This week both Hampshire County and Hampden County are in the yellow "medium risk" category according to the CDC classification, as is every county in Massachusetts. This indicates both high local case transmission and significant burden on the local healthcare system and in hospitals. The specific official case rate by town continues to bump up and down, but we've covered the inaccuracies of the official case rate frequently (in short - it's a vast underreport). Wastewater surveillance data in Hampshire County indicates that this increase in transmission is real and substantial. We also have evidence of an increase in hospitalizations in western Massachusetts and throughout the state.
I know this is not a welcome update, but I am concerned that we are on the precipice of tough times coming. The last two COVID winter surges have been very difficult starting in November and continuing through about February. I am concerned that we are seeing this rate of increase in hospitalization and severe illness in October. Early in the pandemic we could watch trends in Europe to get a sense of what was coming in the US. That hasn't been quite as straightforward in the past year or so, but it's still worth monitoring. Unfortunately, after a similar long high plateau in cases, European countries are now seeing rising cases, hospitalizations, and deaths.
Getting the bivalent omicron-specific booster doesn't mean you won't get COVID-19, but it is our absolute best protection against severe disease. The number one thing you can do to prevent yourself from getting seriously ill is to get the booster. Anybody who has the prime series (one dose of Johnson & Johnson or two doses of Moderna or Pfizer) and is over five years old is eligible for the booster. In general, vaccination rates are high in western Massachusetts - which means most of us are eligible to get the booster. We do see some age groups with low vaccination rates, however. Young children, and young adults have low vaccine uptake at this time. Those groups can get the booster after getting the prime series. Vaccination is undoubtedly important for preventing severe disease, but it's important for a whole bunch of reasons. You don't have to be at high risk of severe disease for it to make good sense.
Perhaps you are wondering if you need to get up-to-date with the vaccine and booster, particularly in light of recent press about the President saying the pandemic is over (it's not, and as such the US government has extended emergency COVID-19 funding for the healthcare system until at least next year) and a press release from the Florida State Surgeon General with their opinion that the COVID-19 vaccine is "not recommended" for certain age / assigned gender groups (this recommendation is widely discredited among the public health and medical community and is based on flawed data analysis). The vaccine and booster will help everyone, including those who are low-risk. Consider the risk / benefit analysis:
Risks of the vaccine / booster:
1) Sore arm, general malaise lasting ~24 hours.
2) Increased risk of mild myocarditis / pericarditis among males aged 18 to 29 years, compared to not getting an mRNA vaccine AND not getting a COVID-19 infection. Research indicates that the vaccine will cause 1 excess case of myocarditis among one million people. However, the risk of myocarditis as a result of COVID-19 infection is even higher. COVID-19 infection will cause 23-35 excess cases of myocarditis among one million people, depending if the person is vaccinated or not. I'll post the citation for this research below this narrative, indicated with a star*.
Benefits for the vaccine / booster:
1) Reduced risk of myocarditis - see explanation above. There is a risk of myocarditis after COVID-19 infection, and the risk at all age groups and among males and females is higher after COVID-19 infection than after vaccination. Further, research indicates that cases of vaccine-induced myocarditis have been more mild than the standard myocarditis that occurs after viral infection, including with COVID-19.
2) Reduced risk of infection. There is likely a substantial short-term bump in protection that wanes over time (the course of probably about 3-6 months).
3) Reduced risk of severe disease, either at home or requiring supportive care at the hospital. This is true at all ages and risk levels, but increasingly true among older adults.
4) Shorter duration of illness if infected. The more vaccine doses you have on board, the more primed your immune system is to neutralize the virus. Rather than being sick for a week or 10 days (or longer), you may only feel yucky for 5 days (for example).
5) Reduced risk of transmission to others. Not only do you get protection, you are also a block in potential trains of transmission. You're a lower risk person for your high-risk friends and family - and community members! - to be around because even if you do get infected, you'll be less contagious for a shorter duration of time.
6) Reduced risk of long-COVID. Being up-to-date on your vaccine makes you less likely to have long-COVID after a COVID-19 infection. Estimates vary from 15% lower risk to 85% lower risk. Estimates also vary on how common long-COVID is, but recent research indicates that about 5% of people with previous COVID infection experience debilitating ongoing symptoms, and about 40% report ongoing troubling symptoms and only partial recovery up to 18 months post infection.
In summary, we may be at the start of another tough COVID surge that could overwhelm healthcare systems, lower quality of care for all, and result in increased hospitalizations and deaths. I'd love to be wrong, and I sincerely hope I can report in the coming weeks that the surge never materialized or was minimal. In the meantime, the very best tool we have right now is the vaccine and respiratory protection. If you are high-risk or unvaccinated, live with someone who is high-risk or unvaccinated, and/or just want to avoid infection, please also remember the value of high-quality well-fitting respiratory protection. KF94, KN95, and N95 masks all do an excellent job protecting the wearer and those around them.
Take good care,
Megan W. Harvey, PhD (she/her)
*Myocarditis information: Patone M, Mei XW, Handunnetthi L, Dixon S, Zaccardi F, Shankar-Hari M, Watkinson P, Khunti K, Harnden A, Coupland CAC, Channon KM, Mills NL, Sheikh A, Hippisley-Cox J. Risk of Myocarditis After Sequential Doses of COVID-19 Vaccine and SARS-CoV-2 Infection by Age and Sex. Circulation. 2022 Sep 6;146(10):743-754. doi: 10.1161/CIRCULATIONAHA.122.059970. Epub 2022 Aug 22. PMID: 35993236; PMCID: PMC9439633.