The Inside Press

Magazines serving the communities of Northern Westchester

COVID

COVID Recommendations are a Moving Target

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Editor’s Note: We contacted Northern Westchester Hospital for guidelines on the latest news surrounding COVID, for thoughts on breakthrough infections, vaccinations and mask wear. Here, expert insights and advice from Debra Spicehandler, M.D., Co-Chief, Division of Infectious Diseases, Northern Westchester Hospital

By Debra Spicehandler, M.D.

To mask or not to mask? That is just one of the questions generating confusion as the CDC tries to nail down current COVID recommendations as the very contagious Delta strain gains traction. We continue to learn more, but the Delta variant appears to cause more severe illness and may spread as easily as chicken pox. In addition to a growing number of breakthrough infections among the fully vaccinated, it appears that symptomatic vaccinated people can also spread the Delta variant.

Dr. Debra Spicehandler

During the past few weeks, New York seemed to have pushed COVID back to the point when people felt comfortable eating in restaurants, attending weddings and going back to the office.  Not so fast. Almost overnight, the Delta variant has become the dominant COVID strain, and we are seeing rates of infection rise especially among the unvaccinated.

Here is what we know:

Being vaccinated is key, but vaccine hesitancy persists, and there is discussion about mandating vaccines among certain groups, including healthcare workers.

We are now seeing breakthrough infections even among people who are vaccinated as a result of the now dominant, highly contagious Delta variant. The good news is that breakthrough infections among the vaccinated seem mild, in most cases, and do not require hospitalization. It is unclear whether people with breakthrough COVID cases will have any of the long-term effects we’ve seen that include cardiac issues, long-lasting fatigue, lung problems, joint pain, and brain fog.

Though we have not seen definitive data, federal health officials announced both vaccinated and unvaccinated people who contract the Delta variant of COVD may carry similar levels of viral load and spread the disease even when asymptomatic. A recent New England Journal of Medicine study of 1,497 vaccinated Israeli healthcare workers found 39 breakthrough infections with three quarters of those people showing a high viral load.

This information raises other questions: if we are seeing more breakthrough infections, is it because the Delta variant is more efficient, or does the efficacy of the vaccine wane over a certain period of time? And, if so, how long do vaccines last?

It is beginning to look as though people who have been vaccinated will soon need booster shots.

As COVID rates rise, the CDC recommends that even fully vaccinated people wear masks indoors where transmission of the virus is high, such as New York City and surrounding suburbs, including Westchester. Since the virus is rising in New York, I recommend caution. It is still okay to be outside without a mask if you are vaccinated, but it looks like indoor masking should be reinstituted, and people should follow the most updated guidelines on the CDC website. This is an evolving situation. Even if we know people have been vaccinated, we cannot be sure that someone has not been exposed to the Delta variant.

For the vaccinated, COVID symptoms can be extremely mild. But if you are concerned that you may have COVID–especially if you have other co-morbidities–then get tested.

Patients who test positive and are at high risk for developing a severe infection may be eligible for infusions of monoclonal antibodies. This risk group includes people 65 and older, who have diabetes, high blood pressure, cardiac disease, obesity, asthma or who are immunocompromised.

Because recommendations are changing so quickly as we learn more, check the CDC website for the most current information. And, if you think you may have COVID, check with your physician. For more information, visit Northwell’s Digital Resource Center.

 

 

Even with Vaccines Widespread and Low Positivity Rates, Caution Over Covid Must not be Thrown to the Wind

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By Gary Eddey, M.D.

A year and a half into the Covid pandemic, residents of the United States have a lot to be grateful for.

By early January of 2020 researchers in China had sequenced and published the genetic code for the SARS – CoV 2, an RNA Coronavirus. The WHO quickly renamed it Covid 19. Before we recognized we were heading toward a monumental pandemic, companies around the world began developing vaccines. Within three months, Moderna, using two remarkable new vaccine technologies, began its first clinical trial. As everyone now knows, months later, the company garnered the coveted “emergency use” designation by our government. Pfizer and other companies were not far behind.

