Entire region at CDC’s high COVID risk level

Vallejo Times-Herald, By John Woolfolk, July 7, 2022

The entire Bay Area is at the high community risk level for COVID- 19 at which federal regulators recommend everyone wear face masks indoors as newer and more immunity-evasive versions of the omicron variant continue to spread across the country.

While infections remain well below the January peak driven by the initial omicron strains, they’re still at February’s elevated levels and show no signs of declining, Bay Area health officials said Tuesday.

“The pattern we’re seeing in our data does make me think a sustained surge is possible,” Santa Clara County Health Officer Dr. Sara Cody said. “Previous patterns were we went up and then down, but we went up and now we’re staying at a high plateau.”

And because so many people are relying on at-home tests that don’t get reported to local health departments, the “actual case rates are really, really high,” said Cody.

It is the first time the entire nine-county Bay Area has been at that high level since the federal Centers for Disease Control and Prevention introduced its “community level” metric in February, which focuses primarily on available capacity in hospital systems rather than high case rates.

What that means in practical terms for Bay Area residents is less clear. Bay Area counties for now aren’t threatening to reimpose mask mandates, which began lifting in the region and the rest of the state in March.

In fact, Alameda County, the last Bay Area county to have a mask mandate, lifted it June 25. Comparing June case rates with neighboring Santa Clara and Contra Costa counties, it’s not clear it was making much difference.

Now, like the rest of the Bay Area, Alameda County only recommends residents wear masks indoors.

“Alameda County continues to experience high COVID- 19 case rates as people increasingly resume pre-pandemic activities,” Health Officer Dr. Nicholas Moss acknowledged.

Dr. Bob Wachter, who chairs the UC-San Francisco medical department, said in a long Twitter thread Sunday that he wouldn’t expect a return to mask mandates over high case rates alone. But if hospitals start to fill up and see staffing shortages, “I think we’ll see mandates return” in states such as California and that “it would be the right call.”

Why haven’t case rates fallen after the latest peak? Health officials blame the rapid succession of omicron subvariants, each proving more transmissible and immunity-evasive than the last.

The omicron variant that swept across the country in December and January, known as BA.1.1, which drove the highest spike in U.S. and California cases of the entire pandemic, has since been shoved aside by a series of cousins — BA.2, BA.2.12.1, BA.4 and BA.5, which accounts for 54% of cases nationally.

“I wish I had a happier analysis of our current COVID state,” Wachter said on Twitter. “But BA.5 is yet another COVID curveball to be dealt with, and it’s not great news. It seems clear that BA.5 will lead to an ongoing plateau, if not a moderate surge, lasting through summer and into fall.”

Wachter and Cody said that unlike in January, COVID hospitalizations currently include significant numbers admitted for other health issues whose infections were found through routine screening tests. At UCSF, Wachter said, only half of the hospitalized COVID patients are there for treatment of the disease rather than something else, down from two-thirds in January.

Cody said that’s been the case with most other Bay Area health departments as well.

“But that doesn’t mean we don’t need to worry about hospitals,” Cody said, noting that infections among hospital staff have caused shortages that have helped put counties in the CDC’s high risk level.

Contra Costa Health Services spokesman Will Harper said hospitalizations there are a third what they were in January, at 91 now compared to some 330 in January. But health officials can’t be sure how that might change as BA.5 spreads.

“At the moment, local health systems and hospitals are able to manage the current caseload,” Harper said. “We are closely monitoring the growth of BA.5 although we’re not sure how its increasing prevalence will change the COVID landscape here.”

Cody said it’s unclear whether BA.5 will prove more virulent than earlier omicron types.

“It’s very infectious,” Cody said. “The big question is, is it more likely to cause severe disease? That we don’t know yet.”

So what are Californians, especially in the highly vaccinated and boosted Bay Area, to make of all this?

Bay Area health experts stressed that vaccines and boosters remain the best defense against severe illness, although Wachter cautioned that people should lower expectations about the shots’ ability to prevent infection.

That’s why experts such as Wachter and Cody stressed that even for the vaccinated and low-risk, wearing high quality masks and avoiding indoor crowds is the best defense for avoiding COVID altogether.

Cody said she’s not planning a new mask mandate but urges people to wear them anyway indoors at stores and other public places as she does. An infection bears risk of “long COVID,” the poorly understood phenomenon in which symptoms linger for months after recovery.

“People are just wanting the pandemic to be over and acting accordingly,” Cody said. “What I want to say as a motivator, you’re not protected from long COVID. And I don’t know about you, but if I can do my best to prevent something that will give me brain fog, that’s why I wear my KN95.”