Public Health Update: Back to COVID Medium Tier; High May Be Coming Soon

COVID-19 cases in Los Angeles cases are now averaging more than 2,700 per day, an 85% increase in just the last two weeks, moving us back up into the “medium” community tier as defined by the CDC, and reminding us, said LA County Public Health Director Barbara Ferrer in her weekly address yesterday, that the pandemic is still very much with us.

Ferrer compared the current COVID-19 case numbers, hospitalizations, and deaths to various points in trend lines from the last two years, and noted that at this point a year ago, just before the huge winter surge (the big spike in the graph below), we were only experiencing slightly more than 800 new cases per day, less than a third of our current number.  Hospitalizations are also currently trending upward, Ferrer reported…but the good news is that deaths from COVID-19 remain stable, though they do tend to lag a few weeks behind the other two indicators.

This week’s numbers, with a case rate of 185 per 100,000 residents, also moves us from the “low” to the “medium” community tier, as defined by the CDC.  This means that while our health care system is not yet being stressed, it may become so if the upward trends continue.  Ferrer also noted that if the numbers keep increasing at the current rate, we could reach the “high” community tier as early as next Thursday.  Also, in addition to the case rate thresholds for each community tier, there are two hospital-based metrics involved in the community tier definitions – new hospital admissions related to COVID-19, and the percentage of staffed inpatient hospital beds occupied by COVID-19 patients.

In the past, if both our case rate and at least one of the two hospital-based metrics passed the “high” community threshold, the CDC and our local health departments would require all people to wear masks in indoor public spaces…but now the CDC has changed its guidelines (which Los Angeles County follows) to require masks only when both of those hospital-based numbers cross the “high” threshold.  In other words, while masks have once again been “strongly recommended” in LA County for a few weeks now, they will not be required again until both the case rate and both COVID-related hospital admissions and the percentage of hospital beds occupied by COVID patients cross the “high” threshold…something that is not nearly as imminent as crossing into the “high” community tier based on case rates alone.

Also continuing an ongoing trend this week was the further fall in the percentage of local cases due to the BA.5 Omicron subvariant of COVID-19 (the red bars on the graph below), which has dominated for most of this year.  Currently, however, BA.5 is “rapidly losing dominance,” Ferrer, reported, with newer variants BQ.1 and BQ1.1 (the white and purple bars below), which are both descendants of BA.5, moving in quickly.  This shows, Ferrer said, that the virus continues to change rapidly, and we all still need to take precautions to protect ourselves and others.  And, unfortunately, Ferrer said, only about 16% of LA County residents have so far received this fall’s COVID-19 booster shot, which is the first to protect against the BA.5 strain and its subvariants.

Unlike in the past two years when, thanks to various COVID-related restrictions, other seasonal viruses were held to a minimum, this year we’re also seeing large and early spikes in both flu and RSV.  Ferrer reported that this week, cases of influenza-A (red line on the graph below, comparing it to flu in the past three years) are still climbing, and test positivity reached 25%.

And wastewater tests for influenza-A (the trend line below) continue to climb quickly as well, Ferrer reported.

The RSV news may or may not be slightly better, though, Ferrer said.  This week’s trend line (red on the graph below) does show a decline in RSV cases this week…

…but wastewater testing for RSV (the trend line below) is still moving upward instead of down.

Ferrer said there could be several factors affecting the RSV case numbers, including changes in the numbers of people being tested recently, so it will be a while yet before officials know if a decline in RSV has really started or not.

Meanwhile, Ferrer reminded people to take sensible precautions against getting sick, such as getting flu and COVID shots, and wearing masks in indoor spaces.  And for those who do test positive for COVID, stay home (even if you don’t have symptoms), talk to your doctor about therapeutics if you are sick, and go to the hospital if you have severe symptoms such as trouble breathing, severe chest pain, bluish discoloration of skin, lips, or nails, being disoriented, and having difficulty staying awake.

And finally, even though masks are not currently required in indoor public spaces, Ferrer reminded people that they are currently “strongly recommended,” and “a strong recommendation means we think everyone should be wearing a mask” because they are a very beneficial way to keep viruses from spreading.

“I know nobody wants to hear this message at this time,” she said,” but we have to protect each other” and “compliance has always relied heavily on people being willing to do the right thing.”