The speed of all this is mind boggling. Sequencing the RNA virus was followed by vaccine development within weeks! Vaccines often take decades to develop. For example, we still don’t have an established vaccine for another RNA vaccine, HIV. And how long did it take Jonas Salk and his labs to develop a vaccine for Polio, another RNA virus?

Fortunately, the mRNA vaccines, and others, are better at producing immunity in individuals than having the disease itself! And that is the reason why immunizing is essential, even for those who have recovered from Covid.

It is extremely important that the entire world have access to Covid vaccines that cover the variants, a process that is now underway. All this is great news.

So, what’s the bad news that demands continued caution, and is causing many scientists behind the scenes to worry, while politicians and lawmakers cave in to public or private pressures to ease restrictions?

First, there’s the death toll staring us in the face. This is a lethal virus, despite the odd fact that as many as 40% of people infected will not know they are infected. As of this writing the United States has 600,000 deaths, but countless more individuals will have to live with the residual effects of the infection, termed by the press as “long covid”. The chronic disability toll from Covid has yet to be determined (one report states this virus can change the function of cells in some organs.)

Second, we have the expected genetic mutations that occur in all RNA viruses. These mutations are called “variants” in the press. Genetic mutations are expected, but especially so in rapidly mutating RNA viruses. Why? Because RNA viruses are really good at following Darwin’s principles, too. The job of any organism is to develop a method to survive long term. Viruses follow survival of the fittest, and, by definition, genetic mutations, or variants, are hardier and more lethal. The only way they can survive is by mutating. (A current lethal variant circulating in India and now Great Britain is the Delta variant; current estimates suggest this mutation now constitutes 6% of all U.S. cases.)

How do we stop the virus in its tracks? The answer is to prevent infection with as many public health interventions as necessary, including vaccines.

This raises the question, “Will these genetic mutations require an annual booster?” Yes. “For how many years will we be dealing with this?” No one knows, but my guess is at least a decade, if not longer.

Here’s the important thing to remember: The longer that virus survives in the body–and the longer the virus circulates in the world– the more time the virus has to mutate. And that means more variants that will be more infectious and more lethal. Don’t get mad at Darwin: he simply understood that all organisms strive for evolutionary advantage. Here’s another issue to remember: When population immunity increases worldwide, that will, in and of itself, create more evolutionary pressure on Sars – 2 CoV to further mutate!

A question often asked, “Can a fully immunized individual get infected, let’s say from their own child?” Yes, its possible, and they can carry the virus for a short time before their body’s immune defense mechanisms rid the virus. The parents will not get sick, if properly immunized, but they will turn positive on testing and may need to isolate for an extended period of time. They will not become sick and it is highly unlikely they will be infectious to others. Wearing a mask in close quarters with strangers may be warranted.

How effective are they? Immunizations are never 100% effective, so there will always be some individuals in whom the vaccine doesn’t ‘take.’ It is not entirely known why we cannot reach 100% effectiveness, but the failure rate is reported to be between 5 to 15%, depending on the vaccine.

In the meantime, how do we deal with vaccine-hesitant folks? As a pediatrician, I’ve had to deal with this issue for decades. There are many good publications regarding  ‘anti vax’ populations, but the best answer I’ve seen so far was on Twitter, by Allen Frances, a thought leader in Medicine and Psychiatry. In response to a question from an individual hesitant about getting the vaccine who asked, “Please share articles and emotional reasons why I should get the shot. I am confused.” His response, “Getting the vaccine is among the easiest decisions in the history of the world: Unvaccinated = 600,000 dead – in the U.S.; Vaccinated = 0 deaths. I add to those statistics the worldwide mortality figures of millions dead, and countless with Long Covid.

