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COVID cases remain high; unvaccinated, kids most at risk

A surge in COVID cases since mid-July has been a continuing concern to the Merced County Public Health Department, especially because the number of children getting the disease has increased with the onslaught of the Delta Variant.

The unvaccinated remain the most at risk of serious disease and fatalities.

The positive case rate is the percentage of those being screened for COVID-19 who test positive for the virus.  It is supposed to be 8 percent or less. On Sept. 13, it was 9.8 percent.

Dr. Kristynn Sullivan, Merced County’s Supervising Epidemiologist, told the Times, “We have seen an increase in cases since mid-July.

“We’re still well over 100 cases per day, and ideally it should be less than 20 per day.  In June, we were seeing single digit days, and since the surge in July it rapidly increased and then stabilized at between 100 and 200 cases per day.

“The highest single day of the surge was 239 cases.  We had 198 cases on Sept. 12.

“This wave is hopefully on a plateau, but we’re still seeing really high hospitalization numbers.  As of Friday, Sept. 10, there were 44 Merced County residents hospitalized in Merced County hospitals.

“Regionally, we have 8.2 percent ICU capacity, and that is all the way from San Joaquin County to Kern County. The ideal is 15 percent or above.

“Surge plans go into place if the capacity is less than 10 percent.  Surge plans are potentially sending in more staff or using other areas in the hospital that aren’t the ICU as an ICU.  For example, hospitals could turn their post-surgery area into an ICU, or they could create another floor of beds.

“From Aug. 13 to Sept. 13, we had 38 deaths.  We had our first pediatric death in a less than one-year-old child.  Fourteen deaths were in the 65 plus age group, and in the age range 50 to 64, there were 15 deaths.  The age group 35 to 49-years-old had eight deaths.

“Typically, the majority of the deaths have been in the 65 plus group, but now we’re seeing the majority is in the less than 65-year-old age group; 62 percent of the deaths in the last month have been of those under the age of 65.”

 

COVID in children

Atwater High, Merced High, El Capitan High, Buhach Colony High, Golden Valley High and Livingston High all had COVID outbreaks as of Sept. 7.

In the Merced City School District, Burbank Elementary, Peterson Elementary and Sheehy Elementary had outbreaks as of Sept. 13.

Dr. Sullivan told the Times, “We’re seeing a lot more outbreaks in schools this wave.  The Delta Variant is affecting kids more, but then also we think it’s because kids aren’t able to be vaccinated so they are more vulnerable.  Everyone age 12 and up is eligible to be vaccinated, but not those age 11 and under.

“Next up to be eligible for the vaccination will be the 5 to 11-year-olds.  Pfizer has collected that data and will be submitting it to the FDA for approval for emergency use authorization.

“Collecting the data takes a long time, and with the 5 to 11-year-olds, they had to change the dosage and find out what dose would be optimal.  The age group 12 and over has the same dosage, but for the little ones they have to figure out the least amount of side effects and optimal protection.  That’s why the data part took longer.

“The FDA then has to review it, and that takes several weeks.  They’ll fast track it as a high priority item because they want to have vaccines available before winter and the flu season but they are not going to take any shortcuts and are going to make sure it’s safe.

“There’s a lot less known about the long-term effect of COVID in kids because the last waves didn’t affect kids much, but there is some evidence.  There is a very rare condition called Multi System Inflammatory Syndrome, which is the most severe side effect of COVID for kids.  Several months after the COVID infection, they may have fever, abdominal pain, diarrhea, headache, neck pain, rash, chest tightness and pain, and feel extra tired, and we have had some cases in Merced County.  It can require hospitalization which we would particularly like to avoid with kids.  There have been 4,461 cases in the country.  Only 41 children have died of it.

“There are a lot of things we wish we would know more about, but it’s still a pretty big unknown, since kids weren’t getting COVID in a big way until about the time they went back to school.

“The Variant is making the situation different.  Last year when kids were back in school, they were having recess and we saw very minimal transmission in elementary schools, although we did see more in high schools where there is more mingling.  But this year, we are seeing a lot more transmission in the school settings, and we believe it is largely due to the fact the Delta Variant is so much more transmissible.

“An outbreak in a school consists of three cases in the same class, after-school program or sports team, and they have to have had no external exposures that would explain the transmission, so it’s three linked cases within a school site.

“We’ve had some outbreaks contained at three cases and some which have gone beyond that.  It depends on how quickly we can get the test results back and are able to establish a link and how quickly we can close the classroom or the sports team.

“I know there is a lot of concern about schools, but the schools are the one place where a great degree of effort is being put in — rapid contact tracing, lots of testing, and universal masking.  The schools continue to be probably one of the safest places for our kids.

“What continues to be the biggest risk for kids in this is losing a parent or a guardian or a grandparent.

“The numbers are astronomical because we’ve had a lot of deaths due to COVID.  The Lancet, one of the top scientific papers in the country, did a study of how many kids lost their caregiver.  From March 1 of 2020 to April 30, 2021, 1.5 million children globally experienced the death of one primary or one secondary caregiver.  A primary caregiver is a parent or guardian.  A secondary caregiver would be like a grandparent who lives in the home.”

 

Vaccination key

Similar to nationwide findings, Merced County COVID cases, hospitalizations and deaths are mainly occurring in individuals who are unvaccinated, according to the Merced County Public Health Department.

The vaccination rate in Merced County for age 12 plus is 44 percent fully vaccinated, and 60 percent have gotten at least one shot.

Dr. Sullivan told the Times, “The vaccination rate is increasing.  We have a fully FDA approved vaccine now, so some people are feeling more confident, but at the same time we continue to worry that if the vaccination rates stay low, then we could have a fourth wave in the winter.

“Having high proportions of unvaccinated people is how variants get worse because there’s more opportunity for the variants to stay alive in the populations and continue to contact vaccinated individuals and then the variants that do best at spreading to vaccinated individuals become more dominant, and that’s what happened with the Delta Variant.

“It’s like a race to get everybody vaccinated versus the variants.  We’re seeing that the variant won this particular leg of this race.

“The details about the booster have yet to be finalized — does it make sense for the general population, or should it be for the immuno-compromised people, who can already get it?  It is yet to be seen if it will be recommended for health care workers who have a lot of exposure to COVID, or people who are 65 plus and have less powerful immune systems.  The details have to be worked out, and it has a lot of steps before we fully determine for whom the booster is necessary.

“The research is showing that sometimes the efficacy for preventing you from getting COVID at all is not as strong, but the two doses even seven to eight months later is still very strong in  preventing vaccinated people from severe COVID or death.  Scientists are discussing if a booster would help and who it would help.

“The original goal was for the booster to be available by Sept. 20, and the FDA is meeting Friday to look at the data.

 

Staffing shortage

“Right now, the real lack is in staffing, and it’s everywhere. Other states are in much worse shape than we are.  Idaho just went on crisis standards where the health care system is so tapped out that they have to do triage care so some people don’t get care.  There’s some of that happening in other states as well.  So other states have much higher hospitalization surges than we do.

“People have left medical and public health fields because they’re tired from the last 18 months.  That just means there are more staffing shortages.  We’re competing for these resources with the whole country.

“Merced County can sometimes get staff to come, but it takes a lot more money and they sometimes leave a lot more quickly.  Sometimes the state will step in and help, but it does look like we are on a plateau in cases right now, and that’s an indication that the worst of the wave may be over.”

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