An unsettled picture. Signs are piling up that California is on the backside of its winter COVID surge, with case numbers, positivity rates and hospitalizations trending downward. The news that bivalent boosters are effective at battling infection by the latest immune evasive subvariants is encouraging. And the FDA is moving toward the idea of an annual COVID shot — a clear sign that the coronavirus is becoming endemic. But immunocompromised people are losing the use of protective monoclonal antibody Evusheld and college campuses are reporting up to one-third of their staff and students experiencing symptoms of long COVID. The worst may be passed, but this virus hasn’t had its last word.
CDC issues new guidance for immunocompromised
With Evusheld, the preventive monoclonal antibody treatment for COVID-19, losing its emergency use authorization in the U.S. this week due to its lack of efficacy against the dominant XBB.1.5 and BQ.1 omicron subvariants, the U.S. Centers for Disease Control and Prevention on Friday issued updated guidance for immunocompromised Americans. The agency said the first line of defense is staying up to date on vaccination for household members, close contacts, and even those with weakened immune systems. “Although persons who are moderately to severely immunocompromised might not mount a strong vaccine-mediated immune response, staying up to date with COVID-19 vaccination does provide some protection,” the agency said. But the CDC proposed some more familiar measures, including wearing a high-quality and well-fitting mask, maintaining physical distance from others and practicing frequent handwashing.
Los Angeles County relaxes universal masking recommendation
Citing improved COVID-19 cases numbers and hospitalizations, Los Angeles County health officials on Friday eased a recommendation issued in mid-November that people should wear masking indoors in all public spaces. They said it should instead be considered an “individual preference.” As of Thursday, the county was reporting 67 new cases a week for every 100,000 residents, per state data, with the county classified as having a low COVID-19 community level according to metrics used by the U.S. Centers for Disease Control and Prevention. Face coverings are still required in health care settings and nursing homes, as well as for 10 days after exposure. Despite the policy change, Public Health Director Barbara Ferrer on Thursday encouraged people to continue to protect themselves. “I do encourage people to continue to think of masking as an effective tool to reduce exposure to COVID-19,” she said during a weekly briefing.
Third anniversary of U.S. public health emergency
Friday marks the third anniversary since the U.S. declared COVID-19 a public health emergency starting on Jan. 27, 2020. “As a result of confirmed cases of 2019 Novel Coronavirus (2019-nCoV), on this date and after consultation with public health officials as necessary, I, Alex M. Azar II, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby determine that a public health emergency exists and has existed since January 27, 2020, nationwide,” the order read.
Leader of pandemic response becomes White House chief of staff
President Joe Biden announced Jeff Zients as his next White House chief of staff on Friday. Before being assigned to his new role, Zients headed the administration’s response to the COVID-19 pandemic. He succeeds Ron Klain. “I’m confident that Jeff will continue Ron’s example of smart, steady leadership, as we continue to work hard every day for the people we were sent here to serve,” Biden said in a statement, adding that Zients, like Klain, “understands what it means to lead a team” and “is as focused on getting things done.”
As COVID-19 coordinator, Zients led the effort that administered more than 220 million vaccinations in Biden’s first 100 days, while shoring up the nation’s supply of therapeutics and tests and distributing them, the Associated Press reports. Zients gradually shifted the administration from a so-called “wartime” effort that grappled with COVID-19 at its most severe levels, to a strategy that would allow people to resume some normality with a virus that is likely to be endemic. “I respect him enormously,” Sen. Mitt Romney, R-Utah, who spoke regularly with Zients during his stint as COVID-19 response coordinator, said this week. “He’s a very bright guy. I expect to be able to communicate with him.”
State’s life expectancy takes biggest dip since WWII
California experienced its most profound decline in life expectancy since World War II due to the COVID-19 pandemic, according to a new report from the Public Policy Institute of California. In 2019, the state was tied with Hawaii for the longest life expectancy, at 80.9 years — higher than the national average of 78.8 years and far higher than the lowest state, Mississippi, at 74.4 years. But life expectancy fell almost two full years in both California and the U.S. in 2020, and provisional estimates suggest a further half-year drop in California and a full-year drop nationwide in 2021.
