The cumulative number of Flagler residents who have died of Covid reached 140 today, an increase of 26 just in the last three weeks, according to the Flagler County Health Department, as local infections and hospitalizations for covid continue to break records. Data is emerging that points to vaccines losing their efficacy over time, underscoring the push for booster shots in a significant shift from earlier guidance.
The reason: the delta variant of the coronavirus, far more infectiously virulent, has radically changed the landscape, making so-called “breakthrough” infections of the vaccinated more common than originally thought and forcing public health agencies to adjust. Put another way: if covid exposure to the original virus was like walking through a backyard sprinkler, exposure to the delta variant is more like walking through a car wash: a coat and hood can still protect you from getting soaked, but it’s easier to get wet.
As of Wednesday, the number of covid patients at AdventHealth’s 16 hospitals in the Central Florida region had spiked to 1,715, up from 1555 a week ago, with 90 in-patients at AdventHealth Palm Coast, 162 in Daytona Beach, 307 in Orlando and 147 in Altamonte, among other hospitals.
An additional 29 students and four staff members were confirmed to have tested positive in Flagler schools on Wednesday, for a cumulative total of 132 students and 33 staff members since school started last week.
At St. Augustine’s Flagler Health+’s Flagler Hospital, there were 14 covid admissions in the last 24 hours, a total of 100 people currently admitted with a covid-019 diagnosis, 22 of whom were in intensive care and 20 on a ventilator, according to the hospital’s Erin Wallner. A week ago, the hospital had 133 admissions and 30 people with covid in intensive care. That would suggest a possible cresting in the latest wave, though it’s not reflected in the broader numbers from AdfentHealth’s 16 hospitals in the Central Florida region.
“We are currently caring for twice as many COVID-19 inpatients than we had in the two prior spikes in July 2020 and January 2021,” Dr. Neil J. Finkler, AdventHealth Central Florida Division’s Chief Clinical Officer, wrote physicians on Wednesday. “All of our ICUs are at capacity as COVID-19 patients in this wave are sicker and staying longer, all while the volume and severity of non-COVID patients are also rising. Additionally, the age range of COVID-19 patients is shifting younger, with half of patients under the age of 44. This has caused emotional strain on our clinical teams, as it is incredibly difficult to see patients this young and this sick.”
Dr. Vincent Hsu, executive director of infection prevention and hospital epidemiologist, painted a more dire picture as he spoke at an AdventHealth briefing this morning: “This is a unfortunately a crisis of unprecedented proportions. We just haven’t seen these numbers,” he said. “So this has resulted in a lot of tremendous stress, shortages. We’ve got ICUs that are completely filled. And some of the ICU care is occurring in non-ICU areas. Many areas of care are being diverted to traditionally non patient care rooms, such as procedure areas or anesthesia, holding areas. There is a significant number of folks in the ED who are waiting to be admitted to either a regular room or an ICU care, that just are waiting for that.” Hsu said the growth rate, “even though we’re at all time highs, is slowing.” But universal masking and vaccination remains essential.
AdventHealth staff is being “redeployed” in response to the crisis, such as sending operating room staffers or registered nurses to the emergency room, and urging “a great need for hospitalist coverage,” according to Finkler’s internal message, which appeals for “Physicians and advanced practice providers that are willing to provide care beyond their regular duties” to make themselves known. Meanwhile the hospital network remains at “black status,” which means surgeries are limited to emergency procedures.
The Central Florida division is also ready to administer 670 monoclonal antibody treatments a week, “which could make a significant difference in helping patients recover at home and avoid hospitalization.”
But while the rate of breakthrough infections is still low and the rate of aggravations or death from covid in the vaccinated much rarer still, neither is as low as originally reported. On Tuesday, the New York Times reported on data from seven states since delta’s spread in July. “Breakthrough infections in vaccinated people accounted for at least one in five newly diagnosed cases in six of these states and higher percentages of total hospitalizations and deaths than had been previously observed in all of them,” the paper reported. “The absolute numbers remain very low, however, and there is little doubt that the vaccines remain powerfully protective. This continues to be ‘a pandemic of the unvaccinated,’ as federal health officials have often said. Still, the rise indicates a change in how vaccinated Americans might regard their risks.”
For example in California there has been 843 breakthrough hospitalizations–0.4 percent of all covid hospitalizations–and 88 deaths, or 0.5 percent of all covid deaths. The figures for Illinois were 0.9 percent and 1.3 percent. For Colorado, 1.2 percent and 3.1 percent. (See the data here.) Florida is not on the list because the DeSantis administration in late spring stopped issuing detailed daily reports on the pandemic’s effects in the state, and now doesn’t even publish death reports other than one weekly total. It is not broken down by age, sex or gender, and it does not differentiate between unvaccinated or vaccinated victims.
On Wednesday, the Biden administration announced plans to make booster shots available to all adults starting in September. “Having reviewed the most current data, it is now our clinical judgment that the time to lay out a plan for COVID-19 boosters is now,” U.S. Surgeon General Vivek Murthy said on Wednesday. “Recent data makes clear that protection against mild and moderate disease has decreased over time. This is likely due to both waning immunity and the strength of the widespread Delta variant.”
“That is why,” she added, “we are announcing our plan to stay ahead of this virus by being prepared to offer COVID-19 booster shots to fully vaccinated adults 18 years and older. They would be eligible for their booster shot eight months after receiving their second dose of the Pfizer or Moderna mRNA vaccines. We plan to start this program the week of September 20th, 2021.” The plan is pending an evaluation of the safety and effectiveness of a third shot by the Food and Drug Administration and the Centers for Disease Control’s Advisory Committee on Immunization Practices.
It’s important to keep in mind: a third dose is not the same thing as a booster shot, even though the terms are too often used interchangeably. The booster shot the surgeon general is referring to will be made available to all eligible vaccinated people starting next month. But a third dose is currently available for a small set of people who are immunocompromised. “The intent of a third dose is to provide that extra protection in populations that are not able to generate that immune response,” Hsu said this morning, “so patients that are immunocompromised, patients with cancer, transplant patients, patients on large doses of steroids. When they got the first two doses of the vaccine, many of them were not able to mount that antibody response to really get that protection. As a result a third dose is what is recommended to help hopefully get their immune system up to where that is.”
That’s different from the waning immunity naturally taking place among the normally vaccinated, for whom the booster option is coming. (See the CDC guidance on who is eligible for a third dose now.)