Podcast: Hospitalized patients with COVID reach record levels

Jim Dryden (host): Hello and welcome to “Show Me the Science,” conversations about science and health with the people of Washington University School of Medicine in St. Louis, Missouri … the Show Me State. As we continue to detail Washington University’s response to the COVID-19 pandemic, in this episode we hear about the current crisis with the omicron variant. Although there is some evidence that omicron may not be as deadly as earlier strains of the coronavirus, it is so infectious that many hospitals are bursting at the seams. That’s particularly true for pediatric patients, with more children hospitalized now than at any time during the pandemic, according to Dr. Jason Newland, a Washington University pediatric infectious diseases specialist at St. Louis Children’s Hospital.

Jason G. Newland, MD: Our hospitals are under siege because of this virus. Don’t climb a ladder right now. Stay off the ice. Actually, you could say, “Don’t drive a car,” because if you get in any sort of accident and need the hospital, your care is going to be different.

Dryden: We spoke to Newland over Zoom, for the sake of safety, about how hospitals in the St. Louis area are suddenly more crowded than ever with COVID-19 patients. We also were joined by an infectious diseases specialist who works with adult patients.

Hilary M. Babcock, MD: So I’m Hilary Babcock. I’m an infectious disease physician with BJC HealthCare and Washington University.

Dryden: My first question in this can be for either of you: What the heck is going on?

Babcock: That’s a great question. What we’re seeing is really — I know that we have used the word ‘unprecedented’ a lot in the last two years – just going to use it again. We’re seeing an unprecedented rise in case numbers across the whole community, which means also among our health-care workers and staff and also means in our hospitals and among our patients. The numbers are really staggering.

Newland: It’s been explosive, explosive rise, starting really right after — it felt right after Christmas, all of a sudden, the positivity rate shot up. Unprecedented numbers of people needing to be tested, wanting to be tested, lining up in places where we really can’t support them to be lining up. You can’t be coming to the emergency department right now for tests. Unprecedented, another part of this pandemic, none of us saw. We knew things could happen but not this kind of stuff. And now, our health-care system’s again on the brink. It’s a little scary right now, for sure, from my perspective, too, even as a pediatric person watching what’s happening in our own pediatric hospitals as we’re at unprecedented numbers of COVID patients, which is impacting other things in our hospital.

Babcock: This is kind of what we worried about at the beginning. And it didn’t happen in exactly this way at the beginning for probably a few reasons. One, people really did shut down. They stayed home. They wore masks, and that worked. But also the virus, that virus, was less transmissible. If we had started with omicron, it would have been a different ballgame. The severity of illness and the deaths look to be a lower percentage of the people that got infected. But when the numbers are so huge, those numbers of people ending up in the hospital and dying are still going to be large, but the percentages are lower. I do just have to share, my son, who’s in high school, said — he did not make this up; he heard them talking about it at school — “This time, we are flattening the curve but against the wrong axis.” So we now have like a straight line up. Instead of a flat line across the x-axis. We have flattened out onto the y-axis, straight line up.

Dryden: You both used the word unprecedented, but I wonder if in some ways this was predictable. Maybe not these numbers, but I mean, we saw a rapid rise in cases in southern Africa. We saw the same thing in the UK, probably some other places, too. And omicron arrived just in the middle of the holiday season, when a lot of folks who did lock themselves down in 2020 were like, “I’m seeing my family this year.”

Newland: We would all — Hilary, myself and others that sit here and watch this every day — would have said, “Yeah, we’re going to have another variant.” I mean, and I think all of us on that Thanksgiving morning, I think that’s when I heard there was omicron, or Thanksgiving Friday, and I was like, “Oh, no.” Yeah. So I’d say, yes, it was somewhat predictable. And maybe you could say it was predictable even before we knew about omicron. But I don’t think any of us, because of what we had seen over the past 18 months, truly appreciated how transmissible and how truly explosive it was. I thought last year’s winter surge was about all — that was going to be our peak. That’s what I thought, but that was wrong because the amount of cases now make that look like nothing.

