Throughout the COVID-19 crisis, Dr. Craig Smith, Chair of the Department of Surgery, sends updates to faculty and staff about pandemic response and priorities. Stay up to date with us.
Dear Colleagues,
I’ve wanted to share what prodded me to write 10 days ago, when the data was still embargoed. David Ho’s lab at Columbia showed that vaccines and monoclonal antibodies are much less effective against the Omicron variant. This was less true with a booster but effectiveness was still markedly reduced. What alarmed me most was the statement “It is not too far-fetched to think that this SARS-CoV-2 is now only a mutation or two away from being pan-resistant to current antibodies…” As bad as that sounds, Omicron does appear to be less severe in vaccinated patients, so T-cell-mediated immunity, plus the few still-effective antibodies generated by vaccination and infection, are still better than nothing.
In the past 10 days those points have been emphatically underlined by the breakthrough infections exploding around us in the fourth Covid wave. Yesterday was the first time that Covid admissions for NYP exceeded the same date one year ago during wave two. Breakthrough infections are the majority. The good news is that average lengths-of-stay have been comparatively short, and ICU admissions remain behind last year. ICU admissions are predominantly unvaccinated. Sequencing done on Columbia patients shows that Omicron accounts for 80%. Early projections suggest that the fourth wave will peak in mid-January.
Columbia and NYP have adopted a 5-day quarantine policy, beginning on the first day of symptoms or on the day of a positive test. 10 days ago I hinted that this was coming. The CDC announced a 5-day quarantine recommendation on 12/27. CU’s 5-day policy came out on 12/28, followed by NYP on 12/29, and most of the working world is stampeding in that direction. We simply must get people back to work as quickly as possible. For the coming week NYP expects to staff only two-thirds of our operating rooms, therefore some elective surgery will have to be rescheduled. Exactly how cancellations will be rationed remains to be seen. Cancellation on the scale of spring 2020 is very unlikely.
On 3/17/20 I shared with all of you that 20% of the ED doctors were out sick, and by the next day five Surgery faculty had volunteered to work in the ED front lines. The first plea for redeployment volunteers in the Omicron wave went out from the Columbia FPO two days ago, and even more Department of Surgery MDs, NPs, and PAs have already volunteered to work as screeners in the ED. Personally, I doubt we will come near the level of redeployment we suffered through in spring 2020, yet it’s already clear that we will meet whatever challenges are thrown at us.
The first 350 days of 2021 were better than 2020, and weren’t really so bad in our realm. Natural disasters stepped in to take up some of the slack, abetted by the worst inflation in 41 years, and the debacle in Afghanistan. For reasons not worth relating I recently picked up Moby Dick for the first time in many years, simply to confirm that it begins with “Call me Ishmael.” It does—as Ishmael sets out “to see the watery part of the world,” with a culturally diverse crew, on an obsessive quest that only Ishmael survives. Notice that we are all living and working and fighting a pandemic in the home port of the Pequod, that “insular city of the Manhattoes, belted round by wharves as Indian isles by coral reefs—commerce surrounds it with her surf.” That description works pretty well today. Interest piqued, I finished the first chapter. I had completely forgotten how Melville had Ishmael contextualize his voyage in 1851:
“…my going on this whaling voyage, formed part of the grand programme of Providence that was drawn up a long time ago…sort of [a] brief interlude and solo between more extensive performances…something like this:--
‘Grand Contested Election for the Presidency of the United States.’
“Whaling voyage by one Ishmael.’
‘BLOODY BATTLE IN AFGHANISTAN.’
… the great flood-gates of the wonder-world swung open….”
2021 works rather too well as a substitute for the second part of the programme. Happy New Year! And may 2022 be the beginning of the wonder-world.
Craig R. Smith, MD
Chair, Department of Surgery
Surgeon-in-Chief, NYP/CUIMC