California faces summer of COVID uncertainty amid subvariants

The California summer is complicated by a dizzying array of Omicron subvariants that have emerged over the past few months.

The most dominant nationally is BA.5, which officials say is not only highly contagious, but has increased the risk of reinfection with the coronavirus – possibly just weeks after an earlier case.

According to federal estimates, BA.5 accounted for 65% of the nation’s coronavirus cases in the week-long period ending Saturday, a stunning increase from a month ago, when it accounted for 17% of case.

Among the impacts of the sub-variant:

  • Transmission levels have been consistently high in virtually every county in California.
  • Los Angeles County is seeing a further rise in cases, now up 14% week over week – ending a short period of relative stability after July 4 which, in hindsight, was likely linked to delays in reporting and reduced testing during the holidays.
  • LA County has averaged about 5,900 daily coronavirus cases over the past week, its highest rate since early February. Per capita, this represents 412 cases per week per 100,000 inhabitants. A score of 100 or more is considered high.
  • In LA County, the number of weekly coronavirus outbreaks in nursing homes over the past month has doubled.
  • Rising coronavirus infections, especially in workplaces, have experts worried. The county is urging employers with three or more COVID cases over a two-week period to consider encouraging workers to perform their jobs remotely when possible.
  • Weekly deaths have doubled over the past month in LA County, which is reporting about 100 COVID-19 deaths per week.

So what does the rest of the summer look like? Here’s a breakdown of what we know:

What can we expect?

It’s hard to predict.

Clearly, California continues to see a surge of cases from the super-infectious family of Omicron subvariants, namely BA.5.

Coronavirus-positive hospitalizations are also increasing, raising the possibility that facilities will be strained again. This is not a certainty, however, as a decline or stabilization in infections would likely trigger the same among healthcare systems.

And while hospitalizations remain well below those of previous waves, the trend lines are troubling.

As of Tuesday, 4,377 coronavirus-positive patients were hospitalized statewide, including 1,170 in LA County. Over the past month, those numbers have increased by 61% and 97%, respectively.

In LA County, about 60% of coronavirus-positive patients in hospitals are seen for reasons unrelated to COVID-19 illness. Still, officials say, they pose a potential burden on hospitals because of the extra resources needed to keep them from infecting others.

A state-released projection suggests coronavirus-positive hospitalizations will continue to rise for the next two weeks before declining. If the model is correct, the number of projected hospitalizations at the peak will be “nothing like the previous surges we’ve seen,” California state epidemiologist Dr. Erica Pan said during an interview. a briefing at the California Medical Assn. tuesday.

A big question is whether BA.5 will remain the dominant variant for some time. That prognosis could eventually stabilize the situation in California and, at some point, lead to a decline in cases, said Dr. Peter Chin-Hong, an infectious disease expert at UC San Francisco.

A possible key to this scenario is the emergence of another Omicron sub-variant, BA.2.75, which has caused concern in India. Scientists say it could spread quickly and bypass immunity from vaccines and previous infections. It is not known whether it could cause more severe illness than other Omicron variants.

In previous outbreaks, dominant strains like Delta and Alpha remained for relatively long periods of time and were not quickly displaced by their successors, meaning an infected person could enjoy a high degree of protection for up to -be several months.

That timeframe has shortened considerably since Omicron first hit the scene late last year. Since April, three different subvariants – BA.2, BA.2.12.1 and now BA.5 – have each been considered the dominant strain nationally. This rapid succession means that it is possible for someone to be infected with an earlier edition of Omicron and then be re-infected with a later version several weeks later.

“Many people who have been recently infected are likely to get the virus again, in three or four weeks, compared to the old days, where they have a three-month window period” when reinfection is less likely, a said Chin-Hong.

What about a new LA mask mandate?

Although LA County hospitals aren’t overwhelmed with COVID-19 patients, Ferrer said it’s prudent to reinstate a universal mask mandate if hospitalizations continue to rise.

“Waiting for hospitals to be overwhelmed is far too late to try to do much to slow transmission,” Ferrer said. “The time to slow transmission is actually when you start to see indicators that you have more usage in your hospitals.”

Ferrer said that if LA County enters the CDC-defined high community level of COVID-19 and stays there for two consecutive weeks, health officials will reimpose a universal mask requirement in indoor public places for 2 years and older. Such an order could come into effect as early as July 29.