Babcock: Yeah. I do think that, as we saw what was happening in South Africa, that it was definitely predictable that we were going to have another surge. It was going to be a big surge. It was going to move fast. And we don’t have sufficient vaccine coverage to really interrupt this transmissible spread with the number of people that aren’t vaccinated in our communities. So even people who have gotten vaccinated — which has really kept them safe and has really kept them out of the hospital and kept them from dying, even with omicron, which is wonderful — they can still get sick and infected. It’s just been a challenge, for sure.

Dryden: I know more people now than at any time during the pandemic who’ve tested positive. And some of them are fully vaccinated and boosted. I even have a friend, he got COVID between his first and second shots last winter, and I think he got a booster in the fall, but this month, he tested positive again. And he’s not in the hospital, but he did feel pretty sick with a fever. I wonder how protected are vaccinated people against omicron, or how protected are people who’ve had a prior infection or, like this guy, both?

Babcock: You’re definitely better off vaccinated than unvaccinated. I mean, there’s just no question about that. And as we see people who have been vaccinated get infected, it is easy to say, “Clearly, the vaccine doesn’t do anything,” but that’s just not right. The vaccines are really working. This would be so much worse if no one was vaccinated, and our hospitals would just be overrun. We are seeing the same disconnect between the massive case rise in the community and the case rise in the hospital and the case rise in the ICU. While all of those are rising, they are not rising proportionally. And even though we’re getting inundated in the hospital just due to the huge numbers of people who are infected, those percentages are still lower. You are still protected. I think there’s a feeling that a vaccine is sort of an all-or-none. ‘The vaccine failed if you test positive for COVID.’ And that’s also not really true. The vaccine’s primary job is to keep you from getting sick and dying, and it’s secondary job is to decrease your risk of infection so that you don’t spread it as much to other people. And it’s doing a great job on the first one, and it’s doing a reasonable job at decreasing infection rates, and that will help to decrease spread from vaccinated and to vaccinated people. But when there’s also a big pool of unvaccinated people, there’s just constant exposure, and it’s what’s going to happen.

Newland: The vaccine, as Hilary said, I mean, it basically turns a potentially fatal disease into a common cold and has shown that over and over. And we are very, very lucky that it has been as effective as it’s been from the get-go. I mean, from the very initial, up to 95%, it has kept people out of hospital. It has helped our health-care system. I am now — if I talk to someone that’s been vaccinated and boosted that’s tested positive, I say, ‘Hey, thank you. Thank you for getting vaccinated because you’re helping us. You might not feel, but you are helping us tremendously.’ And I’ll say, the last real important point is, (with) some of these long-term complications, the vaccines are showing to be protective. We in the pediatric space, our hospitalizations, like Hilary talked about in the adults, it’s completely — if you’re vaccinated, we hardly see any of those in the hospital. That’s why we have to keep vaccinating. I mean, it’s working. It’s doing exactly — it’s doing better than I ever would have imagined, even this far into the pandemic.

Babcock: And there is some data coming out that is suggesting that long-COVID is also prevented by vaccination, so that even people who got breakthrough cases are much less likely to go on to have some of those long-term complications that we’re hearing about that can be really debilitating for people and have a big impact on their life.

Dryden: It’s funny to me, though, I’m hearing from friends more and more that they’re thinking since they’ll probably get this anyway and they’re vaccinated, they probably won’t get all that sick, so maybe they should just stop being so careful. ‘I’m going to get it anyway.’ Maybe I’m just an illness-ophobe, but I’ve never had that thought: ‘I’m going to get a cold this winter anyway, so I’m not going to wash my hands or stay away from the guy who’s coughing.’ But have you heard from folks like that? ‘Everybody’s going to get it anyway. What’s the point?’

Newland: I hope eventually we get there. But the reality of it is — Hilary has to deal with this more than me, being more on the adult side — is that, as we said, our hospitals are under siege because of this virus. Don’t climb a ladder right now. Stay off the ice. Actually, you could say, ‘Don’t drive a car,’ because if you get in any sort of accident and need the hospital, your care is going to be different. You’re going to be waiting. You’re going to have things. So we are pleading with people, in many respects, to do the right stuff. Vaccinate. Get yourself tested if you’re sick. Stay home if you’re sick. We got to protect the health-care system. And over the next couple of weeks, it’s going to be very challenging. I think that’s where we are pleading with the public, ‘Vaccinate, stay away. Do these things so you can help the health-care system.’

