Yale Doctors Warn of Breakthrough COVID Infections, Counsel for Masks

As of August 23, in Connecticut 369 patients are hospitalized with COVID-19. That’s three times more than just one month ago. 

“We are going to see a handful to more than 100 cases in the hospital in a cyclic fashion, up and down for about a year or two,” predicted Dr. Tom Balcezak, the chief medical officer for Yale New Haven Health System at a press conference on Tuesday afternoon. 

Compared to the peak in spring 2020, that surge might not seem like much, but compared to one month and one year ago, it is considerable, Balcezak said. And it’s not just unvaccinated individuals who are ending up in the hospital. 

At Yale New Haven Health 27 percent of patients hospitalized with COVID-19 were fully vaccinated. At Hartford Healthcare, that number is 30 percent. In the state as a whole, 65 percent of the entire population is vaccinated. 

“Remember that the vaccines are only 95 percent effective. Some of you will get sick even with the vaccine,” Balcezak said. “The delta variant has 1,000 times more infectivity than the wild type, so it is just sneaking through.” 

And nearly all COVID-19 cases at Yale are currently the delta variant.

In short, Balcezak said he does not believe the bulk of the recent increase in cases are the result of a waning of the vaccine’s effectiveness, but on the delta variant’s increased viral load in individuals that are infected with it. So, to make up for the 5 percent ineffectiveness of the vaccine, Balcezak recommends wearing masks. 

“Masking and vaccines are synergistic,” he said. 

Although many had hoped vaccines would mean the end of mask wearing, many employers across the state are requiring both the vaccine and masks. 

“This will be the reality … vaccination and masking are going to have to be a continued part of our everyday life,” said Chris O’Connor, president of Yale New Haven Health.

FDA approval and vaccine exemptions

On Monday, the Food and Drug Administration issued full approval for the COVID-19 vaccine. This includes approval for a variety of populations, including pregnant and breastfeeding women, who were not included in the testing for the emergency use authorization. With this approval in place, more vaccine mandates are likely to follow from employers. 

“The FDA does not rush things and does not cut corners,” said Balcezak. “There is a segment of folks who have not yet chosen to be vaccinated and were waiting on this full approval by the FDA.” 

Full authorization was based on following vaccinated individuals in a study for 6 months and all known side effects are detailed with the vaccine. In Connecticut, Balcezak said, few individuals have been hospitalized with reactions to the vaccine, although 13 children have been hospitalized for myocarditis across the Yale New Haven Health System. 

With the full authorization, Balcezak said, Yale New Haven Health and physicians who work in their health system are typically only providing exemptions for two major reasons: the first a prior episode of Guillain-Barre syndrome, a rare autoimmune response that typically occurs after a vaccination, and a known allergy to a component of the mRNA vaccine. 

“Many of our employees are undergoing medical treatments that are making them immunocompromised … and they may choose to defer the vaccine until they are done with whatever treatment they are undergoing so that they can get a good response to the vaccine,” Balcezak said. But immunocompromised individuals are typically only eligible for deferral. 

Most organizations, according Balcezak, are not relying on a typical “doctor’s note” to allow employees to avoid a vaccination, instead most employers are expected to complete their own review and approvals for an exemption. In short, a fear of needles will not allow employees to skip out on the vaccine.

For children 12 and under, who are still ineligible for the vaccine, Balcezak said that masks are the only solution. Gov. Ned Lamont has already mandated masks for all students at least to begin the 2021-2022 school year. 

Balcezak said he expects to see a slow stepped approval process of the vaccine for those younger than 12. First for 10 and up, then 8 and up and so on. 

“I expect some emergency use authorization for some kids under the age of 12 by January 1,” he said. 

Between the vaccines and the masks, Balcezak and O’Connor agreed that the rate of hospitalizations will likely soon plateau and then decrease, that is, unless a new variant that is vaccine-resistant emerges.

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