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N.H. State Health Officials Say The State Is Better Prepared To Handle A Winter COVID Surge This Year

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Dr. Chan says public health officials don’t have the authority to require face coverings in schools. But they will continue to strongly recommend students and staff wear masks.

We’re entering another fall season of the coronavirus pandemic.COVID-19 cases, hospitalizations and deaths have been on the rise in New Hampshire over the last few months.

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Dr. Benjamin Chan is the state’s epidemiologist and Dr. Elizabeth Talbot is the state’s deputy epidemiologist and an infectious disease expert at Dartmouth Hitchcock Medical Center. They joined NHPR’s Morning Edition host Rick Ganley to talk about the state’s current response to this phase of the pandemic.

Takeaways:

  • Dr. Chan says of the 600 or so individuals who have been hospitalized with COVID-19 since January, 35 of those people were fully vaccinated. The state does not receive detailed data on the vaccination status from individuals who are hospitalized, but they do receive aggregate data.
  • Dr. Talbot says as more data becomes available on COVID vaccines, it shows that they are both safe and the most effective way to prevent transmission and serious illness from the virus.
  • Dr. Chan says public health officials don’t have the authority to require face coverings in schools. But they will continue to strongly recommend students and staff wear masks.
  • Dr. Talbot says the state is much better prepared and more equipped to handle a potential winter surge this year.
  • Dr. Talbot says she thinks we’ll see approval for the Pfizer vaccine for children 5 to 11 years old very soon.

Transcript:

(Editor’s note: This transcript has been edited lightly for clarity.)

Rick Ganley: You know, we get questions from listeners every day asking about the vaccination status of new COVID cases, hospitalizations and deaths. Dr. Chan, why is the state not making this data available on a regular basis?

Dr. Chan: Well, we have information on vaccination status of New Hampshire residents across the state. What's more difficult to come by is some of the details and the demographics of individuals who are hospitalized, for example. First off, hospitalizations are not something that are consistently reported to us with individual personalized information. So it's difficult for us to track. What's reported to us are hospitalizations in aggregate. But what we do know is that hospitalizations from what is being called vaccine breakthrough cases is the vast minority of those who are being hospitalized. To put this the other way, people that are hospitalized, people that are dying from COVID-19, largely are people who are not fully vaccinated.

Rick Ganley: But how are you able to tell us that percentage of breakthrough cases if you're not collecting the data?

Dr. Chan: Yeah, so we have the data in aggregate. What we don't have is the data collected on a daily or even weekly basis.

Rick Ganley: So when you're saying aggregate, is it over a month? What period of time are we talking about?

Dr. Chan: Yeah, so we have a weekly report that comes to us. As our case investigators investigate individual cases, we can determine, you know, whether somebody is vaccinated or unvaccinated. And so since we started tracking, in this case, hospitalizations and vaccine breakthrough cases, at the end of January there have been 550-600 hospitalizations during that time, and around 35 people that have been hospitalized after being fully vaccinated. So we can get the numbers, but they're not real-time.

Rick Ganley: Yeah, I got you. You can't do it every single day and it's going to be, as you said, in aggregate, so it will take some time to report those out. Gov. Sununu has said repeatedly over the last month that the state is expecting a winter surge of infections. Dr. Talbot, how is the state using what it learned during last winter's surge to actively prevent similar losses this time around?

Dr. Talbot: There are multiple approaches that have been successful globally, nationally and locally. So we will continue to promote the data that suggests to us that vaccination is the absolute most important thing you can do to prevent cases, hospitalization and death. I'm so pleased to see data coming forward that shows that since Delta has become the most common variant of our pandemic regionally, locally, that fully vaccinated people have reduced risk of infection by fivefold, more than tenfold, each for hospitalization and death. So this is a powerful tool in our armamentarium.