If that happens, LA would be the only county in California with a mask mandate, though the state Department of Public Health continues to strongly recommend indoor masking.

Unlike transmission levels, which take into account coronavirus cases and test positivity rates, COVID-19 community levels take into account both cases and hospitalization rates.

While some have questioned the effectiveness of renewed mask mandates, “there is broad consensus in the scientific community that wearing a high-quality mask in indoor public spaces is an important tool for controlling the spread of COVID-19,” said Dr Ashish Jha. , the White House’s COVID-19 response coordinator said during a Tuesday briefing.

This, he said, “prevents you from getting infected and it prevents you from passing it on to others”.

What evidence is there for the effectiveness of mask mandates?

Ferrer pointed to some studies suggesting that universal masking orders have been effective in reducing viral transmission.

A study, published in February in the journal Health Affairs, said that of more than 400 US counties, those with mask mandates between March and October 2020 had 35% lower rates of coronavirus cases than those without. had not.

Another study, published in March by the US Centers for Disease Control and Prevention, said school districts in Arkansas with universal mask requirements from August to October 2021 had an incidence of cases of coronavirus 23% lower than districts without a mask order.

Another report demonstrated how consistent use of high-quality masks can reduce the risk of infection.

The report, released in February by the CDC, said consistent use in indoor public places of a high-quality face covering — such as an N95 or KN95 respirator — was associated with an 83% lower chance of testing. positive for coronavirus compared to those who did not wear a mask.

N95, KN95 and KF94 masks are much more effective than looser surgical masks, while surgical masks are more effective than cloth masks.

Are the poorest communities affected by more serious diseases?

COVID-19 is more likely to cause serious illness and death in the poorest people, even when the vaccination status is the same. In the spring, unvaccinated residents of poor communities were 11 times more likely to be hospitalized with COVID-19 than unvaccinated people in wealthy areas. During this period, about 35 out of 100,000 unvaccinated residents in wealthy areas were hospitalized with coronavirus infection, while about 400 out of 100,000 unvaccinated people in poor areas were hospitalized.

Disparities persisted even among those vaccinated by income level. Vaccinated people in poor areas were about 1.5 times more likely to need hospitalization than the same cohort in wealthy areas. About 27 out of 100,000 vaccinated people in wealthy areas were hospitalized with coronavirus infection, compared to 38 out of 100,000 vaccinated people in poor areas.

That means LA County’s poorest residents — who make up a significant portion of the economy, including food production, hospitality and tourism — are once again bearing the brunt of this latest wave of COVID-19.

“Families with fewer resources are more likely to be more exposed to work, to live in crowded conditions and to have one or more chronic health conditions” than wealthier people, Ferrer said. “This puts these people at a higher risk of suffering the severe effects of COVID. … Vaccination alone is not enough to erase troubling inequalities.

LA County has a huge concentration of poverty and overcrowded housing, making the effects of a pandemic outbreak particularly intense in a county of more than 10 million people. Of all the southern California coastal counties, LA County has the worst poverty rate and the lowest median household income.

Older people are even more likely to die, but some of those who die are young. On Tuesday, 14 new deaths were reported, including one person in their 30s or 40s and four between the ages of 50 and 64. Four deaths were in people between the ages of 65 and 79, and five people who died were 80 or older.

What about personal behavior?

It is also likely that some people who have avoided infection no longer employ certain protective measures or are exposed to family members and friends who have relaxed their protective practices.

People “take more risks; they’re moving; they travel,” Chin-Hong said. Even in San Francisco, a number of people don’t wear a mask in places where it was once ubiquitous, which means there’s less peer pressure to wear a mask in areas where it was once common. Chin-Hong said.

That’s why it’s so important that people get vaccinated and boosted when they’re eligible, CDC Director Dr. Rochelle Walensky said.

“There’s a lot we can do to try to prevent those ICU stays,” she said.

Jha also noted that “getting vaccinated now will not prevent you from receiving a variant-specific vaccine later this fall or winter.”

And for people age 50 or older, “if you haven’t had a vaccine in 2022…please go get vaccinated again,” he said. Whether you’re eligible for a first booster or a second, “go get one now.” It could save your life.

Los Angeles Times

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