With COVID remaining at a very high level in California, some doctors are warning that transmission could accelerate again after the busy Labor Day holiday weekend — possibly adding to a summer wave that has proven stronger and more durable than some experts anticipated.
Doctors will monitor the data closely for signs of a post-holiday bump, which can occur due to a number of factors. First, Americans are being asked to hit the streets or take to the skies in record-breaking numbers this year and, with COVID transmission increasing in most countries, the risk of exposure is negligible.
Second, the coronavirus continues to mutate in ways that allow it to spread more easily from person to person.
“People are not just going back to pre-pandemic – even more than I thought before the pandemic happened, in terms of travel,” said Dr. Elizabeth Hudson, regional chief of infectious diseases for Kaiser Permanente Southern California.
“So that means there’s a real risk of being in contact with other people who have COVID,” he said. And many California schoolchildren have returned to school, “unfortunately, the most important weekend to have potential.”
California is one of 47 states with “high” or “very high” levels of the coronavirus in wastewater, the U.S. Centers for Disease Control and Prevention said Friday. The same is true of the District of Columbia.
The Transportation Security Administration previously estimated that this past holiday weekend would be the busiest Labor Day travel period on record, with more than 17 million people expected to screen at airports during the seven-day period ending Wednesday.
“A lot of people I know get COVID coming back from travel,” said Dr. Peter Chin-Hong, an infectious disease specialist at UC San Francisco. “Be prepared for the possibility that the sniffles or those symptoms after returning will be COVID.”
He said it’s especially important for people at higher risk — such as seniors 65 and older and immunocompromised — to get tested. If positive, they should immediately seek early antiviral therapy like Paxlovid, especially if they have not been vaccinated in the past year.
At UCSF hospitals, people hospitalized with COVID are generally in their 70s and 80s and have not received the vaccine in the past year, Chin-Hong said.
California and the rest of the country experienced a longer wave of COVID this summer than last. California has had 12 weeks of “high” or “very high” levels of coronavirus in wastewater since June, with more likely to come. For all of last summer, California recorded eight weeks with “high” levels of the coronavirus in sewage, but never reached “very high” levels.
A big reason for this rise in infections is the spread of more contagious subvariants, each with an unofficial moniker referring to a particular mutation that gives it an evolutionary advantage over the previous strain.
May saw the emergence of the FLiRT strain, which has since given way to FLuQE (pronounced fluke) and, more recently, deFLuQE (pronounced de-fluke).
The current dominant version of the coronavirus is KP.3.1.1. That subvariant, which has the deFLuQE mutation, was estimated to make up 42.2% of coronavirus samples nationwide in the two weeks ending Saturday, up from 19.8% last month, according to the CDC.
Hospitalizations and COVID deaths have slowed this summer, but remain lower than previous waves because of ongoing immunity against severe disease from past immunizations and infections.
For the week ending August 10, 881 COVID deaths were reported nationally — more than twice as many as the first week of the summer.
In LA County, the average number of daily COVID deaths rose to 2.9 for the week ending Aug. 6, the latest available. Previously, LA County had reported about one to two COVID deaths per day since early July.
There are signs in some parts of the country that the transmission of the coronavirus may be present. But we’ve been fooled before, some doctors warn.
The CDC has identified California as one of nine states where COVID-19 is considered “declining” or “likely declining,” according to data published Friday.
But it will take time to understand if the trend continues. Earlier this summer, California’s COVID for a week was classified as “stable or uncertain,” only for transmission to worsen again.
“You know, for four to eight weeks, we’ve been doing this thing where we’re sorting through the crests, and then a few weeks later, the numbers start going up again,” Hudson said. “So this is a real wild factor moment. We don’t know where it’s going to go.
Circumstances — “Labor Day meetings and kids going back to school” — could conspire to push transmission rates higher, Hudson said. And the stubborn summer heat can exacerbate the situation by keeping people in places without good air circulation, a setting ripe for the spread of COVID.
The Los Angeles County Department of Public Health said it will take weeks more data “before we know we’re past the peak this summer.”