The number of deaths in California jumped by more than 50,000 in 2020 compared to 2019 (a 19% increase), and 2021 saw an additional rise of almost 10,000 more deaths than in 2020 (and 60,000 more than in 2019). Johns Hopkins University estimates that 76,000 Californians died of COVID-19 in 2020 and 2021, and data from the California Department of Health show a dramatic increase in deaths due to COVID during that period. The only other notable increases were due to accidents (primarily drug overdoses) and heart disease, but those causes, along with all other reasons, accounted for only about a fifth of the additional deaths, with COVID-19 accounting for about 80% of the increase.
But the authors of the report note that the outlook for 2022 is more hopeful, with the year-over-year number of COVID-19 deaths last year less than half the number in 2021—about 19,000 through September 22 of this year, compared to almost 44,000 for the same period in 2021, per Johns Hopkins University. And the average over the past few months has been much lower than at the start of 2022.
Nursing home residents without boosters more likely to be infected
A report published Thursday by the U.S. Centers for Disease Control and Prevention shows that nursing home residents who are not up to date with recommended COVID-19 vaccines are at substantially greater risk for infection. “Weekly incidence rates of COVID-19 among nursing home residents who were not up to date with COVID-19 vaccines were 30% to 50% higher than were those among residents who were up to date,” according to the study, which collected data on residents between Oct. 10 and Jan. 8. About 49% of nursing home residents in the study were up to date on their shots, including the updated bivalent booster, compared to 86% who had completed a primary series and 87% who received the previous monovalent booster doses.
XBB.1.5 makes up more than 61% of U.S. cases
The Centers for Disease Control and Prevention estimates that the XBB.1.5 omicron subvariant accounted for almost two-thirds of all coronavirus infections in the U.S. this week. On Friday, the agency estimated that the new virus strain was detected in 61.3% of COVID-19 cases sequenced in the week ending Jan. 28, up from 49.5% of cases for the week ending Jan. 21. Public health experts call XBB.1.5 the most transmissible COVID-19 subvariant so far. In the Northeast region of the country, XBB.1.5 was detected in 91.1% of new cases this week. The CDC has also started tracking another omicron subvariant called CH.1.1, which currently has a 1.5% prevalence nationwide.
State moves past winter surge as cases fall 62% in a month
The number of new COVID-19 infections has dramatically slowed down in California, following a late November peak. The state’s health department reported 2,715 average cases per day — or about 7 per 100,000 residents — as of Thursday. That’s down from 7,132, or 16 per 100,000, a month ago. Even though the number of official COVID tests performed in California has dropped to levels last seen in the summer of 2020 due to widespread use of home test kits whose results are not reported to authorities, other metrics such as the test positivity rate affirm the downward trend.
California’s seven-day rolling coronavirus test positivity rate, which tracks the percentage of lab test results that are positive for COVID-19, has fallen to 4.9%, down from 12% in the prior month. A rule of thumb among infectious disease experts is that a 5% threshold is required for at least two weeks in order to consider coronavirus transmission under control, according to researchers at Johns Hopkins University.
The daily average of COVID patients in California hospitals now numbers 2,695, down from 4,422 a month ago. Around 5% of the state’s inpatient beds are now in use for COVID-19 patients. About 36 people are dying each day in California due to the virus.
New study says long COVID is affecting college campuses
Long COVID is becoming a reality of college life, according to a study published Thursday by researchers at George Washington University. In an analysis of nearly 1,400 cases of COVID-19 among fully vaccinated students, faculty and staff between July 2021 and March 2022, about 36% experienced symptoms that developed four weeks or more after their initial infection. Individuals with underlying medical conditions, current or former smokers, women, and people who had experienced more severe illness during their initial infection were more at risk for having lingering symptoms. Lynn R. Goldman, the study’s lead author and dean of the George Washington Milken Institute School of Public Health, told The Chronicle of Higher Education that the study demonstrates why colleges should continue mitigation strategies to slow the spread of the virus, even as many move toward lifting vaccine mandates and relaxing measures such as masking requirements. “We need to continue to do everything we can to prevent people from getting COVID, even though things have changed,” Goldman said.
FDA’s advisers back once-a-year vaccine plan
The U.S. is poised to make COVID-19 vaccinations more like a yearly flu shot, a major shift in strategy despite a long list of questions about how best to protect against a still rapidly mutating virus. The Food and Drug Administration asked its scientific advisers Thursday to help lay the groundwork for switching to once-a-year boosters for most Americans — and how and when to periodically update the shots’ recipe. “This is a consequential meeting to determine if we’ve reached the point in the pandemic that allows for simplifying the use of current COVID-19 vaccines,” said FDA’s Dr. David Kaslow, according to the Associated Press. The advisory panel mostly agreed with the FDA’s approach.
