This week brings important COVID-19 news on both the national and local fronts. First, on the national front, the FDA has authorized state-licensed pharmacists to prescribe paxlovid to patients testing positive for COVID-19. According to a statement issued by the agency on July 6:
“The FDA recognizes the important role pharmacists have played and continue to play in combatting this pandemic,” said Patrizia Cavazzoni, M.D., director for the FDA’s Center for Drug Evaluation and Research. “Since Paxlovid must be taken within five days after symptoms begin, authorizing state-licensed pharmacists to prescribe Paxlovid could expand access to timely treatment for some patients who are eligible to receive this drug for the treatment of COVID-19.”
To receive paxlovid at a pharmacy, patients will need to be screened for COVID-19 at that pharmacy, and pharmacists will have to check patients’ medical records or contact their physicians, to make sure they don’t have any risk factors for the drug, and that it won’t interact negatively with other drugs they’re already taking.
According to LA County Public Health Director Barbara Ferrer in her weekly address yesterday, the California Board of Pharmacy still has to give the go-ahead before local pharmacists can begin the prescriptions. But once that happens, she said, “We know that this development is going to increase access to lifesaving medication for people who become ill with COVID.”
The other big, and more local, news this week is that new COVID-19 cases and case rates, fueled largely by the BA.5 variant of Omicron, the most transmissible variant yet, are still rising quickly and pushing us quickly toward the “high” community level as defined by the CDC. And if we reach that level, and stay there for two weeks, it will trigger an automatic return to indoor mask mandates for many indoor spaces.
According to Ferrer, this week’s numbers for LA County, as shown in the graphic above, “remain elevated,” with an average of 5,100 new cases reported every day. Test positivity rates also grew from 13.8% to 17% this week, fueled by the growing number of new cases, and hospitalizations rose from 808 last week to 989 this week. Also, for the first time since last winter, Ferrer said, there was a slight uptick in COVID-19 deaths.
For now, with 8.4 new hospital admissions per 100,000 residents, LA County remains in the Medium community tier, as defined by the CDC. But that number has risen 62% in the last month, Ferrer said, and if it reaches 10 per 100,000 residents, we will move back into the High level, which will trigger mandatory indoor masking rules.
According to Ferrer, if transmissions continue to increase at current levels, we could hit the High tier as soon as July 14. Indoor mask mandates would kick in if we stay in that tier for two weeks, which could be as soon as July 29. Ferrer cautioned, however, that it’s impossible to predict transmissions with certainty, and the rates could increase faster than expected, or – especially if we take enough protective measures now – slow down enough to significantly delay the important thresholds, if not avoid them altogether.
This week, six of the seven early alert signals being tracked by LA County are at the Medium or High level of concern, though one of those – new worksite clusters – did decrease this week, moving down from the High to Medium level of concern.
As we’ve seen for several weeks now, the Omicron variant of COVID-19 now accounts for 100% of local cases, with the BA.5 subvariant growing rapidly. According to Ferrer this is because the BA.5 strain is much more highly transmissible than other variants, and is also much more likely to cause reinfections in people who have had COVID-19 before, which increases the risk of infection for many people.
Another important metric tracked by LA County is the percentage of emergency room encounters involving COVID-19, which Ferrer said has been “steadily increasing” (up from 6% last week to 8.4% this week), is approaching a High level, and is definitely of “elevated concern.”
And two other important metrics – outbreaks in skilled nursing facilities and homeless settings – both of which involve some of our most vulnerable community members – are also rising again after a brief holiday lull.
Ferrer said that when a new variant begins to assert itself, the County always re-focuses on several key preparation measures, all of which are currently at Adequate or Outstanding levels. Ferrer said the particular focus at the moment is improving vaccine access and workplace outbreaks, to help move those from the Adequate to Outstanding level.
The County will also focus on improving surveillance activities, and moving those up from Adequate to Outstanding as well.
With the increasing case numbers and transmission rates, Ferrer urged residents to do all they can to help protect both individuals and the community at large, keeping in mind that individuals have varying levels of risk, based on different factors.
And it’s not true, Ferrer said, that only a few people have elevated risks. On the contrary, she said, those at particular risk for COVID-19 infections, hospitalization, and death include the millions of people who are not yet fully vaccinated, those over 50 years old, those who are overweight, and those who have specific medical conditions such as high blood pressure, diabetes, and/or asthma.
So we “need to remain committed to protecting others,” Ferrer said, and “take advantage of all available safety measures.”
And the best protective measures, she said, are things we’ve been able to do for a while now: getting vaccinated and boosted, staying home if you’re sick, testing before going to gatherings (note that if you haven’t already ordered your three sets of eight rapid antigen tests from the U.S. government, they’re still available at http://covidtest.gov/), gathering outdoors whenever possible, wearing masks and staying in well ventilated spaces when indoors, and seeking out therapeutic drugs if you get sick.
When asked yesterday why LA County would consider returning to a mask mandate at the High community level, even if hospitals are not yet being overwhelmed with cases, Ferrer said, “Waiting until hospitals are overwhelmed is way too late to do much about COVID transmission. The time to slow transmission is when you start seeing indications that you’re having more utilization at hospitals,” which is what we’re seeing right now.
Also, she said it’s common knowledge that if you have high transmission rates – “and ours are really high” – you will start to see increases in hospitalizations. So “that’s the time,” Ferrer said, “to start getting worried and to start trying to do something to slow down transmission.” Of course we don’t expect to eliminate transmission altogether, she said, but we can slow it down enough that we don’t see the kinds of stresses on our health care system that we saw during last winter’s surge. And masks are “a pretty simple safety measure to layer in.”
Finally, responding to a question about why LA County is planning to follow CDC guidelines for mask requirements at the High community level when some other counties in California are not doing so, Ferrer said that “for us, equity issues are paramount,” especially in “essential work environments.” Also, she pointed out, there are still plenty of places – such as public transit, health care settings, and more – where indoor mask rules have remained in effect all long, so other kinds of indoor masking wouldn’t be such a big shift.
“I urge everyone to really be part of the solution,” she said, noting that in addition to preventing another mask mandate, another big goal is to slow transmission before schools start up again in August. “That’s the work of the summer,” she said.
