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    Sunday, December 03, 2023

    With COVID cases rising in Conn., here's what experts say about vaccines, masks, this winter and more

    A Moderna Spikevax COVID-19 vaccine is seen at a drugstore in Cypress, Texas, on Wednesday, Sept. 20, 2023. Since the Centers for Disease Control and Prevention signed off on them for ages 6 months and up in September 2023, people seeking the newest COVID-19 vaccine are running into high demand, insurance headaches and supply delays coast to coast. (Melissa Phillip/Houston Chronicle via AP, File)

    Sep. 22—In recent weeks, Connecticut has once again seen an uptick in COVID, with hospital admissions rising and wastewater surveillance showing a bump in transmission.

    The increase arrives amid the spread of a new variant and the roll-out of updated vaccines now available to all Americans six months and older.

    To make sense of the latest COVID trends, CT Insider surveyed a panel of local experts on data, variants, masking practices and vaccines, as well as predictions for the months to come.

    (Responses have been edited for length and clarity.)

    How would you characterize Connecticut's current COVID trends? Is this a meaningful spike?

    Dr. Manisha Juthani, state public health commissioner: Anecdotally, anybody who is in Connecticut probably knows somebody who has COVID right now. We know that there is most certainly COVID circulating, and we do have an increase in hospitalizations.

    Dr. Richard Martinello, director of infection prevention at Yale New Haven Health: We have certainly and without question seen an increase in the amount of COVID in the community. The good news is among those who are sick enough to be hospitalized with COVID, we're seeing a smaller proportion now who are so sick that they require care in our intensive care unit. And most of our patients who are hospitalized with COVID are under-vaccinated.

    Dr. David Banach, hospital epidemiologist at UConn Health: Over the last four weeks, there has been an increase in COVID. Still well below levels that we have seen in previous waves, but something that we'll need to keep an eye on as things unfold in the coming months.

    Dr. Ulysses Wu, chief epidemiologist, Hartford HealthCare: Right now we're seeing what I'd call the post-Labor Day bump. A lot of kids going back to school, a lot of people on Labor Day got together. So my analogy is it's kind of like the Berkshires, as opposed to previous years where it's been like the Rocky Mountains.

    Dr. Ho-Choong Chang, chief of pediatrics, Community Health Center, Inc.: I think we're definitely seeing a meaningful spike, which is to say that week-over-week, the numbers are definitely going up. However, obviously not nearly as bad as we were a year or two ago.

    What should people know about the new EG.5 variant? Does it change the way you're thinking about COVID at all?

    Juthani: Broadly speaking, it really doesn't change a lot about how we think about this disease. We have variants of flu that happen year after year, and we try to come up with a flu vaccine that will cover the likely circulating strains, and then we hope for the best with that vaccine for a given flu season. I don't think it's that different when we're talking about COVID now.

    Martinello: It really doesn't. We have seen all of these variants come through, and some of them have had some distinguishing characteristics about how transmissible they were, for example, but at the end of the day the important thing is that our vaccines in very large part have been effective, our medications to treat COVID have continued to be effective, and we continue to see masks and respirators to be effective.

    Wu: Doesn't change it at all. We approach it all the same. It's not going to change in infectivity, and it's not changing, necessarily, in symptoms.

    Have you been wearing a mask in public? If so, under what circumstances?

    Juthani: I haven't in general been doing that recently, but the number of cases is going up. I am getting on a plane at the end of this week, and I was planning to wear one then. For general interactions in the office, I'm not wearing a mask. I'm not wearing a mask in stores or other social gatherings at this point in time. But we'll see how things continue. That may change.

    Martinello: I do, under certain circumstances. Recently I've been traveling a little bit and in particular when I am getting on a plane, and then until that plane gets up to altitude, where we know the air filtration is working at its optimal performance, I am I am wearing an N95 mask, respirator or a surgical mask. Other settings when I can't control how I'm physically distanced between people, I'll consider wearing a mask. But in my general day-to-day I have not been wearing one.

    Banach: I have generally not been wearing a mask in public. I would potentially consider one in the future if we see increases in cases. I think masking is going to be a bit of an individualized decision moving forward. Individuals are going to make their own choices based on their age, medical condition and other factors.

    Wu: I always wear a mask indoors, though I did go into the grocery store yesterday by mistake without a mask. For the most part, my rule of thumb is indoors, especially smaller spaces, or especially if you're going to be in crowds, it's a very thin layer of protection that can really go a long way in terms of protection.

    Chang: I have intermittently been wearing a mask in public, when I am in a crowded place, or if I am traveling and there are a lot of people around me.

    What advice do you have to parents sending their kids to school this fall?

    Juthani: I would recommend everybody vaccinate their children, six months and older. The other key thing to remember is respiratory etiquette. If your child has a fever, and if they have productive respiratory symptoms and are coughing potentially on others, keep them at home until those symptoms improve. No matter what it is. It doesn't matter what virus it is.

