New Hampshire public health officials say they see a dangerous combination ahead: a winter rise in COVID-19 cases, hospitalizations, and deaths, and low interest in coronavirus booster shots, especially the new bivalent dose targeted at omicron.

Approximately half of Granite Staters eligible for the first booster have gotten one and far fewer, about 35%, have received a second, according to the Centers for Disease Control and Prevention. The agency has not reported state-level uptakes of the new bivalent booster but has put the national rate at just 4%.

Meanwhile, the Kaiser Family Foundation reported in September that half the country had heard “very little” or nothing about the latest booster, which became available last month and is targeted at COVID-19 and the omicron variants BA.4 and BA.5.

As of this week, Moderna’s bivalent is authorized for people ages 6 and older; the Pfizer bivalent is available to people 5 and older.

“It’s one thing to have the vaccine,” said Dr. Sally Kraft, vice president of population health at Dartmouth Health, in a briefing on the bivalent booster Tuesday. “It’s another to get that vaccine in people’s arms.”

It's one thing to have the vaccine. It's another to get that vaccine in people’s arms.

Kraft isn’t alone in sounding the alarm as COVID-19 cases, hospitalizations, and deaths are already beginning to rise. On Friday, the Department of Health and Human Services asked lawmakers for approval to use $8.9 million in federal pandemic aid to expand access to vaccines and antiviral medications.

Latest on COVID in New Hampshire

There is good news here. The state is in a much better place than it was in January. Deaths have dropped from an average of 11 a day to one, according to the Department of Health and Human Services’ COVID-19 tracker.

Hospitalizations have dropped dramatically, according to the department and the New Hampshire Hospital Association, from about 400 at the start of the year to about 140 on Wednesday. Forty-two were being treated with an antiviral medication, the only patients the state counts on its tracker as COVID-19 patients. The others required other inpatient COVID-19 treatment or care for COVID-19-related illnesses.

It’s impossible to accurately track new COVID-19 cases because home test results are not reported to the state.

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Dr. Michael Calderwood, chief quality officer at Dartmouth Hitchcock Medical Center, attributed those improvements to increased immunity in the state from vaccination, boosters, and COVID-19 infections. But those numbers are ticking up, he said, as immunity wanes and new primary vaccination doses and boosters have stalled. That rise in cases will continue as the holidays bring people together and the cold weather moves social events indoors, he said.

What lies ahead?

Calderwood shared two graphs last week from an October report from The Commonwealth Fund, a health research organization that’s calling for a national fall booster promotion. One graph predicted that by April, hospitalizations nationally would hit 15,000 a day if vaccination rates continue at the current pace. The other forecasted just over 1,200 deaths a day under that scenario.

Those numbers would drop considerably, the organization argued, if as many people got the COVID-19 vaccine as do the flu vaccine, which was about 52% of adults and 57% of children in 2021, according to the CDC. And they’d fall to near zero if the COVID-19 vaccination rate hit 80%.

Calderwood acknowledged the 80% rate is a “large” goal; some would call it impossible. Flu vaccination rates, he said, would be a good second choice.

“Even at those rates, the impact is huge,” he said. “And so we have to understand that this is like any other respiratory virus. It has seasonal variation, and we have vaccines that can protect us much like we do each year coming up and getting our flu shot.”

If we’re past the pandemic, why get vaccinated and boosted?

While President Joe Biden made national headlines three weeks ago by declaring the pandemic over, he noted in the same sentence that the “problem with COVID” remains. That problem is now an endemic virus still capable of causing serious illness and death, Calderwoood said.

Immunization reduces those risks; with a single booster dose, hospitalizations drop 72% for people aged 18-49, Calderwood said. For those 50 and older with two boosters, hospitalizations plummet 82% to 87%, he said.

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Boosters also reduce the risk of developing long COVID by 35% to 40%, Calderwood added. And he cited studies showing that vaccinated people who required monoclonal antibody treatment responded better than patients who were unvaccinated.

