Q&A: With cases climbing again, here’s what the COVID-19 picture looks like in New Hampshire
COVID-19 cases are on the rise again, but unlike previous waves deaths and hospitalizations are climbing at a much slower rate. (Saul Loeb | Poo | Getty Images)
COVID-19 – and the the public’s appetite for safety measures – look different these days.
Cases and hospitalizations, which were relatively flat in late March, are slowly climbing in New Hampshire, though they are nowhere near the numbers we saw in January and February.
On Tuesday, the Department of Health and Human Services’ COVID-19 dashboard reported 41 hospitalizations, which it now defines as only those treated with remdesivir or dexamethasone. There were just four in early April. Meanwhile, 56 others are no longer infectious but still required hospitalization, according to the New Hampshire Hospital Association dashboard.
Deaths are increasing even more slowly. In early April, the state reported deaths at .4 over a seven-day average. On May 11, the most recent data available, that was 1.3.
What is climbing more quickly are cases of long COVID-19, with symptoms ranging from fatigue and respiratory challenges to brain fog.
What isn’t climbing is mask use. The few local mask mandates in place earlier this year have been rescinded. It’s rare to see a store or restaurant requiring or even suggesting patrons use one, and few seem to be choosing to do so. And a reliable vaccination rate is difficult to find; the Centers for Disease Control and Prevention estimates 95 percent of the state is fully vaccinated. The Mayo Clinic says it’s 71 percent.
We asked Dr. Aalok Khole, an infectious disease expert at Cheshire Medical Center in Keene, for a COVID-19 update.
The sharp drop in hospitalizations and deaths is good news. But cases of long COVID-19 are on the rise. What are you seeing in terms of symptoms and risk factors?
We’re seeing quite a bit of an uptick in individuals complaining of residual symptoms, may it be cardiac abnormalities, (heart) rhythm abnormalities, respiratory dysfunction, reduced exercise tolerance, continual fatigue, brain fog, and then a myriad of symptoms ranging from neurological symptoms to thyroid dysfunction to gastrointestinal issues.
Initially, it was thought that those who are unvaccinated were at higher risk for long COVID. The thought was asymptomatic illness or mildly symptomatic illness would not drive you toward long COVID as much as severe illness might. That spectrum has changed.
We are seeing individuals who had asymptomatic and mildly symptomatic illnesses. What’s frustrating is there’s really no medication that we can offer these patients. It’s more of a multidisciplinary approach directed toward rehabilitation activities to try to treat their symptoms.
Even with breakthrough cases, are vaccinations and boosters the best protection against long COVID?
Even though we’re seeing long COVID in people who are vaccinated and boosted, we don’t have enough data yet to say it’s significantly less compared to those who are unvaccinated. But the likelihood is that is true. Getting vaccinated and boosted reduces the likelihood of you getting infected in the first place, which then reduces the likelihood of every other consequence.
This wave is different in that hospitalizations and deaths remain steady while cases increase. Why?
The BA.2 variant (of omicron) is dominating the scene. It is more transmissible than the original omicron sub-variants, so that’s probably leading to increased transmissibility.
I think what you’re also seeing is that more than 50 percent of those eligible for a booster have not gotten a booster. And waning immunity and partial immunity against reinfection … is also probably leaving some folks more susceptible than before. And then, more importantly, as the weather improves and as masks go off, and things are returning to normal, human and social interactions are increasing.
You have to be cognizant of three main things: What’s the risk for yourself? What’s the risk you may be putting others around you in? And what’s your community transmission rates?
If you’re really cognizant about thinking about your response in terms of these things, you can be living your life to some degree of normalcy even with these (community transmission and level) numbers going up.
But we know individuals have not done everything in their power to be protected against infection.
You’ve seen an increase in non-COVID-19 hospitalizations. How are those related to more relaxed safety habits?
We’ve seen an uptick in non-COVID respiratory viruses, which has happened likely as a result of masks going off and people interacting more. We’ve seen quite a bit of uptick in influenza, respiratory syncytial virus, rhinovirus, parainfluenza, all these other respiratory viruses that dogged us for years before COVID came onto the scene. The last two years were an aberration, where we had really not seen any of these.
Antiviral medications, which can reduce the risk of severe illness and hospitalizations, are no longer in short supply. But access remains limited for other reasons. Why?
What we’ve heard commonly is that folks tend to disregard some of their initial symptoms and by the time they do a COVID-19 test, they are on the brink of five or six days and don’t qualify. Do not disregard your allergy symptoms to be allergies unless you’ve proven that you are not COVID positive.
And the recommendation is if you are using a home test not to trust a single negative, especially when the community rates are going up. You would benefit from repeating an antigen test within 24 to 48 hours. If you have two negatives, then you can say with a fair bit of confidence that it’s likely not COVID
And when there are drug interactions (with a person’s existing medications), you may have to ask them to stop taking those medications for a certain duration. And to qualify, you need to be mildly symptomatic. You cannot be asymptomatic and you cannot be symptomatic enough that you’re needing added oxygen support
So really it’s not as simple as prescribing someone (medication) and picking it up over the counter. It is a little tricky.
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