Hospital staff thank local fire, police departments, and EMS as they pay tribute to the health care providers at Saint Mary's Hospital on the front lines taking care of patients with COVID-19 on April 10, 2020 in Waterbury, Connecticut. Joe Amon | Connecticut Public

Connecticut’s COVID hospitalizations have risen by 58% over the last four weeks, and with families and colleagues preparing to gather for the holidays, health officials are urging people to don masks indoors and consider the well-being of others as they go about the seasonal bustle.

On Nov. 17, the state recorded 325 COVID hospitalizations and a seven-day average positivity rate of 7.3%. By Thursday, hospitalizations had climbed to 515 and the positivity rate reached 11.4%. Hospitals have added more than 100 patients with COVID since the start of December alone.

And given the prevalence of home testing, officials have said, the positivity rate is likely an undercount.

“Everybody has a different risk level,” said Dr. Ulysses Wu, chief epidemiologist at Hartford HealthCare. “At one level, you catch a bad cold, and you have to stay out of work for five to 10 days. That can be important to people. Then as we progress, you catch a bad cold, maybe you infect somebody else who catches that bad cold, who then infects somebody else who cannot do well.

“The best way to really assess risk at this point is: What can you afford to lose? And those people around you: What can they afford to lose?”

When weighing risk, people should consider whether they’re caring for someone who is medically vulnerable or whether they can afford to miss extended periods of work, Wu said.

“People are so COVID weary … they know so many people who have gotten COVID, who have been perfectly fine. But what they don’t know is — that person had to be out 10 days from work, or that person ended up with long COVID, or that person gave it to their child, who then gave it to their grandmother,” he said. “We don’t see those secondary and tertiary endpoints, because our primary endpoint is, 'I didn’t die from this.'

“Personal risk really extends beyond the primary. There is a certain amount of empathy as well as altruism that you need to think that far out.”

Wu and others are urging residents to mask indoors during the cold weather months, especially in public places like grocery stores and pharmacies. In addition to COVID patients, hospitals have seen a high number of people with flu and respiratory syncytial virus. By the end of last month, the state had recorded 6,000 flu cases and 102 hospital admissions, up from 51 cases and four admissions at the same point last year.

Children’s hospitals have been swamped with RSV. Throughout November, staff at Connecticut Children’s Medical Center said, the emergency department was “bursting at the seams” and the critical care unit was nearly always filled to capacity.

At Hartford Hospital, Wu said capacity has not yet become an issue, but, “I do expect the numbers to continue to rise.”

“I’ve been recommending everybody mask for respiratory viruses, I would argue, from October through March. We should really be thinking about masking now,” he said. “Outdoors, I think you’re perfectly fine. But indoors, in foreign situations like clubs, concerts, holiday gatherings where you don’t know everybody — I’m a big fan of masking.”

People who are thinking about their risk or the risk of loved ones can look at trends in the positivity rate, hospitalizations and even wastewater data, which show rising cases of COVID in recent weeks. But for many people who want to keep it simple, health officials recommend staying up to date on vaccinations, including the COVID booster, masking indoors and staying home when feeling sick. For those that must leave the house, masking is strongly urged.

“If you feel sick and if you have secretions or your child has secretions — either staying home or wearing a mask if you need to go out in public is a measure of personal responsibility,” said Dr. Manisha Juthani, the state’s public health commissioner. “That then translates into responsibility to society and those around you. If you are sick, that is something people should be cognizant of and really look out for other members in their community by doing that.”

Physicians say residents should particularly be concerned for those 65 and older, pregnant people and those who are immunocompromised or who have an underlying medical condition like diabetes or heart disease.

“A large portion of people have some immunocompromising condition, where they’re very often taking medications that are immunocompromising — people who have cancer or certain types of arthritis or even bad asthma — and they very much appreciate not getting sick and not getting exposed to things,” said Dr. Richard Martinello, professor of internal medicine and pediatrics at the Yale School of Medicine.

“For them, the stakes are really high. We don’t necessarily know who these people are. You can’t tell just by looking at them; they are normal people. That’s why it’s important for us to be thoughtful about others when we’re going out. By wearing masks, it makes it safer for them to go to the grocery store and do other things they need to do.”

The risk of long COVID also persists. The Centers for Disease Control and Prevention estimated that one in five people under 65 who have had COVID-19 experienced at least one health issue that could be deemed long COVID. Other studies say 10% to 30% of coronavirus cases result in long COVID.

In Connecticut, providers say 5% to 30% of cases here lead to long COVID. A CDC analysis of Census data showed 29.3% — nearly a third — of adult COVID survivors in Connecticut have experienced lingering symptoms.

Symptoms can last for weeks or months beyond an infection and include shortness of breath, fatigue, brain fog, headaches, gastrointestinal problems, cardiac and central nervous system issues and cognitive dysfunction.

Doctors are reminding the public of those risks with case rates again on the rise.

At Trinity Health of New England’s COVID Care Recovery Center, Dr. Kathleen Mueller recently saw a patient whose post-COVID fatigue is so severe it’s causing them to quit their job at a prime career age.

“We don’t think about this, because it’s, fortunately, relatively uncommon. But I probably have six people I can think of off the top of my head who are not working six months to a year and a half after having COVID,” said Mueller, head of the program. “And that’s not counting the people who are muddling through with terrible fatigue who are continuing to work.”

Juthani is considering ways the state’s public health department can communicate the benefits of mask wearing. Many people may associate masks with restrictions or punishment, as opposed to a measure of protection for an individual and the community at large.

“Reframing that is one of the things we’re going to be looking at,” she said. “One of our challenges right now is that people have sort of PTSD-type symptoms when it comes to the ongoing messages of this pandemic. [Some] see masks as a punitive measure, and we aren’t far enough away from this to change people’s minds overnight.

“I have the desire to really come up with a broader communications strategy, where we think proactively about our public health communications and ways we communicate in times of calm, so that in times when there’s a storm, you can utilize messaging in that mindset.”

For now, the state is prepared to meet what could be a higher demand for COVID tests in the coming months, Juthani said. Last year, people flooded Connecticut’s scattered testing sites, many waiting in vain, anger building. At one site in Bristol, someone threatened to pull a gun. Hours-long waits became common.

Since the increase in cases began this season, demand so far has been far lower, Juthani said, due in part to the prevalence of rapid home testing. The state still maintains 19 testing sites across Connecticut where people can get a PCR test for free.

But as turnout continues to wane, officials are reevaluating the role of those sites. The state is also partnering with federally qualified health centers to provide free tests to people who visit those facilities.

Connecticut also has dozens of “test-to-treat” centers, where people can get tested and get a prescription treatment filled, such as Paxlovid, if they qualify.

“I would certainly expect that we will continue to see a rise. I just don’t think the run on testing is going to be the same as it was last year,” Juthani said. “I think we’re at a different calculus than we were a year ago. Self-tests were not readily available.”

For a list of the state’s free PCR testing sites and hours of operation, click here. To find a test-to-treat center nearby, click here.

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Jenna CarlessoHealth Reporter

Jenna is CT Mirror’s Health Reporter, focusing on health access, affordability, quality, equity and disparities, social determinants of health, health system planning, infrastructure, processes, information systems, and other health policy. Before joining CT Mirror Jenna was a reporter at The Hartford Courant for 10 years, where she consistently won statewide and regional awards. Jenna has a Master of Science degree in Interactive Media from Quinnipiac University and a Bachelor or Arts degree in Journalism from Grand Valley State University.