The COVID Digest 29Jun2022

Readers, first let me apologize for missing last week’s newsletter. We had a busy medical week at my house. My husband fell while washing the camper and had a concussion. Then I had sinus surgery. I did record data, but there simply wasn’t enough time or sleep to write. Everyone is doing better now. I’m glad to be with you this week.

National

Let’s start with a look at national trends. Below you can see the map for Community Transmission Levels, which takes into account recent case rate and test positivity. Historically, being in the red or orange category (high or substantial) meant that masks should be worn in public places. 95% of US counties fall into one of those categories.

As you’ve probably noticed, people haven’t gone back to wearing masks and the government isn’t really telling them to do so. This isn’t because the virus got less transmissible or stopped causing brain damage in 20% of cases. It’s because the White House and the CDC shifted the goal posts so that more people could go to work while sick and so that people might feel like the country was moving in the “right direction” by spinning the fairy tale that the pandemic was over.

It is curious that we are hearing so much about flight disruptions across the country due to staff shortages and overbooking. I hear all sorts of explanations except for one that the airlines are directly responsible for - advocating for the removal of the mask mandate on air travel. We also hear about new things that are the latest “supply chain” problem. It seems like we’re solidly in the “find out” part of “fuss around and find out” part of this pandemic. But we’re being asked to believe every other possible explanation for our woes other than the obvious one. As cases rise and more people are out sick, they’re not at work. Things slow down. Pretending the pandemic is over doesn’t make it go away. Then we all suffer for it.

Fun fact about the video above - the actress plays Phoenix in TopGun: Maverick.

On the other hand, I understand that while COVID-19 is a really important problem the US is contending with a lot of really big problems all at once. I would just urge caution when it comes to COVID-19. No matter how much someone tells you this thing is over, disease is everywhere.

Georgia

Georgia has had a big week for COVID-19. Compared to last week’s total cases are up 14%, deaths are up 79%, hospital admissions are about the same and ICU admissions are up 69%.

Let’s begin with deaths. These seem to be following the same trend as earlier in the pandemic - the older you are, the more likely it is to happen. The graph below shows the weekly total for deaths for each age group over the past 8 weeks. For a time, we saw some of this shift younger with the introduction of vaccines. But perhaps due to waning immunity or other factors, the historical trend is back. However, for point of reference, the weekly death toll for those 80+ remains 84% below the Omicron peak in February.

Hospitalizations are about the same as they were last week, but there’s something interesting in the age data here too. There are a lot of young adults (18 - 39) being admitted for COVID-19 these days.

While we’re on the subject of hospitalizations, there are some Georgia hospital regions that are making me nervous. To start, we have the first hospital region that is in the yellow zone for patient census since 15Mar and it is region N (the northwest Atlanta suburbs). Regions K (southwest Georgia) and D (Atlanta) are not far behind. In fact, if you look at hospital region K (below), they are seeing a sharp increase in COVID-19 patient census.

There are 2 regions in the red zone for ICU bed usage, 6 regions in the yellow zone. As a state, Georgia is in the yellow zone for ICU bed usage.

Being in the yellow zone isn’t necessarily a problem on its own. But “quiet times” in COVID-19 usually have Georgia below 80% ICU bed usage. Not only has the state crept above 80%, it’s climbed a bit in the past few weeks. Is this the early warning that things are about to intensify?

I am surprised that we are not seeing COVID-19 causing more difficulty in hospitals right now since masks were discontinued for mass transit. While it is still hurting people and poses a significant threat to the immunocompromised, so far at least this wave’s biggest impacts on society appear to be short staffing because people are out sick throughout multiple industries. That does make it harder to convince people to care about the safety of others, including the immunocompromised. Often in public health, these issues don’t matter to people until it matters to them personally. And unfortunately, I think we’re in a place where a large chunk of people don’t *want* to care about the safety of others, aborrent though it seems to say it out loud. We weren’t really a community-oriented society prior to the pandemic and if anything I think the politicization of the pandemic has further strained a person’s committment to a sense of shared humanity. The Centers for Disease Control and Prevention is validating this societal attitude with the “your health is in your hands” approach to public health. That certainly will hamper the agency’s efforts to control public health problems in the future. Those diseases aren’t waiting. In fact, Monkeypox is already here and spreading. The CDC has ordered 500,000 doses of the smallpox vaccine. That sounds like a lot until you remember that the United States is comprised of 328 million people. They’ve ordered enough doses for 0.15% of the US population. The transmission of this illness is different than COVID-19 and the prioritization for vaccination is also different. However, given how rough the response was to COVID-19, the seemingly slow response to the Monkeypox outbreak does not inspire a lot of confidence. Having Monkeypox spread unchecked also makes it harder to spot and identify an even bigger threat - smallpox.

We need new leaders at all levels who take the responsibility of public health more seriously. I don’t think there is credibility or confidence in the ability of current leaders to manage this crisis - that decades-long hard-earned capital was spent earlier in the pandemic for political reasons. It might take decades to regain that public trust, including the trust of public health experts outside of the agency. But I think we start with honest accountability, a fresh start, and a whole lot less political interference in public messaging.

New vaccines?

An FDA panel met recently to determine whether updates might be recommended for the COVID-19 vaccines. Keep in mind that we’re vaccinating with the original version of the virus, meanwhile we’re several variants into the pandemic. As I predicted when it was clear that the US wasn’t going to contain this pandemic, nor were we going to have the vaccine available throughout the world, we are likely going to need to update the vaccine periodically in a way similar to how we update the influenza vaccine.

The mRNA vaccines make this a pretty simple swap technology wise, but the big debate is which variants to use for the vaccine. It’s sort of like putting together a time capsule and hoping we have the right combination for when humanity opens the capsule down the road. That’s because of how long it will take to mass produce the number of vaccines needed for the fall. A lot could change between now and October (?) when the new vaccines are released.

---

Thank you for your support of the COVID Digest.

My Ph.D. is in Medical Microbiology and Immunology and I am Chair of the Division of Natural Sciences and Mathematics at the University of Saint Mary. I've worked at places like Creighton University, the Centers for Disease Control & Prevention and Mercer University School of Medicine. All thoughts are my professional opinion, do not represent the views or opinions of my employer and should not be considered medical advice.