“I think for the next two weeks, we’re going to continue to see our case rates rise,” said Los Angeles Public Health Director Barbara Ferrer on Thursday. That statement was made more ominous by the fact that, on that very day, the county recorded a record number of new daily cases for the pandemic. At 37,000, the new tally was 10,000 cases higher than the previous record.
The rising numbers over the past week have led to a slew of event cancelations, adaptations, postponements and pauses impacting the Grammys, Sundance, production on NCIS and the release of Marvel’s Morbius.
The latter is a case study in the vicissitudes of pandemic planning. It’s been scheduled for July 31, 2020, March 19, 2021, October 8, 2021, January 2022 and now April. In fact, trying to predict the ebbs and flows of Covid has become a bit like early weather forecasting: We have a few days’ visibility, but after that it’s anyone’e guess.
“No one knows for how long the Covid-19 pandemic will endure or the enormity of its impact on California for years to come,” said President & CEO of the California Hospital Association Carmela Coyle on Saturday.
The one thing that does seem clear, however, is that Omicron will be driving infections for some weeks to come.
With an eye to that, California Governor Gavin Newsom called out the National Guard on Friday to support testing operations across the state. On Saturday, Newsom loosened the state’s purse strings and announced a $2.7 billion emergency Covid spending package which is two parts prevention and one part intervention.
“Our proposed Covid-19 Emergency Response Package will support our testing capacity, accelerate vaccination and booster efforts, support frontline workers and health care systems and battle misinformation, with a focus on the hardest-hit communities,” said the governor in a statement.
While officials continue to promote vaccination, testing may be key to slowing the spread, according to Dr. Tony Napolitano whose company, Wellstand, provides testing services to events and film and TV productions.
“People who are going to be vaccinated, we’ve seen that curve flattening out,” said Napolitano. “I don’t think you can move the needle much on vaccination. So what’s left is social distancing, testing and masking, those type of things.”
Los Angeles on Friday set yet another daily case record at over 43,000. That’s up 100% in just four days thanks to an average 7-day test positivity rate that currently sits at 20.4%, which is just about the highest it’s ever been in the region. Put another way, one in five Angelenos is testing positive.
High community transmission will continue to fuel high daily case numbers in the short term. That will likely, in turn, fuel hospitalizations — which have also doubled in the past week — a few weeks down the line. Covid-related deaths will likely rise thereafter.
“My hope is that, you know, by the time we get to February, we’re on the downside of seeing that massive amount of community transmission,” Ferrer said Thursday. Hospitalizations may be peaking at that point, however.
The ensemble forecast model compiled by the State of California now predicts that hospitalizations related to Covid will rise to 23,528 by February 6, a 153% increase over Friday’s number, 9,279 (the state does not post Covid data on weekends). A rise to 23,528 would eclipse the previous pandemic record of 21,938 set January 6, 2021. How does that happen if Omicron is, as most experts say, less virulent than previous strains? The answer may lie in the variant’s increased transmissibility.
The state’s 7-day average test positivity rate has been skyrocketing. It hit an all-time high of 21.7% on Friday. That’s 60-plus percent higher than the peak of last winter’s surge.
Across the country, the picture is even more grim, with U.S. test positivity hitting 26% this week, according to Johns Hopkins University. That positivity rate undoubtedly fueled the record 1,082,549 new daily cases the university reported on Monday and the 900,000 it tallied Friday.
New York City is even worse off than L.A., with the daily number of new cases there hitting an all-time high on Thursday of over 42,000, according to the New York Times. The test positivity rate was over 33%, meaning one in three residents are likely positive. By comparison, the last winter’s high for daily cases was under 6,300.
In L.A., the test positivity rate has begun falling in recent days. The 22.7% rate on Monday dropped to 20.6% today. Paradoxically, the county saw yet another all-time high of 45,584 new cases today, the fourth record count in the past week, and nearly triple the 16,269 cases reported on Monday. But the drop in test positivity may indicate a drop in cases to come which could, in turn, signal the beginning of the end of the current wave.
South Africa, the country where Omicron was first identified, is thought by many to have passed the peak in its Omicron wave. The average number of cases are down 54% over the past few weeks, according to data from the New York Times. The 7-day test positivity rate there was still a staggering 31% as of early January but it had been falling since mid-December, when it peaked at 36%, according to the country’s National Institute for Communicable Diseases.
A drop in cases is not the end of a surge, however. Even if cases in L.A. do fall from today’s record, the surge in cases may fuel record Covid-related hospitalizations in the weeks to come, given trends in hospitalizations tend to trail infections by about 2-3 weeks and the number of Covid patients in L.A. has just started to surge. Increases in deaths generally follow rises in hospitalizations by another two weeks.
South Africa, for instance, has seen a 174% rise in Covid-related deaths in the past two weeks, the Times reported. Of course, comparing South Africa to the U.S. is not an apples to apples operation.
South Africa has a much younger population, with a median age of about 27 years old, while the median age in the U.S. is about 38. That should give South Africa’s population more youthful immune protection. It’s also summer in that country, which is not typically conducive to the spread of flu-like viruses.
Conversely, South Africa’s vaccination rate is only 27%, while the U.S. has vaccinated 63% of its citizens. South Africa is also home to the world’s biggest HIV epidemic, according to Bloomberg. An estimated 8.2 million of its citizens are infected with HIV. That’s about 13% of the country’s population. Those immunocompromised people are more susceptible to other viruses like Covid.
In the U.K., where pandemic patterns have often presaged those in the States, “there are tentative signs the number of new cases may have peaked,” according to Reuters, “with 146,390 new cases reported on Saturday, down from the record 218,724 recorded on Jan. 4.”
But the recent peak in cases there may already be pushing Covid-related deaths higher, with a 38% rise there this week, Reuters reported.
