data on hospitalizations by age group, which I haven’t seen here. What we have seen is that among people age 20 to 29 in Connecticut, confirmed or suspected illnesses have grown from 8,465 on Oct. 1 to 18,413 on Monday. That group has had four deaths.
Ko looks at the infection fatality rate — deaths as a percentage of total infections, known and unknown — and sees that even though it’s well below 1 percent, deaths are coming in some younger age groups.
Then there are the socalled long-haulers, people who develop chronic illness as a result of COVID-19. We don’t know much about that, either, he said.
“We know it happens and we know that it’s real and we know that it can be debilitating. But how many, what’s the risk of somebody getting it, and more importantly, why do some people get it and others don’t, that’s a really important question.”
What keeps Dr. Ko up at night, in his words? “We set up a great system to identify the increase in cases. We’ve seen that increase in cases happen since September, and even August. If we don’t jump on this right now, we will have a very bad December and January.”