“We will continue to see outbreaks like we’ve seen, and we have to continue to live and deal with it. I’d say we’ve got another year or so of what we’ve been living with,” said Dr. Tom Balcezak, Chief Medical Officer at Yale New Haven Health System.
In other words, according to Balcezak, masking, booster shots and restrictions on indoor gatherings are nowhere near over because mortality rate due to COVID is too high a risk.
According to the Centers for Disease Control, in 2020 there were 20.6 million cases of COVID-19 and with a mortality rate of 1.8 percent. In 2021, there have been 30.4 million cases of COVID-19 and a mortality rate of 1.5 percent. For comparison, seasonal influenza has a mortality rate of 0.1 percent.
“On balance, the rate is going down,” Balcezak said. “But it is still more than 10 times the mortality rate of flu. I don’t think we are willing to accept living with this unless the mortality rate falls substantially.”
Today, 210 patients with COVID-19 are hospitalized across the health system. Less than half the number that were hospitalized in December 2020.
One year after the release of the COVID-19 vaccines and 21 months after the start of the pandemic, Balcezak said there are really three potential paths forward. First, the Omicron variant takes over, is significantly less deadly and we learn to live with it similar to how we live with influenza. Second, between the vaccine and natural immunity we develop a true herd immunity. Third, we continue on with restrictions until hopefully one or two happens.
The flip side is that the restrictions put in place by states, towns and private institutions like Yale-New Haven Hospital have caused significant secondary complications that are resulting in loss of life as well.
These complications include an increased number of individuals that stayed home when they experienced symptoms of a stroke, an increased number of individuals that did not seek medical care when experiencing symptoms of a heart attack, have been diagnosed with late stage cancer due to missing routine exams such as colonoscopies and the delay of many different types of so-called elective surgeries like joint replacements and gall bladder removals.
“If someone is delaying a cancer surgery or joint surgery it will be a more complicated surgery and likely a worse recovery,” said Marna Borgstrum, CEO of Yale-New Haven Hospital.
In each of these cases individuals either died or are now dealing with medical complications that may not exist were it not for restrictions or public health messaging put out during the pandemic.
“I think one of the key things is defining what’s elective,” Borgstrum said. “We took a very broad definition of what’s elective at the beginning of COVID. For someone who has an indication to have a colonoscopy, is that really elective?”
Routine colonoscopies, especially for individuals with a family history of colon cancer, allow for earlier diagnosis and successful treatment, Balcezak explained.
“A colonoscopy, while it is something that you schedule, is hardly elective. It is an important preventative clinical care that you have,” he said. “We are now still feeling the impact of delayed care from 2020. If we have to put off those kinds of procedures we know it is just going to snowball.”
As Yale New Haven Hospital prepares for a potentially challenging winter with COVID-19 and the more severe H3N2 flu variant circulating, any restrictions or changes to routine protocols will be evaluated more stringently for the secondary impacts they may cause.
“I think in our field in general we are all talking about not using the term elective, but maybe required,” Borgstrum said. “Physicians can help determine what is really required for people’s health.”