- Why has COVID put such a strain on all the hospitals?
Over the last 18 months, we have found that the length of time that patients stay in the hospital is much longer than someone being admitted for a non-COVID-19 related illness; some evidence shows this can be up to 19 days. Compare this to a patient who has had bypass surgery where only 5% of patients will have a hospital stay of greater than 14 days and the majority are discharged within 5 days. Ultimately, this means that bed availability for other diseases become unavailable when COVID-19 is at high levels in the community. In Oklahoma we have been holding multiple patients in the ED (upwards of 200) because of beds or staffing being unavailable.
Staffing has been key in situations like this and Oklahoma has long been one of the least poorly staffed states. According to the Oklahoma Nurses Association, we have 712 nurses per 100,000 residents when the national average is 1,100. And because of the stress of the pandemic, long hours, high numbers of death, even more nurses are leaving the profession which is making it harder to staff our hospitals.
Lastly, the impact of COVID on the supply chain has far reaching implications for the health care industry. Still 18 months into the pandemic it is still hard to acquire ample supplies in N-95’s, surgical masks, isolation gowns, gloves, ventilators, drugs used to treat COVID and non-COVID related and conditions.
In short, the pandemic has really emphasized that without space, staff and supplies, our three-legged stool of health care starts collapsing which we can see as the pandemic is still surging.
- What makes the Delta variant more transmissible?
The reason Delta has become more transmissible is because of mutations. Mutations, like the one that occurred with the Delta variant, made the virus more efficient by allowing it to hide more effectively from the immune system which then allowed for higher reproductive rates which led to higher levels of virus which made people more infectious. It is important to note that mutations within viruses is very common particularly ones like COVID. When enough mutations occur in a virus, it is called a variant.
When we talk about transmissibility of infections, we talk about in the terms of R0. The R0 tells us how many people you can expect to be infected after being exposed to someone with that infection. The original COVID strain infected between 2-2.5 people, and the Delta variant is expected to infect 4-6 people.
- If we are seeing people that have been vaccinated getting COVID, why should I get
For many viruses that undergo mutations, the likelihood of us seeing 100% guarantee of not getting infected is very small. The same could be said about vaccines like the flu vaccine that do not offer 100% protection from getting the flu. The COVID-19 vaccines are no different. What we have found scientifically and in practice, are those individuals that have received the COVID vaccine and have “breakthrough infection” do not get as sick as someone who is unvaccinated. The COVID vaccine prevents hospitalization and death. In the United States, there have been ~ 630,000 deaths.
Below is a graph from the White House briefing that shows that COVID related hospitalizations are 17X higher in the unvaccinated than the vaccinated.
Another reason to consider COVID vaccination is that the American Academy of Pediatrics states that for every 20 percentage point increase in those > 12 getting vaccinated, results in a 50% reduction in COVID spread for those who don’t have vaccine protection against COVID. There has been an increasing number of hospitalizations of COVID related illnesses in the pediatric populations.
We also know that as we increase the vaccination rate in our communities, we reduce the likelihood of another set of successful mutations leading to another variant like Delta surging through our communities. Right now we have patchwork vaccination in our communities, and COVID is hop, skipping and jumping to the pockets of unvaccinated areas, and driving disease and hospitalizations and death.
- If I have been vaccinated, why should I have to wear a mask?
Because the vaccines are not perfect. Just like the safety rating in your car doesn’t apply if there is six inches of ice on the road. Although your car may be top of the line in safety, you still wouldn’t drive 85 miles down the road without your seatbelt to challenge the safety rating. It’s a layered approach. Buy a safe car, slow down and take extra precautions. Get the vaccine, wear a mask and be cautious about attending large gatherings without good ventilation when transmission in your community is high. Don’t stress test your vaccine or the health care system.
- What happens if I have already had COVID, shouldn’t I just let my natural immunity
Natural immunity and vaccine immunity are not the same. Immunity between the two can differ in how strong your immune response was to either natural infection or vaccine and the length of time that protection will last you. It is also important to note that the amount of immune response you get from infection is unpredictable, while the immune response you get from a vaccine is more consistent. This
holds true for the variants as well. While it is true that the vaccines show less efficacy against the variants, it appears to be more consistent than natural immunity based on antibody testing.
This means that if you have had COVID, you can still get re-infected, particularly with the new variants. In fact, one study showed that after infection by COVID 12 months prior, 88% were protected with their antibodies against the original COVID strain, but fewer than 50% had antibodies that could block the Delta variant.