He also noted that even a COVID-19 infection with mild or no symptoms is disruptive when people must miss work and school.

Where to get vaccine and booster

COVID-19 vaccines are recommended for people six months and older. Under the latest guidance from the Food and Drug Administration, the newest Moderna bivalent booster has been approved for people age 6 and older. The Pfizer bivalent booster is approved for people age 5 and older.

The CDC recommends the bivalent booster, which replaces prior boosters, be administered two months after the primary vaccine series or last booster and at least three months after a COVID-19 infection. The state Division of Public Health Services recommends waiting at least three months in both scenarios because vaccine protections last beyond two months.

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Vaccines and boosters are widely available in the state. Convenient MD locations and 10 health care practices are offering the vaccine for children under 5. All the state’s major pharmacies, including Rite Aid and CVS, and health care providers across the state are administering vaccines and boosters to people over 5. Individuals are urged to begin with their own health care provider if they have one.

The Department of Health and Human Services has resumed its mobile vaccination program, with regular stops around the state. Employers and organizations can book a vaccine van, and the department recently announced it will bring vaccines to people who are homebound. Details for each option are on the state’s vaccine website, vaccines.nh.gov.

Booster concerns and misinformation

Calderwood was asked during the briefing about reports of people, especially adolescents and young males, developing heart complications after getting a vaccine or booster. The risk is low and cases are mild, according to the American Heart Association.

Calderwood said health care providers began seeing an inflammation of heart vessels leading to heart attacks and strokes before vaccines were available. The virus and the body’s response to it are more often the culprit than the vaccine, he said. And when heart inflammation has followed a vaccine, it’s been temporary and mild, he said.

The health risks of not being vaccinated and boosted are far greater and more serious, he said.

While concerns about adverse reactions to the vaccine have dissuaded some from getting immunized, misinformation has played a role, too. It dominated debates over vaccine-related legislation this year.

Kraft offered suggestions for responding when confronted with vaccine inaccuracies: Say it’s wrong but don’t argue, and cite trusted sources of information.

“When we hear something that’s frankly wrong, we need to call that out and say, ‘That is not correct,’” she said. “And then we need to end with the facts, just be calm, and deliver the facts with confidence.”

“It does not do any of us any good to get into an argument and to repeat over and over what the fallacy is or what that just information is,” Kraft said. “Simply acknowledge that that is not correct information, and leave people with the facts and with trusted sources of information.”

How's NH DHHS preparing for a potential surge?

On Friday, the department got initial approval from the Joint Legislative Fiscal Committee to use $8.9 million in federal pandemic money for new vaccination, telehealth, and workforce shortage initiatives. The program still needs Executive Council approval.

The department would use $2.5 million for a rebate program to incentivize health care providers to hold COVID-19 vaccine and booster clinics. The money would pay providers’ administrative costs of vaccinating people who don’t have insurance or whose insurance won’t cover the expense.

Firefighters, medical providers, and other first responders staffed mass vaccination sites when vaccines were first available. The department, which paid for their time, is seeking $500,000 to call them back if necessary to support its own vaccine efforts and those held by the state’s 13 Rural Public Health Networks.

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Hospitals and county nursing homes continue to struggle with workforce shortages. The department is asking to use $2.5 million to help pay for recruitment and retention efforts and staff training and education.

The largest amount, $3.4 million, would stand up a new telehealth program to prescribe antivirals, such as Paxlovid, to eligible COVID-19 patients at no charge. Those medications are being underused, the department said in its request, because health care providers don’t have the staff to do the eligibility screening; providers are not familiar enough with antivirals; or individuals don’t have a primary care physician.

If approved, the telehealth program would provide the public remote access to a health care provider who could evaluate their symptoms and health conditions, and give those eligible for the medication a prescription immediately that could be filled at a pharmacy or via an overnight prescription mail service.

This story was produced by the editorially independent New Hampshire Bulletin, which is part of States Newsroom. Contact Editor Dana Wormald for questions: info@newhampshirebulletin.com.

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