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WPCNR QUARTERLY STATE OF LIFE SERIES # 1: STATE OF COVID. News & Comment by John F. Bailey. March 24, 2023:

The State of Covid will now be whatever our leaders say it is.

Because they who control the reports of covid spread or decline will now be only reporting results once a week on Fridays.

This is not a good development.

Those of you who make my weekly Covid Surveillance Reports developed from the daily trends of the communities in Westchester, Orange, Rockland, Dutchess, Ulster, Putnam and Sullivan Counties (the seven counties in the Mid-Hudson region) reported by the New York State Covid-19 Covid Tracker will not be worried any more or encouraged by lower numbers of new covid infections. You will understand whatever the state chooses to tell you.

Why?  Any figures  they will tell you will not reflect in real time the resurgence of the disease or the continued “diminution” of the disease. (What a lovely word! Diminution presents a very comforting feeling to the person who reads or hears it.

Once a week the authorities will analyze a week results, and who knows if they will level with us as to the real extend of the spread.

Why should they?

Because they have softened the real picture for a year and a half.

The state computerized data collection formats used the very questionable method of  the Center for Disease breaking down the number of new cases reported per county by increments of 100,000 of population.

In order to know how many infections you have in a day, I the reporter, and you the person concerned about statistics must know the population of your county to know how many infections of covid are really happening a day.

Then multiply that out by week and 4 weeks of a month. The state could very easily report the infections by total population automatically without leaving us out here in queryland to do the math.

What this format has done is provide a false sense the disease is not as spreading a lot each day.

But unless you multiply it out according to 100,000 increments of population, the growth of cases is being  reported with an error factor of as much as 50%.

Now the State  as the Center for Disease Control announced a month previously,  said Friday statistics are not going to be issued by the major stat providers. (I guess they are tired.)

This announcement by the state coincided with President Biden announcing the State of Emergency would end May 11.

Now Governor Hochul and the legislature currently controls covid policy and the right to announce a covid state of emergency  again if needed.

To refresh your memory, the  State Senators and Assemblypersons  took this away from the Governor’s office during the sunset of the former governor (Andrew Cuomo).  Now the senators and assemblypersons are now following suit.

The Governor’s updates on covid released to the press via email  have basically stayed the same issuing new statistics based on the former day, sometimes on time and sometimes not — now are going to issue the stats for a week on new covid cases beginning this  week. The day-by-day results will be on the New York State Covid Tracker dailyl

However the state is also looking at relaxing the amount of reporting hospitals have to provide on covid cases coming in, admissions.

It is unclear how detailed or curtailed the hospitalization figures will be. The statkeepers in the hospitals do not for the most part do hot treat patients.

I see no reason why that cannot still be reported the same way it is now. Hospitalizations broken down by daily covid cases compared to total hospitalization admissions.

My concern may be way off base, but the hospitalization stats you can get by hospital off the New York State Health Department Hospitalization site are hard to get a true picture because they are tough for the non-technical person to  even access a hospital without knowing the hospital code. The hospitalization numbers are very difficult to access comparative information fast. (Perhaps that’s why few media report them in a comparative way that actually means something.)

Since the March 17 statistics came out, here is where Westchester County stands:

First the good news that the present daily statistics put out ended March 17

Westchester county had 35 positives if 1,211 tested 2.7%. The county over 7 days average 3.6 new cases a day per 100,000 population.

Westchester has completed a 13th week of decline in new covid cases with 175 cases compared to 254 last week. 989 for the 2 weeks and 3 days of March so far..

However, not so fast. At 3.6 new cases per 100,000 population a day over 7 days, you have to multiply that by 23.26 the number of 100,000 uncrements in Westchester population (1,040,000) to get the true daily figure.

The true daily number of cases for 1 day is 90 a day. Which is 634 for a week and over the month of March would give us 2,559 new cases in the month.

Perhaps this explains the high number of hospitalizations the 7 counties are experiencing the first three weeks of March

According to the report statistics on the hospitalizations graph for the Mid-Husdson Region of the 7 counties this is the hospitalizations were for the counties which have a total population of :

The population of the 7 counties in the Mid-Hudson Region is 2,326,000. That means there are 23.26 segments of 100,000 in the 7 county population. Multiply that daily figure of new covid patients hospitalized in 7 counties (55.56  per 100,000 people, you get 129 hospitalized patients with covid  being hospitalized in 1 day March 16 in the 7 counties as of March 13.

