California faces summer of COVID uncertainty amid subvariants

California’s summer is complicated by a dizzying array of Omicron subvariants that have emerged in recent months.

The most dominant nationwide is BA.5, which officials say is not only highly contagious but has also increased the risk of being infected with the coronavirus again – perhaps just weeks after a previous case.

According to federal estimates, BA.5 accounted for 65% of the country’s coronavirus cases in the week ending Saturday, a staggering increase from a month ago when it accounted for 17% of cases.

On the effects of the sub-variant:

  • Transmission rates have been consistently high in virtually all California counties.
  • Los Angeles County is seeing a renewed surge in cases, now growing 14% week-on-week — ending a brief period of relative stability after July 4 that, in hindsight, likely related to delays in reporting and reduced testing during the holiday season .
  • LA County has averaged about 5,900 coronavirus cases per day for the past week, the highest rate since early February. Per capita, that is 412 cases per week per 100,000 inhabitants. A rate of 100 or more is considered high.
  • LA County has seen the number of weekly coronavirus outbreaks in nursing homes double over the past month.
  • The increase in coronavirus infections, particularly in the workplace, is worrying experts. The county is asking employers with three or more COVID cases in a two-week period to consider encouraging workers to do their jobs remotely where possible.
  • Weekly deaths have doubled over the past month in LA County, which reports about 100 COVID-19 deaths weekly.

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

What can we expect?

It’s hard to predict.

California is clearly continuing to see a surge of cases from the superinfectious family of Omicron subvariants, namely BA.5.

The number of coronavirus-positive hospital admissions is also rising, raising the possibility that facilities could come under renewed pressure. That’s not a certainty, however, as a fall or stabilization in infections would likely trigger the same thing in healthcare systems.

And while hospital admissions remain far lower than previous waves, the trend lines are worrying.

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

In LA County, about 60% of coronavirus-positive patients in hospitals are being evaluated for reasons unrelated to COVID-19 illness. But officials say they pose a potential burden on hospitals because additional resources are needed to prevent them from infecting others.

A forecast issued by the state suggests that coronavirus-positive hospital admissions will continue to increase over the next two weeks before declining. If the model is correct, the number of predicted hospitalizations at the peak “will be unrelated to previous increases that we’ve seen,” said California epidemiologist Dr. Erica Pan in a briefing to the California Medical Assn. on Tuesday.

A big question is whether BA.5 will remain the dominant variant for a while longer. That forecast could eventually stabilize the situation in California and eventually lead to a drop in cases, Dr. Peter Chin-Hong, infectious disease expert at UC San Francisco.

A possible turning point in this scenario is the emergence of another Omicron subvariant, BA.2.75, which is a cause for concern in India. Scientists say it may spread quickly and bypass immunity from vaccines and previous infections. It’s unclear if it could cause more serious illnesses than other Omicron variants.

In previous waves, dominant strains such as Delta and Alpha remained relatively long and were not quickly displaced by their successors, meaning that someone infected might enjoy a high level of protection for perhaps several months.

That time frame has shortened significantly since Omicron first burst onto the scene late last year. Only since April have three different sub-varieties – BA.2, BA.2.12.1 and now BA.5 – been considered the dominant variety nationwide. This rapid succession means that someone can become infected with an earlier release of Omicron and then be reinfected with a newer version a few weeks later.

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

What about a new LA mask mandate?

Although LA County hospitals are not overwhelmed by COVID-19 patients, Ferrer said reinstating a universal mask mandate in case hospitalizations continue to increase is prudent.

“Waiting until hospitals are overwhelmed is way too late to do much to slow transmission,” Ferrer said. “Actually, the time to slow transmission is when you start to see signs your hospitals are becoming more busy.”

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

Should that happen, LA would be the only California county with a mask mandate, though the state Department of Public Health still strongly recommends masking indoors.

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

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

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

What evidence is there for the effectiveness of mask requirements?

Ferrer pointed to some studies that suggest universal masking commands have been effective in reducing virus transmission.

A study published in February in the journal Health Affairs says that between March and October 2020, those with mask requirements had 35% lower coronavirus case rates than those without in more than 400 U.S. counties.

Another study released in March by the US Centers for Disease Control and Prevention found that school districts in Arkansas with universal mask requirements had a 23% lower incidence of coronavirus cases than districts without a mask requirement from August through October 2021.

Another report showed how consistent use of quality masks can reduce the risk of infection.

The report released by the CDC in February says that consistently using a quality face covering — like an N95 or KN95 respirator — in indoor public places was associated with an 83% lower chance of testing positive for the coronavirus than using it who was not wearing a mask.

N95, KN95, and KF94 masks are far more effective than loose-fitting surgical masks, while surgical masks are more effective than cloth masks.

Are poorer communities affected by more serious diseases?

Poorer people with COVID-19 are more likely to cause serious illness and death, even if they have the same vaccination status. During the spring, unvaccinated residents in poor communities were 11 times more likely to be hospitalized with COVID-19 than unvaccinated people in affluent areas. During that time, about 35 out of 100,000 unvaccinated residents in affluent areas were hospitalized with coronavirus infection, while about 400 out of 100,000 unvaccinated people in poor areas were hospitalized.

Differences persisted even among vaccinated individuals by income status. Vaccinated people in poor areas were about 1½ times more likely to need hospitalization than the same cohort in affluent areas. About 27 out of 100,000 vaccinated people in affluent areas were hospitalized with coronavirus infection, compared with 38 out of 100,000 vaccinated people in poor areas.

That means poorer LA County 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.

“Family resources with fewer resources are more likely to have higher exposure at work, live in cramped quarters, and have one or more chronic medical conditions,” Ferrer said, “than wealthier people. “This puts these individuals at greater risk of suffering the severe effects of COVID. … Vaccination alone is not enough to eradicate the troubling injustices.”

LA County has a tremendous concentration of poverty and overcrowded housing, making the impact of a pandemic wave particularly intense in a county of more than 10 million people. Of all Southern California’s coastal counties, LA County has the highest poverty rate and lowest median household income.

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

What about personal behavior?

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

People “take more risks; they move they travel,” Chin-Hong said. Even in San Francisco, a number of people aren’t wearing masks in places where it used to be pervasive, meaning there’s less peer pressure to wear a mask in areas where it used to be commonplace, Chin-Hong said.

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

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

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

And for those aged 50 and over, “If you haven’t received a vaccination in 2022 … please go for another vaccination,” he said. Whether you’re eligible for a first or second refresher, “get one now. It could save your life.” California faces summer of COVID uncertainty amid subvariants

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