Once again I thought I’d leave it be. Try to do what so many others seem to do without much effort: live with COVID as I used to live with the flu. For all those years, I took the flu shot but never really thought about wearing a mask, or social distancing. But then COVID struck and changed our reality.
If you’re wondering if it might be too soon to celebrate the end of the COVID emergency, I suggest you read Ed Young’s “The Pandemic’s Legacy Is Already Clear” in the September 30, 2022 issue of The Atlantic.
Young offers a very sober counterpoint to the near universal push to de-emphasize the continuing risk of COVID: “Recently, after a week in which 2,789 Americans died of COVID-19, President Joe Biden proclaimed that ‘the pandemic is over.’ Anthony Fauci described the controversy around the proclamation as a matter of ‘semantics,’ but the facts we are living with can speak for themselves. COVID still kills roughly as many Americans every week as died on 9/11. It is on track to kill at least 100,000 a year—triple the typical toll of the flu. Despite gross undercounting, more than 50,000 infections are being recorded every day. The CDC estimates that 19 million adults have long COVID. Things have undoubtedly improved since the peak of the crisis, but calling the pandemic ‘over’ is like calling a fight ‘finished’ because your opponent is punching you in the ribs instead of the face.” (Emphasis added.)
Like you, I’ve been inundated by the continuing TV coverage of hurricane Ian, before, during, and now after. The destruction has been mindboggling. So much has been lost. This morning they’re reporting that we may have reached more than 130 deaths.
There is something about the human mind and how we process tragedy. Clearly these deaths over the past several days have had great impact. Meanwhile, the 400 or so deaths from COVID yesterday, today, and probably tomorrow will pass without notice. That is except for family members, friends, their community, and all the hospital personnel involved in treating them. How is it that we have gotten so used to a weekly COVID death toll that once might have horrified us?
And so it recently dawned on me that we need to think of COVID as we think of one of the hurricanes about to make landfall. How about Hurricane Omicron?
Sadly, in the case of approaching Hurricane Omicron, many in our governments—national, state, and some local—no longer really want to take the time to tell us about our still remaining vulnerability to COVID. Certainly, not with urgency or in a way that will have maximum impact.
Yes, I appreciate that during the earliest surges, when we actively mobilized our resources, when we emphatically put public health first with mask mandates, social distancing, closing schools and universities and indoor public places like bars and stadiums, and when we actively encouraged working and learning at home, we paid a price. The economy suffered. We quickly discovered the reality that our broadband capabilities were significantly unfair and unequal. Poor students and many in rural areas were at an obvious disadvantage. Many missed the socializing in school and at work.
Ordinary citizens, unable to live as fully as they were used to living, grew depressed and angry and impatient. And so, it’s no wonder there’s been little public protest as public health precautions take a backdoor to moving on from COVID.
There’s just one problem. COVID’s not going anywhere. At least not yet. In fact, every day immunologists and medical researchers and health professionals learn more about how COVID is adapting to our attempts to protect ourselves.
Dr. Jeff Gilchrist’s recent series of tweets, entitled “COVID-19: Things everyone should know (Part 1: Immune System),” offers some valuable information:
Here’s some additional information about the possible impact of Hurricane Omicron. Many have pointed out that there is usually about a month’s delay between what is happening with the virus in Europe and the United Kingdom—a preview of sorts of what we can be soon be facing. In this case, these reports should sound an alarm.
Thomas Kingsley of the UK Independent reports: “The UK is heading into a ‘devastating’ Covid wave this autumn exacerbated by a drop in testing and inadequate surveillance of new immune-evasive subvariants, experts have warned.
“Covid-19 infections in the UK have risen 14 per cent, according to the latest figures. Some 1.1 million people in private households tested positive for coronavirus in the latest survey, which covers the seven days to 17 September in England and the week to 20 September in the other three nations, according to the Office for National Statistics (ONS) …
“Professor Tim Spector, co-founder of the Covid ZOE app, told The Independent the UK was already at the start of the next wave of coronavirus.
“‘It looks like we’re in the start of the next wave and this time it’s affected older people slightly earlier than the last wave,’ Prof Spector said.
“He added: ‘Many people are still using the government guidelines about symptoms which are wrong. At the moment, Covid starts in two-thirds of people with a sore throat. Fever and loss of smell are really rare now—so many old people may not think they’ve got Covid.
