After a short lull in cases, healthcare systems are once again reviewing the COVID-19 playbook as new strains of the omicron variant cause a steady rise in hospitalizations nationwide.
The strains, including BA.4, BA.5 and, most recently, BA.2.75, are highly transmissible, evading vaccines and immune responses. The seven-day moving average for new cases topped 118,000 this week, compared with about 31,000 cases three months ago, according to the Centers for Disease Control and Prevention. Recent case numbers are largely underreported, however, because of the availability of at-home tests.
“This is a more dynamic time in the pandemic than probably ever before. I mean, we’ve cycled through four variants being dominant in just about as many months, which we haven’t seen before,” said Dr. Ben Weston, an emergency medicine physician at Milwaukee-based Froedtert and the Medical College of Wisconsin.
The seven-day average for hospital admissions has jumped nearly 300% to more than 5,600 admissions in the past three months, according to CDC data.
Hot spots are cropping up across the U.S., particularly in the Southeast and Southwest, according to a New York Times analysis. This past week, as many as 22 patients were admitted because of COVID to Jackson Memorial Hospital in Miami, one of the hot spots. That’s an increase from admissions in the low teens about a week and a half ago, said Dr. Hany Atallah, the hospital’s chief medical officer.
The White House is urging people over the age of 50 to get COVID boosters, even if previously infected.
Healthcare providers say they are more prepared to handle increases but nonetheless are unsure of the full impact of these latest strains, which typically have milder symptoms. Severely ill patients tend to be elderly, not fully vaccinated and/or suffering from other underlying health issues.
In the Chicago area, Edward-Elmhurst Health has recorded a steady uptick in hospitalizations during the last couple of months. Its Edward Hospital is averaging 35 COVID-related admissions per week, up from about 10 admissions per week in March, said Dr. Jonathan Pinsky, its medical director of infection control and prevention.
At omicron’s peak, Edward Hospital reported an average of 168 admissions per week. This time, fewer patients require intensive-care unit beds, and the length of stay tends to be shorter, he said.
“We need to be concerned, but it’s kind of a different concern 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 will likely follow a similar trajectory to the others, said Dr. Sandra Kemmerly, an infectious disease specialist and system medical director of hospital quality at Baton Rouge, Louisiana-based Oschner Health. Heightened community spread results in more hospitalizations a couple of weeks later, followed by an uptick in ICU patients.
CDC data shows the seven-day moving average for COVID deaths is staying flat so far at roughly 300 deaths nationwide.
Hospital systems are staying prepared to handle any surges.
At Oschner, isolation rules and personal protective equipment requirements remain in effect. The system has not recently used designated COVID units, activated when there are at least 20 COVID patients at a hospital. The threshold shifts based on a facility’s size.
“We’ve done it at least four or five times, so we can certainly stand them up and stand them down,” Kemmerly said.
Weston said hospital executives in his area collaborate regularly on operational challenges. The Froedtert system has implemented a centralized, risk-stratification process to disburse COVID treatments.
Staffing remains the biggest challenge, Atallah said. Many workers are out due to COVID infections. Once an employee tests positive for the virus, that employee may be out for up to 10 days, unless there is a critical labor shortage, said Dr. Stuart Cohen, chief of the infectious diseases division at UC Davis Health.
Healthcare providers continue to push for vaccinations. A vaccine tailored for the newer strains is expected to roll out this fall. Combination COVID and flu vaccines may also become an option.
“I think we’re beyond the state where we think this is going to end. It’s not ending. We’re … living with it, but living with it doesn’t mean giving up and giving into the virus. It means adjusting your lifestyle to that,” Pinsky said.
Physicians increasingly view case numbers as a less reliable data point since positive results from at-home self-testing kits typically go unreported, Weston said. Some recent estimates suggest hundreds of thousands of positive cases are falling through the cracks.
Healthcare systems are instead relying on hospitalizations or positivity rates. Milwaukee County, where Froedtert is based, has an approximately 15.4% positivity rate, up from 12% or 13% in recent weeks, Weston said. The national positivity rate had a seven-day average of 17.5% for June 24-30, more than two percentage points higher than the preceding week, according to CDC data.
Cohen said positivity rates may not be accurate either, so it also helps to look at how COVID treatments, including the antiviral medication Paxlovid or monoclonal antibodies, are being disbursed. That gives physicians a general idea of how infections are trending.