Marisa Peryer, Senior Photographer

As statewide COVID-19 cases continue to rise, the Yale New Haven Health System has seen increased coronavirus-related hospitalizations, reiterating the importance of adherence to public health guidelines.

On Tuesday, Oct. 27, YNHHS CEO Marna Borgstrom, Chief Medical Officer Thomas Balcezak, infectious disease specialist Onyema Ogbuagu and YNHH Senior Vice President and Chief Policy and Communications Officer Vincent Petrini gathered at a Zoom press conference to provide updates about COVID-19 hospitalizations and the status of vaccine trials. They discussed the uptick in COVID-19 cases in New Haven, the need for social distancing and progress in current vaccine trials. According to Ogbuagu, if all goes well, a viable candidate could be on track for approval in the coming months.

An uptick in cases

As of Tuesday morning, there were 90 COVID-19 inpatients across the YNHH system — approximately three and a half times the 26 patients who were hospitalized at the end of September, Borgstrom said. 52 of them are in New Haven.

According to Borgstrom, over the past two weeks, the system has seen close to a 50 percent increase in the number of cases, from 64 inpatients on Oct. 13 to 92 patients on Oct. 26. Two patients are no longer hospitalized.

“A month ago, we only had two COVID patients in any of our ICUs,” Borgstrom said. “Today, we have 22 in the ICU, and eight of those patients are on vents.”

She added that even though there are now a number of patients requiring ventilators, the uptick in the system is still significantly less than the 800 cases observed at peak of the pandemic in the spring.

Since March, YNHHS has discharged over 4,100 COVID-19 patients and seen over 600 mortalities — “606 too many people,” Borgstrom said. She also pointed out that, regardless of how current metrics compare to the spring, seeing numbers rise recently “doesn’t feel very good.”

Borgstrom also noted that the hospital staff have been working nonstop since March. Both she and Balcezak stressed that YNHH administration is appreciative and thankful for the work of these employees.

“We were hopeful that we weren’t going to see the kind of uptick that we are, but they are continuing to provide great care to more and more COVID-positive patients again,” Borgstrom said.

Vaccine prospects

Balcezak explained that the YNHHS has a “very special” relationship with the Yale Center for Clinical Investigation, which has been working on a series of clinical trials for COVID-19  therapeutics and vaccines.

Ogbuagu, who is the principal investigator in several of these trials at the center, said that the Pfizer vaccine trial — in which volunteers are injected with harmless viral genetic material to stimulate an immune response — has one of the most inclusive study protocols. Volunteers enrolled include adults, immunocompromised individuals and children older than 12.

As of Tuesday, 300 volunteers at Yale, and a total of 42,000 volunteers globally, were enrolled in the Pfizer trial.

“The safety profile so far has been great and we haven’t had any serious adverse event that would have warranted stopping the study,” Ogbuagu said in the press conference.

He explained that vaccine candidates have to pass Phase 1 and Phase 2 trials — which are designed to assess vaccine safety and function, respectively — to reach Phase 3, which is currently where the Pfizer trial is. Phase 3 is the final step of the three-phase system, where large-scale tests can be run for efficacy and safety.

Even though it is difficult to predict a concrete timeline for the vaccine, the hope is that, maybe some time in November, there will be some information in terms of interim analyses of efficacy and safety, Ogbuagu said.

“All of these are very promising candidates, I wouldn’t choose one above the other,” Ogbuagu said. “There are differences in the vaccine candidates … but, you know, all in all, we are all hoping that some of these candidates perform well, and it appears that Pfizer is somewhat in the lead, and we look forward to those results when available.”

According to him, safety analyses are built into the process of vaccine testing precisely to ensure that whichever candidate is widely distributed is a secure option. He also said that concerning adverse reactions have not yet been observed among volunteers in the Pfizer trials.

Looking ahead: the need for social distancing and increased testing

Balcezak underscored that, in light of the uptick in COVID-19 cases, it is even more important to double down on public health measures, such as mask wearing and social distancing, which have proven scientific efficacy.

He also explained that YNHHS has deployed mobile testing vans in some low-income communities in New Haven, Bridgeport and New London. They have been dispatched to sites such as religious institutions and schools, providing testing for people who might not have had access to it otherwise.

To prepare for future coronavirus surges and serve more people, the YNHHS administration also hopes to increase the number of tests that they can process, Balcezak said.

“We are up to approximately 3,000 tests per day,” he said. “And we’ve performed more than 250,000 tests since the beginning of this pandemic, which is just incredible work.”

The YNHH system’s goal, however, is to perform 10,000 tests per day, Balcezak said. According to him, earlier in the pandemic, they faced testing challenges, such as limited supplies of solutions and reagents.

Another part of the testing struggle has to do with the hospital’s equipment. Balcezak said that, although they placed an order for a machine that can run approximately 1,000 tests per day back in March, it has not yet been delivered. Because of this delay, YNHHS is hoping to procure more supplies and equipment, as well as welcome more staff members to help process lab tests.

“We have never been, as a hospital, a high throughput reference laboratory, and our staff have been working round the clock since March to be able to bring up what has been really a smaller virology lab to make it into a huge testing enterprise,” Balcezak said. “I think they’ve just done a spectacular job.”

Yale is set to begin enrolling patients in the Merck vaccine trial in January 2021.

Maria Fernanda Pacheco | maria.pacheco@yale.edu