The Middletown Press (Middletown, CT)
‘A long, cold and dark winter’
Yale top doc: 2nd-wave peak here by 2021
The number of COVID-19 patients in Yale New Haven Health’s five hospitals has more than doubled in two weeks, though the percentage of the sickest patients is a third of what it was in March, officials said Wednesday.
The surge of hospitalized patients at Yale came as the state continues to see a steady increase in COVID-19 infections and hospitalizations.
On Wednesday, 36 more patients were hospitalized with the illness, bringing the total in Connecticut to 584. There were 1,754 new COVID cases reported out of 36,814 tests. The daily positivity rate fell to 4.76 percent, down from nearly 7 percent on Tuesday. However, there were over 14,000 more tests reported on Wednesday than the previous day.
Connecticut’s seven-day average positivity rate reached 4.21 percent on Wednesday. The state’s daily average number of cases has surpassed 30 per 100,000 residents in the past 14 days.
Nine more deaths attributed to the disease were reported in Connecticut on Wednesday, bringing the statewide death toll to 4,716.
“As of (Wednesday) morning we have 210 hospitalized patients across our health system, which is more than twice the number we had … two weeks ago,” when there were 92, Yale New Haven CEO Marna Borgstrom said during an online press conference. On Sept. 17, there were just 18.
“So this is a very significant rise,” Borgstrom said. “Two weeks ago, we had 22 patients in our intensive care units across the system and eight of those were ventilated. Today, we have 33 patients in the ICU, 15 of whom are on vents. This uptick that we are experiencing is consistent with what others are seeing around the state and around the region, and actually, as concerning as it is, it is many fewer than what some other parts of the country have been experiencing.”
On Wednesday, there were 125 COVID-19 patients at Yale New Haven Hospital, up from 51 two weeks ago. There were 53 at Bridgeport Hospital, up from 16, 19 at Lawrence and Memorial Hospital in New London, up from 11, five at Greenwich Hospital, which has not seen an increase, and eight at Westerly Hospital in Rhode Island, an increase of two.
According to Yale New Haven spokesman Vincent Petrini, 18 of the 125 patients, 14 percent, at Yale New Haven Hospital are in the intensive care unit. Of the 210 patients in all five hospitals, 33 are in the ICU, or 16 percent.
Since the start of the pandemic, 4,400 COVID-positive patients have been discharged, but 618 have died. That is an increase of 16 in two weeks. “The death rate is not climbing proportionately with these [inpatient] numbers, so we’re grateful for that,” Borgstrom said.
Dr. Thomas Balcezak, chief clinical officer for Yale New Haven Health, said, “We are finding ourselves where we were right around the middle of March in terms of the total numbers of cases.”
But he said the peak of this second wave will come near the end of the year.
“We are heading into what is going to seem like a long, cold and dark winter. Some of our forecasting models are showing that if this trend doesn’t reverse itself, we will be seeing a peak sometime before the end of December or the first of the new year. That’s daunting considering that it’s only in the first part of November.”
But the good news, Balcezak said, is that while there are the same number of patients in the hospital as in March, the number of patients on ventilators is less than a third of what it was then, at 5 percent.
However, he said, people must continue to wear masks, socially distance and take other precautions, including not having large gatherings at Thanksgiving.
“Now is not the time to let down our guard. It’s time to redouble it,” he said.
Last week, Gov. Ned Lamont announced the state would be restricting gatherings to 10 people — including in private homes, though the governor admitted residents will be on the honor system inside their residences. He indicated that restriction will last through the holidays.
The governor is also recommending a 10 p.m. curfew for residents, and announced the state will enforce a 10 p.m. curfew on dine-in service at restaurants. Restaurants will be allowed to serve takeout after that point.
New York Gov. Andrew Cuomo announced similar measures Wednesday, instituting a 10 p.m. curfew on gyms as well as dine-in service at restaurants and bars that are licensed to serve alcohol, The Associated Press reported.
Massachusetts and Rhode Island imposed similar restrictions last week.
