Yale New Haven Health Doc: Peak in Covid Will Not Come for at Least Another 3 Weeks.

Covid-19 hospitalizations have doubled across the Yale New Haven Health System in Connecticut compared to two weeks ago.

“This is a very significant rise,” said Marna Borgstrom, COO of the System during a press briefing on Wednesday.

Borgstrom said the System had 210 Covid-19 patients hospitalized in the System as of Wednesday.

For context, back on April 21, there were 800 patients across the System on a single day.

At the end of September, there were just 26 patients across the System.

Two weeks ago there were 22 patients in ICUs across the System, and 8 of them were on ventilators.

On Wednesday, there were 33 patients in ICUs across the System, and 15 of them are on ventilators.

This uptick is consistent with what others are seeing in Connecticut and in the region, though Connecticut’s numbers are lower than other parts of the country.

The 210 in patients across the Yale New Haven Health System, breaks down as follows:
125 at Yale New Haven Hospital, (up from 51 two weeks ago)
53 at Bridgeport Hospital (up from 16 two weeks ago)
19 at Lawrence+Memorial in New London (up from 11 two weeks ago)
5 at Greenwich Hospital, which is about the same as two weeks ago.
8 at Westerly Hospital (up about 2 from two weeks ago)

To date the System has discharged about 4,400 Covid-positive patients back to their homes and communities.

There have been 618 deaths.

“The death rate is not climbing with these numbers proportionately, so we’re grateful for that,” Borgstrom said.

“Unfortunately the uptick in the number of cases and community spread is real,” said Chief Medical Officer Dr. Tom Balcezak. “We are finding ourselves where we were right around the middle of March in terms of the total number of cases.”

“There is diminishing and depleting support at a federal level in terms of stimulus coming out of Washington,” he added. “There is not as much local support for what our heroes have been through and are accomplishing.”

“We are heading into what is going to seem like a long, dark and cold winter. Some of our forecasting models are showing that if this trend doesn’t reverse itself, we’ll see a peak around the end of December or the first of the new year.”

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

Balcezak said that while the numbers were similar to those back in mid-March, much had been learned.

The percentage of ICU patients on ventilators is lower.

Treatment protocols have been improved.

The science, nationally and internationally, has gotten better.

Treatments, both pharmacologic and non-pharmacologic, work.

More patients are getting steroids.

There is better treatment of complications from the disease.

Of Pfizer’s announcement this week saying their vaccine is about 90% effective in preventing the virus that causes Covid19, Balcezak said the data is being overseen by the FDA.

“I think we’ll be seeing that vaccine in a few short weeks,” he said, adding that they are working with officials and the CT Hospital Association to plan effective distribution of the vaccine and the new Ely Lily monoclonal antibody.

Balcezak said staying home to prevent the spread of Covid is again as important as it was in the first part of March.

“Like our staff, I know the public is tired. Now is not the time to let down our guard. It’s time to double it.”

Balcezak said vaccine trial was 90% effective but the raw data was unavailable.

The vaccine trial’s initial review was for 94 patients. The vast majority of those who got Covid-19 were in the placebo group.

“It hasn’t been peer reviewed, which is the gold standard in science. We need to wait until they reach the next threshold, which is 140 patients that get infected,” he said, adding that from there it would be possible to seek FDA emergency use authorization.

“I think we’re a couple weeks away from the FDA issuing this emergency use authorization,” he said.

The vaccine doses require extremely cold storage – minus 70° Centigrade, which is roughly 100° Farenheit below zero.

Balcezak said the Yale New Haven Health System has freezers with capacity to store up to 50,000 doses, though they are pursuing acquisition of more freezers.

They also have experience through their vaccine trial of storing and thawing the vaccine.

Pfizer has a supply chain where they are able to put the vaccine doses in a super cooler with dry ice and ship it.

The US Army logistics supply chain experts are helping.

The surge in Covid-19 cases was stretching capacity in the System’s six hospitals.

“We are the point now, that because of delayed care back in the spring, and our desire to catch back up, that our capacity is being stretched,” Balcezak said. “It’s stretching our staff. It’s stretching our facilities.”

“There’s been national data that because of the suspension of elective screenings and elective testings and in person visits offices, we’ve seen an uptick of patients in later stages of disease – whether it be cancer or heart disease. We don’t want to go back to where we were, closing everything on an outpatient basis.”

Balcezak said Yale New Haven Hospital and Bridgeport Hospital have both activated a Code D, which is a disaster alert code, because of rising Covid incidents in the community.

Code D activates a reporting structure up to a single incident commander at each hospital. The idea is to assure there will be resources to accommodate the increased number of in patients.

“And we probably will not see our peak, based on our forecasts, for at least the next three weeks,” he said.

Balcezak said the System had not seen an uptick in college aged students being hospitalized.

However, he said, “college spread has had some impact in the community spread, and that has resulted in older people being exposed and entering the hospitalized population. All kinds of social gatherings are contributing to that spread.”

“Any gathering of individuals – at schools, parties, family gatherings – without appropriate distancing, and masking is a potential spreader event,” he said, adding there were weddings and even scientific conferences that were spreader events.

Balcezak said that while there had been a relatively low number of children admitted to the System’s institutions it didn’t mean children cannot get Covid-19. Further he said, children are at risk of spreading it between themselves and to older adults.

“The risk to children is real. The ability to spread by children is real, and the biggest concern is they will spread it to more susceptible populations like the elderly.”

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

With the Thanksgiving holiday just a couple aweks away, Balcezak was asked how to judge whether it is safe for a family member to come to the house for the holiday.

“Do it on Zoom,” he replied. “Let everyone stay home in their own pod and connect virtually. I don’t look forward to that. It’s not ideal. Personally we will not be having my parents for Thanksgiving because I just don’t feel that’s safe.”

He said an alternative, slightly less safe step, would be to have a guest quarantine for 14 days.

“(Taking) a test before coming to the home provides some degree of safety, but it’s not perfect. Just because the test is negative today, doesn’t mean it’ll be negative the next day, or day after that if they had been exposed the previous 14 days. That’s where the origin of the 14 day quarantine comes from. There is no perfect solution other than not gathering.”

See also:

All Eyes on Pfizer’s Covid-19 Vaccine Developed in CT

Nov 10, 2020