Dr. James Lederer, the chief medical officer at Berkshire Medical Center in Pittsfield, says the new XBB1.5 strain of COVID-19 is highly contagious, but perhaps less virulent than previous strains.
PITTSFIELD – One day last week, the number of people hospitalized with COVID-19 in Berkshire County hit an unusual high. That tally has eased, but questions remain: How severely will a new strain of the virus, known as XBB1.5 and nicknamed "Kraken," affect public health in the region?
Hospitalizations of COVID-positive patients at Berkshire Medical Center in Pittsfield hit 22 on Jan. 9. That's evidence that though the emerging strain’s symptoms are mild for most, the virus can cause serious illness for those medically vulnerable.
Dr. James W. Lederer Jr., chief medical officer and chief quality officer at Berkshire Health Systems, says that as 2023 begins, it isn’t clear whether the XBB1.5 strain will bring a lasting surge of infections, as the omicron strain did early last year.
“We're at a turning point. The question is, ‘Which way is it turning?’” he said. “And now we're facing this new XBB strain, which appears to be highly, highly transmissible — very contagious. But fortunately, maybe not as aggressive and virulent as the prior omicron sub-variants. So that is the question: What will tomorrow look like?”
The 22 inpatients with COVID-19 on Jan. 9 fell to 13 later last week. As of Wednesday, BMC had nine inpatients with the virus. In the past 14 days, BMC and Fairview Hospital in Great Barrington together cared for 38 patients with COVID-19.
Lederer says that social gatherings at Thanksgiving, Christmas and New Year's appeared to produce “blips” in the number of cases. The question now, he said in an interview, is whether the new strain will result in more.
“We're seeing more COVID cases, more COVID admissions, but the earlier blips were very short lived,” he said. “So will we be in the same position or is this new XBB1.5 strain going to really be the predominant strain?”
One fact already established is concerning.
Nationally, experts project that existing vaccines, and any prior COVID-19 infections, will not be able, in 80 percent of exposures, to prevent a new infection. The positivity rate on tests conducted by the hospital for COVID-19 has risen, recently, to over 11 percent. That’s up four or five points from recent months.
In a recent 14-day period, Berkshire Medical Center in Pittsfield and Fairview Hospital in Great Barrington cared for 41 patients with COVID-19.
“They’re still protective against serious illness, hospitalization and intensive care unit need,” Lederer said of vaccines. “That’s where we’re at. What will tomorrow bring?”
The following interview with Lederer and with Michael Leary, the hospital system’s spokesman, addresses the disease’s impact on young people, current attitudes about vaccination, best measures to avoid infection and the nature of an “endemic” illness, one that is ever-present in a community and spreads at a relatively expected level. A pandemic, by contrast, spreads exponentially, as COVID-19 did during its outbreak in 2020, and causes great disruption and hardship.
On prevention, the message to the public remains the same.
“Get vaccinated for everything. Get a flu shot. Get the bivalent COVID booster,” Lederer said. “Wash your hands. Wear a mask.”
The interview has been edited for length and clarity.
QUESTION: Though most recent cases result in mild symptoms, for some it becomes serious enough to result in hospitalization. Why is that?
LEDERER: That's always been the case with coronavirus. There have been those populations, particularly with chronic respiratory disease, who suffered significantly in prior decades with coronavirus infection exacerbating a chronic obstructive pulmonary disease course, or underlying restrictive lung disease. Any number of respiratory ailments would be compromised by a coronavirus infection.
So, we've known that for a long time. But for the vast majority of people, the old coronavirus was a very mild common cold.
It's looking like this new strain is maybe a bit more than a mild cold. But for those people who have underlying immuno-compromised or respiratory or cardiac conditions, it can be significant.
Q: A lot of people are treating it now as something that may set them back a few days and make them not feel well, but not be a risk to their lives.
LEDERER: I will say that the underlying premise, for all of us, is if you haven't had a booster, most certainly get the bivalent boosters that are available today. If you have had a booster and it's been enough time from the prior booster, say, four months, get another.
Because we know that while its protection may only be 20 percent — that it’ll prevent 20 percent of the infections — for those 80 percent that do get this new strain, data has shown that the bivalent vaccine protects more significantly than the old monovalent vaccine. And it provides much better protection against intensive care unit admissions, hospital admissions and severe illness.
While you may not escape an infection, you certainly will escape the ravages of infection.
Q: Are more people with COVID-19 surviving hospital admissions?
