Three Things Thursday
Wrapping up 2022 with all the news about COVID
Three Things Thursday highlights three things I am paying attention to as an epidemiologist each week.
Hoping these posts help to educate and empower you
to be healthy and create healthy communities.
Today’s Three Things Thursday — wrapping up 2022 with news about COVID-19.
And just to be clear — news about COVID will continue to be in the headlines throughout the new year.
Was I hoping 2023 would be quieter? YES.
Was I hoping things would settle down and become more predictable? YES.
But the reality of our next normal is we need to create healthy communities (and adequately fund public health) that can identify and respond to public health threats.
COVID — updates from China & the United States
As expected, the (abrupt) end to China’s Zero COVID policy has resulted in an explosion of cases, hospitalizations, and deaths. There are also reports of pharmaceutical shortages, overwhelmed crematoriums, and disruptions to everyday life because the virus is spreading so quickly.
In the midst of the surge in cases, the National Health Commission in China has STOPPED (yes, you read that correctly) reporting the number of cases, hospitalizations, and deaths from COVID. The global public health community is therefore relying on anecdotal reports to determine the state of disease spread in China (which is home to nearly one-fifth of the world’s population). It is estimated that somewhere between 5000-10,000 individuals are dying each day from COVID in China. And there are reports that between 500,000 and 1 million new cases are being diagnosed daily (yes, every day).
With the surge in cases, several countries, including the U.S., have issued new travel requirements for individuals coming from China (see below). Additionally, CDC is expanding its Traveler-based Genomic Surveillance Program (TGS) in order to sequence the virus’s genome and identify any new variants.
Given that China is not collecting/sharing any epidemiological data, the TGS Program is essential in order to identify any new variants that evolve during the explosion of cases in China.
And as case counts explode in China, there is a new subvariant of concern in the U.S. — XBB.1.5.
XBB.1.5 is making those of us in the public health community worried — based on data from New York, XBB.1.5 is growing exponentially (an R-naught of ~2). Additionally, the viral count in wastewater throughout the Northeast is increasing.
What does this all mean?
COVID hasn’t gone away. And isn’t going away anytime soon.
What should you do?
Get vaccinated.
We all need to receive our COVID-19 booster (3-4 months after your last shot or most recent infection). The new COVID booster is highly effective against severe illness and death (more below).Stay home when you are sick.
There is no such thing as just a sore throat or just a little cough. A cough, sore throat, headache, fever, and runny nose are all symptoms of the three diseases behind this tripledemic. Regardless of what virus is causing your symptoms, it is best to stay home until you have been symptom-free (without medication) for at least 48 hours. And when you return to work/school, wear a mask for a couple of days to prevent others from getting ill.
Wear a mask when necessary (not always).
Masks can be worn as a form of protection or prevention. If you want to avoid exposure to a respiratory virus, a well-fitting n95 or kn95 mask will reduce your exposure to virtual particles and decrease the likelihood of you becoming sick. If you have to be in a crowded indoor environment with poor air circulation, a mask will provide you with protection. Additionally, an individual can wear a mask to prevent others from contracting their illness. I highly recommend wearing a mask for ~5 days after you’ve been sick to ensure you are not sharing your illness with others. And if you cannot stay home while you are symptomatic (maybe you don’t have paid sick leave), please wear a well-fitting mask at all times and do not take it off while you are around others.
I also highly recommend wearing a mask if you are flying in the coming months. Wear your mask as you pass through security, on the jetway, and as much as possible while you are on the plane.
New Requirements for Individuals Traveling from China
Beginning January 5, 2023, all passengers (ages 2 and older) arriving in the United States from China, Hong Kong, and Macau will be required to show the airline a negative COVID-19 test result before they depart. Specifically, passengers are required to have a PCR or antigen self-test results no more than two days before their departure. All self-tests must be administered or monitored by a telehealth service or a licensed provider and authorized by the FDA (or relevant national authority). The new requirement also applies to individuals flying to the United States from Seoul, Toronto, and Vancouver who have been in China in the last 10 days.
The goal of the testing program according to the CDC is to —
“slow the spread of COVID-19 in the United States during the surge in COVID-19 cases in the PRC (People’s Republic of China) given the lack of adequate and transparent epidemiological and viral genomic sequence data being reported from the PRC.”
But the new policies will likely only delay the spread of disease worldwide.
Specifically, the requirement to test before traveling will keep individuals who have COVID-19 and are symptomatic at home and out of the airports (where they could share the virus with individuals traveling worldwide). But the 48-hour window between when the test is performed and when an individual gets to the airport allows for a lot of (potential) exposure and the potential for individuals to get sick during that window of time is large — so contagious passengers will be boarding those planes.
Additionally & unfortunately, this is a U.S. travel requirement and not a global requirement. Only Japan, Taiwan, and Italy require negative COVID tests for passengers coming from China. Individuals who have been in China, Macau, or Hong Kong and are traveling elsewhere will still be in the airports and exposing passengers who are flying into the U.S.
And since the requirement does not go into effect until January 5, individuals who have COVID are free to travel anywhere for the next seven days.
The requirement to test will not keep all asymptomatic, but contagious passengers from traveling. Antigen self-tests are known to produce false negatives (a negative COVID test result from an individual who actually has COVID), especially among individuals who do not have any symptoms. In my mind, the best-case scenario is that 50-60% of asymptomatic COVID cases test positive and are required to stay home. Upwards of 40-50% of asymptomatic patients will test negative and will be allowed to travel.
We should expect the uptick in cases in China to result in an uptick in cases in the U.S. And it would not surprise anyone if a new variant arises as a result of the current wave of cases in China.
COVID — one of the leading causes of death in 2022
Based on mortality data collected through September 2022, COVID-19 is on track to be the third leading cause of death in the United States for the third year.
And in January and February of 2022, COVID was the number one cause of death in adults ages 45-84 in the United States.
It is estimated that ~234,000 deaths from COVID (since June 2021) could have been prevented by vaccines. Individuals who are unvaccinated represent a small share of the population, but a majority of COVID deaths. The majority of individuals dying from COVID are unvaccinated.
The message here should be clear (but it is worth repeating) — GET VACCINATED.
As we head into 2023, COVID will continue to be part of our everyday conversation. Do you have any questions?
And be sure to share this update with your friends and family because (to quote Will McAvoy from The Newsroom) —
The first step in solving any problem is recognizing there is one.
Thanks Becky. We’re finally getting through Covid infections. Whew. Let’s hope for a happy 2023. The best to you and your family.