OC ICUs’ COVID-19 cases far from surge highs, but is it too soon to get hopes up?

January was grim, grim, grim. The creepy, mechanical rasp of ventilators, breathing for gravely ill people who couldn’t breathe for themselves. The beep, beep, beep of heart monitors announcing each labored muscle contraction. The machine’s piercing wail when those heartbeats stopped.

On one day in January, COVID-19 sent 207 very sick people to Orange County intensive care units.  But four months later — in mid-April — it seemed like an alternate universe. There were just eight COVID-19 cases in Orange County ICUs. But as last week wore on, ICU cases crept up to 10, and then to 14.

It seems almost dangerous to get too excited about this. But the precipitous dive in really sick people has been repeated in Los Angeles, Riverside and San Bernardino counties, and in California as a whole: The Golden State had a stunning 2,609 folks in ICUs on Jan. 25, and just 141 — repeat, just 141 — in ICUs on April 18, according to state data.

That’s a 95% drop.

Delirium

Remember the dreamy delirium we enjoyed at this time last year, when folks fought for vaccine appointments and believed — really, truly believed — that vaccination offered an impenetrable shield and a wee bit of magic, sort of like “unicorn farts,” as UCI Irvine epidemiologist Andrew Noymer so artfully observed? We hadn’t heard of delta or omicron or stealth omicron. We didn’t fully understand how swiftly the virus was mutating to dodge our defenses.

We still may not fully understand that. Clouds gather on the East Coast as stealth omicron spreads and case numbers shoot up. There were 14 people in Orange County’s ICUs as of Friday, April 22. The U.S. will soon log its 1 millionth dead — a tragedy unthinkable two years ago when all this started.

“This last surge was tremendously busy — it felt very similar to the first wave,” said Dr. Anthony Gan, a pulmonologist and critical care physician at Pomona Valley Hospital Medical Center. “We saw a lot of severe cases. There was a lot of sickness, a lot of death.”

But something, it seems, has truly shifted.

“At Mission Hospital, we have two patients right now with COVID, none in ICU,” said Dr. Charles Bailey, medical director for infection prevention with Providence Mission Hospital and Providence St. Joseph Hospital, on Tuesday, April 19.

“We’re entering an era where we’re seeing more incidental positives — people who come to the hospital for something not COVID-related, then test positive — than we’re seeing people who come due to COVID itself.”

Same at Pomona. There were three patients with COVID-19 in the hospital on Wednesday, April 20, and none were in the ICU, Gan said.

“The numbers have gone down, down, down very quickly, and are staying low,” Providence’s Bailey said. “They’re going up in other places, but we’re not really seeing that here in Southern California. That’s probably what we’re going to be looking at in the future: Here’s a hot spot, there’s a hot spot, but not a nationwide surge. We’re going to have to find new vocabulary to explain it.”

What’s happening?

This steep decline is likely a function of population immunity (from vaccination and recent omicron infections), a somewhat less virulent variant and subvariant, and better treatment options such as Evusheld, monoclonal antibodies and oral antivirals like Paxlovid, said Dr. John Swartzberg, professor emeritus at UC Berkeley.

Agreed, said Dr. George Rutherford, professor at UC San Francisco, “along with selective booster uptake in older (and more susceptible) populations.”

Stanford University’s Dr. Yvonne Maldonado said it’s clear these combined factors are protecting us right now, but whether we will remain in a relative lull is, of course, unknown.

“I suspect we will need to be vigilant about the fall because there will be lots of waning immunity as well as potential for new variants building over time,” she said by email. “Vaccines are the primary means of protection, including boosters especially for high-risk populations, with antivirals keeping infected individuals out of the hospital.”

Whether or when another surge appears is anyone’s guess.

“There are a few states that are showing an increase in hospitalizations, albeit modest,” Swartzberg said by email. “I think it is premature to celebrate (and, remove mask mandates on public transportation).”

UCI’s Noymer is cautious as well. “We’re in a good period right now, no doubt about it,” he said. “I’m just a little skeptical that this is going to be permanent.”

The U.S. Centers for Disease Control and Prevention is trying to up its game on the prediction front: Its new Center for Forecasting and Outbreak Analytics aims to be “the equivalent of the National Weather Service for infectious diseases,” blending myriad projections of a disease’s path into an “ensemble,” which is supposed to be more reliable.

“This week’s national ensemble predicts that the number of new daily confirmed COVID-19 hospital admissions will remain stable or have an uncertain trend, with 200 to 4,000 new confirmed COVID-19 hospital admissions likely reported on May 13, 2022,” it said.

Whether “200 to 4,000” is helpful is for you to judge. The death predictions are more precise, however: “The number of newly reported COVID-19 deaths will likely decrease over the next four weeks, with 1,200 to 3,500 new deaths likely reported in the week ending May 7, 2022. The national ensemble predicts that a total of 993,000 to 1,001,000 COVID-19 deaths will be reported by this date.”

Ouch.

Corner turned?

Moderna has a vaccine in the pipeline to address the new variant, which could be ready by fall. A vaccine for younger kids is on track as well. Test and treat is gaining traction.

Despite the past two years, it’s hard not to be optimistic.

“The COVID-19 trends we’ve seen in California over the past few weeks have been heartening,” Dr. Elizabeth Hudson, regional chief of infectious diseases with Kaiser Permanente Southern California, said by email. “The challenge is to know if we’re in a lull before we see more cases, or if a combination of high levels of immunity due to vaccination and natural infection are going to be able to blunt any sort of bump in cases due to the BA.2 variant.

“In California, we do have the advantage of warmer weather, so more activities can happen outdoors, hence lowering the risk for people getting sick. We also are in a very different place in terms of treatments for COVID-19 with oral treatments now readily available. This means, happily, we can get people treated sooner and help them avoid getting so ill that they need to be treated in the hospital.”

It’s important to note, though, that case numbers are going to be hard to truly gauge, thanks to the explosion of at-home testing. “This means there may be more cases that are not reported as they don’t make it on the local public health department’s radar,” Hudson said.

“The bottom line is that, although the news is good now, we know that for all the previous surges, California has been a few weeks behind the East Coast’s trends. We’ll know in the next few weeks if California has truly managed to avoid another surge. In the meantime, if you’re not vaccinated, this is great time to do so. Also, if you’re eligible for a COVID vaccine booster, please be sure to get one.”

Bailey, of Providence hospitals, believes that we’re on that bridge between pandemic — screaming siren, pants-on-fire emergency — and endemic, when the virus fades to background noise, always present, like flu.

“We’re on that journey,” he said. “I don’t’ know if we’re well along – will BA.2 be just a blip? — but in Southern California, we’re well on our way.”

UCI’s Noymer is more cautious.

“I don’t think the next wave in SoCal, whenever that may be, is going to be devastating,” he said. “I’m not panicking — I think the next wave may be a little wavelet, not a mountain — but we can’t rest on our laurels. COVID is going to be here to stay for years. It’s not necessarily going to fade away, like flu, to something that causes 60,000 deaths a year. Maybe it’ll fade to 100,000 deaths a year — but that’s still way too many.

“Your emergency room doctors are on the sharp end of the stick. We may need, in the long run, to bake more capacity into the cake so hospitals aren’t constantly burning out employees. Healthcare is going to have to deal with this, one way or the other.”

Maybe that will mean specialized COVID-19 treatment units in hospitals.

As masks peel off on planes and trains, in schools and office buildings, front line medical providers like Gan of Pomona are bracing themselves for what’s next.

“None of us are overly optimistic,” Gan said. “This COVID fear is dying down, and in some sense that’s good. But for how long?”

Source: Orange County Register