Health systems prep for vaccinations as caseloads rise

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Vaccines may be the light at its end, but area residents and the region’s already beleaguered hospitals can expect to spend at least the next six months in the COVID-19 tunnel.

The first coronavirus vaccines could become available locally as soon as next week. In the meantime, COVID caseloads keep rising, hospital staffs are increasingly overburdened and hospital space is in ever shorter supply, the chief medical officers of the Rochester area’s two largest health systems warned Wednesday. 

The Finger Lakes region’s numbers, updated today, are worrisome, the state’s Early Warning Monitoring System COVID-19 Dashboard indicates. On a seven-day rolling average, the percentage of positive tests per day is 7.7 percent, the highest in the state. Mohawk Valley comes close at 7.4 percent, followed by Western New York at 7.2 percent. The average statewide is 5.1 percent.

New cases per 100,000 people, also on a seven-day rolling average, is 66.73 here compared with 50.31 statewide. However, the Finger Lakes region has more hospital capacity than most regions across the state. The share of total hospital beds available here is 27 percent, with 58 percent of ICU beds available. Statewide, those numbers are 22 percent and 36 percent, respectively.

There were 607 new confirmed cases in Monroe County today, with a seven-day rolling average of 578 new cases a day. The positivity rate on a weekly average is 8.31 percent. Since March, 20,477 people have tested positive. Currently, 599 are hospitalized, with 109 in intensive care units. There have been 364 deaths.

The villain in the picture is community spread—the too easy transmission of the potentially deadly coronavirus from person to person. The white knights riding to the rescue are vaccines developed in record time that can protect against the virus.

By providing fewer and fewer hosts for the COVID virus, vaccines can slow its spread to a point where it no longer forces schools, businesses and socializing to be put on hold.

What is needed to end the pandemic is herd immunity—a state in which enough of the population is immune to the virus to begin to choke off its ability to invade cells, steal genetic material to make copies of itself and, as a byproduct of that process, cause many to sicken and others to die. 

“We need 60 to 70 percent of the population vaccinated before we get herd immunity so that the spread from person to person is not the same as it is now,” explains Michael Apostolakos M.D, chief medical officer of the University of Rochester’s six-hospital UR Medicine health system. 

“If we’re able to get enough vaccine, which, I believe, we will be able to do,” he adds. “We’re hopeful that by this summer and certainly by this fall, we should be able to get those numbers of people vaccinated.”  

Because it must be stored at minus 70 degrees Fahrenheit and be very carefully handled, the Pfizer vaccine, the first of two that so far are expected to be available for U.S. distribution, can only be practically stored at and administered by hospitals. 

Rochester Regional Health and UR Medicine are laying plans to begin a local Pfizer vaccine rollout as early as next week by inoculating their own medical staffs, with immunizations for a widening swath of the community to come as doses become available, say Apostolakos and Robert Mayo M.D., chief medical officer of the five-hospital RRH system. 

As of midweek, however, the health systems had no firm word on when the first doses would arrive. A vaccine developed by Moderna is expected to soon be available in the United States, but it has yet to be greenlighted by the U.S. Food and Drug Administration.

“If the estimates are correct, we hope (vaccinations) will start next week,” Mayo says. “But we don’t know when we will receive the vaccine.” 

Meanwhile, COVID caseloads at RRH and UR Medicine hospitals have risen dramatically over the past week, stretching the systems’ capacity to accommodate COVID and non-COVID cases, with no sign of an immediate let-up.   

To free up space and ease pressure on overworked frontline workers, both systems continue to employ measures including shifting patients among hospitals, using non-clinical employees to assist ever more thinly stretched nursing and physician staff.

“But as the number of COVID patients needing hospital care continues to rise, that becomes harder to do,” Apostolakos cautioned. Mayo seconds the warning.

In expectation that cases will continue to rise while space shrinks and staffs grow more overburdened, both systems are preparing to take steps to add capacity like converting non-clinical areas to treatment spaces. But keeping staff levels adequate could prove to be trickier than finding room for patients, the officials say.

Whether vaccines will provide relief as soon as Apostolakos hopes is a question still to be answered. Achievement of a 60 to 70 percent immunization rate is by no means guaranteed.

Even before COVID began to spread in the United States, a growing anti-vaccination movement was gaining strength and causing alarm among public health officials as diseases like measles that were thought to have long been virtually eradicated resurfaced. Now, anti-vaxxers are joining forces with a persistent anti-mask movement to call for resistance to COVID immunizations, Politico reported in a Nov. 5 post.

Recent polls show that vaccine distrust is high among New Yorkers including first responders and minority communities, New York University medical ethicist Arthur Caplan wrote in a recent Newsday column. 

First responders like EMTs may wrongly believe they have already been exposed and do not need to be immunized, while “poor minorities distrust the health care system having often been denied access to care,” Caplan wrote. 

How widespread such sentiments are locally is difficult to say. Both health systems plan campaigns to overcome what resistance there may be.

UR Medicine is planning town hall events for its own faculty and staff that will include “frank discussion and question-and-answer period to answer questions about the vaccine,” Apostolakos says. “We are taping these to use in all of our regional hospitals and we’re working with community leaders to help bring the message out to the community, especially to the underserved areas where there may be even more resistance, mistrust of the medical system and vaccines.” 

Echoes Mayo: “Rochester Regional has a number of messages that we’re building and starting to share with our employees about the importance of the vaccines. I am aware of efforts in the community to also reach out to the Black and Brown communities and address their valid but unique concerns.” 

Until herd immunity takes hold, masking, avoiding unnecessary gatherings, social distancing, handwashing and other such measures remain the only sure defense against the virus, the medical officials caution. 

As it stands now, the rise in cases has prompted the state to designate parts of Monroe County as orange zones in which some activities are curtailed. The next step would be to move into red-zone status, in which the county would largely be shut down.   

As hospital capacity continues to shrink, Mayo warns: “We’re closer (to red-zone status) than we would like and we are getting closer, so flattening this curve is of utmost importance.”

Will Astor is Rochester Beacon senior writer. Managing editor Smriti Jacob contributed to this article.

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