State of the Pandemic

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Res Ipsa
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State of the Pandemic

Post by Res Ipsa »

It's Friday, which is the day that the CDC updates its data on which variant is currently making folks sick. Not surprisingly, it's Omicron from sea to shining sea. BA.5 continues to dominate the rankings, having almost eliminated BA.2 from contention. The CDC estimates that 65% of new infections are BA.5, followed by BA.12.2.1 (17%) and BA.4 (16%). So far, no sign of the new dark horse sub lineage BA.2.75, which appears to have originated in India.

BA.4 and BA.5 are more transmissible than other Omicron sub-lineages because they have evolved to escape antibody protection that resulted from being infected with an earlier strain or vaccination based on earlier strains. Tricksy little devil, this virus.

So, how are we doing in terms of transmission and hospitalization? The CDC generates two charts to help individuals assess their risk (as "public health" has been replaced by "private health). One is Community Community Levels, a risk assessment largely based on hospitalization rates, but taking into account transmission rates. Here's this chart from the beginning of May, when we'd recovered from the big Omicron surge at the end of 2021 and early 2022.

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With the exception of New England, which I think had BA.12.2.1 surging at the time, the country looks pretty good. With few exceptions, Community Levels were low. Yay us!

Here's the same map for today:

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That's the difference BA.5 makes, when combined with pretending that the pandemic is over. Here are the CDC's recommendations based on this map:

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Personally, I wear a mask in public, indoor spaces when my county is yellow or orange. The CDC recommends for orange. When my county is orange, I simply avoid public indoor spaces altogether, as well as crowded outdoor spaces.

Before these maps, the CDC used what it called Community Transmission maps, which were based on testing and the rate of positivity of tests. The CDC still keeps them up to date, but discourages the public from using them. Here is what that map looked like in early May:

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Looks quite a bit different from that green, safe looking map that the CDC encourages the public to use. Note, the CDC's version does not include purple and brown. That was added by an epidemiologist to show gradations within the red, which is the CDC's color for the high end of transmissions.

For example, here is today's Community Transmission Map from the CDC:

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And here's the same map with the brown and purple colors added:

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And here is what the colors represent:

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So, what does it all mean? It means that transmission has increased substantially across the U.S. since the spring due to B.5 sub-lineage. If it seems like everyone you know is getting COVID for the first time (or second or third), it's because they are. BA.5 is so good at immune evasion, if you're going into public indoor spaces without a mask, you're very likely to get infected. And, while your case may be mild, you have no control over who you spread it to. That's shown by the increase in COVID-19 hospitalizations.

The whole idea of the "it's over strategy" was to protect the vulnerable and let the rest of us live "normal" lives. How's that going?

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Given that age is an important vulnerability, it looks like we're putting the old folks back in the hospital.

The good news is that, while BA.5 and other Omicron sublineages are good at escaping antibody immunity, they aren't so good at escaping T-cells. That seems to be why vaccinator protection against infection declines over time, but the protection against serious illness and death persists. Still, COVID-19 is still killing over 400 people a day in the U.S. I'd like to avoid being one of them.

Sources:
CDC Variant Tracker:https://covid.cdc.gov/covid-data-tracke ... roportions
CDC Community and Transmission Level Trackers: https://covid.cdc.gov/covid-data-tracke ... -type=Risk
CDC Community Transmission with augmented high end range:https://covid19florida.mystrikingly.com
NYT Hospitalization by age tracker:https://www.nytimes.com/interactive/202 ... cases.html
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Gadianton
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Re: State of the Pandemic

Post by Gadianton »

What's the latest on booster effectiveness against the new variants?

Thanks for the info. I'd been contemplating getting the masks out again.
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Re: State of the Pandemic

Post by Jersey Girl »

Gadianton wrote:
Sat Jul 16, 2022 3:14 am
What's the latest on booster effectiveness against the new variants?

Thanks for the info. I'd been contemplating getting the masks out again.
Get the masks out.

I posted a link to this article yesterday or the day before on the Life on the Ground thread in Paradise. I'll quote it here with bold emphasis.

What makes BA.5 different? Eric Topol, a cardiologist and professor of molecular medicine at Scripps Research, has called BA.5 "the worst version of the virus we've seen." He explained in a recent newsletter: "It takes immune escape, already extensive, to the next level, and, as a function of that, enhanced transmissibility," well beyond earlier versions of Omicron.

