'Timing could not be worse' -- COVID variant plus holidays a dangerous combination

Nov. 30—Health care workers in Decatur and statewide are gearing up for a feared holiday spike in COVID-19 cases, hospitalizations and deaths, a fear magnified by the uncertainties surrounding the emerging omicron variant.

"The timing could not be worse," Dr. Jeanne Marrazzo, director of UAB's Division of Infectious Diseases, said Monday of the variant. "People are returning to their communities, their families, for vacation and the holidays. It really is a great opportunity for the virus to take advantage of us once again. That's exactly what happened last year."

She said the omicron variant of the coronavirus — first detected in South Africa and since detected in countries including Canada, Belgium, the Netherlands, Australia, the U.K., Spain, Italy, Israel and Austria — likely is already in the United States.

Kelli Powers, CEO of Decatur Morgan Hospital, shares Marrazzo's concern. While COVID hospitalizations remained relatively low Monday, she said the number of hospital staff with COVID infections is on the increase. Finding adequate staffing, especially nurses, if the community experiences a holiday spike in cases like the one a year ago will be problematic, she said.

"We are worried about it. We are seeing an increase already today from yesterday in the positivity rate in some of our employees," Powers said Monday.

The hospital had 17 patients with COVID on Monday, including eight in intensive care. Most worrisome to Powers: The average age of the seven patients on ventilators is 50.

"I feel like we will have an increase over the holidays," Powers said. "Some of that is because people are not getting their booster shots. After six months you should get your booster shot, and we're just not seeing many people taking advantage of that. I think, along with the holidays, that is going to cause a spike."

She said Decatur Morgan is preparing for an anticipated increase in COVID hospitalizations by bringing in as many staff members as possible.

She said staffing, especially among nurses, is a "huge" problem. "We have a lot of people working overtime. I hate that because it wears them out, but we don't really have a choice. We've been asking all our staff, nurses mainly, to work at least one extra shift per week," taking them to about 50 hours per week. "How long can you continue to do that? That's what I worry about more than anything: the fatigue."

She said she fears more nurses will choose to leave the profession.

Low vaccination rates complicate the problem, Powers said. In Morgan County, about 41% of the population is vaccinated, according to the Alabama Department of Public Health. In Lawrence County, the vaccination rate is 37%, and in Limestone it is 42%. Alabama's 46% vaccination rate is the lowest in the nation except for West Virginia and Wyoming, according to the Mayo Clinic database.

Powers said the lowest vaccination rates are among the younger generations, and that poses problems during the holidays.

"It's not that I want them to be vaccinated as much for them, because their chances of survival are greater," she said of young people, but during the holidays they are more likely to interact with and infect the immunocompromised and elderly.

Marrazzo said it is too early to know how severe the omicron variant will be. There are indications that it is more transmissible than other variants, she said, including the fact that South Africa has seen an increase in COVID-19 cases that may correspond to the presence of the variant there. On the other hand, South Africa has so far not seen an increase in hospitalizations or deaths that corresponds with the increase in infections.

A major concern, she said, is whether omicron is more resistant to vaccines than previous COVID variants. She expects laboratory testing will provide more answers to that question within about two weeks.

"The challenge with the omicron variant is that the sequences that we are seeing have told us that it has around 50 mutations that haven't been seen in combination before," Marrazzo said. "They're heavily concentrated in the spike protein. That spike protein is the thing that sticks out of the coronavirus and attaches to the lining of your throat, your nose, your lungs."

She said antibodies generated from vaccines or previous COVID infections bind to the spike protein, decreasing the likelihood that the virus will attach to the body.

"There could be enough mutations (of omicron) to affect not only its ability to bind, which would make it potentially more infectious, but also the ability of antibodies that are produced from the coronavirus vaccine — or even previous infection from delta, for example — that might reduce the vaccine's efficacy," Marrazzo said.

The emergence of omicron — even if it turns out to be more resistant to vaccines than previous variants — makes booster shots even more important, she said.

"When you get a booster, you are probably not just ... increasing the level of the antibodies you have against the virus, you may even be increasing the breadth or the type of antibodies you have against the virus," she said. "Even if the omicron is evading some of the current vaccines, it's still going to be advantageous to have had that booster shot because you're going to have more antibodies and you're going to have more different types of antibodies."

She also stressed the importance of wearing masks and keeping hands clean.

"You touch your nose and then you touch something else, you touch somebody else's hand, that's really a great way for the virus to get transmitted," Marrazzo said.

Judy Smith, administrator of the Alabama Department of Public Health Northern District, said COVID cases are already increasing and she expects a more significant increase over the holidays, although she hopes it will be less dramatic than a year ago because of the availability of vaccines. That hope is dampened by the low vaccination rate.

"We need to do everything we can to protect ourselves and each other," she said. "It's just not worth dying over. We've had over 8,000 people die this year, after we had a vaccine, that won't have Christmas this year."

— eric@decaturdaily.com or 256-340-2435. Twitter @DD_Fleischauer.