The official case rate, measured as the 7-day average of new cases per day per 100,000 people, continues to hover in the region between 15 and 30. The official case rate includes both confirmed and probable cases, which means that the results of PCR tests and rapid antigen tests conducted by a healthcare provider are counted. The results of home rapid antigen tests are not included. It is clear, therefore, that the numbers you see reported each week are significantly underreported. Many people test positive at home, know to stay home for at least 5 days, and aren't seriously ill. This means their case will never enter our official case count. It's incredibly challenging to figure out just how many unreported cases exist, because, by definition, we don't know about them. There are ways to estimate it, but even that varies so much. For example, in an area with high vaccine coverage (like Hampshire County), the "per 100,000 people" risk of severe disease is lower than in an area with low vaccine coverage. Ironically, what this probably means is that there is more "silent" spread in areas like Hampshire County than in other areas with a smaller proportion of the population vaccinated. Why? Because fewer people have any reason to seek help and have their case confirmed. Is it worth continuing to track the case rate, then?
Even though we know the official case rate is lower than the true rate of infection, tracking the weekly case rate and noticing if the rate is trending up or down remains very helpful. It's a signal of stability. The official case rate itself is inaccurate (lower than the true rate), but there's no reason to suspect that the trend is inaccurate. With that in mind, I'm pleased to see stability in the case rate as we move into September, as schools open. I'm watching the trend in the case rate carefully over the next few weeks to see what is coming.
Wastewater surveillance data continues to be an excellent way to monitor the local situation. It's not perfect, but it's not subjective, which means that you don't have to decide whether to send your wastewater in or not. (Thank goodness. Can you imagine?) Everyone hooked up to the public water supply that is getting tested is included. So I'm watching the wastewater data closely, too, and if you squint to see the overall pattern, we're actually seeing the same stability (ish) there. Relatively speaking!
That brings me to the discussion of risk again. Even with my answer above to the question of if it's worth continuing to track cases, you may still be wondering if it's truly worth tracking this kind of information. If you're wondering that, I suspect that you may consider yourself low risk. The public health approach to "living with" a disease like COVID-19 is that we consider and protect the most vulnerable members of our community, though. COVID-19 remains a serious risk for some people. With that in mind, tracking case data is incredibly important. You may select one threshold of risk for when you'll start "shielding" (masking, more testing, being careful of public situations) again, but your neighbor may select a different threshold. We all need to know what direction cases are heading if we're going to make those personal decisions. And if you or your friends or family are the people starting to shield again, it's helpful if your fellow community members recognize that and can choose to help in your efforts (for example, by testing before they see you, or by masking in public).
I can't talk about risk without talking about the most effective way to reduce your risk of serious disease: get up-to-date on the COVID-19 vaccine. The bivalent omicron-specific booster is available. Both Pfizer and Moderna have a booster ready. You are eligible for the booster if you are over 12 years old and you're 2 months out from your last vaccine dose or 3 months out from your last infection. Based on the research I've seen, I recommend waiting 4-6 months from your last infection or dose for the most "bang for your buck", but you should speak to your healthcare provider about this recommendation. If you're high risk or you have a big event coming up, you might decide to stick to the 2-3 month timeframe.
A few notes from the COVID-19 news world this week:
- A recent report was released indicating that we've now surpassed a horrific milestone: COVID-19 has killed more than 6.5 million people around the world. I truly cannot think of a way to understand that number. The report also indicates that there are more than 10.5 million children in the world who have lost one or both parents as a result. 10.5 million children! lost! 1! or! both! parents! We have so much long-term work to do to make sure we take good care of these children and their families as they navigate the rest of their lives.
- Dr. Jha, the US's COVID-19 Response Coordinator, has said that the approach to the COVID-19 vaccine will likely mimic the approach to the seasonal flu vaccine, with a yearly booster offering. This annual booster schedule would definitely alleviate confusion, but it's not clear if it's a good scientific solution. For one, COVID-19 is mutating much faster than the flu virus mutates. Perhaps the rate of mutation will slow down? If so, this annual approach may eventually be acceptable, but probably not until that point. The primary critique from scientists and the infectious disease community at this point is about the message this sends about "settling" for an annual approach when we know we can do better. Rather than settling now on an annual approach, we should be focusing our efforts on funding next-generation vaccines - for COVID-19, and the flu! Scientists are working on nasal or oral vaccines that are focused on preventing infection (rather than severe disease), and on pancoronavirus vaccines that aren't targeted toward any variant but that would cover current and future mutations. By the way, they're working on these for the flu as well, and we should be funding that effort as well! Investing in public health often tapers off after an emergency (like right now), but it is well worth continuing to fund public health. Call your representatives!
- Lastly, Dr. Jha also announced research indicating that there is no scientific or biological reason to space out the COVID-19 bivalent booster and the annual flu vaccine. You can get them both at the same time. There is no evidence to suggest worsening of side-effects after getting the vaccines at the same time. If you'd rather space them out, that's fine too! Perhaps you're ready for the flu vaccine now, but you need a little more time before you're far enough past your last vaccine or COVID-19 dose to be ready for the fall COVID-19 booster. No need to wait to do them together!
Megan W. Harvey, PhD (she/her)