Staff of a funeral home and staff of the funeral home of the University Hospital of Bucharest, all with personal protective equipment, prepare a COVID-19 victim for transport to a cemetery, in Bucharest, Romania, October 29, 2021.
Inquam Photos | Reuters
The ChristianaCare healthcare system in Wilmington, Delaware, implemented last month “crisis standards of care” for the first time in its 130-year history as a fresh wave of Covid-19 infections through the northeastern U.S. ripe.
This gives the organization’s three hospitals, which have more than 1,200 beds, the flexibility to treat more than one patient in private rooms and to reschedule critical procedures to respond to the onslaught of Covid cases.
“There is nothing mild about what happens in our hospital and in our ICUs, especially if you are unintentional or non-boosted,” said Drs. Ken Silverstein, the chief physician of ChristianaCare. Silverstein referred to reports that the highly contagious omicron variant produces milder infections than previous strains.
A shortage of monoclonal antibodies, which were standard care for Covid patients before proving little use against omicron, has also forced ChristianaCare to “make clinical prioritization decisions about who is most eligible,” Silverstein said. “Not who is eligible, who is most eligible.”
Covid’s daily death toll has averaged more than 2,400 deaths in the previous seven days as of Monday, up 39% in the past two weeks and the highest level in about a year, according to data compiled by Johns Hopkins University.
Jennifer Nuzzo, head of epidemiology at Johns Hopkins Covid Resource Center, said Covid deaths could increase even more because states with lower vaccination rates were later hit by omicron and have not yet experienced the full brunt of the variant. She said it is a tragedy that people are still dying when vaccines are available that protect against serious illness.
“Every time we have deaths after the development of a vaccine – which for the most part takes the possibility of death off the table – it is a tragedy,” Nuzzo said. “There is no way this is a bad development for the pandemic.”
Faxes were not widely available the last time Covid deaths were so high in America. The Pfizer and Moderna recordings only received emergency approval in December 2020, followed by Johnson & Johnson about three months later. Just 28 million Covid shots were delivered by this time last year, with 4.7 million people receiving a second dose. As of Monday, nearly 250 million Americans have received at least one shot, and more than 88 million of them have received both primary doses and have been stimulated.
Because infections have been painful lately, vaccines have at least prevented serious illness and death from occurring at the same rate; yet, with a quarter of Americans still getting a single shot, many remain sensitive.
Reported Covid deaths generally slow in cases. States that have not yet reached a peak in infections are likely to do so within the next two weeks, with peak deaths following about two weeks later, Drs. Scott Braithwaite, Professor of Public Health and Medicine for NYU Langone Health.
Dr. Shereef Elnahal, CEO of Newark, New Jersey-based University Hospital, said it is not yet clear if his provision is completely over the hump in Covid-related deaths in this wave. After an increase in deaths in the past few weeks, the hospital has seen a plateau in ICU patients and deaths.
About half as many patients who come with Covid need intensive care in this wave compared to previous surgeries, Elnahal said. “It’s just so transferable that the absolute number of people who need fans were comparable to previous waves,” he said.
Some parts of the country are seeing encouraging signs, and cases and hospitalizations are declining nationwide. Hopkins data show that cases in the United States escalated to a pandemic peak of nearly 1 million new infections per day in mid-January. The country now reports an average of seven days of about 450,000 new cases per day, down 36% in the past two weeks.
Hospital admissions fall
The roughly 140,000 patients currently in U.S. hospitals with Covid are also down from the recent peak of 159,400 on Jan. 20, according to an average of seven days of data from the Department of Health and Human Services.
This relaxation is most evident in the northeast, where cases were already on the rise when the omicron variant spread earlier than in other parts of the country. Cases and hospitalizations are falling sharply in that region than others, but it now feels the effects of the first hit by omicron, with population-adjusted daily deaths higher than anywhere else.
The number of ChristianaCare patients has decreased by 33% in recent weeks, but their hospitals were still operated at 99% capacity from last week. This includes patients who came to the hospital because of Covid, as well as those who were admitted for something else and then tested positive. All patients who test positive for Covid, regardless of why they were admitted, need extra care and resources to isolate them from other patients and staff, which is a burden on the system, Silverstein said.
“There are a lot of sick people, with Covid and because of Covid,” he said.
Mortality rates, the percentage of people with Covid who eventually succumb to the virus, are lower in the Northeast during this wave than previous surges. But other parts of the country that have lower vaccination rates may not be so lucky, doctors say.
“If you look at the delta period and last winter, as cases increased, hospitalizations and deaths increased in a similar pattern,” Centers for Disease Control and Prevention Director Dr. Rochelle Walensky told reporters last week. “Strikingly, if we compare the past month when omicron was the predominant variant, we see a clear separation between cases, hospital admissions and deaths.” She attributed the lower death rates to the faxes, which proved to provide good protection against Covid’s death.
Cases are currently five times higher than they were during the delta wave, Walensky said, but hospitalizations and deaths have not increased at the same rate. Nuzzo said the current wave of infection, hospitalization and death would have been much worse without the vaccines.
“Part of why omicron looks milder is because it finds communities that already have a fair amount of immunity accumulated against prior infection or vaccination,” Nuzzo said.
In the New York and New Jersey area, “many of the cases were not fatal, and / or extremely serious because of the high vaccination rates,” said Perry N. Halkitis, dean of the Rutgers School of Public Health. “But in the rest of the country that may not be the case.”
That’s both because of lower vaccination rates and because of less robust hospital health care in other parts of the country, he said, which could mean even a peak in total deaths in those areas that surpass those of last winter’s surge.
“We are in this at least until the end of February, for the rest of the country,” he said.
This is because so many people in the US still need to be vaccinated; more than 80 million have not received a single shot. Omicron makes people generally less ill than the delta variant, but the rapid jump in new infections in the past month means deaths will continue to follow.
“As long as we have tens of millions of people who will not be vaccinated, we will have complete hospitals and needless deaths,” President Joe Biden said earlier this month.
Although omicron in general does not make people as sick as previous strains, Walensky said that does not mean the variant is mild. She called on the public to wear and vaccinate masks and encourage them to reduce the burden on hospitals.
“I know a lot of people are tired, but a lot of our hospitals are still struggling beyond capacity,” Walensky said. “It’s been a long two years. Now please do your part to pay off in this present moment.”