“I don’t know that we’re at the end, but from where I’m sitting, it really looks like we may be plateauing.”
— LA County Public Health Director Barbara Ferrer to KCBS-TV News yesterday
- Omicron cases falling a bit, but still high
- Hospitalizations still increasing, hospitals still overwhelmed
- 102 deaths reported today; highest since March, 2021
- LAUSD attendance up this week, and test positivity down, but schools still struggling
- Shifting from preventing infection to preventing harm
For the first time in weeks, the number of new COVID cases in LA County, and in our local neighborhoods (see graph above) seems to be trending downward.
In her weekly briefing with LA County Supervisor Holly Mitchell today, LA County Public Health Director Barbara Ferrer reported 42,115 new COVID cases, but this was after three days with numbers in the low 30,000s and even just 22,688 cases on Tuesday, the day after the Martin Luther King, Jr. holiday.
In an interview with KCBS-TV yesterday, Ferrer said that it does look like the numbers in the current COVID-19 surge may finally be peaking, but that she won’t know for sure until we have data from the next few days, because this week’s holiday, and the accompanying delays in testing and reporting it may have caused, might still be skewing the numbers. But at both appearances, Ferrer said she is cautiously optimistic. “I’m very hopeful that we are plateauing and the good news about that is that shortly after we plateau, we should start to see that decline we also desperately need,” Ferrer told KCBS.
At the same time, however, Ferrer also acknowledged that it doesn’t mean we’re out of the woods yet with Omicron. “Plateauing at about 30,000 new cases per day is about the highest we’ve ever seen throughout this entire pandemic, from daily case numbers, so we don’t want to stay this high very long, because…high case numbers result in increases in the people who need to get hospitalized and, tragically, we’re starting to see an increase in the people who are passing away from COVID.”
Indeed, while new cases – the leading indicator in any surge – may be starting to level off, if not decline, the two other major indicators are still worrisome.
First, hospitalizations, which tend to lag at least a week or two behind new case reports, are still increasing, with 4,799 reported yesterday, and 4,814 reported today.
And for the first time during the current surge, deaths from COVID – which tend to lag another week or two behind hospitalizations – are starting to move up this week, with 59 deaths reported yesterday, and 101 new deaths reported today, the highest total since March of last year, according to Ferrer.
Also, Ferrer reported, the time between first infection and death with Omicron, which now represents about 99% of samples tested, appears to be significantly shorter than the same cycle with the generally more lethal Delta variant. According to Ferrer today, among the 102 people who died today, 80% first showed symptoms after January 1, and more than 90% didn’t get sick until after Christmas. In contrast, she said, people who died from Delta usually didn’t do so until four or five weeks after they first became symptomatic.
According to the LA Times today, the still increasing wave of infections is still hitting hospitals particularly hard, even though many COVID patients are primarily hospitalized for other illnesses or treatments. This is because staff members are also getting sick, and even if COVID isn’t a patient’s primary illness, they still have to be treated with the same additional protocols and equipment as those who are primarily ill with COVID.
As a result, reports the Times, hospitals across the state are increasingly overwhelmed, with necessary hospital admissions, surgeries and other treatments often being delayed, while emergency room patients wait longer than ever to be seen, or longer to be admitted to the hospital from the ER, because there are no beds available, or staff to manage the beds.
“I think there’s a perception in the community that [Omicron] is not as serious,” said Dr. Jeffrey Smith, Cedars-Sinai Medical Center’s vice president of operations and chief operating officer, in the Times story. “But it is still the burden on the health system, be it the emergency medical services or the ambulances in the hospital emergency departments in the hospital themselves. It’s really just the sheer number of patients that causes challenges.”
Meanwhile, the news is also cautiously optimistically this week for local schools, with LAUSD reporting 25% of students absent this week, which is actually better than the previous week, when about 33% of students were absent, either due to COVID or delays in testing and/or receiving test results.
Also, with testing resuming at schools since students have returned from winter break in the last couple of weeks, LAUSD is reporting test positivity of just 8.07% in 426,155 tests, as opposed to LA County’s current 19.14% test positivity rate over the last week. (And both of those numbers are down slightly from a week ago.)
