Submitted by Stephanie Paulmeno, DNP, RN, NHA, CPH, CCM, CDP, Greenwich Dept of Health, Public Health Promotion Specialist
The COVID landscape in Greenwich, Fairfield County, and Connecticut consistently changes. It’s what viruses do. They mutate.
Since September 2021, when COVID’s Omicron variant became dominant in Connecticut, we’ve transitioned through Delta, Omicron BA.1, BA.1.1, BA.2, BA.3, BA.4, BA.5, to name but a few, and we now have BA.2.12.1 infecting about 1 in 5 new COVID victims. (New Omicron BA.2 Sub-Variant Gains Foothold In US: All You Need To Know)
Each mutation has been more transmissible (contagious) than Delta; each one infecting increasing numbers of people over the mutation preceding it.
Fortunately the new variants have not proven to be more lethal or vaccine resistant than the earlier ones, just more highly contagious (https://CDC.gov and, https://portal.ct.gov).
We are better prepared now to fight back; we have vaccines and medications that can minimize the effects and duration of this contagious disease. We also have more effective treatments to offer those who become infected than we had earlier in the pandemic. These can reduce the severity and length of time a patient suffers with their COVID symptoms, but they must be taken early in the course of the infection. If your illness reaches the point that you require oxygen, then your chance of avoiding hospitalization goes down. If you get exposed or become ill, get yourself tested, diagnosed and treated right away.
These new therapeutics include Remdesivir (FDA-approved), which was followed by an assortment of
individual and combinations of Monoclonal Antibody Infusions, all of which are given intravenously (IV) and all are prescribed under Emergency Use Authorizations (EUA). The IV infusions are a one-time treatment; you get infused and return home. There are now professionals who will bring the infusion to you in your home. More recently two oral antiviral medications became available. This was a big access-to-care improvement for COVID treatment because primary care providers (MDs, DOs, APRNs, and PAs) could now test, diagnose and begin treatment right away.
To locate one of Connecticut’s Test to Treat sites, visit https://portal.ct.gov/DPH/Press Room/Press-Releases—2022/Test-to-Treat. People can be treated at home with pills rather than needing to spend time in an IV infusion center or medical office. These pills included Mulnupiravir (Merck & Ridgeback Biotherapeutics) and Paxlovid (Pfizer). Both are given twice daily for five days. Hospitalizations dropped; they weren’t always needed! We learned that beginning aggressive medicinal treatment early in the illness reduced the risk of hospitalization and death by 30% (Merck) and 90% (Pfizer). We found that positioning a COVID patient on their stomach rather than their back helped ease their breathing.
Who is getting COVID in Greenwich now? Who’s getting hospitalized, and who is dying?
Fairfield County, which includes Greenwich, is risk-designated by the CDC as a “Medium/Yellow County” (color-coded system available on the CDC website). To understand how the CDC community coding color is assigned, visit https://www.cdc.gov/coronavirus/2019-ncov/science/community-levels.html#anchor_82254.
Fairfield County currently has 50.1 cases /100,000 people (Mayo Clinic, 5-14-22, New York Times COVID Tracker 5-16-22, Worldometer, 5-16-22, CT DPH), which previously would have put us in the Red Zone but a different compilation of calculations are now used to assess community risk levels. The CDC has suggested that people living in Medium/Yellow Counties wear a mask indoors in public settings, to stay up-to-date with vaccines and boosters, and get tested if they have symptoms. Residents with high-risk factors should be especially careful. The Greenwich Dept of Health urges you /your families to also get tested if you have been exposed or potentially exposed. Dept of Health staff continues to call each person whose positive test result is reported to us by the State so we can be sure you are progressing well and check to see if you need guidance or support.
Vaccines do not prevent you from getting COVID.They prevent you from becoming very ill and dying from COVID. We are having many breakthrough infections along with infections in the un- or under-vaccinated. Deaths are higher among our elderly, immunocompromised, and those with underlying health conditions.
Here in Greenwich many of our infected are students and employees in our schools:
The Greenwich Department of Health, the Connecticut Department of Public Health, and the CDC, who represent your local, state, and national public health experts, advise that the best prevention measure for avoiding a bad COVID outcome is to get vaccinated and boosted.
With COVID numbers rapidly rising in Connecticut, the public is urged to apply common sense by weighing your self-protection-measure-options against the numbers of COVID cases in your community, against your/your family’s personal health risks, your genetic/cultural risks, your vaccination statuses, and the health or health-risks of the people around you. You are being urged to properly wear a mask when in indoors settings when you are with others whose vaccination status you don’t know, and if you are with people who are elderly, ill, or have (or might have) compromised immune systems; and to maintain social distancing, and to wash your hands frequently. None of these are an arduous “ask.” Are we or are we not our brothers’ keepers? You do not know who around you may be compromised. An unwelcomed exposure can be fatal for some.