In other words, BA.5 can easily evade immunity from previous infections and vaccines, increasing the risk of reinfection. Though the variant does not appear to lead to more severe illness, in an interview with CNN on Monday, Topol said that given the extent of BA.5's immune evasion, he expects to see an escalation in hospitalizations, as we've seen in Europe and elsewhere that the variant has taken root. "One good thing is it doesn't appear to be accompanied by the ICU admissions and the deaths as previous variants, but this is definitely concerning," he added.
https://www.cnn.com/2022/07/13/world/co ... index.html
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Re: State of the Pandemic

Post by drumdude »

The latest variants are really no worse than the common flu, except for those with comorbidities or immune systems that aren't working properly.

I'm not sure that we should be treating it differently than the flu at this point, because of that. The best thing we can do is incentivize people to self test, and self isolate when they test positive. I was hoping the US would develop a culture of wearing masks more when sick, and not coming into work sick, but that appears to not be the case.
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Re: State of the Pandemic

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drumdude wrote:
Sun Jul 17, 2022 2:44 am
The latest variants are really no worse than the common flu, except for those with comorbidities or immune systems that aren't working properly.

I'm not sure that we should be treating it differently than the flu at this point, because of that. The best thing we can do is incentivize people to self test, and self isolate when they test positive. I was hoping the US would develop a culture of wearing masks more when sick, and not coming into work sick, but that appears to not be the case.
In the US, seasonal flu deaths have ranged from 11,000 to 95,000 per year. Today, COVID-19 is killing Americans at an annual rate of 146,000. And that’s at a trough for deaths rather than a peak. And, given the list of comorbidities, a large number of Americans are still at risk of serious injury, disability or death.

Flu is a respiratory disease. COVID most often presents with respiratory symptoms, but attacks major organs, including the heat, kidneys, and brain. Because COVID has evolved to escape our standard immune defenses, people can become reinfected multiple times over a period of months or weeks. COVID isn’t seasonal, so there is no period of respite during which the disease isn’t a threat. And COVID infections frequently involve a number of sequalae that can be debilitating and of which we have very little understanding.

The complete abandonment of all mitigation measures has seriously eroded hospital capacity. We have lots of beds, but not the staff to use them. Why do we expect nurses, doctors, and other medical staff to stay on the front lines of fighting a disease that subjects them to serious illness, disability and death when the general populace can’t be bothered to do something as simple as wearing a mask when hospitals begin to be overloaded?

Pretending that COVID is a cold or mild flu has been a serious mistake. And it’s a mistake that will continue because those in a position to change it lack the will to do something unpopular.
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Re: State of the Pandemic

Post by drumdude »

Res Ipsa wrote:
Sun Jul 17, 2022 3:36 pm
Pretending that COVID is a cold or mild flu has been a serious mistake. And it’s a mistake that will continue because those in a position to change it lack the will to do something unpopular.
To be clear, the earlier COVID variants were not just a mild flu. But we can't fail to distinguish the differences between the original COVID strain and the current ones.

The original strain typically affected the lower respiratory tract, the new ones typically affect the upper. We're seeing much less COVID induced pneumonia with the current strains.

The other organs affected is still an ongoing area of research. Long COVID is a real and serious threat, but the fact is that most people will be infected at some point. Tying to eliminate COVID is as impossible now as trying to eliminate the flu. It's just not going to happen.

We need to continue to learn what treatments are most effective. Early on in the pandemic, we didn't have many tools to deal with active COVID infections. Now we do. We need to continue to research effective treatments for active infection, especially early treatments that can prevent hospitalization. And we need to stop letting politics dictate things like how long someone should stay at home until they can work again. People should stay at home longer if they need more time, the 5 day guideline is completely arbitrary.
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Re: State of the Pandemic

Post by Res Ipsa »

drumdude wrote:
Sun Jul 17, 2022 7:04 pm
Res Ipsa wrote:
Sun Jul 17, 2022 3:36 pm
Pretending that COVID is a cold or mild flu has been a serious mistake. And it’s a mistake that will continue because those in a position to change it lack the will to do something unpopular.
To be clear, the earlier COVID variants were not just a mild flu. But we can't fail to distinguish the differences between the original COVID strain and the current ones.