Third, even in our society in the U.S., there are many individuals who do not appreciate the reach of this pandemic for any number of reasons. Some cannot understand or read about the pandemic, and are afraid. These are a few of the reasons I believe the suggestion that immunized folks no long wear a mask will be misunderstood, and those who need it may not wear one.

Bottom line: Even with public health measures, including vaccines, we cannot throw caution to the wind with any highly mutating RNA infectious virus.

(This discussion is not meant to provide medical advice; that must come from the reader’s personal physician. These are guidelines that the author follows.) 

Gary E. Eddey, MD, is a retired general academic pediatrician. He received his Medical Degree from Weill Cornell Medicine and holds a master’s degree (ScM Hyg) from the Graduate School of Public Health at the University of Pittsburgh. Currently he is a volunteer physician for Boston Rare Connections, and the University of Pennsylvania Orphan Disease Program. Dr. Eddey received his vaccine as soon as New York decreased the age to 65; at which time he reported to his FQHC center, Ryan Health, and stood in line to receive the first of two shots. He wears his mask when leaving his home, as does most everyone in his neighborhood. 

 

 

 

 

 

 

Northern Westchester Hospital ‘One Year Anniversary’ Remembrance Ceremony Honors Healthcare Team

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On the one-year anniversary of the first COVID-19 patient admission, approximately 50 to 100 people, including the Mount Kisco Fire Department, patient families and visitors, gathered on walkways lined with luminaries around Northern Westchester Hospital (NWH) to remember those who were lost to the pandemic and honor the hospital’s dedicated health care professionals at the change of shift.

 Mount Kisco Firefighters, patient families and visitors applaud Northern Westchester Hospital’s healthcare heroes as they change shifts on the year anniversary of first COVID-19 positive patient admission              

“This was a significant week at Northern Westchester Hospital as we recognized the day that we admitted our first COVID-19 positive patient on March 11, 2020, and reflected on what the past year has meant for our entire organization,” says NWH executive director Derek Anderson. “We are incredibly proud of the resiliency and dedication of our team members and so grateful to the community, which rallied around us with their continued support.  Over the past few days, we have had several opportunities to recognize our team members for the outstanding care they have provided over the past year and for the sacrifices, they made in their personal lives so that they could be here for our patients and community.  We also paid tribute to the lives lost during the pandemic.”     

One particularly moving moment was the change of shift recognition held on Thursday.  Hospital leadership came together to greet team members as they arrived or departed from their shifts.  Each team member was invited to create a luminary bag on which they shared a memory or word of inspiration. 

Each bag contained a prayer card that included the verse read by hospital chaplain Reverend Angela Maddalone during a moment of silence earlier this week. The luminary bags also included a tea light, which staff lit before placing their bag in a growing lineup of tributes throughout the entryways.  On Thursday evening, the luminaries were brought outside to ‘spread the light’ across the campus at the end of the day.  Visitors were invited to join team members as the Mount Kisco Fire Department rang a bell at 7 pm to honor those who were lost during the pandemic. Large spotlights illuminated the campus, spreading light through the community.

Northern Westchester healthcare heroes receive applause during shift change on year-anniversary of first COVID-19 positive patient admission.

News courtesy of Northern Westchester Hospital. 

Mount Kisco Firefighters cheer Northern Westchester Healthcare heroes on year anniversary of first COVID-19 positive patient admission
Northern Westchester Hospital doctors, nurses, staff, patient families and visitors wrote messages on luminary bags that lined the walkways to remember those lost in the pandemic and honor the hospital’s dedicated healthcare professionals .

