Fueled by rapid reinfections, California’s surging summer COVID surge could outpace winter surge

New coronavirus infections in parts of California could increase even more than Omicron’s winter surge, potentially explaining why so many people appear to be infected simultaneously.

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

Wastewater data for much of LA County — the city of Los Angeles and a large swath of eastern and southern LA County — is unavailable due to a supply chain shortage. to test supplies at the state level. But county public health director Barbara Ferrer said last week that steady increases have been seen recently in the Las Virgenes Municipal Water District that serves areas in and around Calabasas and the sewage treatment plant. of LA County Sanitation Districts in Lancaster.

Sewage data suggests that many infections are not recorded in the number of officially reported coronavirus cases. Indeed, many people use over-the-counter tests at home, which may be more convenient than getting tested at a medical facility, where the results are reported to the government.

“When you look at the [coronavirus] number of cases, they are no longer reliable. There are huge undercounts,” Dr. Robert Wachter, chair of the UC San Francisco Department of Medicine, said during a town hall on campus Friday. “And the number of cases now is probably not that different from what we saw during the massive surge in December and January.”

That’s why, Wachter said, he strongly recommends masking in indoor public places “in the face of an overwhelming number of cases.”

At UC San Francisco hospitals, 5.7% of asymptomatic patients test positive for the coronavirus, meaning that one in 18 people who feel well nonetheless have the coronavirus. In other words, in a group of 100 people, there is a 99.7% chance that someone has the coronavirus and is potentially contagious. “Think about that the next time you walk into a crowded bar or get on a plane with 100 people,” Wachter said.

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

The spread of the disease prompted UC Irvine on Monday to renew a mask mandate inside campus buildings, similar to other campuses such as UC Riverside and UCLA and school systems like San Diego Unified. Additionally, the film industry has recently resumed requiring masking on film sets around Los Angeles.

LA County’s rate of coronavirus cases continues to rise. LA County is now averaging about 6,900 daily coronavirus cases, nearly double the peak case rate of 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. COVID-19 deaths in LA County have increased from 50 per week to between 88 and 100 deaths per week over the past month.

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

LA County is prepared to reinstate a universal mask mandate in indoor public spaces for ages 2 and older as of July 29 if the rate of new coronavirus-positive hospitalizations does not improve.

“Around the world, we are clearly in the throes of the sixth wave of the COVID epidemic,” UC San Francisco epidemiologist and infectious disease expert Dr. George Rutherford said at the meeting. “This was caused by the worldwide circulation of the new Omicron sublines: BA.4, BA.5 and now BA.2.75.

“It’s my way of saying, we’re not out of the woods yet,” said Rutherford, adding that the World Health Organization “recently stated that there is no reason to consider that we we are nearing the end”. Last week, he noted that COVID-19 remained a “public health emergency of international concern”.

It is not known how long this wave will last. Dr. Robert Kosnik, director of UC San Francisco’s occupational health program, said the current wave of employees and students has so far lasted twice as long as its fall wave and… winter, which lasted about two months.

It’s easy for COVID fatigue to set in, given how long this wave is. But, Kosnik added, “we still have to be vigilant.”

That means not coming to work if you have symptoms, Kosnik said. Home coronavirus tests can give people negative test results on day one or the first two symptoms, even if they are contagious. It sometimes takes two or three days after the onset of symptoms for enough virus to have replicated in the body for the rapid test to become positive.

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

“If you have symptoms and test negative, you should always assume you might have COVID,” Wachter said.

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

BA.5, the Omicron sub-variant behind this latest wave, “isn’t exactly a brand new ball game, but it’s definitely a new round and we have to take it seriously,” said Watcher.

A challenge with COVID-19, he added, is that once we learn a pattern of how the disease works, “our brain locks onto them. And we kind of assume that they will continue to be true. And then when they go wrong, it’s kind of hard for us to pivot.

That’s what’s happening now, Wachter said. Some patterns are still similar – new subvariants keep emerging that are even more contagious. Additionally, Omicron infections appear to cause less severe disease than Delta, the dominant variant of the coronavirus last summer. During Delta’s peak, about 5.6% of coronavirus cases in LA County required hospitalization, but during Omicron’s winter surge, only about 1.2% of cases did.

Regarding BA.5, “what’s different – and this is where it’s a game changer – is the level of immune evasion, and in particular the extent to which immunity against previous infection, including earlier versions of Omicron, doesn’t seem to matter that much,” Wachter said.

So it’s wrong to think that if you’ve survived 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,” Wachter said. “You can’t rely on the COVID ‘superpowers’ of your infection plus previous vaccination to completely free you from risk for the next three or four months, which is really how we used to think about it. a few months ago. ”

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

But he cited a recent pre-print study by scientists at the University of Washington and the St. Louis Veterans Health Care System suggesting that people who were reinfected “did worse in the long run.” The study suggested that reinfected people have a higher long-term risk of death – even after the acute infection resolves – in addition to other health problems.

“Compared to people with a first infection, reinfection contributes to additional risks of all-cause mortality, hospitalization and adverse health outcomes,” the study says, including in organ systems affecting the cardiovascular, renal, neurological and gastrointestinal systems and increasing the risk of diabetes, fatigue and psychic disorders.

The risks were evident not only in unvaccinated people, but also in vaccinated people who received a booster shot. “The 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 getting re-infected is a bad thing – that once you’re infected you have a bit of extra immunity, but not that much. And you should go back to your previous position of trying to be careful,” Wachter said.

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

Existing vaccines, even if not designed specifically against the latest 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 United States Centers for Disease Control and Prevention found that the effectiveness of the vaccine protecting against hospitalizations or emergency room visits declined five months after the second dose of the COVID-19 vaccine. That’s why it was so important to get a recall, and a second, when eligible, according to the report.

Second booster shots were limited to people 50 and older and immunocompromised people 12 and older. Wachter said federal officials have signaled eligibility for a second recall is coming soon.

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