ALBANY COUNTY — The United States had its highest-ever seven-day average of new COVID-19 cases this week and New York remained the state with the highest infection rate.

On Wednesday, Albany County Executive Daniel McCoy reported 471 new COVID-19 cases — the county’s highest single-day increase since the pandemic started in March 2020, dwarfing the former high of 351 nearly a year ago, on Jan. 12, before the vaccine was widely available.

Last Thursday, McCoy held a press conference, saying “we’re at the peak,” to announce the county was given 138,000 Kn-95 masks and 10,000 rapid test kits to give to residents for free. The federal largesse, distributed by the state, didn’t go far.

Sheriff Craig Apple said the supplies were being given to municipalities across Albany County based on population. Some will say it’s “just a drop in the bucket,” said Apple. The county has about 320,000 residents.

Guilderland Supervisor Peter Barber reported later, in his daily COVID update, that the 900 at-home antigen tests (for roughly 36,000 residents) were exhausted within hours. Next time, Barber said, the town will “use a different means of delivering the tests and avoid the organized chaos yesterday at Station 1.”

Sean Lyons, the supervisor for the rural town of Berne, writes in a letter to the Enterprise editor this week that the 89 tests Berne (population roughly 2,700) received was an insult since Berne is an underserved town.

The tests have been in short supply at area pharmacies as people clamored to get tested before gathering for Christmas.

Albany County Health Commissioner Elizabeth Whalen said that rapid antigen tests — where a swab is inserted in the nose — are easy to perform and should detect the coronavirus. The tests may not give a positive result before symptoms have appeared or after they have subsided.

This week saw two important changes from the Centers for Disease Control and Prevention. The CDC cut in half the recommended isolation period, from 10 days to five, for someone who has contracted the virus, and also shortened the quarantine period for someone exposed to the virus.

And, the CDC recalculated its estimates on the dominance of the Omicron variant. Last week, The Enterprise ran a CDC graph showing over 70 percent of new cases that week in the United States were of the Omicron variant.

Now, the CDC estimates last week’s percentage was closer to 23 percent, with the Delta variant still dominating. This week, the CDC has produced a map of the nation indicating, in various regions, the percentage of cases that are Omicron and Delta.

Nationwide, for the week ending Dec. 25, the CDC estimates close to 59 percent of the new cases were the Delta variant. For Region 2 — New York and New Jersey — the CDC estimates 88.4 percent of new COVID-19 cases were the Omicron variant.

All this week, The Enterprise has reported the percentages from the governor’s office, which on Tuesday stated the Omicron variant comprised 73.3 percent of uploaded sequences in New York State between Dec. 14 and 27.

Those numbers are from the Global Initiative on Sharing Avian Influenza Data, or GISAID, database, which the governor’s office says is the largest repository of coronavirus sequences in the world.

Genetic sequencing, which is used on just a sampling of cases, is the only way to confirm a variant.

Shorter isolation, quarantine

On Monday, the CDC issued new guidance on isolation and quarantine periods. 

“Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation from 10 days for people with COVID-19 to 5 days, if asymptomatic, followed by 5 days of wearing a mask when around others,” says the new guidance.

Most transmission occurs early in the course of illness, generally in the day or two prior to onset of symptoms and then two to three days after, the CDC says.

The CDC also changed the quarantine period for people exposed to COVID-19.

People who are vaccinated and have a booster shot — six months after the second shot of Moderna or Pfizer-BioNTech and two months after the single-shot Johnson & Johnson — do not need to quarantine after being exposed, but should wear a mask for 10 days after the exposure.

For people who are unvaccinated or are more than six months out from their second messenger RNA dose or more than two months after the J&J vaccine and not yet boosted, the CDC now recommends quarantine for five days days followed by strict mask use for an additional five days.

“Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure,” the guidance says.

 Anyone who has been exposed to the virus should get a COVID test the fifth day after exposure, the CDC says. If symptoms occur, the exposed person should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19.

Data from South Africa and the United Kingdom, the CDC says, shows that vaccine effectiveness against infection for two doses of a messenger RNA vaccine — like Pfizer or Moderna — is approximately 35 percent. A COVID-19 vaccine booster dose restores vaccine effectiveness against infection to 75 percent.