If you get vaccinated after COVID, studies showed you have 100 times more antibodies than if you had infection alone, and 100% of people had protective antibodies against the Delta variant.
- What is the rate of breakthrough infection?
Overall, 1/900 people may have breakthrough infection. 1/17,000 will need to be hospitalized, odds that are less likely than dying from electrocution. 1/83,000 vaccinated people died from COVID, which is less likely than dying from a wasp or bee sting.
- What and how do we know what the risks are with the vaccine?
Vaccines are monitored by the VAERS, a vaccine safety monitoring system. Health care providers are required to report certain adverse events following the COVID-19 vaccination.
Vaccine related anaphylaxis: 2-5 per million vaccinated in the United States.
Vaccine related clotting: Seen with the Johnson & Johnson vaccine and occurred primarily in women younger than 50 and there have been 39 confirmed reports.
Vaccine related death: 6,490 deaths (.0019%)
Vaccine related myocarditis: Seen with the mRNA vaccine at a rate of 1300 (762 confirmed)/339 million in younger males. In the general population, there is a rate of myocarditis in young males of 10.2 to 105.6 per 100,000 worldwide.
Vaccine related Guillan Barre: Of the 13 million doses administered, 161 preliminary reports that occurred with the Johnson & Johnson vaccine.
Vaccine related Infertility: This was a false claim. This came about because there was similarity between the spike protein on the virus and a protein on the placenta, but they are NOT the same and do not share the same genetic code. In men, a study showed there was no impact on the sperm count.
- What is a novel coronavirus?
A novel coronavirus is a new coronavirus that has not been previously identified. The virus causing coronavirus disease 2019 (COVID-19), is not the same as the coronaviruses that more commonly circulate among humans and cause mild illness, like the common cold.
- What are the symptoms of COVID-19?
Fever, cough and shortness of breath. Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease 2019 (COVID-19) cases. These symptoms may appear 2 to 14 days after exposure. If you develop emergency warning signs for COVID-19 get medical attention immediately. Emergency warning signs include trouble breathing; persistent pain or pressure in the chest; new confusion or inability to arouse; bluish lips or face.
- How does it spread?The virus that causes COVID-19 is spreading from person-to-person through close contact (within 6 feet) of someone with the virus. Someone who is actively sick with COVID-19 can spread the illness to others through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. That is why CDC recommends that these patients be isolated either in the hospital or at home (depending on how sick they are) until they are better and no longer pose a risk of infecting others.
- What is community spread?Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.
- How do I avoid getting the virus? The best way to prevent illness is to avoid being exposed to this virus. The virus is thought to spread mainly from person-to-person— between people who are in close contact with one another (within about 6 feet) and through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.
- Is there a vaccine for COVID-19 like there is for the flu?There are several vaccines available to the public that are safe and effective. It typically takes two weeks after your second dose of a two-dose vaccine or two weeks after a single dose vaccine for your body to build up immunity and be considered full vaccinated.
- How can I protect myself from the virus?
Get vaccinated as soon as possibe. Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry. Avoid touching your eyes, nose, and mouth with unwashed hands.
If you are unvaccinated, practice social distancing and avoid close contact with people, especially those who are sick. Put distance between yourself and other people if COVID-19 is spreading in your community. This is especially important for people who are at higher risk of getting very sick, such as older adults and people of any age who have serious underlying medical conditions.
- Should I wear a facemask?The CDC recommends those who are fully vaccinated no longer have to wear cloth face coverings in public settings except for health care settings, public transportation and airline travel. Those who are unvaccinated are asked to continue to wear a mask or face covering in all public settings and maintain social distancing.
- Who is at higher risk for serious illness from COVID-19?Older adults and people of any age who have serious underlying medical conditions may be at higher risk for more serious complications from COVID-19, including heart disease, diabetes and lung disease.
- I’m in the higher risk group, what should I do?If you are at higher risk of getting very sick from COVID-19, you should get vaccinated. If you are unvaccinated take everyday precautions to keep space between yourself and others; when you go out in public, keep away from others who are sick; limit close contact and wash your hands often; and avoid crowds, cruise travel, and non-essential travel. Watch for symptoms and emergency signs. If you get sick, stay home and call your doctor.
- If I am exposed to someone with COVID-19, how long should I quaratine? While the CDC still recommends the optimal quarantine time of 14 days from exposure, people can shorten that quarantine time to 7 days if they recieve a negative COVID-19 test or 10 days without a negative test and no symptoms.
For more information and more answered questions, go to the Centers for Disease Control at cdc.gov.