For the first couple years of the pandemic, COVID-19 was a full-time job for Dr. Benjamin Chan.
“It was, you know, full-time work on nothing but COVID-19: tracking COVID-19 on a daily basis, helping to develop guidance, staying up to date on the science, communicating that science and the recommendations,” Chan said in a recent interview.
Today, things have returned to something closer to normal for New Hampshire’s state epidemiologist.
“The last year, year-and-a-half, there has thankfully been the ability to get back to some of the more routine public health work,” he said. “And so people are not seeing and hearing about COVID-19 as much, for example. But it's still out there.”
Hospital admissions for COVID-19 have ticked up since mid-July, in New Hampshire and nationally. But those levels remain well below what they were earlier in the pandemic. About 50 people were hospitalized for the disease in New Hampshire the week of Aug. 12, according to the Centers for Disease Control and Prevention. That’s about half the number from the same time last year.
Still, New Hampshire hospitals are gearing up for what they say could be another busy fall. COVID-19 and other respiratory viruses — like flu and respiratory syncytial virus, or RSV — are expected to increase again, as they typically do in the colder months.
“We expect that as we've gotten back to normal daily living, that these respiratory viruses will likewise get back to their normal patterns of circulation,” Chan said. “So we expect influenza to go up again this year. We expect RSV to go up again this fall and winter. We expect COVID-19 to go up.”Hospitals ‘ready for whatever’ happens this fall
Last year, an early wave of pediatric RSV cases, on top of flu and COVID-19, strained the capacity of an understaffed health care system.
Flu and RSV — which causes a mild cold in most people, but can lead to more serious complications in infants and older adults — had mostly lain dormant for the first two years of the pandemic, due to COVID-related mitigation measures like masking and social distancing.
“It meant that we were not exposing or sharing all of the viruses and getting the protection that we often would have, so we lost some of our population immunity to things like flu and RSV,” said Dr. Michael Calderwood, an infectious disease physician and chief quality officer at Dartmouth-Hitchcock Medical Center in Lebanon. “So as we began to back away from masks, we saw an uptick and a surge.”
Calderwood thinks this respiratory illness season won’t be as severe as last year's. But he cautions that it’s too early to say how it will play out — and some of that depends on people staying up-to-date on their vaccines.
“I don't expect it to be as bad this year, but it really does rely on people getting vaccines,” he said. “These are vaccine-preventable diseases.”
Ashley Conley, the director of infection prevention at Catholic Medical Center in Manchester, called the 2022-2023 season something of a “transition year.” COVID-19 was still around, but flu and RSV came roaring back.
This year, the hospital is making sure it’s ready to handle another influx of outpatient and emergency department visits, if necessary, and stocking up on vaccines and personal protective equipment. Visitors may be required to wear masks again at times during the fall or winter, if infections rise.
“We're just ready for whatever might come our way,” she said.
At Elliot Hospital in Manchester, Chief Medical Officer Kevin Desrosiers said one of his priorities is making sure people can seek care in the appropriate setting. That way, the emergency department isn’t overwhelmed with patients who don’t need to be there.
“Many of the patients who present with respiratory illnesses don't require hospitalization, and so many of those folks need to see their primary care doctor,” he said. “So in those settings, we've looked to open after-hours clinics and expand capacity for patients.”
Elliot Hospital opened a new emergency department this year, which has improved airflow systems and other infection-control measures. The hospital is also planning to ramp up testing for flu, COVID and RSV, and expand the use of virtual appointments.
Desrosiers said hospitals began collaborating more during the pandemic, to match patients with available beds. That helped during last year’s RSV surge, when a wave of children in respiratory distress taxed the region’s pediatric capacity.
“We were taking kids that might be referred to Dartmouth, so they could take the kids who needed the [ventilators],” he said.
Steve Ahnen, who leads the New Hampshire Hospital Association, said that cooperation will continue.
“Hospitals will continue to partner with one another to ensure that patients are able to get the care they need, when and where they need it,” he said.
With advances in vaccines, testing and treatments, he said, the health care system is in “a very different place today than we were, you know, 12 months ago — let alone 36 months ago.”Vaccines, boosters remain key
Medical professionals are encouraging people to get vaccines and boosters this fall — both to keep themselves healthy, and to reduce the overall strain on the health care system.
“To protect yourself going into the respiratory virus season, as we come into the late fall and winter: flu vaccine, the boosters that will come out for COVID, and, if eligible, speaking to your physician about what is available for protection of RSV,” Calderwood said.
Updated COVID-19 boosters are expected in mid- to late-September. Calderwood said those can be given at the same time as annual flu shots.
New tools are also available to help fight off RSV. Earlier this year, the Food and Drug Administration approved the first RSV vaccines, for adults aged 60 and up.
There’s also a new monoclonal antibody treatment that can boost RSV immunity in infants and toddlers. The Centers for Disease Control and Prevention recommends it for all infants under 8 months, as well as children up to 19 months who are at higher risk for severe disease.
Last week, the FDA also approved an RSV vaccine for use in pregnant individuals, to protect their newborns. (The CDC still needs to issue recommendations for the vaccine before it can be distributed to the public.)
Chan said people should also continue to take other basic precautions — things like washing hands, covering coughs and staying home when sick.
“There's a whole range of different ways that people can protect themselves and their families and their communities,” Chan said. “But it starts with vaccination.”
