This new wave of Californian coronavirus does not fit the scenario: great spread, less disease

Over the past two years, COVID-19 has followed a predictable, albeit painful, pattern: As coronavirus transmission rebounded, California was inundated with new cases and hospitals were strained under a deluge of critically ill patients. sick, a distressing number of whom die.

But in a world awash with vaccines and treatments, and with healthcare providers armed with knowledge gleaned during the pandemic, the latest wave is not sticking to that script.

Despite widespread circulation of the coronavirus – the latest peak is the third highest of the pandemic – the impact on hospitals has been relatively minor. Even with the rise in transmission, deaths from COVID-19 have remained fairly low and stable.

And it has happened even with officials who have largely avoided further restrictions and new mandates.

In some ways, that’s what’s supposed to happen: As health experts improve at identifying the coronavirus, vaccinating against it, and treating symptoms, new outbreaks of cases won’t should not result in excessive jumps in critical illnesses.

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

“The one thing that’s predictable about COVID, in my mind, is that it’s unpredictable,” said UCLA epidemiologist Dr. Robert Kim-Farley.

Although it is too early to say for sure, there are signs that the current wave is beginning to recede. In the week-long period ending Thursday, California averaged just over 13,400 new cases a day — down from the last peak of nearly 16,700 daily cases, according to data compiled by the Times.

By comparison, last summer’s Delta surge peaked at nearly 14,400 new cases a day, on average.

And more than 8,300 coronavirus-positive patients were hospitalized statewide on some days during Delta’s peak — nearly three times as many as during the most recent surge.

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

This gap in hospitalizations illustrates how the pandemic has changed.

“At the very beginning of the pandemic, we immediately noted that the game changers were going to be vaccines, easy access to tests and therapies – and now we have all of these things,” the director of public health said. of Los Angeles County, Barbara Ferrer.

“It does not say that the pandemic is over. This is not what we have achieved,” she stressed. “What we have achieved is that we have reduced the risk, but we have not eliminated the risk.”

And while hospitalizations have been lower, overall, over the past wave, Ferrer noted that each infection still carries its own dangers — not just serious illness, but also the risk of a long COVID. Taking individual action to protect yourself, she said, has the added benefit of helping to protect those around you, including those who are at higher risk of severe symptoms or who work in jobs that put them regularly in contact with many people.

“To me, it’s clear that layering on some protection is always the way to go while enjoying just about anything you want to enjoy,” she said.

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

About a month later, with the Delta variant of the time running wild, parts of the state reinstated mask mandates in hopes of blunting transmission.

Towards the end of the year, another new enemy would arise: the Omicron variant. This highly transmissible strain has led to unprecedented viral spread, skyrocketing the number of cases and hospitalizations and prompting authorities to reissue a statewide mask mandate for indoor public spaces.

The fury with which these two surges have struck has left some fearing, and others arguing for, the return of strict orders that restricted people’s movements and shut down large swaths of the economy. However, both waves came and went without California officials using this option.

And in this latest wave – fueled by an alphanumeric soup of Omicron subvariants, including BA.2 and BA.2.12.1 – such aggressive action seems out of place.

“I think, deep in my heart, unless we see a new variant that eludes our current vaccine protection, we won’t need to go back to the more drastic tools that we had to use at the start of the pandemic when we didn’t have vaccines, when we didn’t have access to tests, when we didn’t have therapeutics,” Ferrer said in an interview.

During Delta and the initial surge of Omicron, California “carefully evaluated each variant’s unique characteristics to determine how best to handle the virus’s behavioral changes, and used the lessons of the past two years to address mitigation and adaptation measures through effective and timely strategies,” according to the state Department of Public Health.

“These lessons and experiences have informed our approach to managing each push and variation. Additionally, there were more tools available for disease control with each subsequent surge, including the Delta and Omicron surges,” the department wrote in response to a Times inquiry. “So rather than using the same mitigation strategies as used previously, CDPH has focused on vaccines, masks, testing, quarantine, improved ventilation and new therapies.”

The state also ditched its past practice of setting specific thresholds for tightening or easing restrictions in favor of what it calls the “SMARTER” plan – which focuses on preparing and applying lessons learned to better protect California against future surges or new variants.

“Each flare and each variant brings with it unique characteristics relative to the specific conditions of our neighborhoods and communities,” the Department of Public Health said in its statement to The Times.

Key among them, the department added, are vaccinated and reinforced when eligible and properly wear high-quality face masks when warranted.

The U.S. Centers for Disease Control and Prevention recommends public indoor masking in counties that have a high community level of COVID-19, the worst on the agency’s three-tier scale. This category not only indicates significant community transmission, but also that hospital systems can be strained by coronavirus-positive patients.

“We’re definitely not at a level at these numbers where you’d say, ‘OK, it’s now, quote, endemic, and we’re business as usual,'” Kim-Farley said. “I think, however, that probably indicates what we could see in the future, that we will see low levels in the community, people can relax and let their guard down a bit. But then there will be other times when we might see surges coming. … This is a time when we mask ourselves again. So I think there may be a bit, and hopefully these surges will become fewer, more spread out, and less intense as we go.

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 a public indoor mask mandate.

Ferrer said Los Angeles County would do the same if it fell into the COVID-19 community high for two consecutive weeks.

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

“People now assume that if we don’t issue orders and demand security measures, it’s because it’s not essential, and that’s not what we meant,” he said. she declared. “We have always benefited from having people who are able to listen, ask questions and then, for the most part, align with security measures. And I think because it’s been so long, because there’s so much fatigue at this point and desperation in a sense to go back to normal practices, people are waiting for that order before they go ahead and to take this reasonable precaution.

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