California’s summer COVID wave could top winter surge

New coronavirus infections in parts of California could surge even higher than the winter’s Omicron wave, possibly explaining why so many people appear to be infected at once.

The concentration of the coronavirus in San Francisco sewage is balanced higher levels than in the winter, according to data tweeted by Marlene Wolfe, an assistant professor of environmental health at Emory University.

Effluent data for much of LA County — the city of Los Angeles and much of eastern and southern LA County — was unavailable due to a supply chain deficiency in testing state-level shipments. But District Health Director Barbara Ferrer said last week that the Las Virgenes Municipal Water District, which serves areas in and around Calabasas, and the LA County Sanitation District’s sewage treatment plant in Lancaster have seen steady increases recently.

The sewage data suggests that many infections are missing from the officially reported coronavirus case numbers. That’s because so many people do over-the-counter tests at home, which can be more convenient than getting tested at a medical facility, where the results are reported to the government.

“If you look at it [coronavirus] Cases count, they are no longer reliable. There’s tremendous undercounting,” said Dr. Robert Wachter, chairman of the UC San Francisco medical school, at a city hall on campus on Friday. “And the number of cases now is probably not too dissimilar to what we saw during the massive spike in December and January.”

For that reason, Wachter said he strongly recommends masking in indoor public spaces “in the face of an immense number of cases.”

At UC San Francisco hospitals, 5.7% of asymptomatic patients will test positive for the coronavirus, meaning 1 in 18 people who are still feeling well have the coronavirus. In other words, in a group of 100 people there is a 99.7% chance that someone there has the coronavirus and is potentially contagious. “Keep that in mind the next time you go to a crowded bar or get on a plane with 100 people,” Wachter said.

“I wish the flight attendants would hold up a sign that said, ‘I can guarantee you someone on this plane has COVID,'” he said. “I think the rate of mask wearing would go up quite a bit.”

The spread of the disease prompted UC Irvine Monday to renew a mask mandate inside campus buildings, followed by other campuses like UC Riverside and UCLA and school systems like San Diego Unified. In addition, the film industry has recently started requiring masks on film sets around Los Angeles again.

LA County’s coronavirus case rate continues to rise. LA County is now averaging about 6,900 coronavirus cases per day — nearly double the peak case rate since last summer’s delta surge and 27% higher than the previous week. On a per capita basis, LA County’s case rate is 476 cases per week per 100,000 population; a rate of 100 or more is considered high. LA County’s COVID-19 deaths have risen from 50 a week to between 88 and 100 deaths a week over the past month.

California is seeing about 21,000 coronavirus cases a day, up 16% from the previous week. Per capita, the state records 368 cases per week per 100,000 people. California records approximately 255 COVID-19 deaths per week. Weekly deaths in the state have fluctuated between 200 and 300 deaths per week.

LA County is poised to reintroduce a universal indoor public mask mandate for people ages 2 and older as early as July 29 if the rate of new coronavirus-positive hospital admissions doesn’t improve.

“Globally, we are clearly in the clutches of the sixth wave of the COVID epidemic,” said Dr. George Rutherford, epidemiologist and infectious disease expert at UC San Francisco, at the meeting. “This was prompted by the global proliferation of the newer Omicron sublineages: BA.4, BA.5 and now BA.2.75.

“It’s my way of saying, ‘We’re not over the hill yet,'” Rutherford said, adding that the World Health Organization “recently said there’s no reason to believe we’re nearing the end.” It posed last week he states that COVID-19 remains a “health emergency of international concern”.

How long this wave will last is unclear. dr Robert Kosnik, director of UC San Francisco’s workplace health program, said a recent surge in staff and students has lasted twice as long as its fall and winter surge, which lasted about two months.

Given the duration of this wave, it is easy to experience COVID fatigue. But, Kosnik added, “we still have to be vigilant.”

