Janice R. Andrews
This time, a highly contagious COVID-19 mutation is driving the state of California to unprecedentedly high infection rates—a level not seen since 2022. Beyond the usual midsummer rises in the vaccination era, this unrelenting wave has driven coronavirus levels in wastewater to some of the highest peaks seen during the previous two years. Since there are no signs that the spike will slow down, health professionals are growing increasingly concerned.
A Rise That Equivalents Winter’s Highs
Some are describing the current COVID-19 increase in California as one of the biggest since the epidemic started. “This is a very large surge that we are seeing currently,” says Dr. Elizabeth Hudson, regional chief of infectious diseases at Kaiser Permanente Southern California. Really, this is beginning to equal what we witnessed last winter.”
The coronavirus levels in California’s sewage for the week ending August 10 were estimated by the U.S. Centres for Disease Control and Prevention (CDC) to be 84% of the highest levels from last winter. The maximum from the last two summers have already been exceeded, and these levels are getting close to what was observed in the winter of 2022–2023.
UC San Francisco infectious diseases expert Dr. Peter Chin-Hong expressed similar worries, saying, “I find it astonishing that it hasn’t decreased yet. For California, it’s a little more of an extended season.”
Wastewater Measurements: A Distressing Sign
One important determinant of the intensity of the surge has been the wastewater measurements. For the 10-day period ending August 3, coronavirus levels in wastewater in Los Angeles County increased to 76% of last winter’s peak, up from 54% for the preceding week ending July 27. Similarly, three densely populated sewersheds in Santa Clara County—which contains San José, Palo Alto, and Sunnyvale—had wastewater levels that were deemed excessive.
The primary cause of this summer’s COVID surge has been determined to be the FLiRT subvariants, specifically the KP.3.1.1 strain. According to CDC statistics, the KP.3.1.1 strain has quickly risen from 12.7% a month earlier to constitute an estimated 36.8% of specimens for the two-week period ending August 19. This makes it the most frequent variety circulating countrywide.
The Perfect Storm: A More Infectious Variant and Waning Immunity
A number of variables, such as the FLiRT variations’ hyper-infectious nature and the population’s declining immunity, are contributing to the spike. According to Dr. Hudson, “It’s this combination of a much more contagious variant on top of people’s general immunity having waned — either from natural immunity or immunity induced by vaccinations.” It has suddenly materialised as a perfect storm.
The wave of this summer is turning out to be exceptionally persistent. For the past ten weeks, coronavirus levels in California’s wastewater have been “high” or “very high.” By contrast, the state saw eight weeks of “high” viral wastewater levels in the summer of 2023 and spent sixteen weeks in these categories in the summer of 2022.
Increasing Hospital Visits and Test Positivity Rates
The increasing frequencies of COVID-19 test positive provide more proof of this surge’s unrelenting character. For the week ending August 12, 14.7% of tests performed at medical facilities in California yielded positive findings, a percentage higher than during the preceding summer and winter peaks. Test positive rate one month prior was 10.6%.
COVID-19 instances are increasing as well, while probably being underestimated because at-home testing is so common. For the week ending August 11, Los Angeles County recorded 484 COVID-19 instances on average each day, a 35% rise over the previous month. The county had a peak of 571 instances per day last summer.
In addition, COVID-19 is causing an increase in emergency department visits. The coronavirus was the cause of 4.3% of emergency room visits countywide for the week ending August 11, up from 4% the week before. Despite an increase, hospitalisations are still lower than they were in past summers, in part because of preexisting immunity and the accessibility of anti-COVID drugs such as Paxlovid.
The increase in COVID cases at Kaiser Permanente Southern California, which provides care to over 4.8 million members, has mostly led to more people visiting clinics and doctor’s offices. “We’re not seeing a huge number of people who are admitted to the hospital with COVID,” said Dr. Hudson.
The COVID-19 Burden That Remains
Even with improvements in care and immunisation, COVID-19 still has a substantial negative impact. COVID-19 fatalities in Los Angeles County are still comparatively steady, at one to two per day. However, statistics on fatalities may not immediately reflect a spike in instances.
More than 49,000 COVID-19 fatalities have been recorded nationwide since October, and at least 25,000 estimated flu deaths have occurred over the same time. “COVID-19 remains a greater cause of severe illness and death than other respiratory viruses, but the differences between these rates are much smaller than they were earlier in the pandemic,” according to the CDC in March.
Those who are elderly, immunocompromised, or who have not had the latest COVID-19 vaccination within the previous year continue to be the highest risk categories. One cannot stress the value of vaccination, particularly in light of the virus’s ongoing evolution and the emergence of new strains.
Uncertainty Up Front: Will the Rise Last?
There is concern about how the COVID-19 surge will change as summer comes to an end, especially with students going back to school. To stop the virus from spreading, public health officials are advising those who are sick to stay at home and encouraging parents to keep their sick children home from school.
According to preliminary calculations, there were around 3% fewer viruses in California wastewater this past week than the week before. This number might, however, alter as further information becomes available.
California is not the only state dealing with this issue. In 25 states, including California, the CDC indicates that COVID-19 is “growing” or “likely growing.” In contrast, five states (Alaska, Florida, Hawaii, Louisiana, and New York) have “likely declining” COVID-19 rates. In sixteen states plus the District of Columbia, the situation is still steady or unknown; estimates for Indiana, Missouri, Wisconsin, and Wyoming are not yet available.
The Value of Examination and Attention to Detail
It is recommended that medical professionals test people who exhibit signs of respiratory illnesses to determine whether they are infected with COVID-19. Given that a test’s positive result might come many days after symptoms start, a negative result does not always rule out COVID-19.
Stanford University epidemiology and infectious diseases specialist Dr. Abraar Karan stressed the significance of verifying a COVID-19 diagnosis in order to guarantee prompt Paxlovid therapy. He also emphasised the importance of ongoing testing to identify uncommon forms, like avian flu, which has gained notice recently in the United States owing to outbreaks in dairy cows and poultry.
Although there isn’t much of a threat from bird flu to people right now, it’s still a worry since it can evolve and spread to more serious illnesses. Since 1997, human infections with the H5N1 virus, a form of avian flu, have been documented in 23 countries. The CDC reports that around 50% of cases have ended in mortality from severe pneumonia.
Final Thoughts
The current COVID-19 outbreak in California, which is primarily caused by a highly contagious strain, serves as a sobering reminder that the pandemic is far from ended. With alarmingly high wastewater levels and escalating infection rates, the state will have a difficult time containing the virus. As the crisis develops, public health experts will not stop emphasising the value of immunisation, testing, and caution. The direction of this rise is yet unknown as autumn approaches and children head back to school, but it is obvious that prudence must be exercised going forward.
