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John Delzell, vice president and incident commander for the health system at Northeast Georgia Health System, and Supriya Mannepalli, the director of infectious disease at NGHS, recently answered questions about the current surge in coronavirus cases fueled by the omicron variant.
What can you say about the omicron wave of COVID cases, and how does it compare to prior waves?
Delzell said the omicron wave is similar in many respects to earlier waves of the pandemic: As the new variant spreads throughout the community, cases rise and more people are admitted to local hospitals. That hasn’t changed.
What has changed, however, is that the current rise in cases has happened “very quickly,” whereas the increase in cases during the delta wave was more gradual.
Record numbers of people are showing up to the emergency department.
“That's probably the thing on the ground that we're seeing, the volumes in the emergency department over the last week have been incredibly massive,” Delzell said. “I mean, we've set records on multiple days for just the number of patients seen in the emergency department.”
Mannepalli said during a COVID-19 webinar hosted by the Greater Hall Chamber of Commerce that the omicron variant is up to five times more infectious than the original strain of COVID-19. For example, she mentioned a study which showed that people with the original strain may infect two to three others, while those infected with the omicron can transmit the virus to as many as 10 people.
The good news, however, is that a smaller proportion of those people are being hospitalized.
“The number of people that are actually requiring admission as a percentage of the people that actually have COVID is a little bit lower in this wave compared to the last,” Delzell said.
What are the models predicting for this wave?
NGHS President and CEO Carol Burrell said during a COVID-19 webinar Thursday that the health system will likely break its all-time record for hospitalizations in the coming weeks. The highest peak of 355 was recorded in January, 2021. The second highest peak of 333, which occurred during the delta wave, was recorded in September, 2021. There were 277 COVID-19 patients as of Jan. 13.
Statewide projections from the Institute for Health Metrics and Evaluation, developed by the University of Washington, predict far more hospitalizations during the omicron wave, largely because the omicron variant is causing so many infections. Worse still for Northeast Georgia is that because its vaccination rate is lower than the state average, Delzell said, “we're much more likely to outperform the model in the number of hospitalizations.”
Is NGHS doing anything differently to handle this wave of cases?
Operations haven’t changed much, Delzell said. One thing that has changed is that they do not have any national guardsmen like they did during the delta wave.
“In the last wave, we had the National Guard here and had a whole group of guardsmen that were really helpful in both our hospitals here in Gainesville and Braselton, and we don't have that right now,” Delzell said. “So we're still working on those requests to the state.”
Kemp will deploy around 1,000 guardsmen and more than a 100 contract healthcare workers to hospitals around the state over the next few months.
How reliable are at-home COVID-19 tests?
Most at-home COVID tests are antigen tests. Mannepalli recommends PCR tests over antigen tests because they tend to be more reliable.
“The most important thing we have to remember is that the antigen tests are not as sensitive as the PCR tests,” she said. “And the FDA has also issued a statement recently that the antigen tests are less reliable, especially when done within the first two days of the symptoms. At NGHS, we recommend using the PCR tests … because they're just more sensitive and specific.”
Because the positivity rate is so high, she said, anyone who has been exposed to the virus or who has symptoms should assume they have been infected
“At this point, I think the biggest message is that if anyone has a known exposure to someone with COVID, they have signs and symptoms that are suggestive of COVID, that's what they have, whether they have the test done or not. So the most important thing is that they isolate themselves first.”
Delzell said if you have symptoms, you should assume you have the virus even if your test comes back negative. “When the prevalence is that high of COVID in the community, testing doesn't really improve your diagnosis ability very much.”
“And especially the antigen tests,” Mannepalli added. “You cannot rely on that negative antigen.”
Which kind of mask should you wear?
During the Greater Hall Chamber of Commerce COVID-19 webinar, Mannepalli said the N-95 masks probably offer the best protection, but they come in different sizes and must be fit tested for each person.
For other masks, she said “it's extremely important that we choose a mask that is multi-layered, fits snugly, and covers the nose and mouth.”
What do we know about breakthrough infections at this stage of the pandemic?
Mannepalli said “the most important thing” to know is that the “majority of the infections are still occurring in the unvaccinated.”
Breakthrough infections are usually mild, she said, and get better within a few days.
Nevertheless, she said, “getting the booster is very important” for preventing breakthrough infections. She cited a Jan. 5 report from the Department of Public Health, which shows that 91.7% of breakthrough infections occurred in fully vaccinated people, while the remaining 8.3% occurred in people who received their booster shot.
“That’s the big message we need to send,” she said. “Even those who are fully vaccinated are having the breakthrough (infections).”
Hospitalization data on NGHS’s website does not currently differentiate between patients who are fully vaccinated and those who have received their booster, but they are working to provide that information next week.
Can hospitals determine which coronavirus variant patients have? And how does this impact which treatments they receive?
“The answer to that is no,” Mannepalli said.
The CDC estimated, however, that in the week ending Jan. 1, 97.5% of coronavirus cases in the southeast were caused by omicron.
Given that information, Mannepalli said they are tailoring treatments accordingly.
Monoclonal antibody treatments have been highly effective against earlier variants, particularly those developed by Eli Lilly and Regeneron. But they do not appear effective against omicron. The sotrovimab version, made by GlaxoSmithKline and Vir Biotechnology, does appear effective against omicron, but the supply is very limited. Mannepalli said they received 16 doses initially and a few more this week. They are prioritizing outpatients who are most at-risk, those who have compromised immune systems or elderly people who haven’t been vaccinated.
“The federal government has the supply and they distribute it to the state and then the DPH distributes it out to hospitals based on the percent of patients in the area,” Delzell said.
Antiviral pills have shown promise. Mannepalli said Paxlovid has been shown to cut the chance of hospitalization or death by 80%, but it is also in short supply. The only pharmacy carrying the treatment in Hall County is located in the Walmart on 400 Shallowford Road, according to the DPH.
Does NGHS have enough nurses to handle the omicron wave?
Hospitals have been struggling with a nursing shortage for a decade, and the health system is still short about 400 nurses. Delzell said they are using traveling nurses to pick up the slack.
“We're doing everything we can to make sure that we've got enough nurses and enough staff to take care of the patients,” he said.