What Do We Do Now? YNHH Update Offers Primer On Living With Covid In The Delta Moment

The Delta variant is likely responsible for almost every case of Covid-19 among hospitalized patients at Yale New Haven Health, a quarter of which are ​“breakthrough” cases in people who have received the vaccine.

That raises new questions and altering risk calculations for New Haveners trying to stay healthy and protect their loved ones during the pandemic.

Yale New Haven officials revealed those numbers Tuesday — and offered some FAQ guidance and insights for people scrambling to figure out how to stay safe as the Delta-sparked Covid upsurge upends what we thought we knew about the pandemic. (See examples in the second section of this article.)

At an online press update, the health system officials addressed how Connecticut residents’ day-to-day lives may be affected by breakthrough vaccine infections, Monday’s Food and Drug Administration full approval of the Pfizer vaccine, and the calculus of back-to-school safety precautions.

They also shared the news that over the past two months, Covid-positive patients have tripled to 137 in Yale New Haven Health-affiliated hospitals. That reflects a national trend of rising cases as the summer wanes and the Delta variant spreads.

Thirty-seven of those patients are in the intensive care unit, including 23 patients on ventilators.

Notably, 37 of the hospital system’s Covid-positive patients — or about 27 percent — became infected with the virus despite having been vaccinated against it.

That percentage has been relatively constant over the course of the summer, according to Tom Balcezak, the hospital system’s chief clinical officer. These numbers ​“highlight the durability of the Delta variant,” he said.

The hospital system’s cases have almost all been instances of the Delta variant, according to Balcezak. About 100 hospitalized cases are sampled to be screened for particular viral strains each week.

Of the hospital system’s 137 patients, 54 have been hospitalized in New Haven. The hospital system is also treating 50 Covid patients in Bridgeport, 12 in Greenwich, 8 at Westerly, R.I., and 13 at Lawrence and Memorial in New London.

According to the Connecticut Department of Health, New Haven currently has a Covid positivity rate of 19.7 cases per 100,000 individuals. There were 174 Covid cases detected between Aug. 7 and 14 in New Haven, and 186 new Covid cases the week before.

As of Aug. 18, 57.7 percent of New Haveners — 75,159 individuals — have received at least one dose of a Covid vaccine, according to the state Department of Health. (That statistic includes children under the age of 12 who are ineligible.)

Delta FAQs

At Tuesday’s press conference, Balcezak and Yale New Haven Health President Chris O’Connor answered a variety of questions about what these statistics, along with the latest scientific research on the virus and its vaccines, mean for Connecticut residents’ day-to-day lives. Here’s a summary of the questions and responses:

Why are breakthrough infections occurring? Are the vaccines still effective against the Delta variant?

The three approved vaccines in the United States are only slightly less effective against the Delta variant, officials said. Vaccination remains a critical defense against Covid.

While the rise in breakthrough cases has raised questions about waning vaccine protections over time, or the Delta variant’s ability to evade current inoculation methods, Balcezak said that breakthrough cases can be attributed mostly to the intrinsic imperfection of any vaccine.

“Even the best vaccines are only 95 percent effective,” Balcezak said — and the Delta variant infects people with 1,000 times more of a viral load compared to other strains of the virus. ​“Even if you are fully vaccinated, if we bombard you with the virus, you will get sick.”

That’s why additional protections, like masking indoors and avoiding crowds, remain important, especially for people vulnerable to the virus’ worst effects.

The hopeful data about breakthrough cases that has emerged over the summer is that vaccinated people are far less likely to have severe cases of Covid-19. ​“More than 75 percent of folks that we are admitting are unvaccinated,” Balcezak said. ​“That’s empirical evidence that joins other scientific evidence that the vaccine continues to be extremely effective at preventing serious disease and death.”

With the Delta variant spreading, is it safe to eat inside a restaurant?

Balcezak said he would recommend avoiding indoor dining in public settings at the moment. ​“Right now, dining outdoors is certainly safer than dining indoors,” he said.

