Much time has passed since my last communication with the Merced County community as County Health Officer. With the holidays just around the corner, I feel it is important to give a status report on present conditions that affect the public’s health, on what to expect going forward, and to make suggestions as to how to remain safe.
After nearly 3 years of the COVID-19 pandemic all of us look forward to enjoying the holiday season, the company of friends and loved ones, and for many of us — travel. At the same time, a bewildering array of changes on mandates and guidance have occurred over the past several months as restrictions have been eased in anticipation of a continued decline in hospitalizations, deaths, and long-term consequences of COVID-19. These changes have included modifications on social distancing and masking requirements in many settings. Vaccine and testing verification have been modified or eliminated as well for several settings. Reporting requirements from hospitals, physician offices, and county health departments on the status of COVID-19 are less than before.
The good news is that we can enjoy the holiday season safely, although we must proceed with caution for several reasons.
• First of all, though we may be “done” with COVID, it is not done with us. As a nation, thus far we have lost a total of 1 million and 67,000 total lives. Unfortunately, we continue to lose 350 to 900 per day.
• We have experienced winter surges of COVID-19 in its continually evolving variants every winter since the pandemic first began. That is because cold weather drives us indoors, where we congregate with friends and family, many of whom we have not seen for a long time, and who traveled from distances to visit. In addition, school children returning from holiday break can inadvertently spread COVID-19 to their classmates and subsequently to their families.
• Although the variants we are seeing generally have been milder than previous ones, such as Delta, they are more easily spread. They can infect and be spread by vaccinated people, and continue to spread by people who are not yet feeling sick. By affecting a broad swathe of humans, the more vulnerable by lack of vaccination, age, chronic illness, impaired immunity, etc. can still end up in the hospital or worse.
• Previous infection is no protection against getting COVID again, as such individuals are still twice as likely to get sick than vaccinated persons. However, vaccination after recovering from COVID-19, confers additional protection.
• Furthermore, general experience has been that the protection of primary vaccination wanes over a period of about 4 months, meaning that if people have not received a booster, they can get it again. Fortunately, booster protection has been extended down to age 5.
• The unvaccinated are still the most likely to get COVID-19 infection. In our county the highest percentage of unvaccinated are children. Although children tend to suffer less severe COVID-19 infection than older persons, there have still been 1,500 deaths in the U.S. among children, much more than for influenza. In addition, 122,000 have been hospitalized, of which a majority did not have any underlying conditions. In California 960 cases of MIS-C (multisystem inflammatory syndrome in children) have been registered, all requiring hospitalization and prolonged follow-up.
• The removal of masking requirements in crowded in-door public places and schools means that other respiratory pathogens such as influenza and Respiratory Syncytial Virus (RSV) can be spread more easily, as well as would a resurgence of any new COVID-19 variant. Experts predict a worse than usual influenza season this year based on what has happened earlier this year in Australia and the south of the globe and the drop off in masking generally. For COVID-19, variants active in the Northeast of the United States and in Europe are being watched carefully, as they often are seen in California a month or so later.
In summary, enjoy the Holidays and protect yourselves and your loved ones.
I encourage COVID-19 booster vaccinations for everyone ages 5 and up 2 months after they have received their primary series. Elderly and immunocompromised are particularly important to protect by vaccinations. If you have questions or concerns, please speak with your provider, or contact the Merced County Health Department.
Discuss with your provider the advisability of pre-exposure prophylaxis with Evusheld, a twice-yearly monoclonal antibody injection, if you are immunocompromised for example with cancer, organ transplant, etc.
If unvaccinated, I encourage getting started, including for children ages 6 months and above. For younger infants, protection by vaccination of pregnant mothers protects both and is safe, particularly if she breastfeeds the infant. Please discuss with your primary care provider for more information.
I strongly encourage the influenza vaccine, including for children down to 6 months. Unlike COVID-19 which is worse with elderly, influenza strikes small children and infants severely as well.
I recommend home or lab testing if gathering with persons of unknown vaccination status, or if there are vulnerable individuals present. This can be immediately before or days after such a gathering, especially if someone became ill.
I recommend testing before returning to school. Of course, if ill, stay home but test also.
Lastly, I recommend masks be used in crowded indoor places and classrooms, particularly if we see an increase in COVID-19 cases or influenza, as widespread mask use protects. Fortunately, we have a newer technology of wastewater testing that can give us advanced warning for COVID-19 variants, influenza, RSV, and soon other potential agents.
If you do become ill, treatment can be beneficial if started within five days of onset with Paxlovid, an oral medication. Please consult with your doctor or visit a Test to Treat site such as in front of the Public Health Department. Alternatives to Paxlovid may be recommended if for some reason one of these would be better for you.