Wednesday's COVID meeting brought updates on a rising census, with widespread presence of variants, along with discussion about how to plan for a new normal that will likely look different than we’d hoped. A consistent theme that arose was acknowledgement of all we’ve learned and accomplished in the past year – not only in caring for patients here in Connecticut, but also of the visible role Yale is playing in advancing knowledge globally.
Today, systemwide, we had 199 COVID patients (138 in New Haven, with 10 new admissions in the past 24 hours) and have completed 114,797 vaccinations. A total of 11,374 COVID patients have been admitted since the start of the pandemic and 1,124 patients have died of COVID complications.
Below we offer summaries of presentations from Drs. Martinello and Gunel, along with other updates to equip you with all you need to know today, Thursday, March 25, 2021.
Variants and Vaccine Breakthrough Cases
With this presentation, Dr. Rick Martinello provided valuable context for understanding why COVID numbers are increasing. Noting that “it’s important to understand the nomenclature,” he reviewed the three categories of variants as defined by the CDC: variants of interest, variants of concern, and variants of high consequence.
“All variants of concern have been found here in Connecticut,” says Dr. Martinello, noting that, with a “substantial and growing presence,” the B.1.1.7 variant is expected to predominate.
This is concerning for several reasons. First, though it’s clear that public health measures – including masking and distancing – are effective, the state lifted many restrictions last week, leading many to the misperception that the danger is past. Second, a large community-based study published in the British Medical Journal confirms that this variant leads to more severe illness and a 64% greater risk of death. And third, an as-yet-unpublished study raises concern that the period of contagiousness for B.1.1.7 may be prolonged, compared with those infected by non-B.1.1.7 SARS-CoV-2. The study's co-authors include Nate Grubaugh, Joe Fauver, Mallery I. Breban, and Anne E. Watkins of YSPH.
Finally, Dr. Martinello spoke about “vaccine breakthroughs,” defined as COVID cases identified in people at least 14 days after being fully vaccinated. This is unsurprising, he noted, “because we know that none of the studies showed 100% effectiveness of the vaccine.” He added that, though it is not mandatory, Yale Medicine is cooperating with the state Department of Health in its request that all cases of identified vaccine breakthroughs are shared for monitoring purposes.
Progress Toward New COVID-19 Treatments
“We now have a fairly good understanding of the life cycle of this virus,” said Dr. Murat Gunel, noting that this continues to inform the scientific basis for development of new therapies. For example, the SARS-CoV-2 virus is using two mechanisms for viral entry and Yale is leading the clinical trials targeting both of these mechanisms in outpatients. (Camostat Mesylate in Covid-19 Outpatients and A Study of LAM-002A for the Prevention of Progression of COVID-19)
In addition, several other approaches target the viral molecules, such as the RNA polymerase, as well as modulation of immune response in hospitalized patients. “I believe we will have the initial results of these clinical trials using new drugs for treating COVID in our armamentarium within a few months,” Dr. Gunel said.
Pandemic to Endemic: Preparing for What Comes Next
Commenting that “all data suggest that we are looking ahead at a pandemic that becomes endemic,” Dr. Nita Ahuja has developed a planning guide to address possible scenarios in the coming months and years. “As an academic community we are uniquely equipped to think about and plan for alternative, post-vaccine futures,” she says, noting that right now, operations and workforce planning are key areas of focus and that “burnout is the number-one factor we face.”
In conjunction, she said, “we must broaden our focus beyond COVID. Cancer screenings and chronic disease can’t be put on the back burner. But I remain optimistic that the worst of the pandemic is behind us and confident in the talent and resiliency of our people to adapt and thrive in changing times.”
“The reality is that COVID is here to stay,” agreed YNHHS COO Mike Holmes. “We plan to use Nita’s framework to help us think more holistically about what the future looks like in order to figure out how to apply our resources to get through the next couple of years.”
Friday Deadline to Vote in U.S. News Rankings
All eligible Doximity users should have received an invitation during the past month to vote in the annual U.S. News “Best Hospitals” reputation ranking. This is a reminder that the deadline for voting is this Friday, March 26.
This reputation survey of physicians comprises a significant portion of the evaluation criteria used by U.S. News in creating its "Best Hospitals" rankings, and it provides our clinical faculty with a unique opportunity to help raise the profile and reputation of Yale New Haven Health.
Physicians who are board-certified in one of the 16 adult specialties and 10 pediatric specialties ranked by U.S. News are eligible to vote. If you were emailed a survey link by Doximity, please complete the survey by Friday. If you no longer have the link, go to Doximity.com, claim your pre-populated profile, and include Yale in your “Best Hospitals” rank list.
Please take the time to vote and help spread the word about the exceptional, patient-centered care provided by you and your colleagues across the system.
YM 2020 Annual Report: Recapping an Extraordinary Year
As we observe the one-year anniversary of the COVID-19 pandemic, I encourage you to read Yale Medicine’s recently released Annual Report, which looks back on the challenges and triumphs of 2020. It highlights important updates and achievements of the clinical practice in 2020, along with a special focus on the pandemic, featuring reflections and recollections from some of the YM clinicians who have been on the front lines.
YM Reaches Agreement with CIGNA
To end with a bit of good news, I’m happy to report that Yale Medicine and Cigna have reached a multi-year agreement that ensures Cigna customers will have continued access to Yale Medicine physicians.
Paul Taheri, MD, MBA
Deputy Dean for Clinical Affairs, YSM
CEO, Yale Medicine