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Omicron not driving increases in vaccine uptake yet

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COVID-19 vaccinations

Montana has not seen an uptick in vaccination numbers as the omicron variant spreads.

As the omicron variant sweeps the state, with COVID-19 case loads increasing 135% this week over last, which itself was a 130% jump, early figures don’t show the rapid rise of sick Montanans has led to any higher interest in the vaccinations proven to ward off the most severe outcomes and death from the virus.

“We often look at the first dose administered as an indication of whether there's some movement towards increasing vaccination in response to these situational factors. And as I look back through at least the last three weeks of reported data, it's stayed about the same, if not a little lower,” acting State Medical Officer Dr. Maggie Cook-Shimanek said in a Tuesday press conference held by the Montana Medical Association.

The COVID-19 variant Omicron was first detected in Montana Dec. 20 and has so far shown to spread incredibly fast. Before the variant was detected here, the state health department reported an average of nearly 1,500 new COVID-19 cases each week. Now the state counts more than that daily — 1,760 new cases Thursday, 1,831 on Wednesday and 1,520 on Tuesday. Monday’s report included 1,939 new cases, though the state does not update its online database over the weekend.

Earlier this year the GOP-majority state Legislature banned businesses, including hospitals, from requiring vaccinations in Montana. And Republican Gov. Greg Gianforte has encouraged Montanans to get vaccinated, but he has not required them to or taken further action beyond promoting the message in press releases and public service announcements. 

A review of vaccination data in Montana shows the periods correlated with the most demand occurred when different populations become eligible for shots in the first part of 2021. Since then, the state saw a lull in shots over the summer with some increase in the late fall. Cook-Shimanek said she’d have a better idea of the most recent week’s vaccination demands by next week.

Vaccine data also shows that since Montanans became eligible for boosters, those shots quickly took over as the majority of shots administered each week in the state. Since Oct. 1, boosters have accounted for more than 56% of all vaccine doses in Montana in any given week.

In the most recent week's data available, ending Jan. 7, first shots made up just 20% of those administered while third doses accounted for 63%. Montana's vaccination rate has hovered at 53% of those eligible.

While the U.S. Supreme Court on Thursday blocked a federal vaccinate-or-test requirement for large employers, it allowed the federal government to require vaccination or testing and other preventative measures at medical facilities that receive federal funding, which includes Montana's largest hospitals.

In a statement Thursday, the Montana Hospital Association said the state’s hospitals “will adjust their policies to ensure compliance with the federal law. (The Centers for Medicare and Medicaid) has asserted this federal requirement takes priority over state and local law,” president and CEO Rich Rasmussen said.

The spike in Montana's COVID-19 numbers are also without a doubt an undercount, something acknowledged by Cook-Shimanek and other doctors and epidemiologists who joined her on the association’s call to promote a new effort to increase vaccination uptake in Montana.

That’s because of a range of factors from things that have been an issue throughout the pandemic, such as incomplete reporting to the state and not all sick people getting tested, to new issues like no mechanism existing to capture positive results from at-home rapid tests.

“(The state health department) recognizes that not all of those positive results from at-home tests are going to be reported to local public health departments, and so we know that’s going to contribute to some of the undercounting of COVID-19 circulating in different communities,” Cook-Shimanek said.

Empty store shelves have illustrated the high demand for rapid at-home tests. The Missoulian reported Wednesday the state health department told school districts around the state its warehouse of BinaxNOW testing kids ran dry. On Thursday, the governor’s office said it secured 650,000 rapid at-home tests that local public health departments will distribute for free to Montanans.

In an email this week, state health department spokesperson Jon Ebelt said results from at-home tests don’t meet the Centers for Disease Control and Prevention’s definition of a confirmed or probable case, so they cannot be counted in the state’s reports. 

“As we have from the beginning of the pandemic, (the state health department) recognizes the daily case counts may not capture the full picture of COVID-19 activity in Montana. It should be noted that other states face this challenge,” Ebelt wrote.

Dr. Neil Ku, an infection disease expert at Billings Clinic, said other reasons for case counts being lower than actual infections can include test shortages, people who don’t know where to get a test administered through their county health department or hospital and people who choose not to get tested.

“We don't have an accurate number,” Ku said. “We just have an estimate and a sense based on … some of the other indicators we use like the numbers of visits to a doctor’s office for respiratory illness or things like that. We take all those different indicators and get more of a sense rather than an exact number of actual cases of COVID-19.”

In a press release Thursday, RiverStone Health, the public health agency for Yellowstone County, acknowledged its positive cases reported this week by the state was an undercount. The state had reported 1,007 cases for the county in its updates from Monday (which includes any positives from over the weekend) through Thursday. But RiverStone said Thursday "so far this week, more than 1,500 Yellowstone County residents have tested positive for the COVID-19 virus."

It also noted nearly 2,300 county residents had tested positive so far this month.

Trends in Montana are concerning, the panel said. Last week 84% of all specimens sequenced at the state public health laboratory were the omicron variant, up from 70% the week prior. Only a small percentage of all samples are sequenced.

“At this point, we do consider the omicron variant to be the dominant circulating strain in our state,” Cook-Shimanek said. “It should be noted that more cases of omicron likely exist (than the numbers processed at the lab) but (the state health department) and its partner labs don't sequence every positive COVID-19 test that they receive because the current lab sequencing is intended for surveillance purposes only.”

Ku said that hospitalizations in the state had slowly been trending upward, mirroring the effects omicron has wrought elsewhere in the country where it hit first. Hospitalizations rose 17% from from the week prior to this one, Gianforte was told in his COVID-19 briefing this week.

Ku cited the recent holidays, more people indoors because of the cold weather and a significant portion of Montanans unvaccinated as leading to a surge in cases as the more-contagious omicron spreads.

Omicron is 200% more transmissible than the Delta variant, which itself was 200% more transmissible than the alpha variant, Ku said. The omicron variant also has a higher viral load in infected people, meaning those people make more virus and can spread it further. There’s also some evidence, Ku said, that commonly used monoclonal antibodies are substantially less effective against omicron.

Because the variant can spread much faster, even though those who are vaccinated have a good protection against severe illness and death, the number of hospitalizations and death can “match or exceed that of the Delta variant” simply because so many people are likely to fall ill, Ku said.

Hospitalizations and deaths lag case counts, but during the press conference Rasmussen, with the hospital association, said “without a slowdown to the spread COVID-19, hospitals will once again be forced to consider a return to crisis or contingency standards of care."

The governor’s briefing showed that between April 2021 and Jan. 7, those who weren’t vaccinated accounted for 83% of COVID-19 hospitalizations and 79% of COVID-19 deaths in the state.

Ku said he's optimistic the one bright spot in those dim figures would be an increase in vaccination uptake.

“My hope is that now (seeing) how rapidly this variant has spread in our state … my hope is that that … those who have not been vaccinated will get incentivized to get the vaccine,” Ku said.

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State reporter

State Bureau reporter for Lee Newspapers of Montana.

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