The original strain typically affected the lower respiratory tract, the new ones typically affect the upper. We're seeing much less COVID induced pneumonia with the current strains.

The other organs affected is still an ongoing area of research. Long COVID is a real and serious threat, but the fact is that most people will be infected at some point. Tying to eliminate COVID is as impossible now as trying to eliminate the flu. It's just not going to happen.

We need to continue to learn what treatments are most effective. Early on in the pandemic, we didn't have many tools to deal with active COVID infections. Now we do. We need to continue to research effective treatments for active infection, especially early treatments that can prevent hospitalization. And we need to stop letting politics dictate things like how long someone should stay at home until they can work again. People should stay at home longer if they need more time, the 5 day guideline is completely arbitrary.
I don't think I'm failing to distinguish anything. The fact is that a "mild flu" doesn't kill 400 people a day in the U.S., day in and day out. What the various lineages of Omicron have shown is an increasing ability to evade the body's immune defenses, even when bolstered by vaccination or previous exposure. The attitude we took that "we're all going to get it sometime, so let 'er rip," has led to the situation where we have to deal with multiple infections over short periods of time. From the time the first vaccines came out, we've engaged in much more wishful thinking than grappling with the facts and thinking through sensible alternatives for dealing with what is still a novel virus with a large number of unknowns.

There's a wide range of approaches that lie between zero covid and let 'er rip. Mitigation measures give us some ability to control the rate of transmission. Controlling the rate of transmission reduces the burden of sickness on our health care institutions and employers at any given point in time. By failing to even attempt to control transmission, we've essentially locked down immunocompromised and other vulnerable folks. We've accepted rates of transmission that are so high that it's difficult, if not impossible, to participate in society without becoming infected.

When dealing with a new disease, the presence of significant unknowns weighs toward taking precautions rather than retreating into denial. I agree that science rather than politics should be driving public health. But it's politics that has led to the current let 'er rip approach. The lack of clear mask guidelines is pure politics. The failure to follow through with sliding scale mitigation measures is pure politics. And the five days is certainly arbitrary today given what we've learned about how long folks infected with Omicron stay infected. https://www.nejm.org/doi/full/10.1056/N ... tured_home https://Twitter.com/jeffgilchrist/statu ... 9157837824 People who are symptomatic should be encouraged to stay home. And isolation should continue until the person tests negative on an at home test. But the CDC seems to have given up the concept of updating guidelines based on new information. It's gone all in on the "urgency of normal" and seems impervious to the basics of public health.
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Re: State of the Pandemic

Post by drumdude »

I'm all for caution. But we also need to realize that the "let 'er 'rip" approach might have benefits that outweigh the costs of certain containment measures.

There are so many unintended consequences of lockdowns, mask wearing, social distancing, ect. We won't know the effect that it had on children and adults for decades. Social isolation, disruption of education, depression, anxiety. First order, second order, and n'th order effects that we can't even imagine yet. Then you start to factor in the economic toll, in the middle of a growing global economic disaster.

Same thing with the virus. It could be that the world loses a significant percentage of global IQ due to the effects of the virus on the brain. We could eventually learn that the virus has taken years of life off the people who contracted it. But that could also be the case from the fallout of extended lockdowns, social isolation, and economic upheaval.

It is essentially a certainty that we will look back 10, 20, 50 years from now and see that we made a ton of mistakes. I'm just not convinced that anyone knows the right thing to do right now. The fact that we aren't still seeing 3,000 deaths a day in the US is a miracle, and not one that we seem to have had any control over despite all our best efforts and our blunders.
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Re: State of the Pandemic

Post by Res Ipsa »

Here’s an article I read that discusses the B.4 and B.5 variants, as well as using at home tests to determine when to end isolation. https://insidemedicine.bulletin.com/dat ... ngs-stand/
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Re: State of the Pandemic

Post by Doctor Steuss »

Res Ipsa wrote:
Sun Jul 17, 2022 3:36 pm
In the US, seasonal flu deaths have ranged from 11,000 to 95,000 per year.

[...]
Unless things have changed over the last decade-or-so, flu deaths are also calculated using a kind of indirect modeling, in lieu of actual coroner coding. I am relying on a 10+ year memory here, but I recall an informal survey that indicated the numbers may be a lot lower (i.e. almost all of the practicing physicians surveyed had never had a patient die of influenza).
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