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The original item was published from 1/18/2022 8:22:45 AM to 1/24/2022 4:01:54 PM.

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City News

Posted on: January 18, 2022

[ARCHIVED] 1/13/22 Weekly COVID-19 Dashboard

1-13-22

I never expected to be reporting average daily cases per 100,000 population in the 300s. It's sobering to write you this update. There are somewhere in the range of 500-600 active confirmed cases of COVID-19 in our community right now - about 3.5% of our city. We know this number is significantly underreported. My best guess of the true number of active infections right now is approximately 4-5% of our community. 

I never want to lose track of what these numbers mean. General clinical disease outcomes are difficult to estimate because they vary so widely by age, health status, and vaccination status, but it's reasonable to make a few estimates. There are probably about 250 folks in Easthampton who are infected but entirely asymptomatic. There are probably about another 200 who are sick, who feel like they have something between a cold and the worst flu they've ever had, but they're fine to ride it out at home. There are probably about 100 who are really very sick, who are in touch with their health care providers, arranging for visits and monitoring and treatment, and unfortunately, probably around 10 folks in our community who need to be hospitalized. I want to stress that these are estimates based on usual clinical outcomes. The numbers don't add up to the active case count. I am not providing information on specific disease severity in Easthampton. I am attempting to humanize the extraordinary numbers that are being released on this week's dashboard.

I'm also trying to help us all navigate what this means. With case rates so high, I know there is a lot of discussion right now about if tracking cases even matters. Tracking cases still does matter, especially now, while we need to do everything in our power to flatten the surge. The most important thing to keep our eye on now is what's going on in our health care system and in our hospitals. It's not an exaggeration to say the system is cracking. Our health care providers are overwhelmed, and frankly, exhausted. Recent research indicates that many are continuing to work with incredibly sick patients while also suffering with post-traumatic stress from their experiences working with incredibly sick patients in the early days of the pandemic. If you know a health care provider, ask them if they're okay and thank them for their service.

Health care systems are incredibly understaffed - about 25% of hospitals in the US right now are reporting staffing shortages and many hospitals are reporting the use of crisis standards of care. I am very worried about hospitals in our area needing to resort to crisis standards of care. There's no single answer as to what exactly that means, but a July 2020 update from the National Academies of Science Engineering & Medicine outlines three basic hospital conditions: 1) conventional capacity, in which the provision of health care is "usual care," 2) contingency capacity, in which facility emergency operations plans are activated and surge capacity is used to provide "functionally equivalent" usual care, and 3) crisis capacity, in which spaces, staff, and supplies are not used to standards of usual care and instead there is a "significant adjustment" to standards of care such that the goal is to provide "sufficiency of care.... i.e., provide the best possible care.... given the circumstances and resources available."

Perhaps the most concise explanation of crisis standards of care from that report is that "when crisis conditions exist, the goal is to “gracefully degrade” services to the minimum degree needed to meet the demands, maintaining the maximum patient and provider safety." There is more information in an article from the Washington Post on 12/23/21 titled "As Omicron variant spreads, New England hospitals are under unprecedented strain", including information from Baystate Medical Center CEO Dr. Keroack on their preparations for crisis standards of care.

There has been discussion recently on if hospital numbers are "inflated." The answer is not straightforward. The debate centers on the change in Massachusetts reporting of cases hospitalized "for" COVID-19 vs. "with" COVID-19. On one hand - it matters a lot. If many of our hospitalizations are for folks "with" COVID-19, but who are admitted for some other reason, then we are focusing our efforts to reduce hospital capacity on the wrong things (i.e., reducing the case rate won't reduce the rate of that kind of hospitalizations). But, on the other hand, the hospitals are currently over capacity with patients who have a COVID-19 infection, regardless of what kind they're actually being hospitalized for. COVID-19 is incredibly infectious, and we can't risk having an outbreak in the hospital among our already short-staffed providers. Even just 20% of them feeling sick and not being able to work would crush us. And finally, this "for" vs. "with" debate blurs a line between someone who is being hospitalized for something like a blood clot... which may end up in the "with COVID" category, but in fact, their condition was exacerbated by a prior COVID-19 infection, and thus, is in fact a consequence of COVID-19. If you feel more confused after reading this paragraph than you did before - welcome to epidemiology. Start pulling the thread and more questions appear as a previous question gets answered.

Finally, those action steps I list every week during the surge and a note about vaccines below:

1) Wear a well fitting N95, KN95, or KF94 mask. Cotton masks and surgical masks do not provide enough protection. 
2) Understand that the data being reported is an underestimate. There is a large amount of virus circulating in our community.
3) Avoid group gatherings, particularly without face masks and among people with unknown vaccine status. 
4) Testing is limited: rely on symptoms. Symptoms = stay home. Assume that you might have COVID-19 until you're sure that you don't (based on the results of a PCR test).
5) Get vaccinated. Get boosted. 
*New data from California highlights the incredible effectiveness of the vaccine + booster dose. A booster dose is 94% effective in preventing hospitalization among those 65+ years 2-9 weeks after the booster dose, and 89% effective 10+ weeks after the booster dose.* This week's visual on the dashboard demonstrates this: the height of the bars indicates average daily cases per 100,000 population for each age group, and the bar itself is multicolored to demonstrate what percent of each age group is fully vaccinated + boosted, fully vaccinated with no booster, partially vaccinated, or not vaccinated. Today is a great day to get a first (or 2nd, or 3rd) dose.
This omicron surge will end. There is evidence from places that are a month or so ahead of the US in the surge that omicron is so transmissible that it burns through very quickly and may peak in just 4-5 weeks (from the start! not from now). In that case, places like New York City might be hitting their peak. I hope we will see that here in Easthampton, too. Please, do everything you can to help us get through this surge. 

Stay well,

Megan W. Harvey, PhD, MS

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