This new California coronavirus wave isn’t sticking to the script: Big spread, less illness

For the past two years, COVID-19 has followed a predictable, if painful, pattern: as transmission of the coronavirus rebounds, California has been inundated with new cases and hospitals have been burdened by a deluge of critically ill patients, a startling number of whom have died.

But in a world teeming with vaccines and treatments, and with healthcare providers armed with knowledge gleaned over the course of the pandemic, the latest wave is not living up to that script.

Despite the widespread spread of the coronavirus – the recent peak is the third highest of the pandemic – the impact on hospitals has been relatively small. Despite the increase in transmission, deaths from COVID-19 have remained fairly low and stable.

And this happened despite officials largely waiving new restrictions and mandates.

In a way, that’s what’s supposed to happen: as health professionals get better at identifying coronavirus, vaccinating against it, and treating symptoms, new flare-ups shouldn’t lead to excessive jumps in serious illnesses.

But today’s environment is not necessarily tomorrow’s base. The coronavirus can mutate rapidly, potentially upending the public health landscape and worthy of a different response.

“The only thing I think is predictable about COVID is that it’s unpredictable,” said UCLA epidemiologist Dr. Robert Kim Farley.

While it’s still too early to say for sure, there are signs that the current wave is beginning to recede. In the week-to-Thursday period, California reported an average of just over 13,400 new cases per day – up from the peak of the last spike of nearly 16,700 daily cases, according to The Times.

For comparison, last summer’s delta surge averaged nearly 14,400 new cases per day.

And more than 8,300 coronavirus-positive patients were hospitalized nationwide on some days at Delta’s peak — almost triple the number during the last wave.

The difference in the impact of each surge on ICUs was even more striking. During Delta, there were days with more than 2,000 coronavirus-positive patients in intensive care units across the state. However, in the last wave, that daily count has reached around 300 so far.

This gap in hospitalizations shows how the pandemic has changed.

“Right from the start of the pandemic, we immediately realized that vaccines, easy access to testing and therapeutics would be the game changer — and now we have all of those things,” said Barbara Ferrer, director of public health for the Los Angeles County District.

“It doesn’t mean the pandemic is over. We didn’t achieve that,” she said. “What we have achieved is that we have reduced risk, but we have not eliminated risk.”

And while overall hospital admissions were lower during the last wave, Ferrer noted that each infection still carries its own dangers — not just serious illness, but the possibility of a long COVID. Taking individual steps to protect yourself, she said, has the added benefit of helping to protect those around you, including those who are at higher risk of developing serious symptoms or have jobs that involve them regularly come into contact with many people.

“To me, it makes it clear that some protection is still the way to go while enjoying pretty much whatever you want to enjoy,” she said.

California’s most restrictive efforts to contain the coronavirus ended almost exactly a year ago, as the state celebrated its economic reopening by lifting virtually all restrictions that have long formed the backbone of its pandemic response.

About a month later, with the then-novel Delta variant on the rise, some parts of the state reinstated mask mandates in hopes of blunting transmission.

Toward the end of the year, another new enemy would emerge: the Omicron variant. This highly transmissible strain led to unprecedented virus spread, skyrocketing case counts and hospitalizations, and prompting officials to re-enact a nationwide mask mandate for indoor public spaces.

The fury with which these two floods hit has some fearing and others arguing for the return of the strict orders that restricted people’s movement and shut down large swaths of the economy. However, both waves came and went without California officials resorting to that option.

And during this latest wave – fueled by an alphanumeric soup of Omicron subvariants including BA.2 and BA.2.12.1 – such aggressive action appears to be off the table.

“I think deep in my heart, if we don’t see a new variant that eludes our current vaccine protection, then we don’t have to go back to the more drastic means that we had to use at the beginning of the pandemic when we didn’t have vaccines when we did.” didn’t have access to testing when we didn’t have therapeutics,” Ferrer said in an interview.

During both Delta and the initial Omicron surge, California “carefully evaluated the unique characteristics of each variant to determine how best to manage the changes in the virus’ behavior and used the lessons learned over the past two years to design mitigation and adaptation to address effective and timely strategies,” according to the state Department of Public Health.

“These lessons and experiences have informed our approach to tackling every climb and variant. Additionally, more disease control tools became available during each subsequent wave, including the delta and omicron waves,” the department wrote in response to a query from The Times. “So instead of using the same mitigation strategies as before, CDPH focused on vaccines, masks, testing, quarantine, improving ventilation and new therapeutics.”

The state has also abandoned its previous practice of setting specific thresholds to tighten or relax restrictions in favor of the so-called “SMARTER” plan — which focuses on preparedness and application of lessons learned to make California more resilient to future surges or to prepare new variants.

“Each surge and variation brings unique characteristics related to the specific conditions of our neighborhoods and communities,” the Department of Health said in its statement to The Times.

Key among these, the department added, are vaccinated and boosted when eligible, and when justified, duly wear high-quality face masks.

The US Centers for Disease Control and Prevention recommends indoor public masking in counties with a high COVID-19 community level, the worst on the agency’s three-point scale. Not only does this category indicate significant community transmission, but also that hospital systems can be strained by coronavirus-positive patients.

“We’re certainly not at a level on these numbers where you would say, ‘OK, it’s endemic now, quote, and we’re just going on with business as usual,'” Kim-Farley said. “I think it’s probably indicative of what we might see in the future that we’re going to see a low level in the community, people can relax and lower their vigilance a little bit. But then there will be other times when we might see surges coming in. … This is a time when we masquerade again. So I think there may be some surges and bouts, and hopefully those surges will get smaller, broader and less intense as we progress.”

As of Thursday, 19 California counties were at the high community level — Alameda, Butte, Contra Costa, Del Norte, El Dorado, Fresno, Kings, Lake, Madera, Marin, Monterey, Napa, Placer, Sacramento, San Benito, Santa Clara , Solano , Sonoma and Yolo. However, only Alameda County has reinstated an indoor public mask mandate.

Ferrer said Los Angeles County would do the same should it fall to high COVID-19 community levels for two consecutive weeks.

LA County continues to strongly recommend that residents, like the entire state, wear masks in public. But Ferrer acknowledged “it’s a very difficult needle to thread” and said an unintended consequence of years of health regulation could be that people don’t grasp the urgency of a recommendation.

“People now assume that if we’re not giving orders and asking for security, it’s because it’s not essential, and that’s not what we meant,” she said. “We’ve always benefited from having people who can listen, ask questions, and then mostly stick to safety procedures. And I think because it’s taken so long, because at this point there’s so much fatigue and desperation in a way to go back to normal practices, people are waiting for that order before they go ahead and take that sensible precaution.”

https://www.latimes.com/california/story/2022-06-21/new-california-covid-wave-isnt-sticking-to-the-script This new California coronavirus wave isn’t sticking to the script: Big spread, less illness

Alley Einstein

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