Hospitalizations for  17 days in March for all 7 counties look like this:

MARCH   COVID HOSPITALIZATIONS  ICU INTUBATED  COVID/DAY/100KPop    DAY/WEEK/MONTH

17                  117                              11                            5.56               129  /905 /3,621

16                 129                               10                           5.56                 129  /905/3,621

15                 128                                14                           5.51                128  /897/3,588

14                 129                                13                           5.56                129  /905/3,621

13                  137                               15                           5.9                  137  /960/3,842

10                  136                                12                           5.86                136  /954/3,816

9                  145                                  7                           6.24                145 /1,015/4063

8                  147                                  7                           6.33                147/1,029/4,116

7                  153                                 11                           7                    162/1,139/4,558

6                  151                                 11                            6.50              151/1,058/4,233

3                 147                                  15                            6.33               147/1029/4116

2                 155                                  15                            6.68               155/1,087/4,350

1                  178                                 12                            7.67               178/1,246/4,984

FEB 28         164                                  13                           7.06               164/1,149/4,598

The above chart shows you what the probable hospitalizations will be across 7 Mid-Hudson Counties for the month of March– approximately 4,500 if the current average covid hospitalizations for covid continue

The hospitalizations for covid as you can see are going down  from 164  as of February 28 to 129 last Friday..110but not by much. The average for the 7 counties for the 13 days is 144 for the 7 counties  the new infections a day give you 1,015 infections a day, 4,000 cases in the month.

This covid is out there and we need to be aware.

How does this affect White Plains Hospital Center?

WHITE PLAINS HOSPITAL SITUATION

However, in White Plains alone, in the 30 days since February 15, White Plains Hospital Center has admitted 329 patients and 130 (40% of those admitted) were admitted for treatment of covid.

In the last week, White Plains has  Hospital has seen some slowdown. Of  68 admissions, 42 were admitted for treatment of covid (62% of admissions) from March 8 to 15. March 1st through March 8, 42 persons of the 72 admitted (62%) were for treatment of covid.

Westchester County had 2,906 cases lab verified positive with covid in the month of February. But why all the hospitalizations across the 7 counties?

I worry there are just more covid positive persons out there who of antigen tested saw they were positive but have not  gone to get lab verified becaus they need to work, need to take care of children and covid makes them sick and they eventually get so sick they have to have go to the hospital for treatment. This is just a hunch.

Significantly there is no data now telling the true nature of our covid situation.

If the state is thinking seriously about cutting data from the hospitals because they think it is no longer needed how with the State Senators and Assembly persons and county health officials decide if covid is under control or not.

We need more data not less.

If I was a health administrator I would demand, no, WANT to know:

1. How long each covid infected person is now staying in the hospital.
2. How many are reinfectees, so we can judge how many will come  back. (They have to be coming back now)
3. How many have long covid
4. How much additional medications to they need.
5. Do our hospitals have enough medication to take in these persons so sick they need to be admitted to the hospital at a 40% rate of admissions a day?
6. We should stop worrrying bout keeping empty beds and worry about and find out aggressively what the disease is doing. Are we seeing new variants?
7.  The schools should be told to report new cases of covid, flu so we can see how the new laissez fair State Education Department you do not have to report cases of covid policy is working out. We do not know. Let me repeat that, we do not know.
8. The disease roared back last July with 10,000 new cases in a month, and here after almost 7-1/2 months later we still seeing new cases over 7 counties at a 4,000 a month pace, what if this happens again, only on a larger scale, what will the leadership do?
9. Vaccine boosters for the fall, will county residents have to pay for them? The public is not getting their full compliment of shots when they are free. It is not their fault. They have been told it’s O.K. with no reason except hopeful optimism. If covid throws a 6th wave at us by summer, somebody has to think about how they are going to get the unvaccinated and not completely vaccinated vaccinated.
10. Restrictions have been completely relaxed. Leaders say we are getting back to a new normal. We’re told all about the wonderful things being done in Albany in the budget. Could do a little thinking about the covid situation please.

Thinking is something the leaders in Albany and Counties and cities and towns should do more of.

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Do we need a spring COVID-19 booster?

Katelyn Jetelina

 and 

Jeremy Faust, MD

2 hr ago

(Reprinted with permission)

It’s been close to 6 months since the initial rollout of the fall (bivalent) booster. A lot of people are wondering: Do I need a spring booster? 

The answer hinges on more questions: What is the purpose of vaccines? Does that purpose change depending on age or health status?

The purpose of the vaccines

Last month, the FDA and CDC made it clear that the primary purpose of vaccines is to prevent severe disease and death. Decreases in infection and transmission are a bonus at this point, and unfortunately, protection against infection is only temporary.

This makes sense for younger and healthier people. They are staying out of the hospital from COVID-19 for three main reasons:

1. Hybrid immunity. Younger people are more likely to have been infected. People with both vaccination and infection history have protection that lasts longer.
2. Less likely to have comorbidities. Their immune systems are less taxed.
3. Robust immune memories, particularly T-cells. Their thymuses (the organs that give rise to T cells) haven’t gradually degraded into useless blobs of fat, yet.