But as with LA County numbers overall, while things may be starting to trend downward, the numbers, as Ferrer said, are still very high (and still well beyond their peaks a year ago), and that means that, like hospitals, schools are still struggling, too – largely because so many of their own employees are out sick, and staffs are short. (We’ve heard from local elementary schools that some teachers have had to double their class sizes to take over for other teachers who are out, because no substitutes available to cover the absences. And that leaves the remaining staff pretty frazzled, and students with yet more gaps in their regular instruction, even though they are back in physical classrooms.)
As always, testing remains an important part of protecting ourselves from both getting and transmitting COVID, and as we reported earlier this week, every household in the U.S. can now order four free COVID rapid tests from the federal government, via the US Postal Service (just go to https://special.usps.com/testkits to place your order). Ferrer repeated this information in her presentation today, and also added that private health insurance companies are now also required to reimburse you for up to eight rapid tests per month for every individual on your health plan, up to $12 per test kit. See below for information, and advice on how to get reimbursed by your insurance company.
And, of course, it’s clearer than ever that while vaccinations won’t stop COVID infections completely, they do save lives. Ferrer reported today on a new study done at USC, which calculated that if everyone eligible in LA County had been fully vaccinated, we would have prevented 604,000 of our 711,000 cases over the last month (and that number would have been 680,000 cases prevented if everyone was both vaccinated and boosted). And we could have prevented 9,300 of the County’s 10,500 hospital admissions if everyone was vaccinated (or almost all hospitalizations if all those who are eligible were both vaccinated and boosted).
According to Ferrer in today’s presentation, advice for staying safe hasn’t changed – wear high quality masks, get vaccinated and boosted, avoid large gatherings, and follow proper isolation/quarantine protocols if you’ve been exposed or have symptoms. But she did caution people to carefully analyze their potential risks before various kinds of gatherings or activities, especially large indoor family holiday events.
“This would probably be the time to do a delay,” she said, “unless you can get everyone tested before you gather,” and then also stay outside, maintain appropriate social distance, and wear masks at all times except when eating.
“All of us have to do that assessment for the activities we’re doing,” Ferrer said, and people may want to make conscious choices about when they choose to play one of their “risk cards,” especially when deciding between essential and non-essential activities. “Either this is an activity where I’m going to take on some risk, or this is an activity I think I’m going to delay for a little bit because it’s not worth the risk I may be taking on,” she said.
Moving from Preventing Infection to Minimizing Harm
As the pandemic continues, Ferrer and Supervisor Mitchell both spoke about how things will shift as the Omicron surge subsides and we start to shift our focus from policies and activities focused on prevention to those focusing more on preventing harm from the infections that will inevitably remain with us for a long while to come.
But Ferrer also noted that prevention and minimization are not really an either/or proposition. For example, she said, case rates definitely affect how harmful the virus can be, so we still need to focus on preventive measures such as masks and vaccinations to keep the number of ongoing infections as low as possible. Another component of minimizing harm, she said, is therapeutic treatments for COVID infections, but while there are now at least a couple of effective antiviral drugs, they’re still not widely available, especially in our most vulnerable communities…and they won’t help to minimize harm until they’re widely available to all people who need them. And finally, Ferrer said, we also have to deal with staffing issues in our health care system before we can fully pivot from prevention to harm reduction, because you can’t reduce harm without fully staffed hospitals (and staffing issues can be very complex, including things like pay, equity, burnout, and more).
In the meantime, Ferrer said prevention is still very important right now, and that even though Omicron is “milder” than past variants, it does NOT mean that people should just accept that they’re going to get it and deliberately decide to just get it over with. That, she said, is a “completely inappropriate response,” especially since we know so little so far about things like “long” COVID, and COVID complications in children (such as Multisymptom Inflammatory Syndrome or MIS-C), which can still result from Omicron infections. Also, she noted, “mild” illness may not actually seem so mild when you have it, and can include lengthy fevers, multiple sleepless nights from coughing, and more discomforts. “So I don’t think anybody should be running out to get COVID,” she said, adding that – in addition to the risks involved – data so far seems to indicate that vaccinations provide better immunity to future infections than getting infected does, so there’s really no good reason to seek out an infection.