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THE OTHER SIDE: COVID-01.24

Be careful out there.

Yes, it is here. But you may not know it. We have gone from misinformation and disinformation to limited information. From fake news to almost no news—news you now need to diligently search for. It used to be fairly easy to find out the status of COVID-19 here in the United States. Johns Hopkins had a reliable database. The New York Times published its weekly COVID tracker.

Here in Berkshire County, the Tri-Town Board of Health had its COVID Dashboard. Berkshire Health Systems offered an accounting of the COVID cases they were treating. Yes, all the places I used to go to find out about COVID in our larger neighborhood are no longer posting figures about cases or hospitalizations or, as my Hungarian grandmother used to say fairly regularly, “God Forbid, COVID deaths.”

My point is that while those whose job it is to deal with patients with COVID know their cases are real and require treatment, the rest of us are often unaware the epidemic is still with us.

The Great Barrington Health Department offers advice about isolation and masking once you have gotten COVID, but it doesn’t seem to acknowledge the latest surge or advise residents to actively take precautions:

Great Barrington’s “COVID-19 Surveillance and Guidance” as of Jan. 16, 2024. Highlighting added.

There is one major problem with this advice: It reassures those who are asymptomatic. In reality, a very significant portion of those who are asymptomatic for COVID are indeed infectious and can easily spread the virus.

A 2021 study, “Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis,” found:

By analyzing over 350 papers, we estimated that more than one-third of infections are truly asymptomatic. We found evidence of greater asymptomaticity in children compared with the elderly …

Unaware of their risk to others, individuals with silent infections are likely to continue usual behavior patterns …

Higher representation of asymptomatic SARS-CoV-2 infections among younger people has grave implications for control policies in daycares, schools, and universities. Settings with close, extensive contact among large groups of younger individuals are particularly susceptible to superspreader events of COVID-19 which may go undetected if surveillance focuses on symptomatic cases. (Emphasis added.)

As a 2022 study, “Percentage of Asymptomatic Infections among SARS-CoV-2 Omicron Variant-Positive Individuals: A Systematic Review and Meta-Analysis,” reveals:

[T]he pooled percentage of asymptomatic infections was 32.40 [percent] among SARS-CoV-2 Omicron variant-positive individuals. The people who were vaccinated, young (median age < 20 years), had a travel history, and were infected outside of a clinical setting (community infection) had higher percentages of asymptomatic infections. Screening is required to prevent clustered epidemics or sustained community transmission caused by asymptomatic infections of Omicron variants, especially for countries and regions that have successfully controlled SARS-CoV-2.

… Despite prevention and control measures taken globally to detect and track infected individuals, the transmission induced by asymptomatic individuals remains a dramatic challenge to the global response to COVID-19 … Previous studies showed that the viral load in the upper respiratory system of asymptomatic infected persons was similar to that of symptomatic persons and could cause rapid, insidious spread of COVID-19. (Emphasis added.)

This reality makes it even more important that we have the most up-to-date and accurate portrait of the number of COVID cases and hospitalizations in the community. Despite recent trends to minimize the risks, to put COVID behind us, and to no longer require successful measures like masking and social distancing, it is difficult for people to accept the critical reality that we haven’t yet beaten COVID.

Here is a simple example of what we have instead. The once-a-week New York Times COVID tracker for the Berkshires tells us:

The New York Times’ COVID tracker for Berkshire County, Jan. 11, 2024. Highlighting added.

A shockingly small percentage of us, just 33 percent, have gotten COVID boosters. And here is The New York Times’ graph for COVID hospitalizations over time since 2020:

The New York Times’ charts showing how COVID trends have changed in Berkshire County as of Jan. 11, 2024. Highlighting added.

If only the flat line towards the end of 2023 actually represented zero cases, instead of what The New York Times tells us: “The data in these charts has been archived and they are no longer being updated.”

Meanwhile, my friends in healthcare tell me there are increasing cases of respiratory disease in the Berkshires, including a new surge of COVID. And it seems that everyone I talk to these days has either recently gotten COVID and has taken Paxlovid or knows someone who has it now.

So how bizarre is it that so many of us have pushed to the side the awareness that a contagious virus that, as WebMD reminds us, spreads from person to person via droplets or aerosols through the air? Because we are no longer taking precautions, COVID is once again surging. “When an infected person coughs, sneezes, or talks, droplets or tiny particles called aerosols carry the virus into the air from their nose or mouth. Anyone who is within 6 feet of that person can breathe it into their lungs,” says WebMD. You can add the coughs of the asymptomatic but infected. So, yes, it is annoying to mask, but given the rising number of cases, why aren’t more people doing the most simple thing of all, masking? And why does it take a new mini-epidemic for our healthcare institutions to better protect their staff by insisting patients and visitors mask up?