In releasing the new guidance, CDC Director Rochelle Walensky said, “The Omicron variant is spreading quickly and has the potential to impact all facets of our society. CDC’s updated recommendations for isolation and quarantine balance what we know about the spread of the virus and the protection provided by vaccination and booster doses.

“These updates ensure people can safely continue their daily lives. Prevention is our best option: get vaccinated, get boosted, wear a mask in public indoor settings in areas of substantial and high community transmission, and take a test before you gather.”

On Dec. 24, a day after the CDC changed guidance for healthcare workers, Governor Kathy Hochul announced essential workers who have tested positive will return to work in five days — if they are “fully vaccinated and are asymptomatic or their symptoms have been resolving and they have no fever for the last 72 hours and they don’t have to be taking medication.”

She listed essential workers as including those in “health care, elder care, home health care, sanitation, grocery stores, pharmacies, restaurants, you know who you are; you know you’re the ones that got us through the first many months of anxiety,” Hochul said.

Those returning workers will be required to wear masks, she said, stressing that the Omicron variant, which is now dominant, appears to be less severe than the Delta variant.

Test-to-stay

Also on Dec. 24, Hochul announced that, after school resumes from winter break, on Jan. 3, students who have been exposed to the virus will take rapid antigen tests home in their backpacks and, if they test negative and are without symptoms, they can return to school.

Hochul cited “an experiment that was done in Grand Island,” which, she said, “had a very good outcome, and so the CDC just confirmed that test-to-stay works.”

“We want healthy kids to stay in school,” Hochul said.

So far this school year, according to the state’s tracker, as of Dec. 23, the last day before winter break, Guilderland, with about 4,800 students, has had 293 confirmed cases of COVID-19 with the vast majority, 247, of students; 29 staff members tested positive as did 17 teachers.

There were 84 cases at the high school, which includes district-wide workers like bus drivers as well; 68 at Farnsworth Middle School; 39 at Westmere Elementary; 33 at Pine Bush Elementary; 27 each at Lynnwood and Guilderland elementary schools; and 15 at Altamont Elementary School.

Voorheesville, with about 1,200 students, has had 80 confirmed cases — 69 of students, 5 of teachers, and 6 of staff — with 12 at the high school, 11 at the middle school, and 57 at the elementary school.

Berne-Knox-Westerlo, with about 780 students, has had 109 confirmed cases — 78 of students, 15 of teachers, and 16 of staff — with 13 at the elementary school and 13 at the secondary school. The rural BKW area has a lower vaccination rate than its suburban counterparts.

Keeping kids in school is an “all hands on deck” operation, said Emergency Services Commissioner Jackie Bray at the governor’s Monday press conference. Of the current distribution of COVID test kits, she said, half of the six million kits allocated to the state will go out this week, with 2 million going directly to New York City.

“There’s 731 end points: Those are our districts,” said Bray. “We’ll be supplying them through 60 different hubs throughout the state. Those will include the BOCES, some direct to school districts and some county hubs. Planes with these kits begin arriving tomorrow. They will be landing in the state every day this week.”

The districts that have the highest level of transmission will be prioritized to get the test kits, said Bray.

“Pharmacies and urgent cares across the state continue to offer testing, including walk-in testing,” said Bray. “Last week, we delivered over a million over the counter tests to county, local health departments outside of New York City.”

Prison tests

Hochul also announced on Dec. 24 that, starting on Dec. 27, the Department of Corrections and Community Supervision is requiring visitors to either provide proof of being fully vaccinated or a negative COVID-19 test taken within the last 48 hours.

She said of prisons, “This is a population where this could run through like wildfire and that is not sustainable. We cannot have staff getting sick because there’s not an alternative. There’s not a lot of people in reserve who will go into our correctional facilities to do the very challenging work that they do day in and day out.”

Hochul said at-home tests will be supplied to the prisons so people can be tested.

Kids at risk

On Monday, as hospitalizations from COVID-19 continued to surge across the state, including in Albany County, the state’s acting health commissioner, Mary Bassett, stressed the increase in pediatric admissions.