Babcock: Yeah. Because I think people are feeling like — we tell them that because you’ve been vaccinated and boosted, this won’t be as bad for you. And that’s a true message. That’s good. I do think, I would just point out, when we say ‘mild’ and ‘you won’t get in the hospital,’ as you mentioned, Jim, sometimes mild means you have a fever of 102 and body aches, and you’re home from work for three or four days, and you don’t feel good. That’s still mild COVID, and that’s better than ending up in the hospital. But because we know that there are so many unvaccinated people in our community and there are people that are immunocompromised — they have underlying health conditions that increase their risk of ending up in the hospital — if everyone else just says, ‘I’m just going to get COVID, and not take any precautions and, ‘I don’t care. I don’t need to wear a mask, and I’m just going to wander around and go to the store, a concert or a party,’ and, ‘Everyone’s just going to get it. It doesn’t matter if they get it from me or from somebody else. I don’t even care.’ Then what Jason’s describing is what we’re seeing now. Your mild illness is going to lead to three other people getting sick, who each infect three more people themselves. And a lot of those people are not vaccinated, have underlying conditions, do end up in the hospital. And our health-care workers are also getting sick at incredible numbers because they live in the same community with everyone else. And Jason’s exactly right. People are staying in our emergency rooms for three, four days because they can’t get into the hospital for a bed because there aren’t any beds that have staff to take care of patients. And people at other hospitals that need care that can only be provided at our hospitals can’t be sent here because we can’t take care of them. And that will have significant impacts on the health of all of those people.

Newland: And in turn, the mental health of the health-care workers who —

Babcock: Yes. It’s scary,

Newland: — for the most part, are in this work because they want to help people. And when you can’t help somebody, it’s just another — you feel like you failed. And that compassion fatigue that you’re hearing more and more about is real. And that’s part of it, is the feeling that, ‘You can’t help everybody.’

Dryden: And Aunt So-and-So had her hip replacement scheduled for January. That’s not going to happen now.

Babcock: I think that we’re going to be delaying procedures for at least the next few weeks. There’s just no sign of a top to this curve yet. There’s no sign of a peak in it. And once we come over the hump, there’s a ways to come back down before we can be sure that we can return those staff to the OR spaces and not have to have them taking care of COVID patients in our hospitals. There are people scheduled all the time, and it’ll take a while to work, and the people who had to get delayed, and to move the other procedures around to accommodate them. And as Jason said, we’re all health-care workers. That’s what we’re here for. That’s what we’ll do. People will work overtime again. They’ll work longer hours again. They’ll add on extra cases again to try to catch up because that’s what we do. But it will take a while for the impact of this to settle.

Dryden: Outside of the hospital, throughout this pandemic, and Jason, I know you studied this, we’ve heard about the importance of keeping kids in classrooms. What about now? I mean, even with the vaccines available to kids, there are more kids in Children’s Hospital than at any other time during the pandemic. Are we at a point where it might be best to just give it a week or 10 days and then try to start again?

Newland: No. I think we got to keep in school. Most schools, thankfully in our region we’ve gone to this, is that they’ve kept these strategies in place, the mitigation strategies in place, that they did before. And those are the masking, the distancing, the keeping people home when they’re sick. Those things should still work against omicron. Now is it going to be, is your margin of error a little less? Yeah. If you decide to horse around somewhere with your buddy who has a cough a little longer and not get to class, yeah, you might get it. But these areas are more controlled. I think that the negative consequence of not being in school has been tremendous to these kids. And I think we can do this, to keep them in and to protect them in this size. And the other thing that’s happened, so in November, beginning of November, we were able to vaccinate the 5 to 11-year-olds. So we actually, from K-12, have all of them eligible to vaccinate. Now, we know the vaccine rates aren’t where we need to be. We need to up that. But that’s another layer of protection. We know our teachers can be that way, our staff. So I think there are the things in place that says it is a safe place. It actually might be one of the safer places because it’s controlled. And yeah, keep them in. I still believe strongly in that.

