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Date: 2/16/2022
NORTHAMPTON – There’s both good and bad news about the future of the pandemic, according to Dr. Joanne Levin, medical director of infection prevention at Cooley Dickinson Health Care (CDHC).
“COVID[-19] will be with us forever,” Levin said. “In the beginning, people were talking about herd immunity, but that is out the window. That is not achievable.”
The current vaccines authorized by the Centers for Disease Control and Prevention (CDC) do not prevent transmission of the virus, according to Levin, which makes herd immunity impossible. The mRNA vaccines do, however, stave off the worst outcomes. While failing to stop transmission or infection, they do prevent serious illness and death.
“People are hearing a lot about breakthrough infections with omicron,” Levin said. Breakthrough infections, those among fully vaccinated people, have increased with the highly contagious omicron variant. “But we’re trying to prevent severe disease and death. In our most vulnerable populations, the vaccines are extremely effective for preventing severe disease and death.”
According to information on the CDC website, the most vulnerable individuals are the elderly, those with compromised immune systems, or serious medical conditions. Comorbidities, such as obesity and diabetes, also greatly increase the likelihood of a severe infection.
Levin, a member of Northampton’s Board of Health, claimed that vaccination is still the main tool for preventing severe illness, but is excited by the newly developed pharmaceutical drugs coming in the next few months.
“Right now, we have no specific treatments for people who test positive,” Levin said. “Now we do have a pill, Paxlovid. It’s a five-day treatment. It dramatically reduces the need for hospitalization. That’s good for the patient and the health care system, keeping people out of the hospital.”
Paxlovid will probably not be widely available, Levin said, for some months. Other oral drugs, including molnupiravir and remdesivir, have been authorized for use, with mixed results. Levin, a board certified consultant in infectious diseases, said CDHC also has monoclonal antibodies that are effective against the omicron variant. Monoclonal antibodies are given to high risk patients as a first effort to keep them from requiring hospitalization.
Keeping people out of the hospital is an important goal. The case counts are falling, Levin said, but burn-out and staffing shortages are one consequence of the long pandemic. Another is having little space to do surgeries and other medical procedures that were delayed during previous waves. The omicron tidal wave, unfortunately, was primed by families gathering to celebrate the holidays.
“All the people who put off medical care in 2020 are now getting sick,” Levin said. “People were celebrating holidays and mixing families, and seeing loved ones ... which meant a lot of our staff were out sick almost all at the same time. The remaining staff were asked to work extra shifts or overtime. It was tough on morale.”
Going forward, Levin recommended two existing measures, masking and full vaccination, but also better ventilation in buildings.
“Most people are aware that masks are still important,” Levin said. She recommended n94 and kn95 surgical masks, or a combination of paper and cloth masks. “Masks work. They decrease transmission, so the better mask you have the more prevention you’re putting in place.”
Levin also saw a longer term solution through a change in the construction of buildings.
“We need to up our game in improving ventilation in public places,” Levin said, “especially bars and restaurants where people are not masking. Ventilation is one reason being outside is so safe. If you have OVID [-19] the particles are taken away by the wind. We want that same kind of thing happening indoors too.”
In CDHC, every area of care has had to change in response to patient needs. Even the charting process, which starts at intake and continues through to discharge, is more detailed now, according to Levin. She believes the more rigorous charting of patients will continue after the pandemic ends. In the meantime, CDHC has opened a new area of the hospital where patients coming out of surgery will be housed.
What has not changed for CDHC, according to Levin, is the high motivation of the staff to provide quality of care. The hospital recently earned an ‘A’ grade from the Leapfrog measure, which grades service quality. The Joint Commission surveyors also visited the hospital during the pandemic, which occurs at least once in three years, and according to Levin, the facility passed with flying colors.
Levin is hoping to get past the infections and adjust to the permanent presence of our new neighbor, SARS CoV-2, the virus that causes the illness, COVID-19.
Levin said, “The hope is this disease will change from a pandemic to an endemic virus, which means it will always be here, but not at the level where we have these huge surges that disrupt daily life.” She emphasized the continuity of service to area residents. “We’re glad the community rates are starting to turn around. We continue to work together and do the best we can.”