On Friday our Connecticut Positivity Rate, which has been steadily climbing again, was 13.71%. That
represents only lab-tested (not home tested) positive findings. The safety threshold is that it be at 5% or lower for two consecutive full weeks before reducing or eliminating community safety measures (CDC, WHO, Johns Hopkins, the Mayo Clinic), but the decision of what you choose to do to protect yourself or others has been put in your hands alone. As of 5-14-22 we had lost 10,914 Connecticut souls to COVID-19 (Worldometer, CT); 122 of them were from Greenwich (Community Connections from Fred, 5-12-22). Since March 2020, when the pandemic was declared, a total of 13,185 Greenwich family members, friends, and loved ones have been diagnosed with COVID (state). Last week, this was an increase of 254 more Greenwich people than the week before.
It doesn’t matter what someone says you CAN do; ask yourself if doing it makes sense to you. Does going to a designated location unvaccinated or without a mask make sense to you when you consider your/your family’s health risks, vaccination status, and our rapidly rising COVID community case numbers? The CDC explains that when a population is vaccinated, this helps to reduce the chance of new COVID mutations from developing. Here in Greenwich, however, we still have three age groups with room for improvement (less than 90% vaccinated) and therefore at higher risk for severe COPVID, Long-COVID and a bad outcome (CDC).
What about Long-COVID?
Many have expressed that since Omicron is less likely to make its victims as seriously ill as Delta and the earlier mutations did, they need not heed the public health-guidance to get vaccinated, masked when in indoor areas with others, &/or to maintain social distancing for themselves &/or their children. I would ask that those people consider the phenomenon called long COVID (also called long-haul COVID, post-COVID, post-acute sequelae of SARS CoV-2, and chronic COVID). While this is most often seen in people who suffered a severe case of COVID, it’s also being seen in those whose symptoms were mild, as well as in completely asymptomatic people who never even knew they had been infected. (https://www.cdc.gov/coronavirus/2019-ncov/longterm-effects/index.html). In this must read article the CDC notes that there is currently no single test to identify post-COVID conditions. It is being diagnosed in people who never tested positive for COVID-19, a viral infection that creates widespread inflammation. COVID-19 impacts multiple body systems, infects multiple organs, and thus creates a wide range of symptoms that can last from a month to potentially years. At this point we only have a two-and-a-half year history with COVID, so we don’t know how much longer these symptoms will persist.. Symptoms flare up and recede, making it a diagnostic nightmare. These symptoms can include fatigue that worsens after physical or mental exertion, temperature elevations, and shortness of breath, as well as coughing, chest pain and heart palpitations. Neurological symptoms being seen in long-COVID patients include “brain fog”, headaches, and trouble sleeping, as well as feeling dizzy or light-headed upon standing up, depression, “pins & needles” sensations, and an altered or lost sense of taste and smell. Other symptoms attributed to long-haul COVID include digestive symptoms, joint
pains, rashes, and altered menstrual cycles in women. This phenomenon is still being studied but at this time, those who appear to be at higher risk for developing long-COVID include those who were severely ill, people with underlying conditions prior to their COVID infection, the unvaccinated, people who developed multi-inflammatory syndrome, and those who are impacted by health inequities. If there is a bright side to Long-COVID, it is that Long COVID can now be considered a disability under the Americans With Disability Act (Guidance on “Long COVID” as a Disability Under the ADA, Section 504, and Section 1557)
Testing and Vaccine Sites: Important note:
Last week the U.S. Food and Drug Administration (FDA) put out an advisement recommending that the Pfizer or Moderna vaccines be used instead of Johnson and Johnson due to a rare blood-clotting/blood platelet effect. With other safer options available, namely the very safe mRNA vaccines, the FDA has recommended limiting the use of the Johnson and Johnson one-dose vaccine in favor of Moderna and Pfizer vaccines for vaccination and boosters.
• The Greenwich Dept of Health just ran a Moderna 1st and 2nd Booster clinic, which received reservations for about 75 people.
• Family Centers, Inc. runs weekday vaccine and testing clinics at 111 Wilbur Peck Court. Details can be accessed here.
• The Connecticut Department of Public Health (CT-DPH) has mobile vaccine clinics. You can access
information on these clinics here.
• The Yale New Haven Health System, which includes Greenwich Hospital, can be accessed through their website.