Yale New Haven Health Docs: Interpreting the Uptick in Covid-19 Cases

At a press conference this week, doctors from Yale New Haven Health System gave a snapshot of the Covid-19 uptick in Connecticut.

On Tuesday the System had 90 inpatients, more than 3-1/2 times the number at the end of September.

In the past two weeks the System had seen a 50% increase from 64 on Oct 13th to 92 cases on Monday.

A month ago there were only two Covid patients in the System’s ICUs. On Tuesday there were 22 – with eight on ventilators. That was after many days with no ventilated Covid-positive patients.

While the numbers represent an uptick, they are still well below the peak of 800 cases last spring.

“But it doesn’t feel very good,” said CEO Marna Borgstron. “People are tired. Tired of the pandemic. Tired of social distancing. Tired of wearing masks.”

As of Tuesday, the 90 Covid-19 cases across the System were as follows:

• 51 at Yale New Haven Hospital
• 16 at Bridgeport Hospital
• 11 at Lawrence and Memorial Hospital in New London
• 5 at Greenwich Hospital
• 6 at Westerly Hospital.

Yale New Haven Hospital Infectious Disease Dr. Onyema Ogbuagu on Zoom
Dr. Tom Balcezak, Chief Medical Officer at Yale New Haven Health System on Zoom.

Dr. Tom Balcezak, Chief Medical Officer for the System, and Yale New Haven Hospital Infectious Disease Specialist Dr. Onyema Ogbuagu, who is working on the Pfizer trial for a vaccination and is deeply involved in care for Covid-19 patients, talked about the recent uptick.

“We didn’t know that (mask wearing) worked in the first part of this pandemic,” Balcezak said. “There is now scientific certainty that mask wearing and social distancing does work.”

How Bad Will It Get?

Balcezak said it was impossible to forecast numbers or predict when a peak might come.

He said a wastewater sampling model showed the Greenwich area was seeing ‘some slow growth,’ and the ‘hot spot area’ to watch was eastern Connecticut.

As for Thanksgiving and Halloween, Balcezak said, “We all have families and desire to reconnect with out families and friends, but this is not the time to be doing that.”

Implications for Flu Season

Balcezak said with the arrival of fall, there was the potential for a flu pandemic in addition to Covid-19. He urged residents to get flu shots to avoid a ‘twindemic’ of flu and Covid-19.

Dr. Ogbuagu said there was concern about how the flu would mimic Covid-19.

Balcezak agreed, adding the challenge wold be to sort out flu patients from Covid patients, who need different therapies and cohorting.

Balcezak said the southern hemisphere foreshadows what might be in store for Connecticut.

“It appears the southern hemisphere had a very light flu season this year,” he said. “But we need to do everything we can to lock that in. That means getting your flu shot this year. We don’t need our emergency departments and doctors offices clogged with folks that have respiratory illness.”

Vaccine Trial at Yale New Haven Hospital with Pfizer

Dr. Ogbuagu said there are 300 people in the trial in New Haven. The target number is 44,000, which they are approaching, as the trial is multinational.

Enrollment is going well. Up to 70% of participants have already received the second of two vaccines. (The second vaccine comes three weeks after the first.)

“I think the earliest a vaccine would receive approval would be end of December or January 2021, at best,” Dr. Ogbuagu said.

“It’s been incredible to watch the speed with which our science has moved with this pandemic,” Balcezak said. “We’re already talking about novel therapeutics and hopefully will have a vaccine approved in the next couple of months.”

Balcezak added that when the first vaccine becomes available, it might not be the best vaccine, and won’t prevent the virus.

He explained when the Covid-19 virus enters the body through the respiratory system, the immunity will stop it replicating, but the vaccine will not prevent infection. It will prevent symptoms but vaccinated people could still be contagious.

“We may have to wait for a vaccine that prevents infection,” he said. “Even if you have got the vaccine, you will still be infectious. Therefore, mask wearing will still be the standard.”

Dr. Ogbuagu said the Pfizer trial has already gone through phases 1 and 2, and the phase 3 trials are advanced. The trials are randomized. Half the people receive the vaccine and the others receive a placebo.

Dr. Ogbuagu said the study has a diverse enrollment, and not only enrolls adults and elderly individuals, but also enrolls pediatric age participants from age 12 +, and immune-compromised patients including HIV patients. Over half the people enrolled in the trial identify as racial minorities.

Asked about the use of embryonic stem cells in some vaccine trials, Dr. Ogbuagu said that scenario was not unique to Covid vaccines.

“There were vaccines long before Covid, like Rubella, which is German measles, and shingles vaccines, which have utilized human embryonic cells to advance development,” he said.

Dr. Balcezak said it was important to note that these are tissues have been grown over many years.

“They are involved in early development,” he said. “But for large scale mass production of these vaccines, they’re going to use traditional manufacturing methodologies that don’t involve stem cells.”

Why are Covid-19 Illnesses Less Severe than in the Spring?

Dr. Balcezak said much had been learned about treating Covid-19 patients.

“We’re more liberal with the use of steroids than we were early on,” he said. “And we have figured out what medications do not work.”

“There’s been a lot of negative studies – whether it be Hydroxychloroquine, or Azithromycin – we’ve stopped the utilization of those drugs,” Balcezak said.

“We continue to use Rendesivir, which seems to have a small benefit, at least in terms of length of hospitalization.”

He said they’d also learned more about non therapeutic therapies.

“It’s putting patients on their bellies, or proning them. It’s how you manage the ventilator and how you use oxygen and high flow oxygen,” he said.
“We’ve seen mortality rates fall substantially.”

Balcezak cautioned, ‘Doing better was far from perfect,” and while the System is seeing a small number of deaths compared to the spring, they’d like to see the number fall to zero.