“‘They’d say it’s a cold and not be tested.’” (Emphasis added)
Significantly, Professor Spector seconds the concern expressed by Dr. Gilchrist: “Prof Spector said early data showed new subvariants of Omicron were becoming immune-evasive and could cause the UK ‘real problems’ as winter approaches with the NHS ‘already on its knees.’
“University of Warwick virologist, Professor Lawrence Young, said two Omicron subvariants—BA.2.75.2 derived from BA.2, and BQ1.1 derived from BA.5—were causing concern in early data and showing signs of being able to escape the immune system … ‘What we’re finding is the virus is evolving around the immunity that’s been built up through vaccines and countless infections people have had.’
“He added: ‘The biggest concern we’re seeing is that in early data these variants are starting to cause a slight increase in infections. In a way, this was to be expected but it does demonstrate that we’re not out of the woods yet at all with this virus, sadly.’
“Prof Young also warned that the downscaling of Covid testing laboratories since the unveiling of the government’s Living with Covid plan means the UK is ‘blind’ to the behaviour of new potential variants of concern … ‘People are going to get various infections over the winter but won’t know what they are because free tests aren’t available—it’s going to be a problem. Another angle is the economic pressure. If people do feel poorly they’re not likely to take time off work. You have a perfect storm here, really, of inadequate surveillance, people not coming forward for vaccination and the economic situation.’
“Both professors called for stronger and more proactive messaging from the government ahead of the colder winter weather, while Prof Young called for the return of mask wearing in poorly ventilated and crowded indoor spaces.” (Emphasis added.)
But sadly, that doesn’t seem to be happening. The always informative Kaiser Family Foundation has published their most recent COVID-19 Vaccine Monitor for September 2022. They found several disturbing trends. While the new bivalent COVID-19 boosters, designed to bridge the gap between previous vaccinations and the now predominant Omicron variant are now available, only half of adults are “saying they’ve heard ‘a lot’ (17 percent) or ‘some’ (33 percent) about the new shots.”
And there is a major age gap at work here: “Almost half (45 percent) of adults ages 65 and older say they have gotten the bivalent booster or intend to get it ‘as soon as possible.’” But younger Americans are far less aware:
The Foundation notes: “Almost six in ten fully vaccinated adults ages 65 and older (57 percent) know the new booster is recommended for people like them, as do about half (49 percent) of those ages 50-64. Younger adults are less certain, with 19 percent of fully vaccinated adults under ages 30 saying they don’t believe the new booster has been recommended for their group and another 43 percent saying they are unsure.
“Four in ten fully vaccinated adults say they are not sure if the CDC has recommended that people like them get the bivalent booster, including about half of fully vaccinated rural residents (54%), Hispanic adults (51%), and those without a college degree (49%) who say they are not sure.” (Emphasis added.)
Clearly, the elderly are far more aware than many Americans about the continuing threat of COVID. I doubt many know that older Americans faced their own COVID version of a hurricane this past summer.
The Foundation writes, “As of the week ending October 1, 2022, the United States has lost nearly 1.1 million lives to COVID-19, of which about 790,000 are people ages 65 and older. People 65 and older account for 16 percent of the total US population but 75 precent of all COVID deaths to date. Vaccinations, boosters, and treatments have led to a substantial decline in severe disease, hospitalizations, and deaths from COVID-19, but with booster uptake lagging, deaths for older adults rose again during the summer of 2022.” (Emphasis added.)
As for the lag in “booster uptake,” unfortunately, politics still continues to play an inappropriate and outsized role when it comes to vaccine hesitancy:
They explain further: “The partisan divide also mirrors early COVID-19 vaccine uptake, with six in ten Democrats (60 percent) saying they’ve already gotten the shot or will get it as soon as possible compared to one in eight Republicans (13 percent). Notably, 20 percent of Republicans say they will ‘definitely not’ get the new COVID-19 booster dose, while a further 38 percent of Republicans are unvaccinated or only partially vaccinated and therefore not eligible for the new updated COVID-19 booster dose.”
Now that officials throughout the country are determined to resume in-classroom education, relax mask mandates, and not acknowledge
what many in the medical community expect to be an autumn surge, it’s especially worrisome to see survey results for parents and their plans for their children:
Kaiser tells us: “Just 2 percent of parents now say they will get their child vaccinated right away, and another 9 percent of parents of 5-11 year-olds still want to ‘wait and see.’ The share who say they will get their 5-11 year-old vaccinated ‘only if required’ (8 percent) or will ‘definitely not’ get them vaccinated (35 percent) has held steady over the past few months.” (Emphasis added.)
