By PAULA TRACY, InDepthNH.org

CONCORD – With the highest number of COVID-19 hospitalizations occurring since the start of the pandemic, now at about 400, top state Health and Human Services staff held their regular call with public health-care providers Thursday to focus on the new Omicron variant and concern for transmission.

They predicted international travel will be disrupted by Omicron, which was found in California on Wednesday and Minnesota and Colorado on Thursday, and together with the Delta variant, there is likely a new incentive to get more people vaccinated as those unvaccinated are more likely to have more adverse outcomes.

The officials, including state epidemiologist Dr. Ben Chan, said there are a number of genetic sequencing abilities the state has to test for Omicron but no cases have been found in the Granite State yet, though cases have now been identified very recently in Minnesota, Colorado and California. It was first discovered in South Africa and has been found in about two dozen countries.

As increases in vaccination rates continue, it is more likely to have a higher percent of breakthrough cases, health-care workers were also told.

“The primary way we have to prevent this is vaccination,” Chan said. “Currently, vaccines are available and recommended for anyone 5 and older and anyone 18 and older is recommended to get a booster shot.”

“It remains important for everyone to follow recommendations, mitigation measures to control COVID-19. People who are sick or having symptoms of COVID-19 should stay home, out of school….and get tested if exposed,” Chan added.
“We continue to recommend when in indoor environments they wear masks and…avoid higher-risk situations,” and rather, have gatherings outdoors.

The Centers for Disease Control also issued a new advisory Wednesday in the wake of Omicron recommending a layered prevention strategy.

“These strategies include vaccination, masking, improving ventilation, distancing, handwashing, and testing to slow SARS-CoV-2 transmission,” the advisory said.

The CDC recommended:

• Everyone ages 2 years or older wear masks in public indoor places in areas of substantial or high
  transmission, which includes New Hampshire.
• Unvaccinated people should wear masks regardless of community transmission level.
• Masks are required in indoor areas of public transportation conveyances and U.S. transportation hubs
  independent of vaccination status.
• Persons who have a close contact with someone who has COVID-19, should get tested 5-7 days after exposure (even if they are asymptomatic) and wear a mask indoors in public for 14 days following exposure or until their test result is negative.
• Persons who develop symptoms of COVID-19 should get tested and stay home until their test result is negative; persons who have a positive test result should isolate at home for 10 days.
• Vaccination remains vital to COVID-19 pandemic control. The COVID-19 vaccines approved or
  authorized in the United States are highly effective at preventing severe disease and death from the Delta
  variant, which is currently the dominant variant circulating in the U.S.
• CDC recommends that everyone ages 5 and older should be fully vaccinated against COVID-19 as soon as possible. In addition, CDC recommends all persons age 18 years and older receive a booster dose at the recommended interval.
• CDC will provide updates as soon as more information is available about vaccine effectiveness against
  the Omicron variant.

Reformulating vaccines to meet the variants is a few months off, likely 90 days, but currently under aggressive study, state officials said.

Dr. Beth Daly, chief of infectious control at the Department of Health and Human Services, in her last day of work in state public health, was joined on the bi-weekly Zoom health-care provider call with Chan and Deputy State Epidemiologist Dr. Elizabeth A. Talbot, an infectious disease physician who focused on what is now known about the Omicron variant.

Talbot has served in Botswana, one of the countries where the variant was discovered last week.

The team fielded questions from a host of health-care providers typing into the Zoom chatbox. The focus was on Omicron.

Chan showed a national graph with the number of new infections in the United States fluctuating but averaging 85,000 new cases per day. He said that is expected to grow during the winter with more indoor transmission and with a new variant possibly emerging.

“It is really too early to give concrete information,” on Omicron, he said in terms of its transmissibility and lethality.

In New Hampshire right now, the situation is among the worst it has been since the outset of the pandemic, Chan said.
The state averages 900 to 1,000 new cases a day, which is one of the highest levels seen since March 2020 when the first case was discovered.

Similarly, test positivity rates have continued to climb and the seven-day average is now over 12 percent in New Hampshire, translating into increasing community transmission levels, he said.

Geographically, the state transmissibility rate on average is considered high and is increasing in all counties, Chan said.

“This has translated into an increasing burden on our hospital system,” Chan said showing a graph of bed occupancies for COVID-19 heading upward with about 403 people statewide hospitalized with the highly transmissible respiratory disease.

This, he said, is putting a burden on a health-care system already dealing with shortages.

Sadly and similarly, he said, the number of people dying has continued to slowly and gradually increase.

Currently, the state is averaging about five deaths per day which translates into 40 per week.

Daly was thanked by Chan for her “steadfast presence” throughout the past 18 years and during the current pandemic and said she has contributed immensely to resident population health. She heads on to a national role on infectious diseases.

Daly thanked Chan for the praise and good wishes and said she will head to the Council of State and Territorial Epidemiologists as its director of infectious disease programs.

She thanked health partners on the call and said she will continue to be inspired by the work here on the pandemic.

“I will be cheering you on,” Daly said.

Talbot said Daly will leave the state as incident commander of the COVID-19 pandemic and she thanked her for her often behind-the-scenes work.

Talbot discussed what is known about the Omicron variant which was announced last Friday and first diagnosed in Africa.

“There is a lot that we don’t know,” Talbot said, “some of the concerns are theoretical.”

She said Botswana is seeing cases rise rapidly, particularly in its most populated province.

The first U.S. case was discovered this week in San Francisco among an individual who traveled to Africa who has mild symptoms and was fully vaccinated but had not yet been eligible for a booster. That person is in isolation and improving.

On Thursday, another case of the COVID-19 with the Omicron variant was identified in Minnesota but this person was fully vaccinated and did not travel to Africa. Instead it was to a convention in New York City. That person was identified with mild symptoms as well.

The Africa case strains have been identified now in 24 countries, Talbot said.
No one knows whether Omicron will overtake Delta as now the most common variant of COVID-19, she added.

“We remain very grateful to the work they are doing” in Africa, Talbot said, where the effective transmission factor has jumped quickly, particularly in Botswana.

“You should anticipate some new rules for all international travelers,” she said.
It is still too early to tell if the new variant is good news or bad when compared to the Delta variant.
Sometimes, Talbot said, mutations are not in favor of the virus.

“So lots to learn in these coming days,” she told health-care workers. “There is certainly an extensive ongoing presence in the U.S. to look for this…and we are receiving instructions to isolate and viral interrogation.”

Bottom line, Talbot said, Omicron has emerged, we can track it, and are watching very closely.

“No doubt, strong emphasis here that this emergence and the ongoing Delta driven surge, that vaccination is absolutely critical,” Talbot said. “For now, it is time to get that vaccine for anyone in your community who is holding back,” she told health-care workers from Berlin to Nashua.

Chan urged potential international travelers to seek CDC guidance and health-care providers to become acquainted with the country-by-country messaging.

The next virtual meeting will be Dec. 16 at noon of the state Department of Health and Human Services and healthcare providers.