As the number of COVID-19 cases continue to rise, the Butler Health System's chief medical officer said he expects to see another increase in cases after the 2021-22 school year begins.

During its first “Business and Community Leader Call” conducted since the pandemic began, health system officials said the proximity of staff and students combined with vaccine hesitancy, the spread of the delta variant and no requirement to wear face masks in schools will lead to an increase in cases after classes begin.

“I expect to see a rise in the number of cases,” said Dr. David Rottinghaus, chief medical officer and physician network president at BHS, on Monday during the remote business and community leader call.

COVID-19 is a respiratory disease spread by gathering in proximity, he said.

Dr. John Love, director of infectious disease at BHS, said he is worried that cases stemming from contact at schools will begin showing up a month after the school year begins.He said the average person who contracts the delta variant infects six other people, and the average person with the typical strain of COVID-19 infects two other people.Dr. Michael Fiorina, vice president of medical education at BHS, said face masks don't stop the spread of the disease, but they provide a layer of protection.“Masking does help prevent the spread,” Fiorina said.Love said he is frustrated that neither federal nor state health agencies have issued guidance about whether teachers and other people who received the single-dose Johnson & Johnson vaccine should get a booster of the Pfizer or Moderna vaccines.Reports from other countries where vaccines similar to Johnson & Johnson have been administered indicate that it is not as effective against the delta variant as Pfizer and Moderna, he said.Love said local teachers received the Johnson & Johnson vaccine, and he is concerned about them returning to the classroom without booster guidance or face-mask mandates.

Ken DeFurio, BHS president and CEO, said 20 patients were admitted as of Monday in Butler Memorial Hospital with COVID-19, and most have not been vaccinated.“Seventy-five percent of the patients who are admitted have not been vaccinated,” DeFurio said.Monday's COVID-19 update from the health system noted: “Vaccines work. On any given day, 75% - 95% of patients admitted with COVID-19 to BHS hospitals have not been vaccinated. And nearly 100% of the most seriously ill have not been vaccinated.”The health system also has had several breakthrough cases, in which fully vaccinated people contracted the disease, and assumes those patients have the delta variant, DeFurio said.Symptoms among patients with breakthrough cases tend to be less severe than original cases, and patients are not admitted to the hospital, he said.The number of COVID cases peaked in December 2020 and January and February this year, and decreased significantly in the spring and summer, but are increasing now.“We are concerned,” DeFurio said. “We are on the upswing.”

He said he would like to think the worst of the pandemic is past, but he does not know when the upswing will end.“We are definitely seeing a significant increase in cases in the community,” Love said.Health system employees are also getting sick, resulting in staff shortages, he said.The local case numbers aren't as high as they are in some other states, where hospitals and intensive care units are overwhelmed, Love said.The health system hasn't curtailed other health care treatment or elective procedures because of the number of COVID-19 patients as it did last spring, because it resulted in patients not receiving treatment and allowed other diseases to progress, he said.DeFurio said the vaccine clinics at BMH and Clarion Hospital remain open, but he is disappointed with the low number of people coming in for first doses.“We continue to believe in and encourage the vaccine,” he said.

Beginning Sept. 20, both clinics will ramp up operations to begin administering booster shots for people who have had both doses of the Pfizer or Moderna vaccines, DeFurio said.Guidelines for the boosters haven't been issued yet, but the booster can be administered eight months after the second dose was given, he said.The Pfizer vaccine will be used in most of the boosters, he said.The health system will announce the plan to administer boosters before Sept. 20, he added.Also Monday, the U.S. Food and Drug Administration approved the Pfizer vaccine that will be marketed as “Comirnaty.”It has been approved for people 16 and older, and continues to be available under emergency use authorization for individuals 12 to 15 years old and for the administration of a third dose in certain immunocompromised individuals.Love said the efficacy of the Pfizer and Moderna vaccines against the delta variant is not known, but there would be more cases with severe symptoms without those vaccines.

Those vaccines don't provide complete protection against delta, but they provide good protection, he said.Officials said 52.6% of county residents and 54% of state residents are fully vaccinated, but 85% of senior citizens in the county are fully vaccinated.The booster is not the same as the third shot recommended for people with compromised immune systems who have received both doses, Love said.People with compromised immune systems receive a three-dose series and might need a booster eight months after the third dose, he said.Boosters regenerate a high level of protection, Love said.DeFurio said the health system wants all of its employees to be vaccinated, but hasn't decided if vaccinations will be mandatory.He said young female employees of childbearing age have voiced concerns about the vaccine, but hospitals in other parts of the country that mandated vaccinations are being sued by their employees. BHS is in the midst of an employee crisis now and doesn't want to lose any more employees, he said.

Long COVID syndrome, in which symptoms persist for months after the initial diagnosis, is still being studied, Love said.The syndrome tends to appear in people who experienced mild symptoms, he said,DeFurio said vaccination is the best way to avoid the syndrome.A question about attending large-gathering indoor events was raised.Love said he wouldn't attend one without wearing a KN95 face mask and would not eat or drink there,He said he has declined invitations to weddings and other events because of COVID-19.DeFurio said BMH still plans to conduct its upcoming annual employee gathering.