That means you don’t come to work if you have symptoms, Kosnik said. Home testing for coronavirus can give negative test results in people on the first or second day of symptoms, even though they are contagious. Sometimes it takes two or three days after symptoms start for enough virus to replicate in the body for the rapid test to be positive.

“The symptoms are pretty sneaky in my opinion,” Kosnik said, although some people who don’t know they’re infected think the symptoms are just from allergies or a cold.

“If you have symptoms and test negative, you still have to assume that you may have COVID,” Wachter said.

The latest California models suggest the virus is spreading even faster. On Monday, the California COVID Assessment Tool released by the state Department of Public Health said the spread of the coronavirus is likely to increase, with every infected Californian likely to spread it to 1.15 other people.

BA.5, the Omicron subvariant powering this latest wave, “isn’t exactly a brand new ball game, but it’s definitely a new inning and we have to take it seriously,” Wachter said.

One challenge with COVID-19, he added, is that once we know a pattern of how the disease works, “our brain latches on to it. And we assume that they will continue to be true. And then when they turn out to be wrong, it’s a bit difficult for us to spin.”

That’s happening now, said Wachter. Some patterns are still similar – there are always new sub-variants that are even more contagious. Also, Omicron infections appear to cause less severe disease than Delta, the dominant coronavirus variant last summer. During Delta’s peak, about 5.6% of LA County’s coronavirus cases required hospitalization, but during the winter’s Omicron surge, it was only about 1.2% of cases.

Regarding BA.5, “the difference — and here it’s something of a tipping point — is the level of immune escape, and particularly the extent to which immunity to previous infections, including previous versions of Omicron, doesn’t seem like that much.” to count,” said Wachter.

So it’s wrong to think that after recovering from a coronavirus infection, you don’t have to worry about COVID-19 for maybe three months, Wachter said.

“We see reinfections as early as a month after a previous infection,” said Wachter. “You can’t rely on COVID ‘super powers’ from your previous infection plus vaccination to make you totally risk free for the next three or four months like we really thought a few months ago. ”

Wachter said it’s unclear whether reinfections average more, less, or the same severity as a previous infection.

But he cited a recent preprint study by scientists at Washington University and the Veterans Affairs Saint Louis Health Care System that suggests people who have been reinfected “perform worse over the long term.” The study suggested that among other health problems, re-infected people have a higher long-term risk of death — even after the acute infection has cleared.

“Compared to people with primary infection, reinfection carries additional risks for all-cause mortality, hospitalizations, and adverse health outcomes,” the study states, including in organ systems affecting the cardiovascular, renal, neurological, and gastrointestinal systems, and one increased risk of diabetes. fatigue and mental disorders.

The risks were evident not only in unvaccinated individuals, but also in vaccinated individuals who received a booster shot. “Risks were most pronounced in the acute phase but persisted in the post-acute phase of reinfection, and most were still evident six months after reinfection,” the report said.

“It’s worth assuming that reinfection is a bad thing – that once you’ve been infected you have a little extra immunity, but not that much. And you should go back to your former position and try to be careful,” Wachter said.

That’s why it’s important to keep up to date on vaccinations and boosters, Wachter said. Federal officials have said not to wait for an Omicron-specific booster that could come in the fall; If you’re eligible for a first or second booster, get it now and you can always get an Omicron-specific booster later.

Existing vaccines, while not specifically designed against the newest subvariants, still help reduce the risk of hospitalization and death, even if they are relatively less effective at preventing infection in the first place.

A report released Friday by the US Centers for Disease Control and Prevention found that the vaccine’s effectiveness in protecting against hospitalization or emergency room visits decreased five months after the second COVID-19 vaccine dose. That’s why it’s so important to get a booster shot, and a second if it’s an option, the report said.

Second booster shots are restricted to people 50 years and older and immunocompromised people 12 years and older. Wachter said federal officials have signaled authorization for a second refresher is coming soon. California’s summer COVID wave could top winter surge

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