The latest CDC ensemble forecast for the U.S. predicts that “the number of newly reported Covid-related deaths will likely increase over the next 4 weeks, with 19,700 to 30,500 new deaths likely reported in the week ending January 29, 2022.” The current 7-day moving average of deaths in the U.S. is 1,513 per day or 10,591 per week. That would mean a 100%-200% increase in Covid deaths nationally this month.
The CDC forecast for California predicts about 1,100 weekly Covid-related deaths by the end of the month. The current average number of daily deaths in the state is 45, which adds up to 315 for the week. Thus, the CDC predicts a threefold increase in deaths by the end of the month.
But those numbers likely won’t mark the peak in Covid-related deaths for this surge. If cases have now peaked and we still have another 1-2 weeks of hospitalization increases and then deaths continuing to rise 2 weeks thereafter. That logic would put the peak in deaths somewhere in mid-February for the state.
How is that possible Omicron could drive such a surge, given experts generally agree that it is much less virulent than the Delta variant? Again, Omicron’s increased transmissibility may be key.
While a smaller proportion of those infected may end up in the hospital due to Omicron, the variant seems to be filling hospitals anyway by infecting a massively greater proportion of people at one time (see this week’s record case numbers for evidence of that).
One hospitalization model created by Harvard-affiliated physicians indicates California is at 80% occupancy and will exceed capacity soon if extra measures are not taken. The forecast shows about 600 counties across the country are at capacity and about 475 others set to exceed capacity. More broadly, 20 states are expected to exceed capacity.
Washington D.C. may already be there. The President and CEO of the D.C. Hospital Association last week asked Mayor Muriel Bowser to declare a healthcare emergency so that facilities could reimplement crisis standards of care, which allows them to break mandated patient to nurse ratios in order to stretch their already short staffs.
Most of the people being infected, according to state data from mid-December, are unvaccinated. From December 13, 2021 to December 19, 2021, unvaccinated people were 10.1 times more likely to be hospitalized with Covid than fully vaccinated people. There are still over 3 million unvaccinated people in Los Angeles County.
Some experts believe that Omicron represents a progression from a pandemic state toward an endemic state, where Covid becomes much less serious and more survivable, akin to the seasonal flu.
“Viruses generally evolve to become more contagious and less dangerous,” said Napolitano of Wellstand.
He pointed out that viruses aim to survive and reproduce.
“If you kill your host,” he said, “you can’t reproduce and spread.”
“Covid will end by becoming endemic. It will end when everyone’s had it and can deal with it.”
That seems to be what the Biden administration is planning for.
Speaking on Meet the Press, former member of President Biden’s coronavirus task force, Dr. Ezekiel Emanuel said: “We think that over the course of 2022, we will get to an endemic stage, and the plan is — or the proposal is — we need a strategic plan for that, that covers vaccines, getting more people vaccinated, and the only way to do that, as we’ve been very clear over time, is mandates,” .
Napolitano points to porcine endogenous retrovirus.
“All pigs have this virus,” he noted about the pathogen, which can also infect humans. “It gets into the pig’s DNA and stays there. It doesn’t hurt them.”
Or, as Dr. Emanuel more bluntly put it, We’re going to learn to live with it.”
There are other developments that may help break the current surge.
New therapeutics have come online, such as Pfizer’s Paxlovid and Merck’s Molnupiravir anti-viral pills, the former of which is thought to reduce the chance of hospitalization by 88%. That could bode well for a return to some sort of normal, which is good news for upcoming events like the Super Bowl, the Olympics and the Oscars — as well as for people just trying to live their lives.
But there may be other countervailing variables.
Students across the country are returning from winter break. While many colleges are opting for a period of distance learning during the current surge, 600,000-student L.A. Unified School District returns to in-person instruction on Tuesday.
The district has deployed baseline testing for all students, teachers and other employees ahead of the return to in-person instruction. Interim Superintendent Megan Reilly said last week that the district is reporting a roughly 13% test positivity rate thus far.
LAUSD deployed a similar strategy when classes resumed last August. At that point, baseline testing before the restart revealed a test positivity rate of 0.8%. That was far below the countywide positivity rate of 3.5% the day classes started.
This year’s return will likely see more infections and there are certainly fears among some parents of school becoming a super-spreader event, but district-wide testing may help staunch outbreaks.
“The responsible thing to do it to test. There’s no way in the world that you’re going to get people together and not have positives,” said Napolitano. “Positivity will appear to go up in the short term. Longer term, they’re going to have lower transmission rates.”
The district will continue to require baseline and weekly testing of all students and staff, regardless of vaccination status, through January. Beginning in February, only unvaccinated students will be required to undergo weekly testing.
Another potential accelerant is the Lunar New Year celebrations in the world’s most populous country and abroad. The holiday runs from January 31-February 15. Epidemiologists point to Chinese celebrations of the holiday (along with the winter holidays in the West) as prime drivers of the flu season each year when families and friends gather indoors to celebrate.
In 2014, Chinese authorities predicted that the country’s citizens would make 3.6 billion trips tied to the holiday. This year, many parts of China are on lockdown and officials have urged citizens not to travel, but gatherings will likely still happen. That worrys officials.
“With the arrival of the New Year and the Lunar New Year, the number of people returning home from abroad will increase and the movement of people within China will rise,” said He Qinghua, an official at the National Health Commission, recently. The Lunar New Year also overlaps with the dates for the upcoming Beijing Olympics, which runs from February 4-20, creating another opportunity for spread.
Finally, there is “Deltacron.” Discovered in Cypress this week, it may or may not be a new variant that combines aspects of Delta and Omicron and leads to increased hospitalization. Some scientists believe the strain is simply the result of lab contamination, not a new super strain. Only time will tell.
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