Meanwhile, “[a]lmost six in ten parents of teenagers, ages 12-17, say their child has been vaccinated (62 percent), with very few parents who say they want to ‘wait and see’ before deciding (2 percent). Around three in ten parents of 12-17 year-olds say they will definitely not get their child vaccinated (31 percent) while a further 5 percent say they will only do so if they are required.”
Just recently, word of the surge in Europe has spread to the States. On October 7, 2020, The San Francisco Chronicle wrote about the state of COVID in California and accurately described the growing contradiction between what seems to be an approaching threat and the relaxation of data gathering and mitigation measures:
“After a precipitous drop over the past two months, California’s COVID-19 trends have hit a plateau. Cases have fallen only 5 percent in the past week and the test positive rate inched down a tenth of a percentage point. In a worrisome sign, cases in Europe are starting to climb again as winter approaches. Even so, rules and tracking in the U.S. continue to be eased: The CDC said Thursday that it will stop reporting case and death data on a daily basis and has quietly dropped its masking recommendation for school nurses’ offices.”
On October 5, 2022 they announced, “Beginning on October 20, 2022, CDC will report updates to COVID-19 aggregate case and death data and line level data on a weekly, rather than daily, cadence. Data processing cutoffs for jurisdictions will be every Wednesday at 10AM ET for line level case and death data, and Wednesday at 5PM ET for aggregate case and death data.”
That same day, the World Health Organization’s “COVID-19 Weekly Epidemiological Update” of October 5 noted: “In the European Region, the number of new weekly cases increased by 8 percent as compared to the previous week, with over 1.5 million new cases reported. Eleven (18 percent) countries reported increases in new cases of 20 percent or greater, with the highest proportional increases observed in Guernsey (210 vs 107 new cases; +96 percent), Austria (77 674 vs 47 769 new cases; +63 percent) and Italy (215 534 vs 135 877 new cases; +59 percent). The highest numbers of new cases were reported from Germany (400 214 new cases; 481.2 new cases per 100 000; +42 percent), France (264 889 new cases; 407.3 new cases per 100 000; +15 percent)and the Russian Federation (256 106 new cases; 175.5 new cases per 100 000; -28 percent).”
Closer to home and north of our border, as The Vancouver Sun details, there are signs of increasing rates of COVID in Canada: “COVID-19 is ticking up again and the country is barely into fall. That shouldn’t come as a surprise, said McGill University genomic evolutionary biologist Jesse Shapiro. Forget, for a moment, all the alphanumeric subvariants, new and old, scientists are watching. ‘Even just based on waning immunity, the time since the average person had their last infection or their last booster, a wave was expected,’ Shapiro said.
“Infections and hospitalizations are inching up in Quebec, Alberta, and British Columbia, but wastewater signals are falling in Saskatchewan. Public Health Ontario reported Friday that it’s seeing a gradual increase in cases and the number of tests coming back positive, when looking back over the past two weeks. Ottawa is already in a ‘new wave’ of COVID-19, the city’s public health department declared last week.”
The Sun reminds readers of new legislation passed in Ontario: “Ontario and B.C. have begun moving people out of hospital in the event of a surge in COVID, in flu, or both, a sign the provinces are worried enough about hospital capacity to make room, Otto said. Ontario’s new law, Bill 7, allows hospitals to move patients awaiting long-term care to nursing homes not of their choosing, and as far away as 150 kilometres away.”
In fact, Ontario medical professionals have been warning for a while that Ontario hospitals are under great pressure because of COVID. One Canadian doctor offered this simple message to the Twitterverse:
Canadian statistician Bill Cormeau cites the obvious challenge facing residents this fall:
Canada’s National Advisory Committee on Immunization (NACI) recommended residents take advantage of the bivalent Omicron-containing mRNA COVID-19 vaccines: “As with previous COVID-19 booster programs, a fall booster dose with any authorized COVID-19 vaccine will be most important for older adults and other populations at increased risk of severe COVID-19 disease, regardless of the number of booster doses previously received.”
