Dora Anne Mills, MD, MPH, originally published May 8, 2022

There is so much I could write about today – Mother’s Day – with so many sweet memories of my own mother, the physical and emotional roller coaster of trying to become a mother, the blessings of my own children, and this last week’s news of the possible loss of reproductive healthcare choices for so many women. But with a busy weekend and a number of changes in the COVID world, I’m focusing on a brief update on the pandemic situation as well as a reiteration of the tools we have and links to resources on how to use the tools. Meanwhile, with so much chaos In the world, I hope everyone enjoys a restful day.

Overview

  • The Northeast, mid-Atlantic, and Puerto Rico have the highest pandemic activity in the country and are rated high on both the community transmission map (which uses incidence and test positivity rates) and community levels map (which uses hospitalizations and incidence).
  • We also have the highest incidence of the Omicron BA.2.12.1 subvariant which is likely contributing to this surge.
  • Although hospitalizations are increasing in New England and higher than in the rest of the country, they are nowhere close to January levels. For instance, in mid-January Maine hit a peak of 436 hospitalized with a COVID-19 diagnosis. Currently, our hospitalizations are about half that (205 on May 7th).
  • More importantly, in Maine, about 1 – 2% of those who are hospitalized are on a ventilator. This is in striking contrast to about 20% during the Delta peak in mid-December.
  • Wastewater levels of the SARS-CoV-2 virus in Maine and New Hampshire are generally headed a bit downward or are steady, and even recent peaks aren’t nearly as high as the January peaks. These levels are felt to be leading indicators. Although there is a lot of variability in them, hopefully, the trend away from going upwards may be a sign that we may be near the peak.
  • Although much of the rest of the country is “green” (for low) on the US CDC community levels map, the US CDC community transmission map shows a different story. It is increasingly being colored red (for high).
  • Because the transmission map consists of incidence and test positivity rates (vs mostly hospitalization data on the community levels map), it is more of a leading or bellwether indicator. Therefore, rates may continue to increase.
  • If you live in a high or substantial transmission area (colored red or orange), then taking some added precautions may be warranted.
  • The Omicron variant, specifically its various subvariants, accounts for ~100% of the SARS-CoV-2 samples sequenced in the U.S. The virus’ mutations are resulting in it becoming increasingly contagious.
  • For instance, when the BA.1 subvariant replaced Delta in early January, it was noted to be very significantly more contagious than Delta. But BA.1 was followed by BA.2, which was noted to be 30% more contagious than BA.1. Although BA.2 is now dominant, it is quickly being replaced by BA.2.12.1, which is estimated to be 25% more contagious than BA.2.
  • Just because the virus is evolving to become more contagious and is currently causing less severe illness, doesn’t mean it will continue to cause less severe illness.
  • We currently have an immunity wall that is protecting us, with high vaccination rates and high rates of people who were infected with previous subvariants of Omicron earlier this winter.
  • Future variants can have mutations that cause them to be more or less contagious, to be more or less virulent (causing worse or milder illness), or to evade immunity (from prior disease or vaccination) more or less strongly.
  • We currently cannot predict mutations – when significant ones will arise and what their impacts will be.
  • We will have more variants (i.e., SARS-CoV-2 viruses with significant changes or mutations). That’s because the virus continues to be widely transmitted among humans and non-human animals (e.g., deer). The more the virus reproduces, the more it will mutate.
  • Influenza provides some analogies. Influenza has circulated among humans and non-human animals (swine, birds, etc.) for at least 500 years, and it mutates almost constantly. Some years, mutations cause more severe influenza or it is more contagious, or it evades prior immunity. Every ~20 – 50 years, it causes a pandemic. We’ve learned to live with influenza by getting vaccinated every year, and likely more will now want to mask during flu season (as they have done in some Asian countries for years). We co-exist with influenza, and similarly, we’re learning to live alongside SARS-CoV-2.

Good news

  • We currently have the critical tools we need to mitigate this surge:
    • Vaccines, high-quality masks, testing, outpatient treatment, and ventilation.
  • Researchers are developing better vaccines, e.g., those that result in immune responses in the nose and mouth that will prevent infection, and those that work broadly against many coronaviruses, which will help prevent infection against many mutations.
  • Researchers are developing more medications.

Not-so-good news

  • Especially if you’re not in New England, pay attention to the US CDC community transmission levels (link to below) map. Transmission levels are rising to red (high) levels in much of the country, and are leading indicators of pandemic activity (along with wastewater levels).
  • Increasingly I’m not as worried about contracting COVID-19, but more concerned about the risks for long-term effects from the infection, such as fatigue, brain fog, and shortness of breath.
    • Data vary, but basically anywhere from 10 – 50% of people after a COVID-19 infection report long-term symptoms.
    • Preliminary data indicate those with milder infections and/or who are vaccinated are less likely to experience long-term symptoms.

What to do during this surge

  • Get up to date on vaccination, especially boosters.
  • Second boosters are for anyone 50 and older as well as younger (but at least 12 years old) with immunocompromising conditions.
  • A new study from Israel indicates the first booster is holding up disease for at least 7 months.
  • Another new study shows a booster dose to be very effective (50%) in protecting nursing home patients against infection with the Omicron variant. This adds to previous evidence of booster doses reducing transmission.
  • Use high-quality masks.
    • As the virus has evolved to become more contagious, masking is becoming a more important tool. Both the US CDC transmission and community level maps indicate that people should consider masking indoors in much of New England when with people outside of their household.
    • Use N95, KN95, or KF94 masks for the best protection.
  • Test and keep tests on hand at home.
    • It’s helpful to maintain a supply of rapid antigen test kits at home. However, if someone tests negative and has symptoms, it is recommended they obtain a PCR test. Antigen tests are often negative early in the infection. If testing negative but with symptoms, consider asking about an influenza test as well, since there is an uptick in much of the country.
  • Have a plan to get treated early.
    • If someone tests positive, they should ask their PCP about getting treatment. Currently, there is a good supply of the oral prescription drug Paxlovid, as well as other options (monoclonal antibodies, Remdesivir, etc.). However, timing is critical. Medications should be started within the first 5 – 7 days (the timing depending on the specific medication), and data indicate that the earlier within that timeframe, the better.
  • Pay attention to ventilation.
    • We have a warm spell on the way. Consider moving meetings and meals outdoors.

Major Tools and Resources

Pandemic Tracking

Who is at high risk for severe COVID?

Long term effects of COVID

Vaccination information

Masking

Testing

Treatment

Ventilation

Long-acting monoclonal antibodies (Evusheld) – a preventive medication for those who are immunocompromised