And all the while the most critical data is no longer being updated. The Southern Berkshires Public Health Collaborative serves a constellation of towns, including Alford, Great Barrington, Lee, Lenox, Monterey, Mount Washington, New Marlborough, Otis, Sandisfield, Sheffield, Stockbridge, and Tyringham. But the last posted summary of COVID cases I could find is from their January–March 2023 quarterly statement:

Southern Berkshire Public Health Collaborative’s quarterly report for January–March 2023. Highlighting added.

WebMD sensibly adds: “By understanding how coronavirus spreads, you can take the right steps so you don’t get sick and infect others.” Clearly, we are failing to do as much as we ought to. And if you think you can go about your life the way you once did before COVID, imaging that the odds are in your favor and you can outfox the virus. Well, according to Our World in Data, an awful lot of folks around the world are losing that bet:

Global cumulative confirmed COVID-19 cases, Our World in Data. Highlighting added.

As of the last day in 2023, the World Health Organization (WHO) estimated that 773.82 million people had contacted COVID-19. Yes, we are talking 773.82 million cases between March 1, 2020 through December 31, 2023. And during that time, 7.01 million people died.

Global cumulative confirmed COVID-19 deaths between March 1, 2020 and Dec. 31, 2023, Our World in Data. Highlighting added.

And what about here at home in the United States? According to Our World in Data, there have been 103.44 million confirmed cases in the United States from January 5, 2020 to January 7, 2024.

Cumulative confirmed COVID-19 cases in the U.S. from Jan. 26, 2020 to Jan. 7, 2024, Our World in Data. Highlighting added.

The cumulative chart shows us we have suffered 1.16 million deaths from COVID from March 1, 2020 to January 7, 2024:

Cumulative confirmed COVID deaths in the U.S., Our World In Data. Highlighting added.

As I continued my search for information, I moved from the international to the national to the state, where there were 4,790 confirmed COVID-19 cases and a total of 5,955 confirmed and probable cases during the week of December 24, 2023 to December 30, 2023. And during that same period, there were 44 confirmed COVID-19 deaths and a total of 52 confirmed and probable deaths.

Having failed to find useful data for Great Barrington from The New York Times or our own health department, I turned to the Commonwealth’s database. There have been 80 confirmed COVID cases this season in Great Barrington.

As for the practical implications of these statistics, the CDC notes: “COVID-19 activity is currently high. COVID-19 infections, hospitalizations, and deaths have increased in recent weeks. JN.1 may be intensifying the spread of COVID-19 this winter.”

The CDC explains that COVID-19-related illness requiring medical attention, such as an emergency department visit, rates remain 21 percent lower than the same time last year. And the number of COVID-19 hospitalizations are 22 percent lower, and the percent of total deaths associated with COVID-19 are 38 percent lower than last year.

But, importantly, the CDC illustrates that between November 11, 2023 and December 30, 2023, there were significant increases in emergency department visits, hospital admissions, and COVID-19 deaths:

The CDC’s COVID-19 update for the U.S., Nov. 11, 2023 to Dec. 30, 2023. Highlighting added.

Most of us are unaware of the changing nature of the COVID-19 virus, but the CDC focuses on the most recent implications of the ascendance of the JN.1 variant:

COVID-19 Activity Increases as Prevalence of JN.1 Variant Continues to Rise, CDC. Highlighting added.

It is interesting to see how quickly the JN.1 variant spread to become the most prevalent of the COVID variants. JN.1 is seen below in purple, and you can see how rapidly JN.1 increased its percentage of the COVID strains being found:

The CDC’s data on COVID variants proportions, Sept. 30, 2023 to Jan. 6, 2024. Highlighting added.

Most recently, here in Berkshire County, the increasing numbers of respiratory disease cases has resulted in the renewal of mask mandates for employees of Berkshire Health Systems. WAMC radio reports:

Berkshire Health Systems cites a spike in respiratory illness in the community. Wastewater tracking data shows that COVID-19 cases are on the rise in Massachusetts again this winter, contributing to a high threat level for indoor activity in combination with other airborne diseases like the flu and RSV. The surge comes amid dismal rates for the latest COVID vaccine in Massachusetts, leaving many residents vulnerable to the disease that’s killed over a million in the United States since the 2020 outbreak. The CDC recorded a 10 [percent] spike in such deaths in late December, and an almost 17 [percent] increase in hospitalizations. (Emphasis added.)

With decreases in the rate of testing, testing wastewater has become increasingly important. The CDC notes: “Wastewater (sewage) can be tested to detect traces of infectious diseases circulating in a community, even if people don’t have symptoms. You can use these data as an early warning that levels of infections may be increasing or decreasing in your community.”

The CDC explains how the process works:

  1. People with certain infections (such as COVID-19), can shed pieces of the virus or bacteria when they use the bathroom, shower, wash hands, or launder clothing, even if they don’t have symptoms.
  2. These pieces of virus or bacteria travel from the toilet, sink, shower, or other drain through the sewage system.
  3. Before wastewater is treated, wastewater operators take samples to send to the laboratory.
  4. Laboratories test the wastewater sample to detect and report on the different types of infections that are circulating in a community. This information is available in as little as 5 to 7 days after waste enters the sewer.
  5. Public health officials use wastewater data to better understand disease trends in communities and make decisions, such as providing guidance on how to prevent infections or increasing testing or vaccination options.

