LA County workers have been urged to dress up to prevent a COVID surge
With the possibility of another COVID-19 spike due to partying and travel during the winter vacation season, Los Angeles County health officials are urging workers and students to wear masks in indoor public places for at least 10 days after they return to work and school.
Wearing masks for that length of time could help mitigate another possible post-New Year’s Day wave, officials say. Ten days is the approximate incubation period for the coronavirus — the time between contact with someone and the point at which they may be contagious, even if they don’t develop symptoms themselves.
“The holiday season inherently carries an increased risk of exposure, including at celebrations and events, while traveling or in crowded public spaces,” LA County Public Health Director Barbara Ferrer said Thursday. “As transmission rates are still high, there’s a good chance many more people have been exposed.”
Masking, which remains recommended but not required in LA County indoor public spaces, can help break the transmission cycle, many experts say. Individual workplaces, venues, and other settings can set their own requirements if they choose.
A statewide mask ordinance remains in effect in healthcare facilities and nursing homes. California workplace safety regulations also require workers to mask if they have been in close contact with an infected person 10 days after exposure.
School systems in LA County have not followed the path followed by their counterparts in Philadelphia, where the school district plans to order indoor masks for students and staff for the first eight days of school after winter break.
LA County health officials are relatively optimistic about recent coronavirus trends at the moment. Case numbers continue to fall after a Thanksgiving spike, and levels of coronavirus in wastewater are also falling — declines that have greatly reduced the likelihood of a universal indoor mask mandate returning this winter.
However, as has been proven time and time again in the COVID-19 era, the nation’s most populous county does not exist in a vacuum. Developments and trends elsewhere are felt locally in one way or another.
The earlier waves of the pandemic have often coincided with the emergence of a newer, more problematic version of the coronavirus, as happened last fall and winter with the arrival of the Omicron variant, and the previous summer when Delta sparked a spike in cases and hospitalizations.
This year was defined by various subvariants of the Omicron vying for nationwide supremacy. In recent months, the long-dominant BA.5 has given way to two of her own offspring, BQ.1 and BQ.1.1.
But these were replaced this month by the rapid rise of another subvariant, XBB.1.5, which now accounts for an estimated 40.5% of cases nationwide, according to data from the US Centers for Disease Control and Prevention.
Two weeks ago, this particular strain was associated with only about 10% of new cases nationwide. The surge has been particularly pronounced in the Northeast, and officials are investigating whether the new subvariant is causing a huge spike in case rates.
XBB.1.5 is a progeny of XBB which is itself a recombinant of progeny of Omicron subvariant BA.2.
In a blog post, Dr. Eric Topol, director of the Scripps Research Translational Institute in La Jolla, states that “New York is leading the way for what’s happening with XBB.1.5 and it’s not looking good with a significant increase in hospitalizations, particularly among seniors, in recent years Weeks since this variant has prevailed.”
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Hospitalization rates in New York City are higher than in LA County.
An explosive surge in China following the end of the country’s “zero-COVID” policy is also worrying.
“When you have these huge spikes in case numbers, that’s fertile ground for new mutations. And new mutations are scary for all of us,” Ferrer said.
LA County reported 2,359 coronavirus cases per day in the seven days ended Friday, down 9% from the previous week. That’s still more than double the first week of November, but significantly lower than the fall peak of 3,929 cases per day recorded in the first week of December.
On a per capita basis, LA County’s latest coronavirus case rate is 163 cases per week per 100,000 people. A rate of 100 or more is considered high.
The official coronavirus case rate captures only a fraction of the true number of infections because so many people are testing for the virus with rapid at-home tests – the results of which are not reliably reported to the government. Still, Ferrer said she was “relieved that the trendline for cases is declining.”
COVID-19 hospitalizations are also not increasing in LA County, although they are still elevated. As of Thursday, there were 1,249 coronavirus-positive patients in LA County hospitals, more than double the number in mid-November.
LA County recorded 113 COVID-19 deaths in the week ended Friday, down 26% from the previous week.
This fall in cases in late December marks a sharp departure from the trend of the past two years – when increases that began in late autumn steadily increased in early winter, eventually leading to the two deadliest waves of the pandemic.
Almost nobody was vaccinated against COVID-19 in December 2020 as the vaccination campaign was in its initial, very limited phase. The following year, the wildly contagious Omicron variant emerged, infecting a record number of people.
But compared to the last two Decembers, “we have more powerful tools that are being used by more people” to protect against COVID-19, Ferrer said.
Most notably among these is an updated COVID-19 booster shot that better matches the Omicron subvariants now in circulation.
According to a study recently published by the CDC, the newer bivalent booster shot provided additional protection against COVID-related emergency room visits or emergency room visits and hospitalizations compared to people who received only the original vaccine formula.
Unlike previous years, there’s also an ample supply of treatments like Paxlovid, an antiviral pill that was in severe shortages for months after the US Food and Drug Administration approved it a year ago.
More residents who are heeding health officials’ pleas to take precautions — like wearing masks in indoor public places and staying home if they’re sick — could also contribute to the recent drop. Other steps to prevent viral disease transmission include frequent hand washing, disinfecting commonly touched surfaces, and staying home when you are sick.
Ferrer said she is confident that continued exercise of sensible precautions could help limit a second spike into early 2023.
“We’ve all had disruptions from sick family members and friends during the holiday season,” she said. “And if it’s not COVID, it’s the flu or some other really bad cold.” So there’s just a lot of disease going around – a lot of respiratory viruses – and the masks are really helping.”
Influenza and respiratory syncytial virus (RSV) have declined both statewide and in LA County, but remain at relatively high levels. In fact, LA County’s flu positivity rate is still higher than it was in the 2018-19 season.
In a recent interview with The Times Podcast, Dr. Anthony Fauci, President Biden’s outgoing chief medical adviser on the pandemic, said he was “concerned that we might become complacent that we’re not out of this.”
“What worries me most is that we have a good updated booster shot…yet only 14% of the eligible population in this country actually got it. We have to do a lot better,” Fauci said. And the US is underusing anti-COVID drugs like Paxlovid, which are effective in reducing serious illness and death.
As we enter the fourth year of the pandemic, “our destiny is in our own hands,” Fauci said. “If we take the appropriate public health measures to counter further increases, we should be fine. But that will not happen spontaneously. We need to go out and get vaccinated. We need to strengthen ourselves.”
COVID-19 is still taking a deadly toll far exceeding that associated with the flu. Nationally, about 33,000 COVID-19 deaths have been reported in the US since early October, compared to 13,000 flu deaths. LA County estimates there were about 360 flu deaths during the same period, less than half the 764 confirmed number from COVID-19.
“The level of devastation associated with COVID remains high,” Ferrer said. Because only 20% of vaccinated LA County residents age 5 and older received the updated booster shot, Ferrer asked 6 million eligible residents to get the new shot.
Long COVID also remains a public health risk as a certain percentage of COVID-19 survivors suffer from a long-lasting and persistent illness that lasts long after the acute coronavirus infection has ended.
“Some of these symptoms might be annoying but not completely disabling, like chronic fatigue and an inability to stay at the level you were before,” Fauci said. “But for some unfortunate individuals, it can really be quite debilitating. And there are estimates that about a million people in the United States have been unable to return to work due to prolonged COVID symptoms. … You speak of a significant impact on public health.”
Times contributor Gustavo Arellano contributed to this report.