Concentrated in the New York City area, Bassett said at Monday’s press conference, there was a four-fold increase in pediatric admissions. Among the hospitalized children aged 5 to 11, none had been vaccinated, she said.

About 27 percent of New York State children in that age group have received at least one dose of vaccine.

Hochul encouraged parents to use the school break this week to vaccinate their children.

Bassett reported that, starting the week of Dec. 5 to 11, there were 70 pediatric admissions, which has gone up statewide two-and-a-half fold.

“Many people continue to think that children don’t become infected with COVID. This is not true,” said Bassett. “Children become infected and some will be hospitalized. The immunization coverage in this group, the vaccination coverage, remains too low.”

She said her department released the data on pediatric hospitalizations to alert both pediatricians and parents to the dangers.

Nursing homes

Also on Monday, Bassett reported that, of the 608 nursing homes across the state, about a third have at least one resident who has COVID. Nearly 90 percent of nursing home residents are fully vaccinated, Bassett said, but not as many are boosted.

“And this seems to be particularly important in protecting against adverse outcomes of Omicron infection. When we do the math, about two thirds of nursing home residents have been fully vaccinated and boosted. We’re working hard to get that number up,” Bassett said, noting her department is using a county-by-county approach.

“The facts are clear,” said Bassett. “We know that three quarters of the lives we’ve lost in this pandemic have been among people who are over 65. So being fully vaccinated and boosted is critical in this very vulnerable population of nursing home residents.”

Hochul said, when it comes to treating nursing home residents, “There are barriers, where someone has dementia and cannot knowingly consent to getting a vaccination or a booster shot, or family members declined the opportunity to get approvals for them.”

Pills authorized

At Monday’s press conference, Bray discussed federal resources and said, “The governor has been very clear that it’s important that New York State receive the monoclonal antibody treatment that continues, the one that continues to work against Omicron and the oral treatment that Pfizer is preparing and is making available.”

On Dec. 22, the FDA issued an emergency use authorization for Pfizer’s Paxlovid to treat mild-to-moderate COVID-19 in adults and pediatric patients who are at least 12 and are at high risk for progression to severe COVID-19, according to a release from the FDA.

“Paxlovid is available by prescription only and should be initiated as soon as possible after diagnosis of COVID-19 and within five days of symptom onset,” the FDA release said.

“Today’s authorization introduces the first treatment for COVID-19 that is in the form of a pill that is taken orally — a major step forward in the fight against this global pandemic,” said Patrizia Cavazzoni, M.D., director of the FDA’s Center for Drug Evaluation and Research, in the release. “This authorization provides a new tool to combat COVID-19 at a crucial time in the pandemic as new variants emerge and promises to make antiviral treatment more accessible to patients who are at high risk for progression to severe COVID-19.”

Paxlovid is not authorized for the pre-exposure or post-exposure prevention of COVID-19 or for initiation of treatment in those requiring hospitalization due to severe or critical COVID-19, the FDA says.

“Paxlovid is not a substitute for vaccination in individuals for whom COVID-19 vaccination and a booster dose are recommended,” the FDA says. “The FDA has approved one vaccine and authorized others to prevent COVID-19 and serious clinical outcomes associated with a COVID-19 infection, including hospitalization and death. The FDA urges the public to get vaccinated and receive a booster if eligible.”

The next day, on Dec. 23, the FDA granted emergency use authorization for a second treatment — this one from Merck — but stated it shouldn’t be preferred over other treatments.

The prescription-only molnupiravir is, like Pfizer’s Paxlovid, for the treatment of mild-to-moderate coronavirus disease for patients at high risk for progression to severe COVID-19, including hospitalization or death — and for whom alternative COVID-19 treatment options authorized by the FDA are not accessible or clinically appropriate. 

Molnupiravir is not authorized for patients younger than 18 because it may affect bone and cartilage growth and it is not recommended for pregnant women.

The main outcome measured in a clinical double-blind trial was the percentage of people who were hospitalized or died due to any cause during 29 days of follow-up. Of the 709 people who received molnupiravir, 6.8 percent were hospitalized or died within this time period compared to 9.7 percent of the 699 people who received a placebo. Of the people who received molnupiravir, one died during the follow-up period compared to nine people who received placebo.