60 and Up, New Yorker? Come Get Your Shot Too

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New Yorkers 60 Years of Age and Older Can Be Vaccinated Beginning March 10

Government Employees, Nonprofit Workers, and Essential Building Service Workers Are Eligible for COVID-19 Vaccine Beginning March 17

Vaccine Distribution Eligibility Expanded; All Providers Except Pharmacies Can Now Vaccinate Any Eligible New Yorker Starting March 17; Pharmacies Can Vaccinate 60-plus and Teachers Per Federal Guidance Starting March 10

New Yorkers Can Make Appointments at State-Run Vaccination Sites by Utilizing New York’s ‘Am I Eligible’ Tool or Calling 1-833-NYS-4-VAX

Governor Andrew M. Cuomo today announced a new expansion of COVID-19 vaccine eligibility in New York. Beginning March 10, all New Yorkers 60 years of age and older will be eligible to receive the vaccine, while public facing essential workers from governmental and nonprofit entities will be eligible beginning March 17. This expansion also includes public-facing essential building services workers.

Additionally, the Governor announced that with increased supply of the vaccine, restrictions concerning which segments of the eligible population specific providers can vaccinate will be relaxed to align with the expanded eligibility on March 17. Previously, certain types of providers were directed to focus their vaccination efforts on specific populations to ensure equitable vaccine distribution. For example, hospitals vaccinated health care workers, local health departments vaccinated essential workers and pharmacies vaccinated New Yorkers 65 years of age and older. Now, providers will be able to vaccinate any eligible New Yorker, with the exception of pharmacies, which will focus on individuals over the age of 60 and teachers, in line with federal policy. Pharmacies may begin vaccinating individuals over the age of 60 and teachers on March 10. As part of this effort, providers are being encouraged to vaccinate those New Yorkers most at risk, such as individuals 60 years of age and older and people with comorbidities and underlying health conditions.

“New York is marching forward expanding access to the COVID-19 vaccine, addressing underserved communities and getting shots in arms as we turn the tide in the fight against this virus,” Governor Cuomo said. “Supply is steadily increasing and we’re opening new vaccination sites and expanding eligibility to match it. New Yorkers over 60 years old and those who serve their fellow New Yorkers in the public sector are more vulnerable to COVID-19, and we’re addressing that vulnerability by providing access to the vaccine. The fight against the COVID beast continues on all fronts, and we’re pushing the infection rate down while getting our vaccinations up.”

Under this new expansion of eligibility, the following essential workers will now be eligible to begin receiving the COVID-19 vaccine on March 17:

  • Public-facing government and public employees
  • Not-for-profit workers who provide public-facing services to New Yorkers in need
  • Essential in-person public-facing building service workers

This includes workers such as public works employees, social service and child service caseworkers, government inspectors, sanitation workers, DMV workers, County Clerks, building service workers and election workers – the everyday heroes who have been showing up day in and day out throughout this pandemic.

New York’s vast distribution network and large population of eligible individuals still far exceed the supply coming from the federal government. Due to this limited supply, New Yorkers are encouraged to remain patient and are advised not to show up at vaccination sites without an appointment.   

CSEA President Mary E. Sullivan said, “Since the start of this pandemic, essential front line public workers have risked their own safety and the safety of their families to make sure our state and local governments keep providing needed services to all New Yorkers. We are gratified to hear all these workers will now be eligible for the vaccine. They deserve to be protected so that New York can fully and safely reopen.”

NY AFL-CIO President Mario Cilento said, “Our essential workers have been on the front lines since the start of this pandemic to ensure our communities can continue to function in the midst of this crisis. While many essential workers have already been vaccinated, it is now time to ensure the rest of the individuals who are going to work every day and interacting with the public are protected against this virus and can keep themselves and their families safe. I thank Governor Cuomo for expanding vaccine eligibility to even more public-facing essential workers and for the state’s ongoing efforts to vaccinate every single New Yorker.”

32BJ SEIU President Kyle Bragg said, “We applaud Governor Cuomo for adding building service workers to the vaccine eligibility list. Building service workers have protected the city during the pandemic and will now get the protection they need to stay safe. Building service workers like door staff, supers, cleaners, security officers, resident managers, porters helped New Yorkers to get through the pandemic and are vital to the city’s recovery. Their health and safety is tied to the city’s health and safety.”