Katelyn Jetelina, MPH PhD, aka Yourlocalepidemiologist (YLE), is an epidemiologist and biostatistician who works at a nonpartisan health policy think tank. On October 5, 2022, she wrote, “Here we go again. The start of a new wave. Eyes are on Western Europe, as hospitalizations are uniformly increasing. As we’ve seen throughout the pandemic, some are hospitalized ‘with COVID19,’ but it’s important to note that the Germany’s numbers are reported purely as ‘for COVID19.’ In other words, not only are infections increasing, but so is severe disease.”
Jetelina reminds us that, for now at least, “the majority of cases are still the ‘old’ BA.5 subvariant. This means changing weather, waning immunity, and/or changing behaviors are the culprit. This theory is only solidified when we see patterns are not changing in neighboring country Israel, for example, whose weather hasn’t started changing yet.”
She, too, is looking warily at what’s coming our way: “This is concerning because subvariants are brewing. They only make up a small percentage of cases for now, but they are gaining ground; historically, we feel their impact when they make up ~30-50 percent of cases. These subvariants will eventually add fuel to the fire.
“Currently, we have a ‘subvariant soup’ on the horizon—a mix of many different Omicrons trying to dominate the space … Each subvariant has ~10 percent growth advantage over BA.5, meaning it has the ability to create a wave, but not a tsunami. (As a comparison, Alpha had a growth advantage of 7 percent/day; the first Omicron BA.1 had a growth advantage of 25 percent/day).”
She offers several insights: “Subvariants with similar mutations are popping up independently across the globe. CA.1 popped up in one place with a R346X mutation, while BQ.1.1 popped up in a different spot with the same mutation. This pattern has been the hallmark of COVID-19, so this isn’t necessarily surprising. What is noteworthy is where these mutations are happening—a spot that helps Omicron continue to partially escape immunity.
“BQ.1.1 … is a direct descendant of BA.5. While it has the most spike mutations, we picked the BA.5 formula for U.S. fall boosters. Our boosters will work best if this subvariant dominates in the future. For now, BQ.1.1 is winning the race in Europe, so this may have a good chance of taking over in the U.S. We may get lucky.”
Jetelina then warns: “More than 90% of testing and sequencing has been stopped across the globe. This means we are largely flying blind and there may be a surprise in the mix we are unaware of just yet.”
Using data supplied by Pandem-ic, she concludes that given the fact that we’ve “mirrored European trends throughout the pandemic, a wave in the U.S. is likely coming.”
Citing the results of the Kaiser Family Foundation polling I referenced before, Jetelina suggests: “The height of a U.S. wave is partially dependent on the number of people who get a fall booster. Unfortunately, it looks like the majority of Americans will be going into the winter ill-prepared. A new Kaiser Family Foundation survey found 40 percent of Americans are unsure if the booster is recommended for them, including about half of fully vaccinated rural residents (54 percent), Hispanic adults (51 percent), and those without a college degree (49 percent). There is clearly a failure of communication and outreach. This must be a priority as vaccines continue to protect against death, severe disease, transmission, cases, and long COVID-19. So far only 7.6 million Americans have received their fall booster.” (Emphasis added.)
Looking at the CDC’s Map of Vaccination percentages by U.S. states and territories, it’s clear that a remarkable percentage of Americans aren’t adequately protected against what might be coming. To return to my metaphor, it’s akin to a great number of people not willing to prepare for the hurricane that’s gathering in the Caribbean.
Since I’m back referring to the CDC, let me take this moment to remind you of some of the most recent research on long COVID. “As part of the CDC’s ongoing partnership with the Census Bureau, the National Center for Health Statistics (NCHS) recently added questions to assess the prevalence of post-COVID-19 conditions (long COVID), on the experimental Household Pulse Survey … Beginning in Phase 3.5 (on June 1, 2022), NCHS included questions about the presence of symptoms of COVID that lasted three months or longer.”
They found that about 15 percent of Americans have had Long COVID symptoms.
So, let me ask you a question. Do you think public health officials and college and university administrators and employers, both public and private, are paying enough attention to a disease that may easily affect 15 percent of their students and professors and staff and employees for years to come?
Back to Yourlocalepidemiologist for a second: “Bottom line—We may be in for a bumpy ride this winter. SARS-CoV-2 is already gaining ground thanks to weather and behavior change. We expect growth to accelerate with subvariants on the horizon. There’s a lot you can do, but the lowest hanging fruit is to get your fall booster.”
I’ll add—get yourself some N95 masks and start wearing them.
This leads to the larger question, as more and more health professionals warn of yet another Hurricane Omicron, are we as a society taking every possible step to best protect ourselves and others?
