It is with relief that I report a few positive indicators this week in the city of Easthampton: the 7 day average case rate per 100,000 population and the 7 day percent positivity have both decreased. Importantly, "new cases last week" has also declined, indicating that perhaps next week we will see another decrease in the 7 day rates. The city appears to be headed in the right direction, but please don't lose sight of the fact that the SARS-CoV-2 virus is circulating widely in our community and many remain at significant risk. I'll try to evaluate risk a bit more below.
First, an overview of the situation and what may happen next: The omicron surge has been quite consistent, globally. There is a rapid and sharp surge in cases, lasting somewhere around 4-5 weeks, and then a quick decline in cases after reaching a peak. We had hoped that cases would drop back to the pre-delta or even pre-omicron baseline, but unfortunately, that's not what we're seeing in the global pattern thus far. It's only been about 2 months since we identified the variant, so we can't possibly know what will happen any further out than that. What we're seeing so far indicates that the omicron surge pattern is: 1) a fast, huge surge of cases that peaks after 4-5 weeks, 2) an initial quick descent in cases, and 3) a slow decrease / plateau well above prior levels. I've seen this best described as a long tail to the surge. How long? We don't know - locations with an early omicron surge, like South Africa, are not back to pre-omicron baseline. I'm including a graph of this from Our World in Data, which includes case rate per million population in the US and in South Africa. You'll see that the peak case rate is far lower in South Africa, but try to put that aside for now and look at the pattern in cases: a sharp increase, quick decrease, and then slow decline / plateau. The US surge is about 3-4 weeks behind South Africa, so I would estimate that as a country, we're about at the edge between the fast decline and the slower decline. Time will tell.
I write all this because it helps guide our decision making and helps us understand what to expect: we are going to see cases drop (thank goodness). It will take a good long while before we're back to where we were before. And we will continue to face challenges during that slow decline, including staffing shortages and hospitals at capacity, depending on the specifics of a particular location. Don't lose your vigilance now. There is no reason to panic, or lose hope - I very much hope that this update leaves you with hope. We're on the slow slide down, it would appear. But keep protecting yourself and your community until rates are far lower, and we don't have to worry about staffing and hospital capacity issues.
A sub-mutation of the omicron variant has been reported in the past week. Omicron is officially labeled "BA.1" and this sub-mutation is being called "BA.2". These two versions of the SARS-CoV-2 virus do not appear to be significantly different from each other. In other words, this may extend that slow case decline (or, perhaps, is already part of the explanation of the slow decline) but at this point epidemiologists are not concerned about another "crushing" wave of infection. BA.2 is still omicron. (This is good news.)
Every week I have so much I want to discuss with you! I hope in the coming weeks to dive more into analysis of risk, vaccine protection and booster doses, "flurona", if we'll "all" get infected, and the information we are learning about hospitalizations "for" and "with" COVID-19. A few words for now:
- If you're confused about how to evaluate your personal risk, you're not alone. There is so much debate about if COVID-19 is primarily a mild illness, or if it's a serious illness, and here's the unfortunate truth - it is both. The degree to which it's serious depends on vaccination status, personal risk factors, and hospital capacity (if you can get quality care). This COVID risk calculator is not foolproof but can provide some helpful information: https://qcovid.org/
- The vaccine remains incredibly effective in preventing illness, hospitalizations, and deaths. The center visual on the dashboard this week is a series of graphs from the New York City Board of Health and Mental Hygiene, showing a dramatic difference in rates based on vaccine status. Please, if you can, get vaccinated. The effect of boosters is not evaluated in those visuals, but we know that a booster dose greatly increases protection and is recommended for anyone over age 12. We have started including booster dose coverage in the dashboard. You may be hearing about studies of a 2nd booster dose, or an omicron specific booster - those are not available or recommended at this time.
- I worry that highlighting the incredible risk difference based on vaccine status overlooks that there are serious consequences of infection for some vaccinated folks. Those at greatest risk are older folks and those who are immunocompromised. This is the very group we are hoping to protect with our "wall" of vaccine protection. Please, even if you're vaccinated, do your part to avoid transmission. We want to do everything we can to protect those with immune systems that have difficulty clearing the infection.
- "Flurona" is not a thing. It's not a mutation, it's not a new virus - it means someone has a co-infection of COVID-19 and influenza. This is not unusual with viruses, and it's not new to this pandemic, and you don't need to be concerned about this (any more than you are concerned about a co-infection of influenza and strep, or influenza and any other virus).
- Dr. Fauci said that "just about everybody" will be exposed to COVID-19 sooner or later. The head of the FDA said "most people are going to get COVID." Neither of those are earth-shattering revelations. Exposure does not equal infection (get vaccinated and wear your mask!) and the head of the FDA did not mean most people will get it now - but overall? Over time? This is a reasonable guess.
- I will reiterate what I wrote last week: The information on if folks are hospitalized "for" COVID-19 or "with" COVID-19 is important in helping us understand the severity of omicron. However, the fact remains that our healthcare system is overwhelmed and overburdened. Do what you can to stay out of the hospital.
And finally, our action steps for what you can do right now:
1) Get vaccinated and boosted.
2) Wear a high quality mask. The CDC has finally changed their guidance, as well. They are readily accessible, there is no shortage, and if you have difficulty getting some, reach out to the Health Department.
3) If you have symptoms, stay home (to the best of your ability). Assume it's COVID-19 until you're sure that it's not.
Megan W. Harvey, PhD, MS