We know that somewhere around 10 percent of people who have come in for their first of the two shot mRNA series have not come in for that second. So some really low-hanging fruit is come in and get fully vaccinated. And if you haven't initiated your vaccination series, do please come in. This is our best strategy right now. We're also working very hard to maintain testing availability, and also for those who do become infected, access to some of the treatments that have emerged in recent weeks and months.

Rick Ganley: What about staffing shortages, Dr. Talbot? What's the state actually doing about that?

Dr. Talbot: There are all manner of creative strategies to try to overcome the very real staffing shortages in our health care facilities. So there are rapid training programs for people to get into the trenches of care at appropriate levels. There are moving of those who have skill sets and certainly relaxing some of the licensing bureaucracies toward getting people into settings to provide care for those who are infected, but also keep routine health care strong in our state.

Rick Ganley: Are you seeing any indications that that is working, that hospitals that are trying to find staff are being able to get more people in?

Dr. Talbot: I don't have my finger on the pulse of it, but I certainly hear that all facilities are working to bring in, for example, travelers or bring people who have stepped away from their skill set to bring them back into the fold. I think that we're certainly recognizing this virus is not done with us yet, and we need to continue to stay strong, continue to keep fighting at whatever level that you're able to contribute. So citizens getting vaccinated, certainly health care workers staying strong at the front lines of this.

Rick Ganley: Let's turn to schools. Dr. Chan, you've been consistent in your message that masks play an essential role in preventing outbreaks, and the state has made it clear that districts are allowed to require face coverings. But administrators are hearing from the Department of Education that says they have to provide in-person education for all students, including those who refuse to wear masks, and it's been challenging for many schools to enforce mask wearing. Wouldn't a statewide mask mandate solve all of this?

Dr. Chan: I think the position we're in this year is the same position we were in all of last school year. You know, when we entered the 2020 school year, schools weren't included in the statewide mask mandate. Schools had the local control decision making capacity whether or not to require masks. You know, [it's the] same thing this year. And then as the winter surge occurred last year, similar to what you're seeing us say this year is we're more and more coming down on the importance of masks and recommending masks. I think what has honestly changed in this are communities' tolerance for mitigation measures now that we're over a year and a half into this pandemic.

You know, I think we recognize that. That's a struggle for us. That's a struggle for administrators. You know, there's increasing resistance to having people wear masks as a control measure for this pandemic. I will say it's still a strong recommendation from us. It's still important for people, especially in these highly unvaccinated populations, to take precautions to prevent spread of COVID-19, and that includes wearing masks in schools. And so we continue to recommend masks. But public health does not have the authority or the ability to have schools require masks.

Rick Ganley: Dr. Talbot, what do you think? Modeling has shown that masking and regular testing significantly bring down rates of transmission.

Dr. Chan: So absolutely there's science and there's evidence to show masking and testing are effective control measures, and so we continue to highlight and recommend those.

Rick Ganley: Do you have nothing to add there, Dr. Talbot?

Dr. Talbot: Just absolutely agreeing, you know, that it's impossible to look at the avalanche of data and not be enthusiastic that this is a low cost, low impact mechanism of preventing you from being infected and you from infecting others who are vulnerable to hospitalization and death. So for me, it's a no brainer, frankly.

Rick Ganley: We had both parents and school nurses asking about the role of public health officials in helping schools handle potential outbreaks. Dr. Talbot, At what point does DHHS get involved in district management of a cluster or outbreak?

Dr. Talbot: Every single day. We have an incredible team of people who are devoting just long hours and all of their efforts to support the schools. We indeed have a smaller staff than we did in the initial surges. But we also have a greater expertise. As I said, we know what works, and it's a matter of implementing and transferring that to the schools that are clearly doing the best they can to provide education for the kids in person.

Rick Ganley: Are you actually involved in contact tracing, Dr. Talbot? What are you seeing across the state right now?

