Surge in US’ COVID-19 Cases Fuels Fears of Another Pandemic
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Surge in US’ COVID-19 Cases Fuels Fears of Another Pandemic

United States: The surge in California’s COVID-19 statistics, attributed in part to emerging subvariants, hints at an atypically early advent of the summer season.

For the week concluding on June 3, the state’s positivity rate for COVID-19 tests escalated to 5.3%, a significant rise from 2.2% the preceding month.

Although the figures remain relatively modest—last summer’s peak positive test rate reached 13.1%—the uptick has garnered the attention of medical professionals and health authorities as the summer travel season commences.

“Indeed, the numbers are ascending,” remarked Dr Elizabeth Hudson, the regional chief of infectious disease at Kaiser Permanente Southern California. Among the 4.8 million Southern California members of Kaiser, the rise in COVID-19 cases is predominantly observed in non-hospitalized individuals.

The Los Angeles County Department of Public Health recorded an average of 106 COVID cases for the week ending June 2, up from 67 daily cases the week ending May 12.

“We have observed this pattern over the last 4½ years. We anticipate another wave around this period,” Hudson noted. This current wave “commenced slightly earlier, potentially peaking sooner, with hospitalizations often lagging behind.”

COVID levels are also climbing in wastewater. In Los Angeles County, sewage levels reached 16% of the winter peak for the week ending May 25, up from 8% for the week ending May 4. In Santa Clara County, the most populous in the Bay Area, COVID levels in wastewater are deemed high from San José to Palo Alto, with a notable rise in samples from San Francisco.

Statewide, California saw its wastewater COVID levels enter the high range for the first time since February, as of the week ending June 1.

Emerging subvariants are gaining traction nationwide. For the fortnight ending last Friday, 55% of the estimated COVID specimens in the US were of the FLiRT variants—up from 28.6% a month earlier. Another variant, LB.1, constituted 14.9% of specimens nationwide, up from 6.7% last month.

The progenitor of the FLiRT and LB.1 subvariants, the winter-dominant JN.1 strain, now accounts for an estimated 3.1% of strains nationwide. LB.1 resembles the FLiRT subvariants—formally known as KP.1.1, KP.2, and KP.3—and none significantly diverge from JN.1, according to Dr. Peter Chin-Hong, an infectious diseases expert at UC San Francisco.

“They’re distinct enough to be increasing and likely exploiting vulnerabilities, and they’re highly transmissible, but not so different from JN.1 that they pose a greater threat of severe disease,” Chin-Hong stated.

Nonetheless, physicians remain concerned about the risk of severe illness and mortality among seniors and immunocompromised individuals, particularly those who haven’t received an updated vaccine since September. Over 44,000 COVID-related deaths have been reported since October, compared to the CDC’s weekly flu surveillance report estimating 24,000 flu deaths in the same period.

A CDC report published in March found that only 18% of adults with immunocompromising conditions had received an updated COVID-19 vaccine since September.

The CDC recommends vaccination with the updated shot for everyone aged six months and older, and for those 65 and older, two shots—provided four months have passed since their first.

However, only 36% of California’s seniors have received any COVID shots since September, prompting doctors to emphasize the importance of vaccination for the remaining senior population.

Vaccination rates among seniors in various racial and ethnic groups have declined further. In California, only 31.6% of Black seniors, 29.9% of Asian American seniors, and 22.8% of Latino seniors have received an updated COVID-19 vaccine.

Regional vaccination rates also vary, being below the statewide average in much of Southern California and highest in the San Francisco Bay Area. Los Angeles County reports 30.8% of its seniors have received an updated vaccination; San Diego County, 38.6%; Orange County, 34.2%; Riverside County, 28.1%; San Bernardino County, 26.3%; Ventura County, 37.4%; and Santa Barbara County, 40.4%.

In Santa Clara County, about 46% of seniors have received an updated vaccination, more than 50% in San Francisco County, and nearly 60% in Marin County.

“Many individuals haven’t even received one shot. Ensuring that happens should be a priority,” Chin-Hong emphasized. “Everyone over 65 should consider getting a shot before the new one becomes available in the fall.”

Seniors vaccinated now would still have time to receive this fall’s upcoming formulation around Halloween, an optimal time to protect against the winter surge in COVID infections, Chin-Hong advised.

“For the more vulnerable, I would certainly advocate for getting either that first shot or a second,” Hudson advised.

Chin-Hong noted that the patients he has seen who have been hospitalized for COVID haven’t received an updated shot in the last year.

Data continues to support the vaccine’s efficacy, even though the latest version was designed against the XBB.1.5 subvariant, which was succeeded by JN.1 in the winter.

In a presentation to an FDA advisory committee, CDC epidemiologist Ruth Link-Gelles reported that September’s vaccine increased protection against symptomatic illness as well as COVID-associated hospitalizations and urgent care visits compared to those without an updated shot.

However, scientists have also noted waning immunity over time—a trend observed with previous COVID vaccines. The most robust protection from the new vaccine remains against severe illness, Link-Gelles stated.

The current vaccine offers protection against JN.1, albeit possibly less against an XBB subvariant exposure, Link-Gelles noted.

The FDA’s Vaccines and Related Biological Products Advisory Committee recently voted unanimously to recommend that this autumn’s updated COVID vaccine formula be based on JN.1 rather than FLiRT or another JN.1 descendant.

Betting on a later descendant like FLiRT could result in a mismatch if another variant overtakes it. However, using a shot against the parent strain may ensure better coverage this winter.

“COVID vaccination continues to provide robust protection against severe disease and hospitalization,” Hudson affirmed. “Yet, COVID is still very novel to us, and coronaviruses, by their nature, mutate rapidly. Hence, it’s expected that over time, the vaccine’s protection would wane.”

One promising advancement still unavailable is a combined flu and COVID vaccine. This is anticipated for autumn 2025 and could significantly boost vaccination rates. Survey data reported to the CDC indicate that 22.5% of adults nationwide received the latest COVID vaccine, compared to 48.5% for the flu.

“If you can get two vaccinations with one shot, I’m all for that,” Chin-Hong remarked.

Moderna’s combined flu and COVID shot proved more effective than receiving the vaccines separately, according to Hudson. Other manufacturers are also expected to develop combined shots.

The LA County Department of Public Health reported a slight increase in new COVID hospital admissions—averaging 19.6 daily, up from 16.9 daily about three weeks ago. Nine percent of hospitalized patients are in intensive care, but “deaths remain relatively low and stable,” averaging one daily death, the agency reported.

Historically, LA County’s mid-year rise in COVID cases and hospitalizations started in early July—in 2021 and 2023—but in early May 2022.

“With summer travel and gatherings increasing, protection from COVID-19 remains crucial as new variants circulate nationwide,” the Public Health Department advised. “Summer plans can be disrupted by COVID-19 illness, and increased transmission continues to pose higher risks for the elderly.”

In addition to vaccinations, officials recommend commonsense measures to reduce disease spread and risk of illness: ensuring sick individuals stay home and frequent hand washing, particularly before eating and after sneezing or coughing. Testing for COVID is vital to limit the illness’s spread and can help determine when to seek anti-COVID medications like Paxlovid, which can lower the risk of severe illness or death among high-risk individuals.

Those contagious with COVID should remain home, and if interaction with others is necessary, they should wear a mask. Those wishing to minimize infection risk can wear masks in indoor public settings and crowded places.

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