Case rates and hospitalizations are continuing to decrease in our area and as a result, most of New England is now back in the low category of risk according to the CDC. Wastewater data again confirms that we are past the peak, although the decrease in viral concentration does seem to be slowing a bit. It's too soon to know what that means or if it's real. Hampshire county is still in the medium category of risk, and Hampden county has actually moved into the high category of risk. This is primarily because the number of new COVID-19 patients hospitalized each day in these two counties is continuing to increase. The visual titled " Hampshire County CDC Risk Assessment" highlights the three metrics used to determine the category.
Hospitalizations are a lagging indicator, so it's not out of the realm of possibility that hospitalizations in this area would increase while case rates go down, but it is a bit puzzling to see our neighboring county move to a higher risk category while rates decrease. We'll have to keep our eye on it, because one of the major things we have to keep considering at this point with COVID-19 is hospital capacity and overall burden on the health care system. Hopefully we'll see those numbers turn around in the next week or so.
A quick note about variants and wastewater data in Hampshire county - I've included a visual of the proportion of cases in the US and in the Northeast that are due to BA.4 or BA. 5. According to the CDC, about 35% of US cases and about 24% of cases in the Northeast are BA.4 or BA.5. That is not getting picked up at all in Hampshire County wastewater data. Either we're not able to get that data accurately yet (this is my guess) or there really haven't been any cases of BA.4 or BA.5 in our county yet (unlikely). It's not super important, but it might give us some clues about where we are in the next variant push. We'll keep our eye on it.
The center of the dashboard this week is a visual helping us to understand how and why the rate of severe disease is diverging from the case rate. This is good news! If the case severity rate wasn't decreasing, every surge would be an emergency in the healthcare system. The rates have decoupled and hopefully will continue to diverge, primarily because of prior immunity. The best and easiest way to get immunity that will reduce your likelihood of severe disease is with the vaccine. Our understanding at this point is that vaccine immunity or hybrid immunity (vaccine immunity + immunity after infection) provide the highest level of protection against future infection and especially severe disease. Evidence is mounting that immunity only as a result of prior infection is short-lived and, as the virus mutates, increasingly short-lived. The bottom line is that even if you've been previously infected, the best protection comes from getting up to date on the COVID-19 vaccine.
Speaking of which, the vaccine recommendation flowchart has been updated this week! Last week, the FDA and CDC unanimously approved and recommended either / both the Pfizer or the Moderna vaccine for children ages 6 months and up. This is wonderful news for parents who would like to vaccinate! From what I can tell, local pediatricians and health centers are gearing up for vaccine clinics. Be in touch with your provider or find a location on vaxfinder.mass.gov
. We've covered vaccine safety in prior dashboards. The pediatric vaccine is held to the same high standard as the other vaccines. The formulas are the same, although the dosing is different. Children in the youngest age group can get two doses of Moderna or three doses of Pfizer. At this point in time, the efficacy and safety data indicates that they are essentially equivalent vaccines to each other, and essentially equivalent in antibody protection as the adult versions of these vaccines. The American Academy of Pediatrics recommends that all children, even those with prior infection, receive either of the vaccines available. Local pediatricians are also recommending either vaccine, including Northampton Area Pediatrics. There is no recommendation for one over the other - I have a child under 5 years old and I took the first available appointment at a local pharmacy, without regard to if it was Pfizer or Moderna. For those who would like to review the safety data, the efficacy, or the need, Your Local Epidemiologist has an excellent short list of sources to check out. Search for "YLE COVID-19 Vaccine Info for Trust Providers Messengers" or copy and paste this link yourlocalepidemiologist.substack.com/p/covid-19-vaccine-info-for-trusted
I highlighted last week that we need to consider someone fully vaccinated if they have the "prime series" and the booster, not just the prime series, for age groups with a recommended booster dose. (Recall that the prime series is 2 doses of an mRNA vaccine or 1 dose of J&J... or for children under 5, it will include 3 doses of Pfizer). The vaccine flowchart reflects this (and has in prior versions), and the dashboard now also reflects this better. I am no longer reporting a separate "partially vaccinated" category with folks who have just one dose of an mRNA vaccine. At this point, that's essentially no protection. We will continue to track how many folks in our community have the prime series and who are boosted. I've included a visual of the proportion of our community (Easthampton / Westhampton) who are vaccinated by age group with the prime series only or the prime series and a booster dose. I'm so glad to see that more than 60% of each age group has at least the prime series. I'd like to see 5-11 year olds and 20-29 year olds move up past 80%, like other age groups! I hope we'll see the youngest age group move quickly up past 60% and up to 80% vaccine coverage. And don't forget to get boosted!
I wanted to make sure I continue to update on long COVID, not just severe disease. The decoupling of severe disease and infection is great news, but it doesn't mean that controlling infections isn't important. There isn't much new information to share this week about long COVID. The estimate of how many folks experience long COVID after any infection (mild or severe) varies wildly. It might be as high as 30%, according to the American Academy of Physical Medicine and Rehabilitation. It surely depends on the severity of symptoms required for the definition. A recent Atlantic article wondered if long COVID would be a "mass deterioration event", which is a scary title and concept. So I dug a little this week into common symptoms and our best guess for why long COVID occurs. I've included two visuals from manuscripts published in peer-reviewed journals. One depicts the timeline of long COVID and highlights some of the common symptoms. Importantly, it demonstrates how long COVID is characterized by symptoms that last 12 or more weeks, long after viral load is low enough that a person no longer tests positive on a PCR test. The other visual highlights a hypothesized mechanism for understanding how and why long COVID occurs. During infection, the SARS-CoV-2 virus attaches to ACE2 receptors in the respiratory system. For some folks, the virus may travel throughout the body and attach to ACE2 receptors in other locations that have the same type of receptor and cause damage to those local cells. The specific symptoms experienced by a person with long COVID would depend on which ACE2 receptors were involved. That all makes sense, but why would some folks have ACE2 receptor involvement in their blood vessels and other folks have ACE2 receptor involvement in their kidneys (for example - there are so many various combinations!). That is still a looming question. By the way, the conclusions from the Atlantic article are not at all clear that long COVID will be a mass deterioration event, although it's certainly something we need to be focusing more attention on, rather than reacting to it down the road. There are some early signs that folks are reporting more disability, but so far that has not been reflected in disability assistance applications. I feel a little like a broken record when I write this but... time will tell what happens next in that regard.
Stay well - and happy summer!
Megan W. Harvey, PhD (she/her)