This means that even if antibodies are waning after 5-6 months, this is okay because protection against severe disease isn’t waning yet.

The story is different for immunocompromised and other very high-risk groups, like older Americans with comorbidities. The purpose of the vaccines for this group should also be to prevent severe disease and death. However, one could argue that in order to do that, we also need to prevent illness.

There’s one big reason for this: SARS-CoV-2 infection can exacerbate potentially fatal underlying illnesses, like heart failure or diabetes. Protection against viruses and underlying illnesses relies on antibodies to act quickly before the immune system is pulled in multiple directions. If it is pulled in multiple directions, it can lead to hospitalization and death.

Immunocompromised 

Of the COVID-19 hospitalizations today, 25% are among the immune-compromised. (Immune-compromised make up 3% of the general population). There are really two subgroups to think about:

1. Non-responders to vaccines. At this point, this is a very small group of people, like organ transplant patients. Some people who did not respond to 2 or 3 doses eventually did respond to 4 or 5 doses. For the remaining non-responders, one could argue that there’s no point in boosting them, but the downsides of trying seem low.
2. Protection wanes quickly. The majority of immunocompromised people belong in this second group. The vaccine works, but just not as well and not as long. For them, vaccine effectiveness against hospitalization with the fourth dose peaks at 51% at 0-2 months, then drops to 28% by 2-4 months. (The bivalent booster may increase protection and duration, but we don’t know yet.)

There are few downsides to boosting this group every 6 months. It’s actually possible that the immune-compromised are somewhat protected against imprinting by virtue of their sluggish immune systems.

Older Americans with comorbidities

Those 65 years and older are contributing more and more to the proportion of deaths over time. Among adults hospitalized for COVID-19, 96% had at least one underlying condition.

This is because 2 of the 3 defense walls have more holes than those of younger people. Comorbidities also increase with age, which means the immune response in general is a lot more taxed.

So this is another group in whom we want to prevent infection in order to prevent severe disease.

The latest data from the last ACIP meeting shows waning protection against infection among this group after 4-5 months.

The good news is that we clearly see that the risk of severe disease even in the very elderly dramatically declines with vaccination. In fact, very few people are in the hospital today who are up-to-date on vaccines. However, will this change with time? How much each booster helps (or does not help) incrementally is something that we really don’t have a good grip on prospectively.

What are other countries doing? 

Canada and the U.K. have offered the bivalent vaccine to the following groups this spring. To our knowledge, this wasn’t based on any new data but rather a similar thought process as above.

Both countries used loose language: people “can” as opposed to “should” get a booster 6 months after the last dose:

U.K.:

• People aged 75 years and older
• Residents of care homes and other living settings for seniors
• Those aged 5 years and older with a weakened immune system

Canada:

• People aged 80 years and older
• Residents of care homes and other living settings for seniors or those with complex medical care needs
• People aged 18 years and older who are moderately to severely immunocompromised
• People aged 65 to 79 years, particularly those with no history of SARS-CoV-2 infection

Will this be needed every 6 months until we start seeing predictable COVID-19 patterns? We don’t know. The WHO is meeting in Geneva this week to discuss global COVID vaccine recommendations going forward.

Bottom line

If you’re immunocompromised and/or an older adult with a comorbidity (and it’s been 6 months since an infection or last booster), a spring booster may be a good idea to stay ahead of the virus. Will it be official U.S. policy? We don’t know. There are rumors of FDA conversations happening behind closed doors. Hopefully, we will have an answer soon. But, as you can tell, it’s not a straightforward call.

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Happy spring! With warmer weather comes a calming of the respiratory season. Hopefully. Viruses are definitely still circulating, but we are seeing some encouraging signs.

A look back

Doctor visits for fever and a cough (i.e., “influenza-like illnesses” or “ILI”) were back to pre-pandemic levels this season, but had some uncharacteristic patterns:

1. Shifted to earlier in the season;
2. Descended as quickly as it ascended (ILI usually peters out);
3. Stalled just above epidemic levels for weeks.

ILI just dipped below epidemic levels.

Hospitalizations for respiratory viruses peaked in December, which is ~3 months early. COVID-19 continues to take the lead for hospitalizations. Interestingly, RSV, COVID-19, and flu peaked at different times. This no doubt helped our healthcare systems and makes me continue to wonder if there is some sort of virus-to-virus interaction (RSV pushes flu and then pushes COVID-19, for example).

Different age groups experienced very different risks of hospitalization this winter:

• 0-4 years: RSV was out of control, peaking at 65 hospitalizations per 100,000. This was 244% higher than the 2018-2019 season. (We really need an RSV vaccine for our kiddos.)
• 65+ years: COVID-19 clearly led hospitalizations.

During this respiratory season (week 40-week 10), we lost 64,180 Americans to COVID-19. This number is higher than any pre-pandemic flu season (see yellow in graph below).

