The gradual decline in new cases per day continued last week. At this
point, while the percent positivity remains higher than I'd like to
see, it's clear that we're through the BA.2 / BA.2.12.1 surge. This is
clear from our official case rate (which, again, is always an
underestimate of the true number of cases) and from wastewater
surveillance data. You can see this trend in our city, our county, and
across the Northeast. As we noted last week, it does seem like the
surge has moved west. I'm especially keeping my eye on travel
hot-spots - the case rate has increased dramatically in Florida,
Puerto Rico, and Hawaii, now that travel restrictions have been
dropped both nationally and internationally. We'll have to watch to
see what happens with the health care systems in those locations, but
also what happens as travelers visiting those areas return to their
home state.
The good news is that Northeast is through the BA.2 / BA.2.12.1 surge
and the peak was minimally disruptive. Hospitalizations and patients
in the ICU did increase, but not to worrisome levels, and are already
dropping. The less good news is that we're watching the BA.4 and BA.5
variants become dominant in the US. Right now both have low overall
prevalence, but you can see their prevalence increasing. Right now,
BA.4 is about 8.3% and BA.5 is about 13.3% of cases in the US. That
prevalence is lower in the Northeast, which in this case is again,
"less good" news. In the Northeast, BA.4 is about 7.0% and BA.5 is
about 3.5% of cases. It's really hard to predict what that means, but
one possibility is that we'll see a BA.4 and BA.5 surge, as we did
when BA.2 / BA.2.12.1 became dominant. Hopefully similar in size, but
- really, there are so many factors that go into that. It's far too
early to predict what that peak would look like. Something to keep our
eye on.
You may have noticed that the dashboard had some visual updates this
week. The color-coding of risk categories has been updated from the
old MA risk categories that are no longer in use (and haven't been for
quite a long time) to the CDC risk categories. Note, however, that the
CDC risk categories only apply to counties because they factor in
hospitalizations. That means that the color of the boxes for
Easthampton, both the 7-day and the 14-day averages, will match the
color category of Hampshire County. Hampshire county remains in the
"medium" risk category.
We seem to be in the "messy middle" of this pandemic. We are certainly
not in an emergency state such as the one that we've been in
previously. We are also certainly not in "normal" times. Our youngest
folks have yet to even have an approved vaccine! As a country, though,
we reacted to the BA.2 / BA.2.12.1 surge and the potential upcoming
BA.4 / BA.5 surge with a shrug. We're also looking ahead to fall and
trying to figure out what might happen and what we're supposed to
"do", and that seems to be getting a shrug, too. No judgement - it's
the mental place we're all in, I think. The official message from our
leaders is unclear - is there a plan regarding infection moving
forward into the fall, and beyond, into endemic times? Is there a plan
for understanding and treating long-COVID? The funding for public
health is already drying up at the federal level - are we giving up on
public health so easily? Have we learned any preparation lessons?
There are no good answers to any of this. I think our collective shrug
right now is probably a combination of anxiety and overwhelm for some,
and readiness to move on for others. And to be clear, neither of those
is the "right" response, and neither is wrong! The risk associated
with COVID-19 is very different for different individuals. Some folks
are already living essentially "normal" lives, have been infected
(perhaps multiple times - reinfection of omicron subvariants is
common) and are low risk and totally fine. A potential future
infection is not a cause for concern. Others are high risk or live
with someone who is high risk, and for those folks, a COVID-19
infection could be devastating. I hope as we move forward in this
uncertainty that we can remember that the stakes are so very different
individually and be careful and courteous to our neighbors who are
living in a different risk situation.
What will happen next? I've seen predictions ranging from COVID-19
continues to mutate in an unpredictable way (as happened with delta
--> omicron) and we have large disruptive surges at semi-regular
intervals, that COVID-19 sputters along with predictable mutations to
omicron that there may be mini-surges here and there, perhaps settling
into something like what we experience with the flu. Which - by the
way - isn't great. The flu as a "gold standard" for our viral
experience is.... a bad standard. The flu causes a lot of minor
disruption and severe disease and death every year. But we're at least
used to it? Ideally, we'd end up figuring out how to manage viruses
like this, and both flu and COVID-19 become more like other common
coronaviruses that cause "colds." Right now, COVID-19 is mutating
something like four-times faster than the flu. We gotta slow that down
if we're going to use anything other than a totally universal vaccine
to control spread. (How do we slow it down? With less transmission.
Yep, practically the definition of a catch-22).
We could help ourselves here in a few ways:
- We need better vaccines - and they seem to be on the way. Moderna is
seeking approval for an omicron specific booster, and Pfizer is
working on one. If the virus follows predictable mutations from here
on out, then this is a big step forward. If the mutations aren't
predictable - well, we need to work on a more universal vaccine.
- We need to think about indoor air quality like we have previously
thought about water sanitation. We know how to filter and clean indoor
air. It would be a massive and expensive undertaking to develop air
sanitation standards and bring buildings throughout the country up to
code, but the savings in infection reduction for COVID-19, other
respiratory viruses we know about, and as-yet-undiscovered viruses
would be invaluable. We know how to do this.
- We need to keep funding public health in general, but also for
COVID-19 testing, vaccinating and treating. Congress didn't provide
any additional COVID-19 funding, and so the Biden administration just
shifted $10 billion from testing to vaccines and treatments. I cannot
believe this is the reality - we have got to stop accepting that it's
testing OR treating. We have to do both. (Call your congress people!)
- We need to increase vaccination rates, and particularly to
transition our thinking around a third dose. Someone is fully
vaccinated after they have 3 doses - right now we call that the prime
series and a booster. We need to stop thinking about a third dose as a
booster, and start including it in our prime series. If you haven't
had a third dose yet, you should get that now. Easthampton is highly
vaccinated, but the US as a whole has dreadfully low vaccination
rates. Easthampton isn't a bubble - the low vaccination rates
throughout the US (and the world) will keep transmission high and will
keep mutations coming fast. We have got to focus more attention on
increasing vaccine coverage everywhere.
That's enough for this week. The FDA is meeting this week to discuss
the Moderna and Pfizer pediatric vaccines. I hope next week that we'll
be talking about where to take your under-5 child to get vaccinated,
if you so choose (and I hope you choose to vaccinate).
Stay well,
Megan
Megan W. Harvey, PhD (she/her)
Epidemiologist
