Can California avoid third devastating COVID-19 winter wave?

For the past two years, Thanksgiving has served as a sobering reminder of staying power during the COVID-19 pandemic.

For everyone, the holiday essentially marked the turbocharged start of the fall and winter’s severe COVID-19 wave, both of which resulted in the pandemic’s deadliest waves, killing thousands of Americans every day.

But there is cautious optimism that this winter could be different – or at least not as bad as the surges of 2020 and 2021.

“You can never say definitively what to expect,” said Dr. Anthony Fauci, President Biden’s outgoing chief medical adviser for the pandemic. “But you should really take some comfort in knowing that we have the ability to mitigate whatever comes our way.”

Some of the benefits we have this year are an updated COVID-19 booster shot that is fairly well matched to the circulating strains of the coronavirus, ample supplies of rapid tests to take at home, and a general awareness of actions we can take to avoid illness, including masking in indoor public spaces, staying home when ill, and improving airflow by hosting outdoor events, opening windows, and turning on air filter units.

Now, when it comes to gatherings, “I think there are ways we can really improve it, rather than spending our time talking about whether or not we should be doing it,” said California Secretary of Health and Human Services Dr . Mark Ghaly.

There’s even some promising news about the relentless emergence of coronavirus subvariants, none of which raised alarm bells as dramatically as the original Omicron strain did when it burst onto the world stage last Thanksgiving.

An optimistic note comes from Singapore, which recently experienced a large wave of coronavirus cases fueled by Omicron subvariant XBB, a recombination of sublineages BA.2.10.1 and BA.2.75. XBB has raised concerns that vaccines may not be as effective against it.

“They had [an] Increase in cases, but they didn’t have a concomitant large increase in hospital admissions,” Fauci said Tuesday. “So we’re hoping that a combination of people who’ve been infected and refreshed and vaccinated – or people who have been vaccinated and refreshed and not infected – gives enough community protection that we won’t be repeating what we saw around this time last year. “

Two other Omicron subvariants, BQ.1 and BQ.1.1, accounted for about 57% of estimated coronavirus cases in the most recent available week, according to data from the US Centers for Disease Control and Prevention. Both are descendants of BA.5 – a long dominant strain that has been on the rise this summer.

However, some experts who previously warned of the rise of new Omicron subvariants say the latest data seems reassuring for now. New York state, for example, has the highest proportion of BQ.1.1 in the nation — but there’s no sign hospital admissions are also increasing, said Dr. Eric Topol, director of the Scripps Research Translational Institute in La Jolla.

However, coronavirus-positive hospital admissions have increased in California. As of Wednesday, there were 2,782 coronavirus-positive patients in hospitals, up 84% from the fall low of 1,514 on Oct. 24. This summer’s high was 4,843, set on July 26, and last winter’s high was 15,435, set on January 24. 21. The all-time high of 21,938 was reached during the first pandemic winter on January 6, 2021, and the all-time summer high of 8,353 was reached on August 31, 2021.

Nationwide, hundreds of Americans are still dying every day from COVID-19, which remains a leading cause of death. And there are signs that transmission is on the rise again.

Los Angeles County is seeing an average of 2,337 coronavirus cases per day for the week ended Friday, up 32% from the previous week. On a per capita basis, LA County is seeing 142 cases per week per 100,000 residents. A rate of 100 or more is considered high.

LA County’s coronavirus case rate has been rising since mid-October, when it hit an autumn low of 60 cases per week per 100,000 residents. The latest case rate is the highest since Labor Day.

California recorded 95 coronavirus cases per week per 100,000 people for the seven-day period ended Tuesday. The state’s rate rose 16% from the previous week.

It is estimated that the proportion of admitted coronavirus-positive patients statewide who are hospitalized for COVID-19 has remained relatively stable at about 45% since April. The other patients are being treated for issues not related to COVID-19.

BQ.1.1 was of concern due to assessments that it was “one of the most immune-avoidable SARS-CoV-2 variants seen to date,” Topol wrote in a blog post that included “resistance to all available monoclonal antibodies,” referring to the Medicine related that can help treat patients infected with the coronavirus or prevent infection.

“This is the first time in the pandemic that a variant with clear, pronounced immune evasion has not sparked a major new wave,” Topol wrote. In contrast, several of the Omicron subvariants that became household names, such as the original version and then BA.2 and BA.5, “made big waves around the world.”

It could be that the cumulative immunity is now working against the newest strains.

“Under pressure from previous infections, vaccinations, booster shots and combinations thereof, the virus is having a harder time finding new hosts,” Topol said. “To date, BQ.1.1 has failed to trigger a new wave in two countries, a very positive sign.”

The optimism doesn’t mean that “we’re over the hill,” Topol said. And that’s not to say that the rise of BQ.1.1 is without consequences.

The variant has already effectively rendered monoclonal antibodies useless as medicines to treat or prevent COVID-19. UC San Francisco said it was abort Administration of bebtelovimab and evusheld due to “a rapid increase in circulating omicron subvariants predicted to be resistant” to the drugs. Paxlovid, an oral antiviral drug, continues to be an effective treatment against COVID-19.

The rate at which the coronavirus is mutating has increased by 30% over the past year, Topol added, giving Omicron still room to “pose a significant threat.” And there’s still a chance that problematic variants might pop up in the future.

Much of the optimism this fall and winter stems from the availability of updated COVID-19 booster shots. Data released this week shows the updated COVID-19 vaccines provide “significant additional protection” against symptomatic infections in people previously vaccinated or boosted with the older formulation.

“Everyone was asking, ‘Where is the clinical efficacy data?’ Now it’s out with the CDC [report] this morning,” Fauci said. “We know it’s effective.”

However, uptake of these doses was slow to begin with.

Nationwide, approximately 16% of eligible residents have received the updated refresher.

“We found very low uptake of the bivalent booster,” Ghaly said recently. “I know every day I wonder with Californians if they should get it, if now is the right time. And it’s a resounding yes.”

The coronavirus isn’t the only game in town heading into this winter, either. The flu is rising at levels not seen in years, and RSV continues to plague children’s hospitals across California. Regarding the flu, however, this season’s vaccine also appears to be well matched to the strains currently circulating.

Nationally, hospitalization rates related to RSV — or the respiratory syncytial virus — are exceptionally high, said Dr. Theodore Ruel, Chief of the Division of Pediatric Infectious Diseases and Global Health at UC San Francisco.

RSV continues to expand the available emergency department capacity at Children’s Hospital Los Angeles, which means the facility is not always able to accommodate patient transfers from other locations. Orange County Children’s Primary Hospital sees a high number of emergency room visits every day, according to the county health department.

Riverside County reported the death of a child under the age of 4, possibly from RSV, in the eastern portion of the county, officials said Monday. The child died in hospital after a short illness.

Officials say babies at high risk of severe RSV — like premature babies and young children with heart and lung disease — can take a drug called palivizumab to protect them. “If you’re concerned about your child’s risk of serious RSV infection, talk to your child’s health care provider,” the Riverside County Public Health Department said. Can California avoid third devastating COVID-19 winter wave?

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