“Molnupiravir is limited to situations where other FDA-authorized treatments for COVID-19 are inaccessible or are not clinically appropriate and will be a useful treatment option for some patients with COVID-19 at high risk of hospitalization or death,” said Cavazzoni in a statement, announcing the authorization.

Albany County

Three Albany County residents died this week of COVID-129 — two women in their fifties and one woman in her sixties — bringing the county’s virus death toll to 469.

According to the CDC, the rate of transmission in Albany County and New York state remains high, meaning masks should be worn indoors in public regardless of vaccination status.

On Dec. 10, Hochul mandated businesses to either have a vaccine requirement for patrons to enter or to require people to wear masks inside. County health departments were charged with enforcing the mandate.

Two weeks ago, Mary Rozak, the spokeswoman for McCoy’s office, told The Enterprise, when asked how the health department would enforce the mask requirements, “This will largely be a complaint-driven system for enforcement, and Albany County is reactivating its complaint hotline. Once active, those visiting Albany County businesses should utilize that hotline to report any violations, which will be followed up on by county staff to determine next steps in terms of any necessary enforcement.”

On Wednesday at noon, Cameron Sagan, in McCoy’s office, responded in an email to Enterprise questions about the complaint hotline, which hadn’t yet been set up. Sagan said the online portal would go live on the county’s website later in the day.

“However,” Sagan went on, “the County Executive’s staff continues to field any complaints regarding COVID restrictions at 518-447-7040. We’ve received a handful of separate complaints for individual businesses and all of them have been investigated.

“The majority of complaints did not require follow up, as they were the result of a misunderstanding of regulations, and only one requires further inquiry in terms of enforcement. Members of the County Executive’s Office, the Division of Finance and other members of the Albany County workforce are assisting with this process.”

Hochul’s mask order includes a maximum fine of $1,000 for each violation. The state is making $65 million available to counties to cover costs associated with state protocols — at least $1 million will be available to small counties and up to $2 million for larger counties, Hochul said at her Dec. 20 press conference. The money can be used for purchasing masks, or putting up signs, or setting up call centers for people to make complaints.

Sagan told The Enterprise, “No fines have been issued at this time, and the county has not received any funding from the state for enforcement efforts.”

In Wednesday’s release announcing Albany County’s 471 new cases of COVID-19, McCoy said, “While concerning, it’s still unclear what kind of impact this will have on our hospitals and for now, COVID hospitalizations seem relatively stable, though there is a lag in time after a spike in infections.”

There were eight new hospitalizations since Tuesday, and there are 58 county residents currently hospitalized with the coronavirus — a net decrease of three. Seven of those hospital patients are now in intensive-care units, down from eight yesterday.

The county’s seven-day average of new daily positive cases is now up to 285.4. Albany County’s most recent seven-day average of cases per 100,000 is up to 74.9 and the Capital Region’s average of cases per 100,000 is now up to 70.2.

There are now 1,122 active cases in Albany County, up from 1,028 on Tuesday. The number of county residents under quarantine increased to 2,063 from 1,930. Of those who have completed quarantine, 38,868 had tested positive and recovered — an increase of 336 additional recoveries.

“We know vaccinations and boosters are doing their jobs in preventing many serious illnesses and hospitalizations caused by the virus, and the initial evidence is showing that the Omicron variant is comparatively less dangerous than Delta,” said McCoy in the release. “With that being said, we can’t predict the future and we still need everyone to remain vigilant. Please continue to do your part by getting vaccinated, getting the booster shot, wearing masks indoors, and getting tested and staying home if you’re feeling sick.”

As of Tuesday, 78.8 percent of all Albany County residents have received at least the first dose of the vaccine, and 71.5 percent have been fully vaccinated. The first-dose vaccination rate for county residents who are 18 and older is 87.8 percent.

Statewide, 83.4 percent of New Yorkers have received at least one dose as have 95.0 percent of New Yorkers 18 and older. At the same time, 71.5 percent of New Yorkers are fully vaccinated.