The adage “one step forward, two steps back” seems apt in describing our work trying to put the pandemic behind us. We have every reason to feel celebratory about our vaccination efforts, but the inevitable – and quickening – evolution of variants in people who are unvaccinated and in those for whom the vaccine appears to be less protective (i.e., with immune-compromising conditions) continues to present challenges.
At Wednesday morning’s COVID meeting, Dean Brown succinctly described the situation we face as “a race between vaccination and the variants” as we discussed the latest developments. Here is a status report and summary of our discussions, with numbers updated this morning, Friday, April 16, 2021.
COVID Patients & Vaccination Totals
This morning there were 194 hospitalized COVID patients throughout the YNHHS system, with 97 in New Haven.
Systemwide, 79% of health care workers have been vaccinated. The Yale New Haven Vaccination Program has administered 284,583 vaccinations in total and 181,145 patients have been fully vaccinated (6,105 yesterday).
Vaccination Program: What’s New and Newsworthy
This week’s announcement of the need to pause administration of the J&J vaccine to learn more about its potential link to rare and serious blood clots didn’t seriously slow down our vaccination program, since we had a relatively small supply of that formulation, says Dr. Brita Roy. Existing J&J appointments were replaced with either Moderna or Pfizer vaccines. “We anticipate resuming its use later in the month but, of course, we need to see what decisions are made by the CDC and FDA about the vaccine after further investigation,” she said.
Other than that, she says, “the roll-out is still going well, appointments are still filling up quickly, and we continue our efforts to get as many people vaccinated as quickly as possible.”
Dr. Roy said that there have been a small number – seven or so – of cases in which fully vaccinated patients needed to be hospitalized for COVID. This percentage is consistent with expectations, given the 95% success rate of the mRNA vaccines in preventing symptomatic COVID. However, she said, “I’d still consider the vaccine effective in that, despite these patients being elderly and/or immunocompromised, only one required ICU care.”
“We continue to prioritize vaccinating people living in socially vulnerable neighborhoods,” she continues. “We will be increasing direct outreach efforts to these priority populations, and we will continue scheduling community mobile clinics as well as partner with DPH on a higher volume mobile vaccination unit using the FEMA trailer in socially vulnerable zip codes. In addition, we are partnering with universities and high schools to begin vaccinating their students.”
Variant Update: How Is Connecticut Doing?
The CDC is tracking and reporting on five known variants here in the U.S., with 29 states – Connecticut included – experiencing high numbers of cases and showing no signs of decline.
Dr. Gary Desir provided a summary of what’s happening in Michigan (where COVID cases have reached an alarming high) and New York (because what happens there impacts us directly).
- In Michigan, the B.1.1.7 variant is the most prevalent (40% of cases) and appears to be driving the current crisis there. The other variants (South African/B.1.351, two California variants, and one from Brazil) are also present in lesser numbers.
- In New York, B.1.526 is the most prevalent. Similar to but not the same as the South African variant (B.1.351), B.1.526 incorporates several different mutations. It is worrisome because it is less responsive to treatment with monoclonal antibodies; there is concern, also, that it may be less responsive to vaccines, though there is no data supporting this.
- B.1.526 is also here in Connecticut; in New Haven, we’ve seen 92 B.1.526 cases, double last week’s total. The New York Times publishes live data on COVID status throughout the country, which you can see here; risk of COVID exposure for people in New Haven County is reported as “very high.”
Higher Surgical Risk for Post-COVID Patients: Policy in the Works
On behalf of the Surgical Services Governance Council, Dr. Maxwell Laurans reported on recent large studies (including this one in The Lancet) highlighting an elevated risk of post-operative complications and higher mortality in patients who’ve recently recovered from COVID. He noted that the effect peaks at about four weeks post-diagnosis, is still seen at six weeks, and returns to baseline at around seven weeks. “It’s a remarkable increased risk, which is seen not only in patients who were symptomatic, but also those who had asymptomatic infection,” he said, adding that “the effect is more pronounced in the symptomatic population.”
“We are looking at the recommendations for deferring elective surgery based on this information,” said Dr. Nita Ahuja. A systemwide protocol is the likely result, she said, adding that it will be stratified, to some degree, with guidelines for both elective and semi-elective procedures.
Paul Taheri, MD, MBA
Deputy Dean for Clinical Affairs, YSM
CEO, Yale Medicine