The Perfect Enemy | COVID in California: ‘No guarantee’ virus will become endemic - San Francisco Chronicle
September 22, 2023

COVID in California: ‘No guarantee’ virus will become endemic – San Francisco Chronicle

COVID in California: ‘No guarantee’ virus will become endemic  San Francisco ChronicleView Full Coverage on Google News

Though California figures for COVID-19 are trending flat to downward, San Francisco is showing signs of an uptick in test results and wastewater samples. Hopes for a combination COVID and flu jab before the end of 2023 have been dashed by technical delays and policy questions. President Biden is asking Congress for $1.6 billion to root out fraud in pandemic-era relief programs. And a new Canadian study finds signs that people with long COVID can have reduced oxygen uptake to the brain, impairing their cognitive abilities.

Virus levels remain stable nationwide

About 82% of all U.S. counties have low COVID-19 community levels, according to updated figures from the U.S. Centers for Disease Control and Prevention, up from 78% in that tier last week. Another 16% have medium levels, down from 20%, and 2.5% have high levels, compared to 2% in the same period. The COVID-19 community levels — determined by the number of new hospital admissions, inpatient beds metrics, and new cases per 100,000 population in the past seven days — have remained stable since early February. In the Bay Area, Napa and Solano counties slipped back into the medium category this week, while the seven other counties in the region held in the low tier. But all the counties in the region have substantial virus transmission levels based on a separate metric using new cases per 100,000 persons in the past seven days and the percentage of positive tests. Once the national public health emergency comes to an end on May 11, the CDC will no longer report community transmission levels due to a lack of regional data.

End of mask and vaccine mandates for California health care workers

California will drop COVID-19 mask and vaccination mandates for health care settings next month, according to updated guidance issued Friday by the state’s health department. Beginning April 3, health care workers, patients and visitors will no longer be required to wear a mask or be vaccinated to work in facilities that include hospitals, urgent care centers and dental and doctors’ offices. The new rules also apply to correctional facilities as well as homeless, emergency, and warming and cooling centers, said the California Department of Public Health. Read more about the changes in California, which took place the same day as similar moves in Oregon and Washington.

“No guarantee” virus will become endemic, prominent researcher tells Wachter

In a fireside chat with UCSF’s Dr. Bob Wachter on Thursday, Eric Topol of Scripps Research expressed optimism that the U.S. may be moving toward an endemic state with COVID-19 but noted there is “no guarantee” it will happen.

“It’s about as good as it’s been for a long time. We got through this XBB.1.5 in this country pretty darn well. Withstanding that was a big deal because it was predicted from its functionality to be quite transmissible and potentially quite a bit of immune escape,” he said. “It looks as though our immunity wall — that is both the vaccinations, the boosters, the infections, and all their combinations — is holding up well.”

But he cautioned that the country may not be ready if another SARS-CoV-2 mutation emerges beyond omicron and its subvariants, which have been dominant for more than a year, to become more transmissible, immune evasive, and potentially virulent. Even if another lineage of the virus does not emerge, Topol said the current pattern of surges and declines will continue for the foreseeable future.

“What happens if Paxlovid starts to show signs of resistance?” asked Topol, who has nearly 700,000 followers on Twitter. “We’re out of monoclonal antibodies. None of those work. We’ve left our immunocompromised in a very compromised position. Especially for people of an advanced age, it’s not an ideal thing because the virus will continue to circulate. If you let your guard down completely, you could wind up getting COVID and then there’s the unpredictable aspect of long COVID that we can’t ignore.”

He lamented that the federal government has taken a step back from pandemic preparedness and vaccine development, especially without a plan in place to provide additional immunity for people who got the bivalent booster in September. “Right now we’ve got more capitulation than preparation,” Topol said. He also told Wachter that it was “a no-brainer” that high-quality masks provide protection against respiratory viruses, despite a recent widely-circulated study that questioned their efficacy. He added that he hopes to see the development of a nasal spray vaccine in the near future.

“The real question is, are we going to see that family that is unexpected like omicron, that is a pi or sigma or whatever you want to call it, where the virus finds yet another major new path to get even more transmissible, more immune evasive, potentially even more virulent?” Topol said. “That’s what is out there dangling. I hope we never see that, but there’s no guarantee.”

All pandemic origin theories remain viable, says WHO

Officials from the World Health Organization on Friday said that all COVID-19 origin theories remain viable despite recent U.S. reports promoting the idea that the deadly virus originated in a lab in Wuhan, China. “If any country has information about the origins of the pandemic, it is essential for that information to be shared with WHO and the international scientific community,” Director-General Tedros Adhanom Ghebreyesus told a press briefing. He urged for more transparency from China, adding it would be impossible to come to a conclusion without the country’s leaders sharing all available data.