LEDERER: More people are surviving and leaving the hospital. Our lengths of stay are actually lower than they had been in the earlier part of the pandemic. So people are coming in and leaving quicker.
We are still seeing people of a very advanced age come in requiring intensive care unit stay who've never had a vaccine.
Q: Does that lack of vaccination surprise you?
LEDERER: To me, it's akin to being an 18-year-old who comes in, having grown up with parents who stressed the need for seatbelt use, and comes in, no seatbelt, ravaged by being thrown through the windshield of a car. I mean, it's just inexcusable. Why would anyone do that?
And to have an 8-year-old coming in, who is in critical condition requiring intensive care unit management, have never had a vaccine. Granted, they escaped [the virus] for three years. But it still got them.
Q: So you're seeing young people hospitalized as well as older people?
LEDERER: Definitely, I mean, the young people are the norm. If anyone's not vaccinated, it's going to be someone that's sub-40.
Q: Why is that?
LEDERER: You just don't have the sense of your own mortality. Illness is not something that has ever bothered you. You might get a cold and then it's gone. You're too young to have significant cardiac disease. So what have you had to worry about?
This winter has seen the emergence of a new sub-variant of SARS-CoV-2, the virus that causes COVID-19. This sub-variant – XBB1.5, or ‘Kraken’ – is the daughter of the globally-dominant Omicron. he scientific community.
Q: Is this now an endemic illness?
LEDERER: Let’s be clear. It has been an endemic illness. It was just this coronavirus 2019 strain, which acted differently, behaved differently and exploded as a pandemic, much like we see with influenza from time to time.
We see a resident background of the strains, we cover them well with our flu shots and all of a sudden, a new strain emerges, which is not covered by any flu shot. And so the numbers of people are more highly impacted, more infected, with more serious outcomes, because there's really nothing to prevent it. And that’s what coronavirus 2019 was.
Q: If someone has had the coronavirus in the past year, are they any better protected from the new strain?
LEDERER: If you've had it in the past year and it was an omicron-based strain, then yes, in concert with protection if you got vaccinated. Vaccination alone is good protection. Coronavirus infection alone is good protection. Both are better.
Q: How are you feeling about public use of masks in early 2023?
LEDERER: Now is not the time to assume that we'll never need masks again. We've had an RSV outbreak. We've had a higher influenza outbreak than we've had in 10 years. We have a new strain of coronavirus, which is highly transmissible.
This is the time to put masks back on. They worked — and they worked so significantly that our numbers of admissions for pneumonia were 60 percent of what they used to be, in the early days of COVID, when we were heavily masking. Our admissions for constructive pulmonary disease were 60 percent of what they usually were. Our number of kids who got ear infections needing the ear tube, the ventilation tubes, were non-existent.
Our ENTs weren't doing surgery. Visits to the pediatrician for sick kids were non-existent. They weren't getting sick.
And so now we're back to the status quo. We just had a tripledemic with RSV, influenza and coronavirus, all circulating at the same time and unchecked — because, really, we're not distancing anymore. We don't wear masks.
It's inevitable that returning to normal means you return to normal in all aspects of community life, which is being exposed to viruses and getting sick.
Q: Has the way the hospital goes about caring for people who are positive for the coronavirus changed in the last year?
LEDERER: Only in that we have many more therapeutics available. Many more medications are available to help us, particularly the two that are most notable, Paxlovid and Remdesivir. So with those, we have an antiviral opportunity in effect that didn't exist in the early days of the pandemic.
A lot of the regular hospital care is all there and not a problem. But what we've lost is the monoclonals. None of the monoclonals are approved for therapeutic use because this shift in the virus escapes that antibody, which is the monoclonal.
Q: The state classifies the Berkshires as being in a state of high transmission for the coronavirus. But you note that it is hard to gauge that because so much testing occurs at home. What should people do if a home test comes out positive for the virus?
LEARY: When you test positive you should be calling your provider.
If you do test at home and you're positive, even if your symptoms are mild, we are recommending that you call your primary care provider and ask that he or she schedule you either for a Remdesivir infusion, which we have here, or to get you a prescription for Paxlovid,, which is an [antiviral] pharmacy product. Both of which have proven to be very, very effective at reducing the severity of illness.
Q: What is the impact, for public health, at this point in the pandemic when home testing is the norm?
LEDERER: We sometimes lack a full understanding of the true positivity, because so many people are doing home tests. We only have the tests that we administer in a lab setting to go by — and that's all the state has. We don't have any real estimate of what the community is experiencing and how the community is managing itself with home testing.