CHARLESTON — A peak may be reached in active COVID cases in West Virginia within the next 10 days, but hospitalizations are expected to continue to rise two to four weeks after that, leaving hospitals in a “fragile” position.

Dr. Clay Marsh, state COVID-19 Czar, said Friday during Gov. Jim Justice’s pandemic briefing that, looking at transmission rates, the peak may be soon.

“We expect a two to four-week continued increase in hospitalizations after the peak of new cases,” he said, with that number setting a new record of 29,744 on Friday. “But we are not out of the woods yet even when the number is coming down.”

Hospitalizations of COVID patients around the state also set a new record Friday, jumping to 922, after falling to only 52 in early July.

Retired Maj. Gen. James Hoyer, director of the state Joint InterAgency Vaccine Task Force, said hospitalizations may hit 1,000 before they cap out.

“Our data shows from past surges that once we hit a peak it is about four weeks before we peak in hospitalizations,” he said.

That leaves hospitals in a precarious situation, Marsh said.

“Our hospitals are being challenged like never before,” he said of the stress on capacity, adding that they are holding their own now and patients are being treated.

However, at some point the critical care services needed by people who have a heart attack or stroke or who are injured in a car wreck may be in jeopardy.

Marsh said it is important now to avoid adding more stress to hospitals by going to emergency rooms unless it is an acute issue.

“We are at a fragile moment,” he said of the balancing hospitals are doing now involving patient volume as well as staffing issues.

One service that is being expanded to help some COVID patients stay out of the hospital is the availability of monoclonal antibody infusion treatment.

Hoyer said the treatment will be available not only in hospitals, but in health departments and health centers as well.

“We have a great plan in place (to distribute and administer them),” he said.

Marsh explained the treatment is not a vaccine that activates a person’s own immune system, but a treatment that helps block the virus from getting inside cells.

It is administered to people who have not been vaccinated or who are sick and it’s been a longer time since the vaccination.

Marsh said it is temporary but may prevent symptoms to worsen to the point a person needs to be hospitalized.

On the Pfizer booster shots the state has been pursing, the FDA voted on Friday to recommend emergency use authorization of a booster dose of Pfizer’s vaccine six months after full vaccination in people 65 and older and those at high risk of severe COVID-19.

Earlier on Friday, the FDA rejected a widespread booster for those younger.

Justice had been pushing for permission to give the booster to those 60 and above.

The CDC must now give its okay to move forward with the plan.

Justice continues to reject any plan regarding a mask mandate, although his home county, Greenbrier County, now has one in place.

The Greenbrier County Health Department issued an indoor mask mandate on Friday, requiring masks be worn indoors in any public building, including businesses, regardless of vaccination status.

The board of health authorized the mandate.

Justice said on Friday after a question about mask mandates that “masks are not the answer, the answer is vaccinations.”

“Masks won’t hurt and they can help to some degree, but that is not the answer,” he said.

— Contact Charles Boothe at cboothe@bdtonline.com

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