The phone lines, as of late, have been busy at primary care offices across Western New York, with calls from patients testing positive for Covid-19 coming in at an increasing clip as they work through stockpiles of at-home test kits.
Cases and hospitalizations are up, a mini-surge following school breaks, Easter gatherings and a less-than-cooperative Mother Nature this spring that has us all indoors for long stretches of time while extremely contagious Omicron subvariants circulate.
But there's something much different than the prior surges – and it may even provide hope for the future.
"In general, the severity of illness does seem to be considerably less than past waves," said Dr. Robert Zielinski, associate medical director of Buffalo Medical Group.
Experts see a few reasons why we're now seeing fewer cases that end up in the ICU. Aside from better treatments two years into the pandemic, it also boils down to a population with higher-than-ever immunity, either from vaccinations or prior infections, meeting a variant that is super transmissible but appears to be causing less severe infections – exactly the way a virus wants to operate.
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"When the host dies, whatever virus is active in the host dies with them," said Dr. Sam Cloud, an associate medical director at Erie County Medical Center and an attending physician in the emergency department. "The competitive advantage for the virus is to not kill its host. It'd rather have the host out there at Wegmans."
Proof in numbers
The day after Easter, the five-county Western New York region had 89 Covid-positive patients hospitalized, including 10 in the intensive care unit. This past Thursday, hospitalizations reached 200 – but that included just 6, or 3%, in the ICU.
That's a big change from previous surges.
During this winter's Omicron surge, the region's peak day for hospitalizations arrived Jan. 18, when 701 Covid patients were hospitalized, including 101, or about 14.4%, in intensive care.
Incidental cases rising
With many people not realizing they have Covid – a theme and major challenge throughout the pandemic – hospitals have recently seen a high percentage of incidental cases.
Of the 200 hospitalized Thursday, 104, or 52%, were admitted due to Covid or complications of Covid, state data show. The remainder – 96 patients, or 48% of the total – were admitted to the hospital for another reason and happened to test positive for Covid while there.
On Thursday morning, ECMC had 37 Covid-positive patients in its hospital, a figure that has steadily risen since bottoming out at just four patients on March 29.
Of those patients, however, only eight have what Cloud called "active Covid," and there were no Covid patients in the ICU. Cloud said ECMC typically only admits Covid patients if they either require oxygen or are weakened because of chronic conditions that don't allow them to go home safely.
"We are rarely admitting people purely for Covid," he said.
Compare that to the first wave. On April 9, 2020, for instance, ECMC also had 37 Covid patients, 21 of whom were in the ICU.
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Vaccination and prior infection
One of the major reasons we're seeing fewer severe cases during this wave: The virus is encountering a population that has more immunity than ever before.
A key driver of that is more people today are fully vaccinated, including booster shots.
"Our vaccines are not perfect, but they've done a really good job," said Dr. Thomas Russo, professor and chief of the Division of Infectious Diseases in the University at Buffalo Jacobs School of Medicine and Biomedical Sciences. "But the key is to have at least that one booster and if you get that second booster if you’re eligible, it really has done a great job in keeping people out of the hospital."
About 63% of Erie County residents eligible for the initial booster have gotten it, outpacing the 55.5% statewide rate, according to state data.
More people also got immunity through infection from the fast-spreading Omicron over the winter, though that won't necessarily prevent them from getting reinfected, Russo noted.
"But it's almost certainly going to give a significant degree of protection from you landing in the hospital and developing severe disease," he added.
The virus itself
Take a look around. Maybe you're at a grocery store, your work or an airport. How many masks do you see?
Probably not many. Russo described it as everyone being in "post-pandemic mode." Pair no restrictions with indoor activities and an extraordinarily infectious variant, and you're bound to get cases.
"This virus is infectious as stink," Russo said. "I mean it's really starting to approach measles, which is one of our most infectious viruses."
But while Omicron is more contagious, it also seems less virulent than the earlier variants, meaning it's less likely to cause severe disease.
Officials said they're not terribly worried about the recent rise in Covid-19 cases here and across the state because it hasn't been accompanied by a corresponding rise in hospitalizations – yet.
That's given hope to local hospitals, which were overwhelmed during prior waves.
Western New York has about 20% of its hospital and ICU beds available, percentages that were in the single digits toward the end of the Delta wave in early December. There are still challenges, however, with ECMC, for one, noting delays in discharges for Covid-positive patients who need to be sent to nursing homes, group homes or rehab facilities.
Dr. Rajinder Bajwa, chief of infectious disease at Niagara Falls Memorial Medical Center, said the hospital has seen 15 new Covid patients since April 1, including three who had to be treated in the ICU. Compare that with 60 patients over the course of December, followed up by 90 the very next month.
Lately, Bajwa has seen patients with milder symptoms, which has kept the situation well under control compared with prior surges.
"This virus since the beginning, every time we predict something, it gives us something new," he noted. "This time, I'm cautiously optimistic."
There's also been advances in treatments to keep patients out of the hospital and, if they do land in the hospital, medications to minimize the likelihood that they need intensive care.
Paxlovid, an oral antiviral treatment from Pfizer, has proven effective at reducing hospitalization. Pfizer's data shows Paxlovid reduced the risk of hospitalization or death for high-risk patients by 89% if given within three days of a Covid infection.
High-risk patients, such as the elderly and the immunocompromised, who test positive for Covid should call their primary care doctor to get a Paxlovid prescription.
If a Covid patient does become hospitalized, Russo mentioned the antiviral Remdesivir can be used in combination with steroids depending on the person's sickness. If a patient is sicker, there are also some other anti-inflammatory medications, with Russo mentioning tocilizumab as one of the key ones to try to prevent people from ending up in intensive care.
While there are fewer instances of severe illness from Covid, experts say certain groups, especially those who aren't fully vaccinated or those in high-risk categories, should take precautions.
Several Western New York counties, including Erie, Niagara, Orleans, Genesee and Wyoming, are considered to have a high Covid community level under CDC parameters. At that level of spread, the CDC recommends wearing a mask in indoor public spaces and on public transportation.
Despite the surge of cases from variants of the Omicron strain, county hospitalizations remain low. The Health Department said, as of Thursday, county hospitals had 86 Covid-19 patients, 34 of which were admitted due to the virus.
And despite the low ICU numbers, people are still dying from the virus: There have been 33 Covid deaths in Western New York hospitals from April 1 through Thursday, state data show.
While it's clear there's a lot of Covid cases out there right now – exact numbers are difficult to compile because many positive home test results are not reported to health officials – experts are optimistic things will improve moving forward and Covid-19 will become a seasonal virus.
"What most of us are hopeful of is that we're going to get into a phase, perhaps starting this coming fall and winter, where this becomes another one of our seasonal viruses like influenza," said Dr. John Sellick, an infectious disease expert at Kaleida Health. "A lot of the viruses that pass around in the winter are much milder, but influenza, there's a lot of death and destruction every year, and I think we'll continue to see some death and destruction with Covid. But hopefully it gets more into that seasonal kind of mode."
As for this most recent wave?
"Hopefully if we do get a little bit better weather, we'll see this flatten out more and then start heading down," he said. "That's what we're all hopeful for. And again, we're obviously thrilled that the ICUs are not overwhelmed."