California is enjoying “good COVID weather,” but winter could bring surprises

California enters fall with the coronavirus in retreat.

Cases have fallen significantly since the height of the Omicron wave this spring and summer, and that has allowed government officials to ease mask rules and recommendations.

But health experts warn that those conditions could change as the weather cools, people move indoors, and new variants and subvariants may emerge. As the state moves deeper into fall and winter — seasons that previously saw the arrival of the two worst waves of COVID-19 to date — Los Angeles County officials say they can’t rule out returning mask orders if conditions deteriorate significantly.

Although the situation has improved greatly since the beginning of the year, there are early signs that the coronavirus is on the rise again in Europe, a development that had previously foreshadowed increases in the United States. In England, coronavirus cases in the most recent week have increased by 13% compared to the previous week and hospitalizations have increased by 17%. Belgium and Denmark have also seen their numbers rise, said Dr. Peter Chin-Hong, an infectious disease expert at UC San Francisco.

“Enjoy the good ‘Covid’ weather,” Chin-Hong said. But “realize that we have to be flexible.”

Experts are also watching for a number of emerging subvariants of Omicron that laboratory studies suggest could still infect vaccinated or previously infected people, and possibly render ineffective some anti-Covid treatments known as monoclonal antibodies.

And locally, observed levels of coronavirus are no longer declining in LA County wastewater, indicating significant transmission is still occurring.

Officials regularly point out that, thanks to high levels of vaccine coverage and the availability of therapeutics, California could be well positioned to handle a potential resurgence of the coronavirus this year. Aiding this effort is the release of updated booster shots specially formulated to target BA.5, still by far the most common version of the coronavirus in circulation.

But COVID-19 has regularly surprised and defied prognosis. And given California’s past winter experience, some officials and experts say it would be foolish to rule out the need for masks in the coming months. Never in modern times has the world faced a global pandemic caused by a coronavirus, and it will likely be some time before a predictable pattern emerges.

“When we see things spiraling out of control, we have to go back to the strategies that worked before we got our vaccines and boosters,” said Barbara Ferrer, director of public health for LA County. “If our vaccines don’t work, because we have a new variant or the new variant evades a lot of protections, you’ll want to put the mask back on, because that will give you the protection you need. need to stay safe.”

Dr. Eric Topol, director of the Scripps Institute for Translational Research in La Jolla, said he suspects “we’re going to see more problems with this virus — I mean, if there’s anything you can bet on, that would be the best “. ”

Topol said there are at least four subvariants that scientists are watching closely that could cause problems in the coming months.

Experts also note, however, that attitudes and recommendations can and should change depending on the playing field of the pandemic. Chin-Hong, for example, said it’s reasonable to go out and enjoy many activities without a mask when case rates are lower. But if that changes, people should be prepared to get that extra layer of protection.

But with most mandatory mask rules now in the rearview mirror, and many people eager to shake off the 2 1/2-year-old pandemic, it remains to be seen whether residents would be willing to don masks once again in certain situations.

LA, for example, was for months the only California county that still required masking while aboard public transportation and at indoor transit hubs. But anyone who took a train or flew out of Los Angeles International Airport before that rule was lifted on Friday could tell you that compliance was spotty, to say the least.

Still, Ferrer said he’s hopeful residents will hear the call “if we’re surrounded by people getting really sick” once again.

“When we’re in a situation where there are threats to the health care system and we’re surrounded by people who are getting very sick … I think people will go ahead and comply,” he said. “These are reasonable public health precautions.”

Chin-Hong, meanwhile, said he believes people would go back to wearing masks “when things go wrong.”

As of last June, when the Omicron surge in the spring and summer was gaining momentum, the majority of LA County respondents to a survey conducted by the USC Center for COVID-19 Pandemic Research say they still wore a mask, at least sometimes, when they left home.

Also, most respondents said that fully vaccinated and boosted people should still wear a face mask in crowded indoor settings and agreed that doing so reduced the risk of contracting a coronavirus infection, Ferrer said.

Whether California as a whole, or even a significant number of counties, would return to mandatory masking remains to be seen.

Last week, the California Department of Public Health largely rescinded its broad recommendation that everyone wear masks when in indoor public settings and businesses, guidance that had been in place since mid-February.

