Public Health Update: County Enters “Low” Community Tier; Omicron Boosters Coming Next Week; Monkeypox Plateauing

Public health news continues to be quite good this week, with COVID-19 cases still declining rapidly, and new Omicron-specific boosters coming as soon as next Wednesday.  And monkeypox case rates continue to flatten, too, sparking hope that a decline will begin soon.

COVID-19

In this week’s LA County Public Health update, Public Health Director Barbara Ferrer reported that we saw “significant further decline” in new COVID-19 cases in the last week (the green line in the chart below), averaging less than 2,600 per day, about what they were in early May.  Hospitalizations (orange line, below) are also continuing to decline (with the slight uptick in last week’s hospitalizations likely a reporting error).  Meanwhile, daily deaths from COVID-19 (blue line) are so far holding steady, but deaths tend to lag a few weeks behind the other indicators, so it’s likely they, too, will start falling soon if current trends continue.

In one of the two best pieces of COVID-19 news this week, Ferrer reported that LA County’s new case rate of 193 per 100,000 residents, and its falling hospitalization rate (down to 9 per 100,000 residents), have moved us from the Medium to Low community level, as defined by the CDC.  As she has done previously, however, Ferrer was careful to explain that this means our health care system is not currently being stressed by the pandemic, but it does not describe our current transmission rates for the virus.  In fact, she said, we continue to experience “significantly elevated transmission” of COVID-19, and although transmission rates are better now than they were during the summer surge, “we’re still not where we’d like to be”…so it still makes sense to take “common sense” precautions against catching or transmitting the virus.

As for which variant of COVID-19 is currently dominating, Ferrer said it’s still the Omicron subvariant BA.5, which now represents 92.1% of the cases in LA County (up from 90% last week).  In other parts of the U.S., Ferrer said, the BA.4.6 subvariant has gained some ground, but so far there have been only 4 cases in LA County, and no new cases in the last week.  BA.4.6 progress, though, is now one of the “early alert signals” that LA County is tracking closely.

Schools have been re-opening over the last few weeks, so Ferrer also presented data this week on the number of new school-based case clusters, which have tripled each week over the last three weeks as more and more campuses have re-opened.

Ferrer said most of the recent clusters have been at elementary schools, with youth sports the next largest nexus.   Ferrer also said that “clusters” are generally more than five cases in a single location, though some have involved more than 20 cases.  (And she explained that the Department of Public Health is now tracking only case clusters at schools, not individual cases.)

This week, Ferrer also provided information on how COVID-19 has affected death rates in LA County, and reported that the virus has been the major factor in an overall drop in life expectancy for two years in a row now.

COVID-19 is also now the leading cause of premature (under age 75) death in LA County, Ferrer said, followed by drug overdoses and coronary heart disease.

The week’s other big COVID-19 news, of course, is that new “bi-valent” (two-strain) boosters are coming, which will protect against both the original strain of COVID-19, and its Omicron variants.  Ferrer said the CDC is meeting today to finalize recommendations for the new boosters, but they should be available locally as soon as next Wednesday, with the Moderna version recommended for ages 18 and up, and the Pfizer version OK’d for those 12 and up. Also, the shots will be used as boosters only, not primary vaccines, and people will likely be eligible to receive the new boosters two months after receiving their primary shots or previous boosters.  Ferrer said there should be more than 900 sites available to receive the boosters, including public health locations, drug stores, and other providers.

Monkeypox

In monkeypox news this week, the numbers were also at least mildly encouraging.  According to LA County Chief Medical Officer Dr. Rita Singhal, there have now been 51,257 cases of monkeypox reported worldwide, with 18,989 in the United States, and 1,518 in LA County.  The median age of people reporting monkeypox infections is 35.  98% are male, and 96% identify as LGBTQ+.  So far, locally, Singhal said, there have been 49 monkeypox-related hospitalizations, and no deaths.

According to Singhal, however, the graph of new cases by date shows some leveling off in the last two weeks.  Case rates have slowed, too, with new cases now doubling every 22 days, as opposed to every 8 days in early August.

Singhal also reported that 42% of monkeypox cases in LA County have been among people living with HIV, which makes it especially important to make sure that that group, in particular, has access to vaccines and gets vaccinated as soon as possible.

To date, Singhal said, LA County has received 113,490 doses of monkeypox vaccine, of which about 50% have been delivered.   Another 82,500 doses will be arriving soon, as part of the County’s most recent allotment.

But as with many health-care-related issues, Singhal said, there is already an equity issue with monkeypox vaccines.  So far, she said, while Hispanics have experienced the largest percentage of monkeypox cases (40%), they have received only 32% of vaccine doses…while whites have accounted for only 29% of monkeypox cases, but have received 41% of the vaccine doses so far.  The disparity, Singhal said, highlights the need for greater outreach, education, and vaccination efforts in the Hispanic community.

As Singhal reported last week, monkeypox vaccines are now available to gay or bisexual men and transgender persons who have had multiple or anonymous sex partners in the past 14 days, or who have had skin-to-skin or intimate contact (including kissing and hugging) with persons at large venues or events in the last 14 days.  Vaccines are also now available to persons of any gender or sexual orientation wo have engaged in commercial or transactional sex in the last 14 days.

Finally, there’s also the good news that while you can still make appointments for monkeypox vaccinations, you can also now just walk up to LA County and some other community vaccination sites, without an appointment.  For more information and a list of walk-up vaccination sites, see ph.lacounty.gov/Monkeypox.