Here in Massachusetts, the CDC reports that in the two sites reporting wastewater levels for COVID, the viral activity level is “very high.” Unfortunately, we don’t check wastewater for COVID in Great Barrington.

Another important indicator, according to the Massachusetts Department of Public Health, is the fact that during the week of December 31, 2023 to January 6, 2024, 8.9 percent of emergency department (ED) visits to hospitals in Berkshire County were related to acute respiratory disease.

While Berkshire County’s percentage of ED visits for respiratory illness is markedly lower than other counties in the state, when it comes to hospitalization for acute respiratory illness, including COVID-19, our percentage of 30.5 percent is one of the highest.

The percentages by county of hospital admissions for respiratory illness, Massachusetts Department of Public Health. Highlighting added.

Perhaps one of the most valuable sources for information is the World Health Organization (WHO). Their recent summary from December 22, 2023 was succinct and very concerning, especially the worldwide increase in hospitalizations and ICU admissions:

WHO’s COVID-19 epidemiological update, Dec. 22, 2023. Highlighting added.

On January 12, 2024, WHO Epidemic and Pandemic Preparedness and Prevention Director Dr. Maria Van Kerkhove held a video press conference. As Fortune Magazine reported, Dr. Kerkhove made the remarkable and frightening claim that “COVID levels are two to 19 times higher than numbers being reported around the world.”

Dr Maria Van Kerkhove, the WHO’s head of the Emerging Diseases and Zoonosis Unit and Technical Lead for COVID-19. Photo courtesy of the WHO.

Dr. Kerkhove went on to explain:

[T]he numbers of deaths have reduced drastically since its peak a couple of years ago but we still have about 10,000 deaths per month and that’s only data from 50 countries — of the 10,000 deaths reported in December over half were reported from America and a thousand from Italy so we are missing deaths from countries around the world …

I am going to quote extensively from her press conference because I don’t believe many people have absorbed the critically significant reality that Dr. Kerhove illustrates: that while we are experiencing a reduced impact from COVID, “there is far too much burden in countries from Covid when we can prevent them with adequate tests with adequate access with use of antivirals with appropriate clinical care, medical oxygen, and of course vaccinations.” She continues:

Covid is still a global health threat and it’s causing far too burden and we can prevent it. So we’re seeing impact on a smaller scale compared to previous waves but now the preventable burden of Covid 19 is adding to the burden of other respiratory diseases as opposed to other years when we had public health and social measures which were in place and so we have to consider Covid with flu and other pathogens.

And here’s why we’re still at a pandemic: 1) The virus continues to evolve. We do not yet have a predictable pattern or seasonal pattern with Covid. There are basically two groupings of viruses that are circulating right now. We have the XBB sublineages and we have the BA286 sublineages: XBB is going down and XBB most noticeably JN.1. JN.1 represents 57 [percent] of the global sequences …

2) … Despite reduced reporting from countries the virus is still infecting, it’s re-infecting. It’s killing. It’s causing suffering from acute disease represented by people in hospitals, and right now we estimate that there are hundreds of thousands in hospitals for Covid. We have limited data around the world. In fact, the data that we have on hospitalization only comes from 29 countries out of 234 countries and territories, Data on ICU admissions only comes from 21 countries out of 234 … So we’re worried about the acute disease, but we’re also worried about post-Covid conditions … We have estimates from some recent meta-analysis estimates that about 6 [percent] of systematic infections who’ve been diagnosed with Covid will result in post-Covid conditions and the burden of post-Covid conditions affects multiple organs — it’s very debilitating to persons who suffer from it, anywhere from 4 months to 12 months and even longer.

And we don’t know the long-term impact of repeat infections. Separate to post-Covid conditions people are getting re-infected – You’re getting re-infected. I’m getting re-infected. I may not know it … we don’t really know necessarily how often we’re getting re-infected and our concern is in five years or ten years from now or twenty years from now what are we going to see in terms of cardiac impairment or pulmonary impairment or neurologic impairment. We don’t know. We don’t know everything about this virus. It’s year 5 of the pandemic and I know it feels a lot longer but there’s still a lot we don’t know about it and we’re worried about the acute effects, post Covid. (Emphasis added.)

Finally, here is a recent tweet from Dr. S. Blishteyn, a neurologist and director of The Dysautonomia Clinic, with some critical insight into Long COVID:

Dr. S. Blitshteyn’s Jan. 17 tweet on the medical complications resulting from long COVID. Highlighting added.

We are so very lucky to have doctors like Dr. S. Blitshteyn and organizations like the World Health Organization continuing to provide a wide range of responses to the ongoing COVID-19 epidemic. As more and more institutions cut back on providing accurate information about what is happening with COVID, it is so important that the World Health Organization is monitoring and providing information about daily case numbers and trends around the world.

Be careful out there.

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