Acting governor extends authorization for test-to-treat sites

With California’s COVID-19 state of emergency coming to an end this week, Acting Governor Eleni Kounalakis on Wednesday signed legislation to codify a pandemic-era preparedness measure into state law. Assembly Bill 269 authorizes sites contracted with the California Department of Public Health to continue offering “test-to-treat” services through January 2024. Test-to-treat is a program that gives people the chance to be tested for COVID and receive the antiviral drug Paxlovid immediately if the test comes back positive. “This measure preserves important tools in the state’s response to the pandemic and will continue to protect public health as California moves forward, focusing on preparedness and support for our communities,” Kounalakis said in a statement.

XBB.1.5 grows to 90% of U.S. cases

The Centers for Disease Control and Prevention estimates that the XBB.1.5 omicron subvariant made up about 89.6% of COVID-19 cases in the week through March 4, up from 63% of cases sequenced in the week ending Feb. 4. The BQ.1.1 and BQ.1 omicron subvariants together accounted for 8.3% of new cases, down from 27% over the same period. In the Western Region of the country, XBB.1.5 was detected in 86.3% of new cases, while making up 98.4% of cases in the Northeast. The emergent omicron subvariant CH.1.1 slid to below 1% prevalence nationwide.

The U.S. is averaging about 226,218 new COVID-19 cases per week, based on federal data, down from 287,509 a month ago. Hospital data shows 3,318 new admissions per day of patients with confirmed COVID-19, compared with the prior seven-day average of 3,604. About 2,290 Americans are dying each week, compared to 3,501 on Feb. 1. Approximately 16.2% of the U.S. population — roughly 53.6 million people — eligible for the updated bivalent booster have received the shot.

Sweden says people under 50 do not need vaccine

The COVID-19 vaccine is no longer recommended for people under the age of 50 in Sweden, according to new guidance from the country’s Public Health Agency. Until now, officials said that all adults should complete their primary series and receive an additional booster for optimal protection. But that policy has changed as of Wednesday, with officials now saying only older and high-risk individuals should receive a “top-up dose” before the end of the year.

“Thanks to the fact that we continuously receive new data and knowledge about the disease, we can update and adapt our recommendations on vaccination,” Sören Andersson, head of the agency, said in a statement. “We know that there is now good immunity in the population and that it is rare for people under the age of 50 to be cared for in ICU with COVID-19. But the risk of serious illness increases with increasing age and therefore people in certain age groups need a top-up dose.”

Last month, public health officials discarded nearly 8.5 million doses of the COVID-19 vaccine due to low demand for the shots. “The bulk is doses that people have chosen not to take, in other words, the third, fourth, or fifth (booster) dose. These were already purchased and now have to be destructed,” Richard Bergstrom, Sweden’s former national vaccine coordinator, told Radio Sweden.

As virus slows elsewhere, S.F. sees another uptick

While COVID-19 metrics have largely plateaued or shown signs of declining in most regions of California, including a majority of Bay Area counties, San Francisco is experiencing an uptick in cases and hospitalizations. The city’s health department data shows the seven-day rolling coronavirus test positivity rate, which tracks the percentage of lab test results that are positive for the virus, climbing back to 7.4% after falling to 5.2% just two weeks ago.

The city’s two wastewater facilities show levels of SARS-CoV-2 genetic material steadily increasing, while the current effective virus reproduction number (R-effective estimate) of 1.15 shows the “spread of COVID-19 is likely increasing.” City data is showing an average of 10.2 new daily cases per 100,000 residents, which is substantially higher than the statewide average of 6.9 per 100,000 residents. There are currently 85 patients and rising hospitalized with COVID-19 in the city, the most since early January.

San Francisco ended its local public health emergency in alignment with the state on Tuesday, striking down its remaining masking and isolation requirements. But health experts say that does not mean the pandemic is over.

“The big theme is there’s still COVID around,” Peter Chin-Hong, an infectious disease doctor with UCSF, told The Chronicle. “At our hospital, we have 25 people with COVID, three people on a ventilator. That hasn’t really changed. We have to be mindful that even though it’s better there are still a lot of vulnerable people who can get ill.”

Long COVID linked to lower brain oxygen levels

Long COVID is associated with reduced brain oxygen levels, worse performance on cognitive tests and increased psychiatric symptoms, according to a new study. In an analysis of two parallel studies — a laboratory study involving cognitive testing and imaging and a population survey — researchers from the University of Waterloo found that individuals who experienced symptomatic COVID-19 illness showed impaired brain function compared to those who had not been infected. The paper was published Wednesday in the journal Brain, Behavior, and Immunity.