Looking ahead, the FDA said most Americans should do fine if they get a once-a-year booster targeted to the newest variants in the fall. The agency asked if some people might need two doses — adults with weakened immune systems and very young children who’ve never been previously vaccinated. That’s similar to how youngsters get their first-ever flu vaccination. But more data is needed to show exactly who might need two yearly doses — such as a careful count of who still gets hospitalized with COVID-19 despite being up-to-date with today’s vaccinations, said FDA adviser Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia. “Only then can we really best make the decision about who gets vaccinated with what and when,” he said.
“It’s hard to say it’s going to be annual at this point,” said Harvard’s Dr. Eric Rubin. Fall might not even be the best time to boost, something that would depend on when infections start rising and how long a booster’s protection might last, said FDA adviser Dr. Arthur Reingold of the University of California, Berkeley. Unlike flu which circulates in the U.S. mostly during late fall and winter, COVID-19 waves have occurred year-round.
Judge questions “scientific consensus” in blocking COVID misinformation law
The federal judge who blocked a California law subjecting doctors to disciplinary action for giving patients information about COVID-19 that the state considers false said there was no established “scientific consensus” about prevention or treatment of the disease. Senior U.S. Judge William B. Schubb of the U.S. District Court in Sacramento granted the motion filed by a group of doctors for a preliminary injunction, noting that because agreement on COVID is ill-defined and vague, the physician plaintiffs in the lawsuit are “unable to determine if their intended conduct contradicts the scientific consensus, and accordingly what is prohibited by the law.”
Under AB 2098, doctors can be disciplined for spreading misinformation about COVID, defined as “false information that is contradicted by contemporary scientific consensus contrary to the standard of care.” Two lawsuits were filed against the law after its passage last year — one by a group of five doctors, and another by a doctor and two advocacy groups including Robert F. Kennedy Jr’s Children’s Health Defense. The ACLU has also questioned the constitutionality of the law and supported the legal challenges.
More than 80% of test results not publicly reported, UCSF study finds
As home coronavirus tests become the standard, fewer results are reported to public health agencies, substantially skewing epidemiological data on public dashboards. A study by UCSF researchers that measured the prevalence of home testing as it became increasingly common last spring and summer found that as of August, more than 80% of all SARS-CoV-2 test results were not reported to official tallies. “Our findings confirm common wisdom that official COVID-19 case counts increasingly underestimate the number of people who test positive and vastly underestimate the number of true infections,” wrote the authors of the paper, published Wednesday in JAMA Network Open. They added that the lack of publicly reported data has made it difficult to detect new surges of transmission, and how to track trends in officially reported case counts and test positivity.
Report finds spike in heart-related deaths during first year of pandemic
The number of people dying from cardiovascular disease in the U.S. spiked during the first year of the COVID-19 pandemic, marking the steepest single-year increase since 2015, according to a new report from the American Heart Association. In 2020, there were 928,741 deaths related to heart disease, stroke, and high blood pressure — marking a substantial increase from the 874,613 fatalities linked to cardiovascular disease (CVD) in 2019. The latest figure also tops the previous record of 910,000 from 2003, based on the data published Wednesday in the peer-reviewed journal Circulation. Read more about the study and why researchers think cardiovascular deaths jumped in 2020.
FDA officially pulls emergency use authorization for Evusheld
The U.S. Food and Drug Administration on Thursday revoked its emergency use authorization for the Evusheld coronavirus treatment, since agency officials determined the drug cocktail is unlikely to neutralize XBB.1.5, which is the omicron subvariant estimated to account for nearly half of now-circulating variants in the U.S. “Based on this revision, Evusheld is not currently authorized for use in the U.S. until further notice by the agency,” the FDA said in an update. Hailed as a lifesaving COVID-19 drug, AstraZeneca’s Evusheld was a preemptive defense measure for 7 million immunocompromised Americans who cannot get vaccinated or do not mount an immune response to vaccination. The monoclonal antibody treatment was shown to reduce the risk of COVID-19 symptoms by 77%, according to clinical trials. In a Tuesday telebriefing, officials from the CDC suggested that immunocompromised Americans should resume measures like social distancing and mask-wearing to protect themselves.
