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Covid

Risk levels reflect dramatic lowering of the bar!

The reason so many counties are now categorized as “low” risk for COVID is because the CDC changed the metric it uses to calculate risk. Prior to the end of February 2022, a community was considered at substantial or high risk when COVID case rates exceeded 50 new cases per 100,000 people or 8% positive test rate over the past 7 days. Old metric:

Source: CDC, Indicators for Monitoring COVID-19 Community Levels and COVID-19 and Implementing COVID-19 Prevention Strategies.

The CDC has changed this to 200 cases per 100,000 people and hospitalization levels in the community. With this one change, >95% of the counties inthe U.S. that were at high or substantial were suddenly at low risk. New metric:

Source: CDC, Indicators for Monitoring COVID-19 Community Levels and COVID-19 and Implementing COVID-19 Prevention Strategies.

As of 10 Mar 2022, Wayne County cases were 55.68 per 100,000. The average for the 4 area counties (Wayne, Washtenaw, Oakland, and Macomb) is 78.68. Several weeks ago, these levels would have been considered substantial and now they are considered low.

Historical case rates are only available at the CDC website at the state level. Last year, offices were closed and there were mask mandates at lower case levels than current rates.

Source: CDC, Trends in Number of COVID-19 Cases and Deaths in the US Reported to CDC, by State/Territory.

COVID is not like the flu. The number of people that died in the U.S. from COVID in the month of February 2022 alone (nearly 60,000) exceeds the number of deaths from influenza in this country in a bad year.

Problems with these new metrics

This risk assessment is misleading for several reasons.

1. New cases and positive test rates are under-reported, because far more people are testing at home and these tests are generally not reported to public health officials. It is no longer possible to accurately assess case numbers or positive test rates.

Source: WXYZ Detroit, What you need to know about reporting a positive COVID-19 at-home test.

2. Hospitals do not restrict admissions to county residents.  The number of beds occupied by COVID patients at any given hospital do not accurately reflect the level of infection in the immediate community. The strain on the health care system is a serious problem, but putting emphasis on this aspect of the pandemic and focusing on the level of severe disease does not help individuals assess risk of infection and triggers some sort of action only after many people are more seriously ill and hospitalized.  The guidelines no longer seriously address prevention measures!

See also Science News, How to interpret the CDC’s new mask guidelines.
The Atlantic, The Biden Administration Killed America’s Collective Pandemic Approach

Vaccines are not a guarantee against serious illness

Vaccine effectiveness against hospitalizations from the omicron variant declined to 78% four months after third dose (DOB: Oct 29, 2021). Thus, the risk for hospitalization is now ≥ 22%. This risk is increased for those with health conditions, including moderate to severe asthma and heart disease, according to the CDC.

Source: CDC, Waning 2-Dose and 3-Dose Effectiveness of mRNA Vaccines Against COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance — VISION Network, 10 States, August 2021–January 2022.

Current treatments less effective, becoming less available

Anticlonal antibody treatments developed last year are less effective with the common omicron BA.1 and BA.2 variants.

Source: Univ. Wisconsin, Current anti-COVID pills work well against omicron, but antibody drugs are less effective.

Elimination of COVID aid package in current spending bill thwarts administration’s Covid plan. Funding will end or be reduced for supplies and development of new and existing monoclonal antibody treatments, new vaccines, testing capacity, genomic sequencing, and coverage of testing and treatment for the uninsured.

Source: The Atlantic, The Coronavirus Funding Collapse Is a Disaster.

Source: New York Times, Uncertainty for Biden’s Covid Plan After Aid Is Dropped From Spending Bill.

Susceptibility and risks of long COVID largely unknown

Source: American Journal of Physiology, Cell Physiology, Long-term complications of COVID-19.

Various studies have identified many disorders and impairments associated with COVID which persist for weeks or months. One large meta-analysis determined 54% of >250,000 patients had some symptoms of 6 months past infection. Another found 10 to 25% of patients with only mild initial infections had long COVID.

Other problems have been found in recovered COVID patients that do not suffer from long COVID. For example:

  • Brain scans of 401 recovered COVID patients revealed loss of brain gray matter and total brain volume in all patients.
  • Long-term, whole-body inflammation after infection in an animal model with metabolic changes that were similar to those in Parkinson’s Disease, Alzheimer’s Disease, and ALS.
  • Incidence of heart problems was 58 to 63% higher for people who had COVID over the following year; this rate was 39% for people who only had mild symptoms, and increased rates of cardiovascular problems were also found in some peoplel who were asymptomatic.

Sources: JAMA (Journal of the American Medical Association), Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 InfectionA Systematic Review; Family Practice (journal), Post-acute and long-COVID-19 symptoms in patients with mild diseases: a systematic review; Nature, SARS-CoV-2 is associated with changes in brain structure in UK Biobank, Scientific American, COVID Smell Loss and Long COVID Linked to Inflammation; Scientific American, Even Mild COVID Can Increase the Risk of Heart Problems.

Our ability to predict the effects of variants is poor

The family tree of major COVID variants shows the surprising lack of close relationships between the major variants so far, and the accompanying article at NPR explains how the virus has surprised researchers. The evolutionary distance between some of these variants is larger than expected for the rate of mutations occuring in humans, suggesting a secondary host.

Variants are discovered and monitored through genomic sequencing of positive tests. Most states, including Michigan, sequence less than 5% of samples. This level is considered inadequate to effectively track and respond to variants.

Source: Nature, Omicron blindspots: why it’s hard to track coronavirus variants. See also Chapter 3 in Getting to and Sustaining the Next Normal: A Roadmap for Living with COVID.

Maskless and defenseless

The lack of mask mandates and other dropping of protective measures cannot safely protect workers and others who must interact indoors with strangers. Chapter 5 in Getting to and Sustaining the Next Normal: A Roadmap for Living with COVID, a document by over 50 experts including epidemiologists, pharmacologists, virologists, immunologists, and policy experts, published in March 2022, discusses workplace safety and notes:

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This guide in the same chapter shows that a worker wearing an excellent mask will be exposed to an infectious dose of COVID from an unmasked, infected person within 3 hours.

Commentary

How did we come to accept the loss of nearly a million Americans? A thousand people in this country die each day from COVID, and we’ve now codified this rate as acceptable by modifying the risk metric to permit — encourage — people to act as if this disease no longer exists.

Ed Yong’s piece in The Atlantic, “How did this many deaths become normal?” outlines the cost of “back to normal” in human lives.