“We are the first to show reduced oxygen uptake in the brain during a cognitive task in the months following a symptomatic COVID-19 infection,” said Dr. Peter Hall, lead author and researcher in the School of Public Health Sciences at Waterloo. “This is important because a lack of sufficient oxygen supply is thought to be one of the mechanisms by which COVID-19 may cause cognitive impairment.”

In the population survey of more than 2,000 Canadians aged 18 to 56, respondents who had COVID reported difficulty concentrating, as well as increased symptoms of anxiety and depression. These effects were more detectable among unvaccinated individuals. Older women, in particular, appeared most impacted by the brain imaging outcomes.

“It appears that, regardless of gender and other demographic factors, COVID-19 infection at baseline is correlated with increased problems with emotion regulation six months later: depression, anxiety and agitation. In some cases, we are talking about symptom levels that are at or above recommended as cut-off scores for psychiatric diagnoses,” Hall said.

Hopes dashed for combo flu and COVID vaccine this year

According to a federal official, vaccines that provide vaccination against both influenza and COVID-19 will not be ready this year. Dr. Peter Marks of the Food and Drug Administration previously said he expected the combination shots to be ready for consumers in 2023. But this week he told a webinar by the National Foundation for Infectious Diseases that hitting a target for the fall season was “too heavy a lift,” and they would not be available until 2024. “I think that had to do with the fact that it was not so clear that annual vaccination against COVID-19 was likely to be necessary until the past several months,” Marks said. “But our goal is for the following season to have that available.” Pfizer and Moderna have both been working on developing the combo shots, but Pfizer told investors in January that it did not anticipate hitting the market with its shot until 2025.

State cases and hospitalizations remain stubbornly high

California tallied another 237 confirmed COVID-19 deaths this week, bringing the statewide pandemic toll up to 100,424 as of Thursday, with an average of 18 people still dying each day due to the virus. While the COVID-19 state of emergency ended this week, the prevalence of the coronavirus remains stubbornly high as the state’s overall metrics appear to have stalled for the third consecutive week.

California’s health department reported an average of 2,760 new daily cases — or about 6.9 per 100,000 residents — as of Thursday, compared to 2,859 cases per day, or 7.1 per 100,000 residents in the prior week. The state’s seven-day rolling coronavirus test positivity rate, which tracks the percentage of lab test results that are positive for the virus, remains unchanged at 6.5%. The state’s wastewater facilities show levels of SARS-CoV-2 genetic material plateauing in most regions. The daily average of COVID patients in California hospitals now numbers 2,506, compared to 2,607 last week. Nearly 4% of the state’s inpatient beds are now in use for COVID-19 patients, up from 2.61% over the same period.

Biden asks for $1.6 billion to tackle pandemic fraud

President Biden will ask Congress to approve $1.6 billion in funding to clamp down on fraud tied to a variety of COVID-19 pandemic relief programs, the White House said on Thursday. The move comes ahead of anticipated investigations by House Republicans into the trillions of dollars of aid distributed by the president and his predecessor, Donald Trump.

Some $600 million will go toward rooting out criminal syndicates, $600 million will be used for investing in fraud and identity theft prevention, and $400 million will go toward helping victims who had their identities stolen. The White House will also ask that the statute of limitations for pandemic unemployment insurance fraud is increased to 10 years. The money will help triple the size of the Justice Department’s COVID Strike Force.

“We must empower law enforcement to pursue, investigate, prosecute, and recover money from those who were engaged in major or sophisticated fraud — from well-off individuals who took hundreds of thousands, if not millions, of dollars from taxpayers to sophisticated criminal syndicates engaging in systemic identity theft,” the White House said.

Last month, a federal watchdog report estimated that the government distributed about $5.4 billion in COVID aid to people with “questionable” Social Security numbers.

Global cases down 76%, deaths down 66%

There were over 4.8 million new COVID-19 cases and over 39,000 confirmed coronavirus deaths reported globally in the last 28 days, according to the latest epidemiological update from the World Health Organization. The figures mark a decrease of 76% in cases and 66% in deaths compared to the previous 28-day period, the U.N. health agency said. The countries with the highest number of newly reported deaths were the United States, China, Japan, Brazil and the United Kingdom. But all saw declines over the past month. 

The WHO cautioned the numbers are likely underestimates of the true number of global infections and reinfections. “This is partly due to the reductions in testing and delays in reporting in many countries,” the update said. “Data presented in this report may be incomplete and should, therefore, be interpreted with caution.”

separate report from the WHO’s technical advisory group showed that the omicron subvariant XBB.1.5 continues to grow in proportion. It was detected in 41.5% of sequenced samples, compared to 18.7% in the first half of January. The emerging sublineage XBF made up an estimated 1.2%.