In LA County, the rate of coronavirus in sewage was 86% of last winter’s peak in the 10 days ending August 17, roughly unchanged from the beginning of the month. For the week ending August 25, an average of 410 coronavirus cases were reported per day, down from the previous week and below the summer peak of 484.
The number of cases of the coronavirus is certainly low, because there is no factor in the tests being done at home or the fact that fewer people are trying. But the trend is still useful in determining the trajectory of the wave.
The percentage of emergency room visits in LA County related to the coronavirus has remained flat over the past three weeks – hovering between 3.9% and 4.3%. This last figure was the highest of the season. Last summer’s peak was 5.1%.
The statewide rate at which coronavirus tests come back positive continues to rise. For the week ending August 26, 13.7% of reported coronavirus tests in California were positive, up from 11.7% the previous month. The latest figures have surpassed the peaks from last winter and last summer.
Chin-Hong said the COVID wave started early in California and the West, and he suspects the state has actually reached its peak. COVID has “basically infected a lot of people who are going to be infected. … We will see more infections during Labor Day for sure, but (it will) probably not continue to rise.
At the UCSF hospital, on Friday, there were eight patients who were admitted positive for the coronavirus – almost the same as in late spring. At the height of the summer peak, about three or four weeks ago, there were about 30, Chin-Hong said.
To combat the spread of COVID, doctors are urging people who are sick to stay at home and stay away from others. And if you are sick, you should try.
You may still have COVID-19 even if your first rapid test result is negative. The doctor advises to test once a day, or once every other day, until the fifth day after the symptoms.
For those still traveling, wearing a mask in indoor settings – like airplanes and airports – can also reduce the risk of infection.
The CDC recommends that everyone 6 months and older be vaccinated for the 2024-25 season, ideally in September or October.
The COVID-19 vaccine from Moderna and Pfizer was approved by the US Food and Drug Administration on August 22, and doses were made available the following week. On Friday, the FDA authorized Novavax’s updated seasonal vaccination formula, which is made using an older protein-based technology.
For some people, Novavax could be an attractive alternative to Moderna and Pfizer’s mRNA vaccines. The mRNA vaccine is less likely than Novavax or other protein-based vaccines to cause side effects such as swollen arms and low-grade fever, according to Hudson.
But Novavax’s vaccine for the 2024-25 season is designed against the older subvariant, JN.1, while Moderna and Pfizer’s is designed against KP.2, a newer subvariant that is closer to KP.3.1.1.
Time will tell how this season’s Novavax formula compares to Moderna and Pfizer, “but you know, it’s still a very good choice,” Hudson said.
For those interested in Novavax, given that there are only a few differences between JN.1 and KP.2, “I feel very confident that it will give people excellent protection,” Chin-Hong said.
As for side effects that can sometimes occur with Moderna or Pfizer’s COVID vaccinations, they usually don’t last more than a day, and tend to be mild — much milder than COVID illness, Hudson said. Only about 25% of people who get the vaccine tend to experience more obvious side effects like sore arms and a low-grade fever, Hudson said.
Some doctors recommend scheduling your COVID vaccinations when you have time to rest.
The COVID vaccination is already available at stores like CVS, Walgreens, Rite Aid, Vons, Albertsons, Pavilion and Safeway. Health systems like Kaiser Permanente and Sutter Health are poised to give the shot in mid-September.
For uninsured or underinsured residents, the LA County Department of Public Health will provide free doses through public health clinics and multiservice vaccination sites. “We are waiting for the supply from the manufacturer, but we hope to have it on site in the next few weeks,” the agency said – that is later in September.
Officials also said the California Department of Public Health will get additional funding to make free doses of the COVID vaccine available to uninsured and underinsured adults. The country is expected to make the vaccine available for order in October. LA County officials said it’s likely that inoculations will be available to health care providers that previously offered free COVID vaccines.
Last year, uninsured adults could get the vaccine for free through the federal Bridge Access Program, where people can get immunized at federal health centers, as well as CVS and Walgreens. The Bridge Access Program ends at the end of August.
