Public Health Update: No Post-Holiday Winter Surge (Yet)…but Deaths Highest Since July

There is both good and not-so-good news on the COVID-19 front this week.

On the plus side is that nearly two weeks after the end of the December holiday season, new COVID-19 cases continue to decline in LA County rather than show any signs of the kind of post-holiday spikes or surges we’ve in during similar periods in the last three years.  (And wastewater testing confirms the decline.) COVID-19-related hospitalizations are also fairly stable.  All of this is very good news, said LA County Public Health Director Barbara Ferrer in her weekly update yesterday…but she did add a note of caution, saying that “while our numbers are still really stable, they’re stable at an elevated level, and we’d like to see all of these numbers start to decline.”

Also, in the less good category, Ferrer reported that COVID-19 deaths are still at a high point of 23 per day during the last week – about where they were during the peak of last summer’s big surge in July, and higher than they were in late December, despite the drop in new cases and case rates.

One likely reason for the stubbornly high number of deaths, Ferrer said, is that there are still great disparities in the effects of COVID-19 by age and income…and those who are most vulnerable to more severe infections, which can lead to hospitalization and death, continue to suffer at higher rates than the general population, even though the overall number of cases is dropping.

For example, Ferrer reported that over the last 90 days, people 80 years old and older are hospitalized at rates three times higher than than those ages 50-79, and are five times more likely to die from COVID-19 than those in that next lower age group.  (Also, those who are ages 65-79 are three times more likely to be hospitalized than those 50-64, and five times more likely to die than 50-64-year-olds.)

Similarly, Ferrer said, individuals who live in areas where more than 30% of residents are below the federal poverty line have nearly twice the hospitalization and death rates for COVID-19 than those living in areas where less than 10% of residents fall below the poverty line.  (This is due to a number of factors, Ferrer said, including the fact that lower income residents tend to hold more jobs where they’re in contact with large numbers of customers, have reduced access to quality medical care, and more.)

Currently, Ferrer reported, the BQ.1 and BQ.1.1 strains of COVID-19 (pink and purple on the chart below) remain dominant in LA County, accounting for about 67% of sequenced specimens.  Both of these are subvariants of the Omicron BA.5 variant, but although they seem to be more easily transmissible than the earlier BA.4 and BA.5 variants, they are actually descendants of those lines, and thus targeted by this year’s bivalent booster shots…which may be at least part of what is keeping our numbers lower than they were last year at this time.

One note of caution that Ferrer reported, however, is the growth of the newer XBB and XBB.1.5 strains (yellow and gold on the chart above), which have so far remained a small (and this week rather stable) 6.8% share of LA County’s total samples…but which have grown quickly in the northeastern United States, where they now account for as much as 70% of all cases.

Ferrer said the XBB strains spread even more easily and rapidly than the current BQ variants, and they have mutations that make them even more likely to evade prior immunity from either vaccinations or infections with other COVID-19 variants.  But Ferrer also said there’s no clear picture yet of the overall risks from XBB, and no real information about whether it causes more severe illness or presents any other more significant dangers than the variants we’ve experienced so far.  Also, she said, while this year’s bivalent boosters specifically targeted sub-lineages of Omicron BA.4 and BA.5, and XBB is part of the Omicron BA.2 lineage, it is still in the Omicron family, and the boosters should still provide some additional immunity to XBB.

That said, of course, Ferrer said only about 19% of eligible Angelenos have received the fall boosters so far, so there’s still a lot of room for improvement, with about 6 million people still eligible to upgrade their protection.

To continue to help stave off another winter surge as people return to work and/or school after their holiday breaks, Ferrer recommended that those who haven’t received their boosters do so, that those returning to work or schools after holiday breaks test for COVID-19 before they return, that people wear masks in those public indoor spaces for the first 10 days (the length of the likely incubation period for new COVID infections), and that anyone who gets sick (whether with COVID, flu, RSV, or any other bug), stay home.

And if we can do that, said Ferrer, the outlook should remain positive.

“We don’t know how the coming months will look in terms of COVID,” she said. “We know the pandemic is not over.  However, we have likely entered a new phase, in part because of the tools now available to blunt the impact of COVID and in part because of the choices people in L.A. County are making. My hope is certainly that we continue to report lower numbers and that transmission is significantly lowered in the weeks ahead.”