January was gloomy, gloomy, gloomy. The fans’ eerie, mechanical rasp that breathes for seriously ill people who could not breathe on their own. Beep, beep, beep from heart monitors announcing every strained muscle contraction. The machine’s piercing howl as the heartbeat stopped.
One day in January, COVID-19 sent 207 very sick people to Orange County intensive care units. But four months later – in mid-April – it seemed like an alternative universe. There were only eight COVID-19 cases in intensive care units in Orange County. But as last week progressed, ICU cases crept up to 10 and then to 14.
It seems almost dangerous to get too excited about this. But the abrupt dive into really sick people has been repeated in Los Angeles, Riverside and San Bernardino counties and in California as a whole: Golden State had an amazing 2,609 people in intensive care units on January 25 and only 141 – repeat, with 141 – in intensive care units on April 18, according to state data.
That is a decrease of 95%.
Remember the dreamy delirium we enjoyed at this point last year, where people fought for vaccine deals and thought – really believed – that vaccination offered an impenetrable shield and a little bit of magic, like “unicorn farts”, as UCI Irvine epidemiologist Andrew Noymer so artfully observed ? We had not heard of delta or omicron or stealth omicron. We did not fully understand how quickly the virus mutated to dodge our defenses.
We may still not fully understand that. Clouds gather on the east coast as stealth omicron spreads and case numbers pop up. There were 14 people in Orange County intensive care units as of Friday, April 22nd. The United States will soon log its 1 million dead – a tragedy unthinkable two years ago when all this started.
“This last wave was hugely busy – it felt very similar to the first wave,” said Dr. Anthony Gan, a pulmonologist and critical care physician at Pomona Valley Hospital Medical Center. “We have seen many serious cases. There was a lot of illness, many deaths. “
But something, it seems, has really changed.
“At Mission Hospital, we currently have two patients with COVID, none in the intensive care unit,” said Dr. Charles Bailey, Medical Director of Infection Prevention at Providence Mission Hospital and Providence St. Joseph Hospital, Tuesday, April 19th.
“We are entering an era where we are seeing more random positive things – people coming to the hospital for something that is not COVID-related, and then testing positive – than we are seeing people coming because of COVID itself. “
The same in Pomona. There were three patients with COVID-19 in the hospital on Wednesday, April 20, and none were in the intensive care unit, Gan said.
“The numbers have gone down, down, down very fast and remain low,” Providence Bailey said. “They’re going up elsewhere, but we do not really see that here in Southern California. That’s probably what we’ll be looking at in the future: here’s a hot spot, there’s a hot spot, but not a nationwide rise. “We’ll have to find new vocabulary to explain it.”
This steep decline is likely a function of the population’s immunity (from vaccination and recent omicron infections), a somewhat less virulent variant and subvariant and better treatment options such as Evusheld, monoclonal antibodies and oral antiviral drugs such as Paxlovid, said Dr. John Swartzberg, Professor Emeritus at UC Berkeley.
Agree, said Dr. George Rutherford, professor at UC San Francisco, “along with selective booster uptake in older (and more susceptible) populations.”
Stanford Universitys Dr. Yvonne Maldonado said it is clear that these combined factors are protecting us right now, but whether we will remain in a relative break is, of course, unknown.
“I suspect we will have to be vigilant for the fall because there will be plenty of declining immunity as well as potential for new varieties to build over time,” she said via email. “Vaccines are the primary means of protection, including boosters, especially for high-risk populations, with antiviral agents that keep infected people out of the hospital.”
Whether or not another rise appears is someone’s guess.
“There are a few states that are showing an increase in hospital admissions, albeit modest,” Swartzberg said via email. “I think it’s too early to celebrate (and remove mask mandates on public transport).”
The UCI’s Noymer is also cautious. “We’re in a good period right now, no doubt about it,” he said. “I’m just a little skeptical that this will be permanent.”
The US Centers for Disease Control and Prevention is trying to step up its game on the prediction front: its new Center for Forecasts and Outbreak Analysis aims to be “equivalent to the National Weather Service for Infectious Diseases,” to mix innumerable projections of a disease path into an “ensemble” that is supposed to be more reliable.
“This week’s national ensemble predicts that the number of new daily confirmed COVID-19 hospital admissions will remain stable or have an uncertain trend, with 200 to 4,000 new confirmed COVID-19 hospital admissions likely to be reported on May 13, 2022,” it states.
Whether “200 to 4,000” is useful is up to you to assess. However, the death predictions are more accurate: “The number of recently reported COVID-19 deaths is likely to fall over the next four weeks, with 1,200 to 3,500 new deaths likely to be reported in the week ending May 7, 2022. The National Ensemble predicts , that a total of 993,000 to 1,001,000 COVID-19 deaths will be reported on this date. “
Despite the past two years, it’s hard not to be optimistic.
“The COVID-19 trends we’ve seen in California over the last few weeks have been encouraging,” said Dr. Elizabeth Hudson, Regional Director of Infectious Diseases at Kaiser Permanente Southern California, via Email. “The challenge is to know if we are on a break before we see more cases, or if a combination of high levels of immunity due to vaccination and natural infection will be able to dull any kind of bump in cases due to. BA.2 variant.
“In California, we have the benefit of warmer weather so more activities can take place outdoors, reducing the risk of people getting sick. We are also a very different place in terms of COVID-19 treatments with oral treatments now available. “Fortunately, this means that we can get people treated faster and help them avoid becoming so ill that they have to be treated in hospital.”
However, it is important to note that case numbers are becoming difficult to measure, thanks to the explosion of home tests. “This means there may be more cases that are not reported as they do not make it onto the local public health department’s radar,” Hudson said.
“The bottom line is that even though the news is good now, we know that California for all the previous hikes has been a few weeks behind the trends of the East Coast. We know over the next few weeks whether California has really managed to avoid another hike. “In the meantime, if you are not vaccinated, this is a good time to do so. If you are eligible for a COVID vaccine booster, be sure to get one too.”
Bailey, from Providence Hospitals, believes we’re on the bridge between pandemic – screaming siren, pants-on-fire emergencies – and endemic when the virus disappears into background noise, always present, like the flu.
“We are on that journey,” he said. “I do not know if we are doing well – will BA.2 just be a blip? – but in Southern California we are well on our way.”
The UCI’s Noymer is more cautious.
“I do not think the next wave in SoCal, whenever it may be, will be devastating,” he said. “I’m not panicking – I think the next wave may be a small wave, not a mountain – but we can not rest on our laurels. COVID is going to be here to stay for years. It will not necessarily disappear , like the flu, to something that causes 60,000 deaths a year.Maybe it will fade to 100,000 deaths a year – but it’s still too many.
“Your emergency room doctors are on the sharp end of the stick. Maybe in the long run we need to bake more capacity into the cake so that the hospitals do not constantly burn out staff. The health care system will have to deal with this, one way or another. “
Perhaps this will mean specialized COVID-19 treatment units in hospitals.
While the masks loosen on planes and trains, in schools and office buildings, front-line doctors like Gan of Pomona are preparing for the next one.
“None of us are overly optimistic,” Gan said. “This COVID fear is dying down, and somehow it’s good. But for how long?”