This is a long one. The brief overview is that rates dropped ever so slightly in Easthampton this week, but that drop is almost certainly a reflection of data reporting issues related to the holidays. Cases remain extremely high. We did move to the yellow category of risk because our percent positivity dropped before 5% again, likely indicating that our community is trying hard to proactively test in response to the surge.
The next 4-8 weeks will be the most challenging weeks of the pandemic so far, in many ways. We all need to be thinking today about how to get through these weeks. Restrictions and pre-emptive closings are unlikely. However, we must be prepared for closings related to staffing shortages. We need plans for:
- how to reduce our risk as much as possible to flatten the surge- what to do if your work or school closes due to staffing shortages- where to get tested - what to if you are exposed- what to do if you are infected.
The hospitals in Western MA (and all of MA) are overwhelmed already. Baystate Medical Center reported their highest number of COVID-19 patients since the beginning of the pandemic. They are 20% overcapacity. We are not even close to the peak of hospitalizations in this surge. As quoted in a recent MassLive article, Dr. Andrew W. Artenstein, chief physician executive and chief academic officer at Baystate Health, has said the state is the “midst of a resurgence of the coronavirus pandemic the likes of which we haven’t seen.” MA has been reducing elective surgeries since the end of November. No matter what metric you use to look at our health care system, we are overwhelmed, understaffed, stretched too thin, and in dangerous risk of the situation becoming far worse and needing to move to rationing of care. Your chance of having a severe outcome will be lower if you can avoid getting infected during the surge, because you will have more access to testing, care, and treatment. If you take nothing else from the update this week, please do all you can to flatten the surge for our heroic health care workers.
What do we know about the omicron variant? We already know it's far more contagious than the delta variant. We also know that our vaccines are less effective against infection with the omicron variant than against the delta variant. A booster dose provides a significant amount of additional protection against infection. To be clear, we're talking about infection: the vaccine is less effective against infection, but still very effective against severe outcomes of hospitalizations and death. We also know that reinfection is much more likely with the omicron variant compared to the delta variant. Those with "natural immunity" who have been previously infected are 5x more likely to be reinfected with the omicron variant compared to their risk of reinfection with the delta variant. The last major piece of data we're waiting on is if the omicron variant is less severe than the delta variant. Data from other countries including Denmark, South Africa, England, and Scotland indicate that those infected with the omicron variant have somewhere between 15% and 80% lower risk of hospitalization. This is good news! Particularly if the true value is closer to an 80% lower risk.
However, and this is a big however, this does not mean that our hospital system will not become overwhelmed. The sheer infectiousness of the omicron variant means the dramatic increase in cases, even with a smaller proportion going to the hospital, will still result in a massive increase in hospitalizations. More than we can handle, if we don't flatten the surge. This is evidenced in the visual in the dashboard this week. The purple arrows indicate the rate of growth in cases and patients in the ICU during the surge last winter, and the green arrows indicate the rate of growth in cases and patients in the ICU in the current surge. As you can see, the purple arrows are generally on the same slope - there was a pretty clear connection between cases going up and hospitalizations going up. The green arrows indicate that now cases are sharply increasing, and we're seeing slower growth in hospitalizations. This may be partially due to decreased severity of the omicron variant but is also partially due to increased immunity ("natural" or vaccine).
What do we do to flatten the surge?
- Wear a well fitting N95, KN95, or KF94 mask. Cotton masks and surgical masks do not provide enough protection.
- Understand that the data being reported is almost certainly an underestimate. Anticipate a large amount of circulating virus in your community.
- Avoid group gatherings, particularly without face masks and among people with unknown vaccine status.
Finally, a few words on the updated recommendations from the CDC. The CDC has updated COVID-19 quarantine and isolation guidelines, and notably, has shortened the isolation requirement from 10 days to 5 days. Details of this change are available in a post from the Easthampton Health Department. I have personal opinions about this, as do many epidemiologists, but I do want to offer some perspective. It's certainly an imperfect response - it would be better to be 100% sure that people are no longer infectious before they rejoin society. However, in the context of the surge we're really just entering, getting noninfectious or minimally infectious people back to work after just 5 days means that our society can continue to function. The reality is that the options are to have minimally infectious workers back in high quality masks or to have no workers and have suboptimal care or shutdowns. I wish we could rely on testing more to identify who needs to isolate longer and who does not, but we're just not there yet in this country.
Any sign-off feels trite in the midst of what we're facing today. I'll stick to my sign-off from last time, to make decisions one decision at a time, thinking about our loved ones, our community, and our health care providers. One decision at a time. Every single decision counts.