Instead, state health officials now recommend universal masking only for counties with a high community level of COVID-19, a category defined by the US Centers for Disease Control that indicates that transmission of the coronavirus has increased to point that possibly begins to negatively affect hospitals.

Masks are still required in health care facilities and long-term care and senior care facilities under a state health order. The state also requires that businesses and places, including K-12 schools, “must allow any person to wear a mask if they choose.”

However, the state’s new guidance said nothing about when, or if, widespread public masking would become mandatory again.

But L.A. County, which this summer moved to the brink of reinstating a new order for universal public indoor masks, has shown a willingness to do so in the event of a severe fall and winter surge.

LA County opted to lift its mask requirement on public transportation, including ride-hailing services like Uber and Lyft, and at indoor transportation hubs like airports after the region’s coronavirus case rate dropped by below the threshold of 100 new cases per week per 100,000 residents. .

But if the rate exceeded that mark again and remained there for 14 consecutive days, the mask requirement would be reinstated in traffic settings, Ferrer said.

The last time LA County had such a low case rate was during a 50-day period between March 5 and April 23, before a series of Omicron subvariants drove rates up of cases in late spring and summer. Last fall, the county’s case rate stayed below that threshold for a 67-day period between Sept. 29 and Dec. 4.

However, levels of coronavirus in wastewater in LA County are no longer decreasing as they once were, and in the Antelope Valley, they may be increasing. Virus trends in wastewater from other regions of the county appear to be flat.

“The fact that we’re no longer seeing declines in sewage data is a reminder that carryover remains substantial throughout the county and that reasonable precautions will help reduce the risk,” Ferrer said.

Topol said he thought it was premature for the mask mandate to end for public transportation.

“It’s not like we’re getting very low levels of the virus, like we are [did in] in June 2021,” he said. “We still have a lot of cases.”

If another increase materializes, LA County could resort to a universal public indoor mask mandate for residents 2 and older. This order does not apply from the beginning of March.

However, the criteria for pulling that lever again is demanding, and it’s unclear if the county would ever get to that point, even if transmission ramps up again this fall and winter.

Conditions would have to deteriorate to a point seen only twice before in the pandemic: during the first fall-winter surge that began in late 2020, when mortuaries were so overwhelmed, the National Guard; and Omicron’s first post-Thanksgiving surge in 2021, which left emergency rooms flooded, ambulances facing hospital delays and patients’ scheduled surgeries canceled .

Specifically, LA County would need to meet two thresholds to return to a universal mask order.

Assuming a high coronavirus case rate, a universal mask mandate would return only if LA County saw at least 10 coronavirus-positive hospital admissions per week per 100,000 residents and had at least 10% of all hospital beds with staff busy due to coronavirus. positive patients.

According to the most recent data available, the county reports 6.5 new coronavirus-positive hospital admissions per week per 100,000 residents, and only 3.6% of hospital beds are occupied by such patients.

During the peak of this summer’s surge, LA County surpassed 7.2% of hospital beds occupied by coronavirus-positive patients, although it temporarily outperformed the other hospitalization metric.

There are reasons for optimism heading into the colder months. For starters, no compellingly worrisome new subvariants have emerged in LA County to any significant degree, and the updated COVID-19 boost matches the dominant circulating strain. Therapeutics to treat COVID-19 are also widely available.

Children ages 5 to 11 are expected to have access to the updated booster as soon as mid-October, Ferrer said. The updated booster is available from the beginning of September for those over 12 years old.

But Dr. Anthony Fauci, President Biden’s chief medical adviser on the pandemic, said at a talk hosted by the Center for Strategic and International Studies that he expects “it’s likely we’ll see another variant emerge.” Health officials have long warned that continued transmission could spawn another problematic variant, one that might be more transmissible or better able to evade the protection afforded by vaccines or previous infection.

LA County is monitoring a number of newer and lesser known Omicron subvariants, but they are not circulating in large numbers.

A new variant being tracked is called BF.7. It’s actually a subline of BA.5 and is therefore also known by a more complicated name: BA. Officials picked up a specimen of BF.7 in LA County in early August, but no additional cases have been found.

Fauci expressed concern about another subvariant, BA.2.75.2, referring to it as “on the horizon, one that looks suspicious.”

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