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Tuesday, November 29, 2022

California’s COVID-19 incidence is now double that of Florida – what to do about it?

California's COVID-19 incidence is now double that of Florida - what to do about it?

A month ago, in disguised and well-vaccinated California, it looked like the coronavirus was heading for a long winter nap. Gov. Gavin Newsom boasted that the Golden State “continues to lead the nation” as the only state to achieve yellow “moderate” transmission in the CDC community.

But COVID-19 cases no longer fall in California. They have climbed back to the blood-red “high” transmission rate set by the CDC as the highly contagious variant of Delta continues to wreak havoc.

Meanwhile, the virus has died down in the Deep South states, which have canceled orders for masks, opposed vaccination demands, announced lower vaccination rates, and witnessed larger outbreaks over the summer. The incidence in California is now significantly higher than in Texas and twice that in Florida, which, along with the rest of the Gulf Coast, has dropped to the CDC’s “significant” orange transmission rate.

“There are early signs that the national delta recession in the US is over,” said Ali H. Mokdad, professor of health indicators at the University of Washington, who uses a widely used model to predict the course of a pandemic. Currently, 19 states are seeing an increase in transmission of the virus, including several states, such as California, “where transmission previously appeared to be declining.”

And while much of the current coronavirus problems in the Golden State are due to the spread of the virus in less vaccinated and limited inland counties, the Bay Area has not been protected. Most of the Gulf counties that hoped to achieve moderate yellow levels are now stubbornly adhering to orange. Marin and Santa Cruz counties that reached yellow levels returned to orange. San Francisco is the only county marked in yellow.

For Bay Area residents, this has real implications. Local health workers have re-applied home face masks regardless of vaccination status and say they will only cancel the order after their counties fall below orange levels for three weeks, among other conditions.

So why aren’t Golden Staters more rewarded for adhering to health guidelines while the virus gives Dixie a break?

“You pay for your success, which is strange,” Mokdad said. “You managed to control the virus and now you have infections.”

But he and other health experts say it’s not because health recommendations aren’t reliable. Outbreaks burn out as soon as the virus depletes enough new people without immunity to infect them. And people can gain immunity from both the cure for the infection and the vaccines.

With a higher vaccination rate than the southeast, California saw a smaller spike in cases over the summer as the Delta variant spread across the country, mostly infecting those who were not vaccinated. Now that they have recovered, they too have immunity that blocks the way the virus spreads.

“These regions are currently partially protected by high rates of prior contamination,” said Dr. Bob Wachter, head of medical school at the University of California, San Francisco. “But these people, whose immunity is associated with COVID, are not well protected, and their immunity will weaken over time.”

While California’s vaccination rate is comparable to that of many other states, it still isn’t enough to quell outbreaks. Currently, 62% of the total California population is fully vaccinated, compared with 60% in Florida, 54% in Texas, 49% in Georgia, 48% in Louisiana, 46% in Mississippi, and 45% in Alabama. Thus, every third California resident remains unvaccinated.

In California, face mask regulations introduced over the summer to schools across the state and to other public buildings in the Bay Area and Los Angeles also helped contain the spread of the virus. But the unvaccinated in the state – especially those who have not been infected – remain vulnerable.

States in the southeast, hit by a big spike in summer sickness, are doing better now, Mokdad said, simply because their combination of vaccinations and infections leaves them less exposed to the virus than California. But “they got it at a price.”

There are other factors as well. Hot and humid summers in the southeast force people to visit air-conditioned rooms where the virus spreads easily, while Californians enjoy mild weather on the waves and on the sand. But the autumn chill is now attracting Californians too.

Moreover, immunity weakens over time due to vaccination or infection. Californians who rushed to line up for vaccines in early spring are now wondering how long their protection will last.

Booster shots are generally approved for the elderly, immunocompromised or people at high risk of infection to help protect them from infection. But among those over 65, only 30% in California received an additional injection, similar to 29% in Texas and 27% in Florida.

Mokdad said immunizing newly eligible children and unvaccinated adults, vaccinating and encouraging or requiring a mask could reduce the projected rise in infections in the winter. Will people heed the call?

“California has been doing very well over the past few months, but we still have too many unvaccinated people,” Wachter said. “People spend more time inside and become more active, and the camouflage is reduced.”

Combined with a weakened immune system and low consumption of boosters, he said, “the end result is that we stalled our improvements both nationally and in California, and we are likely to see significant growth soon.”

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