Excess deaths (red line below) continue to be above the “epidemic threshold” (black line). We haven’t had a national conversation defining the new baseline. What do we now consider normal given that we have an additional threat in our repertoire? As we move out of the pandemic phase, this black line needs to shift up.

A look forward

SARS-CoV-2 in wastewater is nosediving. However, levels in the Northeast have started to plateau. If this trend continues, having a high baseline throughout the year would be incredibly inconvenient.

SARS-CoV-2 continues to mutate quickly, as expected. The international community is keeping an eye on two Omicron subvariants:

• XBB.1.9- In the U.K., this is causing a slow uptick across metrics, including hospitalizations. In the U.S., the growth advantage of this subvariant is only ~35%. (As a comparison, the original Omicron had a 500% growth advantage causing the tsunami.) In other words, we shouldn’t fret.
• XBB.1.16–This has a case growth advantage of ~250% in India (17% increase in deaths). But, it’s hard to tell how much this is due biased testing and/or changing behavior due to the celebration of Holi.

XBB.1.16 could possibly disrupt a quiet spring in the U.S. But, a wave is not only dependent on weather, a new subvariant, or changing behavior, but also the number of susceptible people. This precise number is incredibly difficult to grasp because it depends on a number of factors: Who has been infected, when, and by what variant?

In other words, future waves are getting harder and harder to forecast.

With COVID-19 declining, flu may have the opportunity to start inclining for an out-of-season resurgence, especially since the Flu B strain hasn’t shown its colors yet in the Northern Hemisphere. No signs yet, but time will tell.

Norovirus

Norovirus wasn’t part of the “triple-demic” winter talk, but positive tests keep going up. It’s not entirely clear how high this will go, but in pre-pandemic times it typically peaked in March. Regardless, wash your hands.

Bottom line

Every pandemic winter has been unique and, thus, created unique challenges. While disease levels may be back to normal, the usual patterns are off. It may be years until we know how COVID-19 permanently changes the landscape.

In any case, reprieve is now here. For parents, flu and RSV are in the rearview mirror. For older adults and immunocompromised people, COVID-19 is declining. It will sure be interesting to watch how the rest of the year plays out.

Love, YLE

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“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, data scientist, wife. During the day she works at a nonpartisan health policy think tank and is a senior scientific consultant to a number of organizations, including the CDC. At night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well equipped to make evidence-based decisions. This newsletter is free thanks to the generous support of fellow YLE community members. To support this effort, subscribe below:

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Dear Friends, It was another busy week in Albany, with a snowstorm putting session on pause for a day, the One House Budget Resolutions being introduced and passed in each house of the Legislature, and several of my bills passing the Senate.   The Senate One House Budget Resolution represents the Senate’s priorities and policy positions. I am pleased with many aspects of our budget, including important measures for education. Read more about it below. With the April 1 deadline approaching, negotiations continue between the Governor, Senate, and Assembly, and I remain hopeful that a final budget will be put forth with policies that are reflective of the needs of all New Yorkers, and those in District 37.  This Friday, I will co-host a Women’s History Month panel alongside Majority Leader Andrea Stewart-Cousins, featuring three women writers from Westchester County. More details on this event and how to join are below.  As always, if there is anything my office can assist you with, please email me at smayer@nysenate.gov or call (914) 934-5250. Warm regards,Shelley B. MayerState Senator37th DistrictLegislative Update One House Budget Proposals In response to the Governor’s proposed budget, the Senate and the Assembly have each presented their own budget resolutions.  Education: Our resolution proposes historic investments in schools – including the full phase in of the Foundation Aid Formula. We propose to continue and increase our investment in full-day Pre-K for four- year-olds, to provide universal free breakfast and lunch for every eligible school in New York, and to increase investments in our 853, 4201, and Special Act schools to help put them on a sustainable path for the future. I am proud to be part of a Senate Majority that believes deeply in investing in our education system that serves the next generation and supports the diverse needs of our students. Housing Compact:  The Senate resolution also responds to the Governor’s housing proposal by rejecting the mandatory housing growth targets and the overriding of local zoning while increasing the available incentives for smart growth and creating a land use advisory council to review municipal growth over the next three years. The Senate also included language in support of the principles of placing reasonable limits on residential rent increases and ensuring tenants are not removed from their homes without “good cause,” as well as providing $250 million for a new Housing Access Voucher Program. We are committed to addressing the affordable housing crisis in a way that honors the unique character and existing efforts of all of our communities. Our work is not complete. The Governor’s office, the Senate, and Assembly will begin negotiations to craft our final enacted budget, due April 1st. I will continue to fight for the needs of Westchester residents and all New Yorkers, and I look forward to providing details about the final budget. Here’s a description of the NYS budget process which shows the stages of the process

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