Babcock: The only thing I would add or just highlight, to be really sure that it’s clear, is that we would all want kids to be able to stay in school as long as all the safety practices that are needed to keep them safely in school are there. It does not make sense to say, ‘All the kids can come back to school. They don’t need to be wearing masks. They don’t need ventilation. They don’t need distancing. They can all just come back free-for-all.’ That doesn’t make sense. And it’s not safe. And I know that’s not what Jason was saying, but I just want to super highlight, if you’re all wearing masks and most kids get vaccinated, this is possible, though there are still going to be clusters and outbreaks, and there may have to be these, sort of, short-term circuit breakers for a few days off and then come back in.

Newland: And probably the biggest thing that’s going to impact schools is staffing, because there’s so many more people infected. You’re going to have — that might end up closing schools more, because you just don’t have the staff to safely provide school. So I think the next two to three weeks is going to be the most challenging time of this whole pandemic, which I think is the school officials and especially the school nurses. So anybody out there who’s listening, you go and thank your school nurse and tell them how much they mean to you because those poor people who have kept our kids safe and their staff safe have been, have had the worst of it. And they deserve a lot more credit than they’ve been given, so tell them that they’re doing a great job and thank them for what they’ve done.

Babcock: They get pilloried, people yell at them all the time, and they’re doing their best to keep everybody safe. So totally got that. Everyone who’s listening, go get your school nurses a gift card, too.

Dryden: I want to point out, because people are listening, they can’t see us doing this, that even though we’re having a conversation and we’re all on the campus here in midtown St. Louis, we’re doing this by Zoom to be safe so that we’re not unmasked close to one another. When all of us come to work, we’re supposed to verify on this little checklist that we feel OK. And one of the items on that checklist every day that I look at is, ‘Have you been exposed to a person with COVID in the past 10 days?’ And there’s only two answers: yes or no. And I’m thinking they ought to add a third, which is, ‘probably.’

Babcock: At this point, I do think that everyone should just sort of assume that you’re at risk for being exposed, and you should be doing the safety things that you should do if you’re exposed to COVID. So don’t go unmasked around other people, so that you don’t get it but also so you don’t give it to anybody else. Stay home as much as you can. I think that it’s true that people should assume that they could get exposed anywhere that they are, and take precautions to avoid that and then take precautions to not pass on to other people.

Dryden: One last thing: You mentioned masking. What about the quality of the masks? I mean, when this first started back in 2020, we weren’t supposed to get N95s because health-care workers needed them. But now, there’s more in circulation. Should we be putting on a higher-quality mask?

Babcock: My general message to the public is to please wear a mask. I would be happy if everyone wore any kind of mask. That would make a huge difference. If you’re already wearing a mask and you are worried that your mask is maybe not as good, wearing a medical-grade mask, an isolation mask or a surgical mask does provide better protection than a cloth mask. And if you upgrade to a KN95 or an N95, if you find one that’s comfortable that you can wear for a period of time, I think that’s also fine. The most important thing is to wear something. And if everyone would wear something, we would be much better off.

Dryden: Both Babcock and Newland say the rest of January is likely to be very crowded in very many hospitals all around the country, and they’re urging people to get vaccinated, to wear masks, to avoid big crowds and to do all of those things to limit the spread of the virus, that they’ve been recommending for almost two years now. Both say it’s possible that omicron is going to be less deadly than earlier strains. But with so very many people getting sick, that won’t necessarily mean a slowdown in hospitalizations and deaths.

“Show Me the Science” is a production of the Office of Medical Public Affairs at Washington University School of Medicine in St. Louis. The goal of this project is to keep you informed and maybe teach you some things that will give you hope. If you’ve enjoyed what you’ve heard, please remember to subscribe and tell your friends. Thanks for tuning in. I’m Jim Dryden. Stay safe.