DC 37 Executive Director Henry Garrido said, “District Council 37 members have put their lives on the line every day to provide essential services New Yorkers rely on. Prioritizing our workers for vaccine eligibility is the right thing to do. It keeps them, their families and their communities safe. I applaud this expansion.”

Uniformed Sanitationmen’s Association Local 831 IBT President Harry Nespoli said, “We have been in constant communication with the governor’s office on this issue and are very happy that our members will be eligible to receive vaccinations. Upwards of 25% of our members have been infected by COVID-19 and, tragically, four died. We greatly appreciate the governor’s actions.

Eligible New Yorkers will be able to schedule appointments at state vaccination sites by utilizing New York’s ‘Am I Eligible’ website or by calling the state’s COVID-19 Vaccination Hotline at 1-833-NYS-4-VAX (1-833-697-4829).

New York is maintaining and expanding a vast vaccine distribution network. On March 8, Governor Cuomo announced that as the federal vaccine supply continues to increase, New York will establish 10 additional state-run mass vaccination sites in the New York City, Long Island, Hudson Valley, Capital, Southern Tier, Mohawk Valley and Western New York regions to further grow New York’s vast distribution network. The sites remain in development and are expected to launch in the coming weeks. Final details, including appointment scheduling information and hours of operation will be released in the coming days. 

Not only has New York already established 13 other state-run mass vaccination sites, but in order to meet the Governor’s mandate to ensure the fair and equitable distribution of the vaccine, numerous other sites have been established to ensure those New Yorkers living in underserved communities have direct access to the vaccine. This includes six joint state-FEMA community-based vaccination sites, the Yankee Stadium mass vaccination site, and more than 120 community-based pop-up sites in public housing developments, churches and community centers.

All of the above News is via the Office of the New York Governor.

Plans for County’s March 3 Covid Commemoration: “One Year Later”

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 In the lobby of the Michaelian Office Building where the County’s “Ribbons of Remembrance” memorial now stands, County Executive George Latimer will host a commemoration of the County’s first confirmed COVID-19 case. To date, Westchester County has lost over 2,000 lives to the virus. The commemoration will take place on Wednesday, March 3 beginning at 11 a.m. To watch live, tune into www.facebook.com/WestchesterGov.

Latimer said: “What today is about is remembering those we have lost not as merely an integer or statistic, but as human beings and the valued members of our community that they were. While in this last year we have rallied together in so many ways,, it is imperative we also take time to grieve and heal together.”

The solemn event will begin at 11a.m. with an interfaith prayer service lead be Father Luke Hoyt from Holy Innocents Catholic Church, Rabbi Annie Tucker from Temple Israel Center and Imam Shaffieq Chace from Islamic Center of New Rochelle.

Deputy County Executive Ken Jenkins said: “Westchester residents are strong, resilient and also compassionate people.  One year later, we commemorate those we have lost and honor those who worked so hard to keep us safe.”

 

Westchester County Health Commissioner Dr. Sherlita Amler said: “One year ago, all of our lives changed forever. I am proud of the work of my department, and health care workers county-wide, as we faced this crisis of unprecedented proportions.”

The prayers will be followed by remarks from Latimer and other invited guests, poems read by the County’s Poet Laureate B.K. Fischer and the County’s Youth Poet Laureate Danielle Kohn and a musical interlude from a string quartet made up of students and faculty from White Plains High School. 

Following the program at 12p.m., Latimer will lead the County in a moment of silence remembering those we have lost.

This commemoration will continue again later in the evening when Latimer will lead a County-wide applause for health care workers in recognition of the life-saving, stress-filled work they have done during these tumultuous times.

On Wednesday, March 3, Latimer will also direct flags at all County facilities to be flown at half-staff in honor of the over 2,000 Westchester residents who have died from COVID-19.

News courtesy of the Office of the Westchester County Executive