Dr. Talbot: So I am aware of the contact tracing that's ongoing. Sometimes Dr. Chan and I get consulted when there are complex situations, but indeed, as time has gone by, our team is just great at handling these situations. So we have many calls each day, some on small questions like, you know, are gaiters good face coverings, or larger ones like we're seeing a number of cases. So it ranges the gamut, and the team is engaged in this in a very dedicated, professional way.

Rick Ganley: Just last week, Health and Human Services Commissioner Lori Shibinette had to very publicly correct the chairman of a powerful State House committee who was sharing misinformation about COVID vaccines. Dr. Chan, how concerned are you about the role that local elected officials are playing in undermining public health recommendations around this? And have either of you done any specific outreach aimed at local legislators?

Dr. Chan: Yeah, I think that’s a great question. You know, my ability to comment on any specific situation or anything a specific person said is, I think, limited, but I will just acknowledge that misinformation is an ongoing and chronic problem, not only in New Hampshire, but across the country, right? I mean, we are looking at the data that's coming out on COVID-19 and on COVID-19 vaccination on a daily basis.

Dr. Talbot, myself, and others are reviewing the primary literature, and we're trying to share that with our partners, our health care provider partners, our school partners on, you know, weekly calls that we're having. But certainly, misinformation remains a challenge because there's a lot of sources of wrong, incorrect information out there. So, you know, we're doing the best we can to try and put out accurate, reliable information and would encourage everybody else to, you know, be looking at trusted, reliable sources of information as well.

Rick Ganley: Dr. Talbot, what's your response to that?

Dr. Talbot: I'm so grateful for the vaccines, you know, that this has exceeded our expectations. I think we can be very proud of the fact that these vaccines have come to us by bypassing the usual bureaucracy for delivery of an important tool like this. And it does actually break my heart that there are malicious efforts, you know, there are anti vaccine persons spreading mistruths, myths. And then people simply just don't have the information we need. So as Dr. Chan says, we are on a mission to share the exciting data that continues to come to us about how effective and safe these vaccines are. So I think I've made my statement very clearly that I'm a huge proponent of these vaccines and it makes me, you know, obviously sad that there is misinformation out there. So we'll continue to talk about these with the emerging science. You know, the latest thing is that Pfizer BioNTech has shared encouraging data regarding the utility of these vaccines in 5 to 11-year-olds. So we'll have the next stage of vaccine rollout coming to that population, depending on how our federal agencies review this data themselves independently.

Rick Ganley: Let me ask both of you if either of you have any idea when that approval might come. Might we see that before the end of the year? Approval for vaccines for the 5 to 11-year-old category.

Dr. Talbot: Yes, I think the writing's on the wall with this. We may see headlines even today and tomorrow showing that the federal agencies that look at safety and efficacy will give us marching orders toward reaching this population. That's going to be so important to controlling these outbreaks that we've already talked about happening in schools and in our younger population.

Rick Ganley: One last question for you both. Some schools are worried that limited supplies of tests are going to make it hard to identify outbreaks quick enough. The market for these tests is tight right now. Nurses are having a hard time keeping them in stock. Dr. Chan, should the state be playing a bigger role in acquiring and administering tests for schools?

Dr. Chan: Yeah, so you know, remember back to the last year, year and a half, and we had these National Guard- run fixed testing sites. The National Guard have since been demobilized and the testing sites have gone away. But I think we are looking again at how to deliver more testing to communities across the state. You know, I think right now there's still hundreds of sites across the state that offer testing anywhere from urgent cares to commercial pharmacies. We've heard from the federal government that they're rolling out at home test kits at cost to people who have the money and can –

Rick Ganley: I just have 20 seconds, Dr. Chan. But is the state doing anything about testing in schools specifically?

Dr. Chan: Yeah. So there is federal funding. We're enrolling schools in our SASS program (Safer at School Screening). That's our free school testing program. We're making supplies available to school nurses, for example, for testing. And I think we're also looking at how to conduct testing still more at a community level similar to what we did last year.

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