Yale New Haven Health System: More Doses than Arms. Vaccination Hesitancy is Slowing Demand.

At a Yale New Haven Health System press conference CEO Marna Borgstrom said as of Monday there were 142 Covid in-patients across the system – 50 fewer than two weeks earlier.

“That’s a very good sign,” she said.

Both Borgstrom and Chief Medical Officer Dr. Tom Balcezak said the profile of people they’re seeing hospitalized is changing, a reflection that the vaccine is working.

Balcezak said Covid survival rates are higher among those who are vaccinated.

“What’s changed is with the vaccination of elderly first, we’ve seen fewer elderly people admitted and fewer elderly dying.”

Now, he said the same pattern is taking shape for people age 50 and above.

As for “break through cases,” Balcezak said he was not aware of any deaths. “We have about a dozen break through vaccine admissions (across the system).”

Since the pandemic started, the health system has discharged over 11,500 Covid patients, and they are trying to move to a “new normal” that includes telehealth and telemedicine to keep patients comfortable seeking care, especially for those who delayed getting care during the pandemic.

“We’re asking the state legislature to adopt HB 6472 and SB1022 to provide ongoing reimbursement for telehealth services by both commercial payers and Medicaid alike,” Borgstrom said, adding that the system remains incredibly busy.

“In-patients are a lot sicker, as measured by the case index, than what we saw earlier,” Borgstrom said, adding there was a huge backup in behavioral health services.

“Our hospitals are full and our ERs are quite active,” Balcezak said. “Not that there are more patients, but they are accessing services often times later in the courses of their disease. They are sicker, have longer lengths of stay, and are requiring acute services for longer periods of time.”

Vaccination Hesitancy, Slowing Demand, Break Through Cases

Balcezak said across the system, just shy of 80% of all employees were fully vaccinated.

In Connecticut about 54% have gotten at least one dose, and 38% were fully vaccinated.

At the peak of the system’s vaccination program, they were vaccinating just shy of 50,000 people per week despite a constraint in supply of doses.

Today, because of vaccine hesitancy, there are more doses than there are arms.

“Last week we only administered 25,000 doses,” he said, adding that the system was no longer constrained by vaccine supply, but rather challenged by vaccine hesitancy in communities, and that there are unfilled appointments and walk-in appointments available. Balcezak said there was the most slack on the days they administer J&J vaccine.

“Today at Brunswick we have about 960 appointments available. They’re delivering Johnson & Johnson, but as of 8:00am there were only 25 individuals scheduled.”

Dr. Tom Balcezak, Chief Medical Officer Yale New Haven Health System

Balcezak also said he anticipated emergency use approval by the FDA to allow the Pfizer vaccine to be given to individuals as young as 12, and hoped for that would happen in the next few days.

Vulnerable Populations

Balcezak said the health system had worked to penetrate 50 of the most vulnerable zip codes in the state and were now delivering more than 25% of their vaccine doses into those vulnerable neighborhoods which represent about 25% of the state of CT population.

“That’s definition of equity there,” he said. “We’re really proud of that.”

He said they are working to create more “pop up sites” at places like churches and houses of worship. Vaccination teams are dispensed to groups with a minimum of 100 people, and the vaccinations are done in about 8 hours.

“We’re blessed to have such an effective vaccine so early on in this pandemic. It’s up to all of us to encourage each other to get the vaccine, if not for yourself, then for the other people you will protect – your elderly neighbors, your family, your loved ones.”

Dr. Tom Balcezak, Chief Medical Officer, Yale New Haven Health System

“As you thin out the population that the virus can impact, then the virus’s ability to spread becomes less efficacious. Think about it like a forest fire.”

Balcezak said vaccinations could create the equivalent to a “fire break.”

“We can get some benefit by merely thinning out the fuel,” he added. “We are all the standing timber. The fire is the virus. If we can thin out the number of individuals the virus can effectively spread to, we will decrease the amount of spread.”

Herd Immunity?

Asked about public health ramifications for CT and the US if herd immunity is not achieved, Borgstrom said she was optimistic that more people will be vaccinated over time.

“If we don’t reach that 80% number, which most experts say is the threshold, that means we’ll be living with this disease for some time to come,” Balcezak said. “Just like Influenza, Tuberculosis and Polio. In history we’ve only eliminated one infections disease: that was smallpox.”

Long Haulers: “Covid Long Haul Syndrome”

Balcezak said there was a study featuring anecdotal evidence that people with long haul symptoms including shortness of breath, cardiac challenges, and “brain fog” have improved after getting vaccinated.

“I think a formal study on that is important. We have our own Covid long haul clinic with a cohort of these patients. There’s a lot of demand for it.”

Balcezak said he agreed with Dr. Anthony Fauci that the US would see a turnaround in the next few weeks. He gave as an example the decrease in numbers across the Yale New Haven Health System, noting fewer cases and deaths among those age 75+, attributing that to more people being vaccinated.

Still, he said, “This disease is with us for a very long time. I think we’ll see those who are not vaccinated get sick on occasion. They’re at higher risk of getting sick and higher risk of dying.”

He said he anticipated hospitals will have to maintain designated areas for Covid patients, featuring negative pressure rooms.

Asked who is being hospitalized, Balcezak said they were younger unvaccinated people.

“Our  inpatient Covid volume is almost entirely unvaccinated individuals. Of all those admitted over last 3 months, only about a dozen were fully vaccinated,” he said.

CT Reopening on May 19

Asked about the state reopening on May 19, Balcezak said it was a tough decision he was glad he didn’t have to make.

“The impact on so many people’s lives because of the shutdown is real. In a couple weeks the weather will better and there will more opportunity for windows to be left open and some meetings and events to take place outdoors. Balancing safety against the need for us to get back to whatever version of a normal life we can must be made.”

“There’s more that you can do safely if you’ve been vaccinated. That’s the incentive,” Borgstrom said. “That may be much more powerful than a free drink at a bar. I think most people don’t want to continue to live this way. If the guidance is enforced and all of us are required to enforce it by the question, ‘Have you been vaccinated?’ Hopefully it will inspire more people to get vaccinated.”

Asked how long he anticipated the system would keep the mass vaccination sites open, Balcezak said rather than close sites, they would consolidate days.

“Given the geographic spread from Greenwich to Mohegan Sun, we need to have those facilities to have access to local populations. We’ll make the calendar clear. For right now I think we’ll keep the majority of those sites open and keep a footprint in each of the communities where we operate.”