Balcezak said that while Pfizer’s report of 90 percent effectiveness for its vaccine hasn’t been peer-reviewed, “I believe the data.” He said the results were based on how many test participants who developed COVID-19 had received the vaccine and how many had received the placebo. The analysis was made when the number of COVID cases reached 96.
The next measuring point will be when there are 140 cases, when “they can turn those results in to the FDA and seek emergency use authorization. … I think we’re a couple of weeks away from the FDA issuing this EUA and then we can begin distribution,” Balcezak said.
The vaccine requires storage well below zero degrees, and Balcezak said, “We have the capacity for storing up to 50,000 doses right now in our freezers.”
Balcezak said while the number of inpatients is rising, the outcomes, whether discharge or death, are no different than they were in the spring. He said the spread among college students has not increased the number of inpatients in that age group but may be pushing up the cases among older people.
“I do think, however, that college spread has had some impact on the community spread, which has resulted in more of those older people being exposed and admitted to the hospital,” Balcezak said. He said “all kinds of social gatherings” are contributing to the overall rise in COVID cases, not just among college students.
But Balcezak said, “I wouldn’t single out schools. I think any gathering of individuals in any location — schools, parties, family gatherings — without appropriate distancing, masking, ventilation is a potential spreader event.”
He said it is “patently false” that children can’t contract COVID or spread it to others, whether other children or adults. “The risk to children is real, the ability to spread by children is real, and of course the biggest concern is that they could spread it to some more susceptible populations like the elderly.”
As for Thanksgiving, Balcezak said, “the safest thing to do is to do it on Zoom. Let everyone stay at home in their own pod and connect via one of those platforms that allow you to do it virtually. … Personally, we will not be having my parents, for example, for Thanksgiving because I just don’t feel that it’s safe.”
He said the next best thing would be if people have quarantined for 14 days and that “a test just before coming into the home is some degree of safety, but it’s not perfect, especially if that person is going to remain in the home for a day or two or three.”
That’s because, “just because the test is negative today, assuming it’s an accurate test, it doesn’t mean that it will also be negative the next day or the day after that if they had been exposed in the previous 14 days. … There is no perfect solution here, other than not gathering,” he said.
Balcezak said there is data nationally that because hospitals completely stopped elective procedures, patients now are coming to the hospital with more advanced illnesses, such as cancer and heart disease. “We don’t want to go back to where we were, where we really closed down virtually everything that was on an outpatient perspective.”
Instead, procedures are being categorized as emergencies, which never stopped, urgent and elective. “This gray area is where urgent procedures will be handled” as “our capacity is being stretched.”
Balcezak said Greenwich Hospital is the only one of the five that is not on Code D, which activates the hospitals’ emergency operations plans.
“When we declare a Code D as a hospital ... it is specifically to very much clarify and crisp our reporting structure so that we can have line-of-sight authority up to a single incident commander,” he said.
Michael Holmes is the incident commander for Yale New Haven Hospital, and “can make sure that there are the resources brought to bear to meet the needs, to care for our patients in support of the critical care within our communities.”
Balcezak said Yale New Haven was put on Code D because of the increase in COVID patients, combined with the increased number of other patients who had care delayed in the spring. “So we are both simultaneously trying to clear the queue of patients from delayed care from the spring and experiencing a surge in COVID.”
He and Borgstrom praised the health system’s staff, including medical, environmental service and food service workers, and gave special thanks to veterans on the staff, as Wednesday was Veterans Day.
“At the beginning of this, most people were kind of hunkered down,” Borgstrom said. “Everybody was scared to death of the virus. They stayed home; schools closed in Connecticut. … Our staff has been there throughout this time, when we were all terrified of the unknown, in February, March, April, May. They came and they cared for unprecedented numbers of ill patients with this virus, and they did a phenomenal job, putting themselves and their families, frankly, at a much higher risk than most people were.
“Now they’re going through it again,” Borgstrom continued. “We can’t say it enough but our staff have been awesome.”