He gave the analogy of calculating the risk of a crash while driving a car. There are common-sense safety measures while driving, like wearing a seatbelt and riding in a car with airbags. He compared these to viral safety measures like mask-wearing and vaccinations. But ​“there is still a chance you will get into a car accident.”

Extending the metaphor, Balcezak compared the Delta variant to an icy road: ​“It adds an additional risk, even with all of the safety features.”

As more and more employers — including the state of Connecticut — institute vaccine mandates, what are the legitimate medical reasons for an exemption or deferral?

There are two confirmed medical justifications for a vaccine exemption, Balcezak said.

One is if a patient has had a past episode of Guillain-Barré syndrome, a rare immune disorder that typically causes muscle weakness and can sometimes lead to paralysis.

The other is if a patient has a rare allergy to a component of the vaccine — which is usually determined after an allergic reaction to an initial dose of the vaccine. At vaccine distribution sites, patients are asked to wait for a few minutes after receiving their shots to ensure that if such an allergic reaction occurs, they can receive medical care.

Some people on immunosuppressant treatments have received medical recommendations to defer their vaccine — not because of a possible adverse reaction, but so that they can maximize the vaccine’s protective effects. Those patients may choose to wait until they can pause or end their treatments so that their immune systems can fully respond to the vaccine.

Yale New Haven Health was one of the earliest institutions to require employee vaccinations against Covid. How has that been going?

Since announcing a vaccine mandate in late June, Yale New Haven Health has given hospital employees a deadline of August 31st to either get vaccinated or to obtain a religious or medical exemption from the requirement.

About 83 to 84 percent of hospital employees have been vaccinated so far, with just a week to go before the mandate takes full effect, Balcezak reported.

That statistic may be an underestimate, officials said. Some employees are listed as ​“casual status” workers, who are called to work on an as-needed basis, according to Balcezak. The hospital is currently reassessing those employees to determine who actually still works for the hospital.

And O’Connor added that some employees got vaccinated outside of the Yale New Haven Health system and are simply still filing paperwork to verify their vaccination status.

When kids return to in-person classrooms this fall, should they be required to wear face masks?

Yes, according to Balcezak. While the majority of children don’t get bad cases of the virus, some have had severe cases of Covid-19. There is currently one 16-year-old with Covid-19 in a YNHH pediatric Intensive Care Unit, Balcezak said. The system has admitted more than 180 Covid patients under the age of 18 since the start of the pandemic.

“It’s not a trifle for children,” Balcezak said. And even kids who don’t get severely ill from Covid are often capable of spreading the disease to others.

Meanwhile, while Covid vaccines have not yet been approved for kids under 12 in the United States, ​“there is no doubt about the science that masking works,” Balcezak said. He argued that there is no reason to believe there is a downside to wearing masks as a kid. ​“There’s very little-to-no evidence that masking in kids has any influence on their ability to learn speech patterns… Kids are very adaptable.”

As the fall semester begins, an influx of university students from across the country and the globe are moving back to Connecticut. Will this affect viral spread in the state?

Balcezak said he doesn’t think so. While Connecticut has a relatively high vaccination rate, ​“at this point the virus is endemic in the United States,” Balcezak said. “[I don’t think] importing new cases into the state… is going to have a large impact on us.”

Many universities in the state, both public and private, are requiring students to be vaccinated. In some cases, as with UConn, this requirement has been met with resistance. Many schools have also instituted testing regimens and masking requirements for indoor gatherings. Vaccine mandates will be an especially helpful measure in preventing community spread, Balcezak said.

Finally, what can we say about the next few months of the pandemic?

Balcezak’s most optimistic prediction is that if more people get vaccinated and stick to public health guidelines, the virus may fade away.

But realistically, he said, the pandemic will likely continue for a long time. He predicted that over the course of the next year, infection rates will ebb and flow in cycles, oscillating between a handful of hospitalized cases and over a hundred cases.

The worst case scenario, Balcezak added, is that a variant of the virus emerges with a mutation that significantly alters the way Covid should be prevented and treated — which could change the whole game. The likelihood of such a mutation increases as the virus continues to spread and mutate.