The White House is urging people over 50 to get vaccinated against COVID-19, even if they have previously been infected. Health officials say they are more prepared for an increase in cases, but are nonetheless unsure of the full impact of these latest strains, which typically have milder symptoms. Critically ill patients are usually elderly, under-vaccinated, and/or suffering from other underlying health problems.
In the Chicago area, Edward-Elmhurst Health has recorded a steady rise in hospital admissions over the past couple of months. His Edward Hospital is taking an average of 35 COVID-related hospitalizations per week, up from about 10 per week in March, said Dr. Jonathan Pinsky, medical director of infection control and prevention.
At the height of the omicron, Edward’s Hospital reported an average of 168 admissions per week. This time around, fewer patients require beds in intensive care units, he says, and stays tend to be shorter.
“We should be concerned, but it’s a different issue now than it was two years ago. Two years ago we had a population that was not immune, not infected, not vaccinated,” Pinsky said.
The new strains are likely to follow the same trajectory as the others, said Dr. Sandra Kemmerli, an infectious disease specialist and systems medical director for hospital quality in Baton Rouge, Louisiana, at Oschner Health. Increased community spread leads to an increase in hospital admissions after a couple of weeks, followed by a spike in the number of patients in the intensive care unit.
CDC data shows that the seven-day rolling average of COVID deaths has so far remained unchanged at roughly 300 deaths nationwide.
Hospital systems are ready to handle any surge.
At Oschner, isolation rules and requirements for personal protective equipment remain in effect. Recently, the system has not used dedicated COVID units, which are activated when there are at least 15 to 20 COVID patients in the hospital. The threshold changes depending on the size of the object.
“We have done this at least four or five times, so we can certainly support them and fight back,” Kemmerli said.
Weston said hospital leaders in his area regularly collaborate on operational challenges. The Froedtert system has implemented a centralized risk stratification process for paying for COVID treatment.
Staffing remains the biggest challenge, Atallah said. Many workers are out of work due to COVID infection. According to Dr. Stuart Cohen, head of infectious diseases at UC Davis Health, after testing positive for the virus, an employee can be out for up to 10 days, unless there is a critical workforce shortage.
Medical workers continue to insist on vaccination. A vaccine adapted for the new strains is expected to be released this fall. Combined COVID and influenza vaccines may also be an option.
“I think we are out of the state where we think this will end. This is not the end. We… live with it, but living with it does not mean giving up and succumbing to the virus. a way of life to this,” Pinsky said.
Doctors are increasingly treating case numbers as a less reliable data point, Weston said, because positive results from home self-test kits are not commonly reported. According to some recent estimates, hundreds of thousands of positive cases go unnoticed.
Instead, health systems rely on hospital admissions or positive outcome rates. Weston said Milwaukee County, where Frodtert is based, has an estimated 15.4% positive result, up from 12% or 13% in recent weeks. According to the US Centers for Disease Control and Prevention (CDC), the seven-day average national positivity rate was 17.5% for the period June 24-30, up more than two percentage points from the previous week.
Cohen said positivity rates can also be inaccurate, so it’s also useful to look at how COVID drugs are distributed, including the antiviral drug Paxlovid or monoclonal antibodies. This gives doctors a general idea of how infections develop.