It’s a pleasure to start 2021 on an optimistic note. In addition to the excellent progress being made on our vaccination program and in contrast to the surges being seen around the country, our community has not seen a significant rise in the numbers of post-holiday COVID infections.
This morning the systemwide COVID census was 314 inpatients (151 in New Haven). Several indicators point to potential for these numbers to rise: we’ve seen slight increases in both test positivity rate (which is still in the area of 10%) and wastewater concentration, plus today brought news of local occurrence of the new UK variant of COVID. But, so far, we’ve maintained our stability and that itself is worthy of note.
Here’s a round-up of what’s going on in our Yale Medicine world as of today, Thursday, January 7, 2021:
Vaccination Update: HCW in Process, Plans to Scale Up for Public Vaccinations
Reviewing the first phase of the vaccine rollout, Dr. Brita Roy, co-chair of the Vaccine Task Force, reported that operations have moved smoothly since the mid-December launch. Now that invitations have been sent to all patient-facing health care providers at YNHHS, system workers who don’t directly interface with patients will be next up, to be followed by external health care workers. Public vaccinations will then begin, according to the phased plan laid out by the State of Connecticut.
Here’s a look at the numbers:
Having administered 76% of allocated vaccines, the YNHHS COVID-19 Vaccine Program compares favorably to the 30% reported nationally by the CDC. Of a total allocation of 23,550, 17,839 doses had been administered by Wednesday, January 6, 2021. Of the 33,807 invitations sent by the System, about 53% have scheduled or already received the first dose and some (those who received the Pfizer vaccine in the first week) are now receiving second doses.
Acceptance rate varies by population. The highest acceptance rate is among residents (90%), followed by physicians (70%). Environmental and food service workers exhibit the highest rates of hesitancy, with 20-25% responding to invitations so far. Dr. Roy noted that a communications campaign aimed at dispelling myths and improving uptake among this group is planned for the coming weeks.
Many first-dose time slots are available next week, Dr. Roy said, because of the one-week difference between first and second doses for the Pfizer and Moderna vaccines. “This is a good opportunity for people who haven’t yet responded to an invitation to do so and get their first dose quickly,” she noted. There will be less availability in future weeks and months.
YNHHS Chief Clinical Officer Tom Balcezak shared early-stage plans for expansion of the program throughout the state. In terms of operational planning, he said the endeavor will involve detailed planning akin to what it takes to launch a new business, including specifics such as scheduling, staffing, and site management. Accomplishing this “herculean task” will require internal collaboration within YNHHS, YM, YH, and YU and among the state’s four health systems (Trinity, Nuvance and Hartford, in addition to YNHHS), in coordination with the Connecticut Hospital Association. At this juncture, the most pressing challenge is the unpredictability of supply made available to and by the state. “We’re seeing a throttling down of the allocation and we’re not sure why,” he said. “It’s hard to plan a large-scale effort when you have only four days’ notice on supply.”
In Appreciation: Shout-Out to Volunteers Who Staffed Holiday Vax Clinics
The YNHHS health care worker vaccination clinics operated throughout the holidays, including on Christmas and New Year’s Days, thanks to physicians who enthusiastically responded to the request to help vaccinate peers. Shifts were four hours each, seven days a week, 7 a.m. – 7 p.m.
Many not involved in front-line COVID care saw the opportunity as a way to pitch in at a time of crisis or a way to acknowledge their gratitude for personally receiving the vaccine. “I felt very privileged to receive the vaccine as early as I did and wanted to volunteer in any way I could to help get the vaccine to others,” said Dr. Audrey Merriam from the Department of Obstetrics and Gynecology. “The sooner we vaccinate our high-risk frontline workers the sooner we can work on getting the rest of the population vaccinated.”
Dr. Josh Copel, who helped galvanize support for the effort, noted the “impressive” response to the request for volunteers, particularly given that he heard “complaints” from several YM physicians who hadn’t been given shifts to work. “What a statement about our doctors, that they are upset that they haven’t been tapped for work over the holidays,” said Dr. Copel, noting that more opportunities will be available. “The job is not over and will grow, especially in the next couple of weeks as we get return visits for second doses on top of new visits.”
Dr. Lee Rubin, of the Department of Orthopaedics & Rehabilitation, said he was grateful to participate. “I felt very strongly that I had to step up to deliver COVID vaccinations to our colleagues and fellow YNHH health care workers. The opportunity to take an active role in delivering these first dose injections effectively marked the beginning of the end of this pandemic and allowed me to administer 75 injections in two volunteer shifts. Learning how to deliver these injections is within the capability of every clinician and all such efforts will be needed to help lead both our hospital community and the public out of the dark days of this pandemic. Volunteering for this effort gave me incredible hope that we will be able to beat COVID, and I am honored to have actively played a small role in this incredible overall effort.”
As seen in the photo below, Dr. Rubin administered the COVID-19 vaccine to his colleague, orthopaedic surgeon Dr. Carrie Swigart.
COVID-19 Variants: What We Know So Far
For the past several weeks, media coverage has been focused on COVID mutations originating in the UK and South Africa. It was announced this afternoon that two cases (which genetic sequencing shows are not related to one another) involving the UK variant have been identified here in New Haven County, both in individuals who’ve recently traveled outside the state.
Dr. Murat Gunel said that, at present, the things to know about the variants are as follows:
- Though there is not yet formal data demonstrating so, epidemiologists suspect that the UK strain (VOC 202012/01, or B.1.1.7 lineage with N501Y mutation), similar to the previously identified strain with the D614G mutation, increases infectivity (click here to see the reference) but does not affect current treatments used for COVID;
- This variant has since been detected in numerous countries around the world, including not only the U.S. but also Canada. (see reference);
- Unlike the UK strain, it appears that the South African strain (B.1.351 lineage with the E484K mutation) might interfere with monoclonal antibody treatments, rendering these less effective in treating patients with COVID-19;
- Neither variant is thought to affect response to the vaccinations currently in use.
Dr. Gunel said that YSM performs genetic sequencing on COVID samples and publishes the results online (https://covidtrackerct.com). “The fact is, these mutations are going to happen and we should expect to see more of them, especially as immunity becomes more widespread,” he said.
After-Hours Clinic Reports Smooth Launch
With just six sessions completed, staffed by both YM and NEMG physicians, the Extended Care/After-Hours Clinic at YPB is already making a difference, according to Dr. Babar Khokhar. Opened December 18, 2020, operational M-W-F from 6 – 10 p.m., and offering x-ray and lab services, the clinic has had 56 patients referred, all from the ED, with many being scheduled in the evening and overnight hours. “Some 20% of patients scheduled in the clinic would have likely been admitted for observation to the hospital with diagnosis such as chest pain and shortness of breath, but were able to be safely discharged with follow-up in the clinic within 24 - 48 hours,” said Dr. Khokhar. “We’ll share additional data later this month once we have completed more clinics,” he noted, “but overall, we feel the results are quite good. We are getting these patients out of the ED, resulting in reduced lengths of stay there, and we are cutting down on hospital admissions, which meets our goals for the clinic.”
Paul Taheri, MD, MBA
Deputy Dean for Clinical Affairs, YSM
CEO, Yale Medicine