    Martinello: Make sure their vaccines are up to date — and not only against COVID, but also flu and all of their other routine childhood vaccinations.

    Wu: The most important advice is one that not necessarily everybody follows: If your child is sick, do not send them to school.

    What should people know about the newly approved COVID shots?

    Juthani: Federal regulators say everyone six months and older are eligible for a COVID shot, and my recommendation is that with the amount of COVID circulating right now, people should get COVID shots as soon as they can get an appointment and when it's available.

    Banach: The new vaccines are updated to match the XBB.1.5 subvariant of omicron, which has been the omicron variant that has been primarily circulating throughout the world. And I think these vaccines are important. And they are especially important for individuals who have risk factors for severe illness, including those who are older and those who have other medical conditions that put them at risk.

    Chang: I think the first thing families should know is that because it's not a new shot, because it's based on this current technology, there have been hundreds of millions of mRNA COVID vaccines that have been administered in the United States, under the scrutiny of arguably the most sensitive and effective side-effect monitoring system that exists. And so with that in mind, we can say with very, very high confidence that these vaccines are incredibly safe. If people are really looking at the science, really looking at what the risks versus benefits are, I think that they will decide that the benefits outweigh the risks of getting the vaccine.

    What do you anticipate COVID will look like in Connecticut this winter?

    Juthani: The CDC published a forecast last week in terms of what we can expect this coming winter, and I think what they forecasted makes sense to me: We are probably going to see a winter similar to last winter, where we will see significant disease activity.

    Martinello: Nobody really knows. We still don't have a sense of what the seasonality of this virus is going to be, if any, and I think it is going to take us a few more years to really understand how it may or may not have a seasonal nature to it. I would certainly hope that with the degree of immunity that we have among our population, that while it may get worse, even a few fold worse than what we're experiencing now, hopefully it doesn't go beyond that.

    Chang: Like many other upper respiratory infections, we'll probably see an increase in COVID like we have seen over the past couple years. I think that the severity of that is going to depend on several variables. One is how much uptake of updated COVID vaccine will take place. The other thing is that big unknown, which is: will there be a new variant that comes along that is going to be much more infectious and much more evasive of the vaccine immunity that's conferred?

    Do you still consider COVID a particular threat, above and beyond other illnesses such as the flu and RSV? Or do you see it now as just another virus?

    Martinello: I think, unfortunately, we are seeing more morbidity and mortality associated with COVID than we do with flu and RSV. Flu and RSV are substantial pathogens, and the fact that we're seeing COVID causing more problems in the public than those two viruses is sobering in its own right. Just because the pandemic is over, let's say, and this virus is endemic, it doesn't mean that we need to give up against the impact that it's going to have.

    Banach: I think there are some unique aspects of COVID that we need to be attentive to moving forward. We think COVID circulates in a different type of pattern than typical respiratory viruses like flu and RSV, which generally tend not to circulate in the summertime. And we also need to be mindful that COVID does seem to have a higher high rate of impact, particularly on vulnerable populations.

    Chang: One way is to just look purely from a statistical standpoint. How many hospitalizations or deaths occur? I think if you simply look at those kinds of metrics, it will probably become very clear that COVID obviously is a significant public health problem.

    Many people now refer to the pandemic in past tense, while others say it's still going strong. In your view, is the pandemic over or ongoing?

    Juthani: The virus is here to stay. Our response is here to stay. I think when we talk about when is a pandemic over, I remember reading something at the very beginning of this pandemic, where it said a pandemic is over when the people in society decide that it's over. And in that way, life has gone back largely to normal. So from that perspective, in the way that people are behaving and interacting in society, I would say that it is over. But that does not mean we stop planning or continue to educate people about it.

    Martinello: At most, we are in a period where we're transitioning from this virus being pandemic to what we would term endemic. But it doesn't mean that we're done with it. It's certainly not done with us, and it's never going to be done with us. This is a virus that's going to be around not only for the rest of our lives, but likely for generations to come.

    Banach: I think the emergency phase of COVID is over. Now we have a large proportion of the population that has immunity from prior infection and vaccination, or both. So I think we will see COVID circulate, and it will have an impact on the population, but we're not in a phase like we were in 2020 or 2021. But we'll need to be mindful of changes moving forward.

    Wu: The answer is always in the middle. It is certainly still widespread throughout the world, which by definition would be a pandemic. What has changed is the the infectivity is still there, but the mortality associated with it has decreased. But that being said, we're still losing 75 to 100 people in the United States alone due to COVID each day. But the reason I don't really care if it's called a pandemic is because our rates are still going to be the same, and we need to take the proper measures to protect ourselves. That's masking, that's vaccination, and if you're sick, don't get anybody else sick.

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