March 17, 2022

Living with COVID: Week 1

BY Dee Pekruhn

This Week’s Highlights:

Volume Zero: Air Date 3.14.22. “The Move from Pandemic to Endemic”

Today, I’d like to share highlights with you from an American Medical Association webcast entitled, The Move from Pandemic to Endemic. Published last week, this 22 minute video features Dr. Stephen Parodi, executive VP of external affairs at The Permanente Federation. Here’s a short summary of the Q&A with Dr. Parodi; you can watch the entire video via the link in our handouts.

Q: What does “endemic” mean?

· The disease is still around but at a level that doesn’t cause significant disruption in daily lives

· Can be at different levels of “endemic.”

· What’s different about COVID is that we have a choice of how high a level to set, based on how we manage the disease. Depends on the practices we put in place – testing, vaccination, isolation, quarantining.

We saw this with Omicron – the vax population, people have mild or asymptomatic disease. It’s within our grasp – if people get boosted, we can move towards lower levels of endemicity. The hope is that vax based immunity will continue to provide broad immunity against variants.

Q: How will we know when we meet the endemic stage?

CDC’s recent guidance gives a pathway. Shifting to looking at severity of disease is an important move – based on hospitalizations and ICU admissions. This follows the science. A measure of endemicity is an evaluation of how many people suffer severe disease at a given time. If we see an increase, we need to take action – if not, similar to flu response.

Vaccine and natural based immunity both have parts to play. Vaccine is broad based immunity and protects against severe disease. Natural immunity does give some narrow immunity to the variant that infected them. Over time, we are achieving a more immune population. Some areas are up to 90% vaccine-based immune.

Q: Children under 5 – how important is it that this population be vaccinated?

Critically important both for those children themselves as well as their parents and the greater community.

Q: What is the future of vaccine mandates?

This played a huge role in the healthcare sector and remain in place. This has been important. It has helped prevent breakthrough infections. Employer mandates have also helped. Hard to say if I see this in the future. We have to follow the science and see what the data shows on boosters. Make a decision at that point in time.

Q: Can you describe what is happening in California?

California has shifted to an endemic approach; this is the time to have that conversation about moving to an endemic state. Public health boils down to local decisions. A state like CA taking those steps and encouraging collaboration between agencies is critically important.

Testing – has melded community health and basic medical care. Time to move beyond that. In CA, they will do surveillance testing on waste water to look for PCR positive samples. As opposed to requiring people to get tested. Helps especially with shortages of available tests. A more sustainable approach.

Making sure therapeutics and masks are available when we need them, and having thresholds to implement them or roll back from them.

Q: The availability of therapeutics – how does that help power this shift?

We must have more therapeutics available, not just monoclonal antibodies. People will still get ill in an endemic setting and people need to have them before sick enough to require hospitalization. We need to work nationally with suppliers to make sure we have enough available for this distribution scenario. Possibly stockpiling to anticipate variants and resurgence.

Q: What role do large health systems have to play in the shift?

The importance of messaging what endemic means and what we are doing with isolation quarantine testing therapeutics. Responsible to combat the misinformation. Unified voice with public health. Physicians need to be on social media to get our voice out there.

Informing public policy – at national and state levels, state medical associations. Have tremendous influence.

Q: How are you preparing for the shift operationally as an organization?

This is a massive shift. Now we are talking about living with COVID, a mind-shift. Not a flip of the switch. Conversations at all levels of the organization, talking through people’s concerns. And talk through the reasoning for making the shift to endemic management.

Q: Constant learning, new science and driving change. Are people hanging on?

Let’s be honest, people are fatigued and tired of all the changes. We’ve been committing to trying to normalize the recommendations, not going for perfection with the latest changes, but follow the generalized evidence and stick with some general guidance. People need stability and recommendations they can embrace. This is part of our messaging internally and to our public health colleagues.

Mental shift about risk – people are bad at assessing risk and too much emphasis on risk of treatment rather than risk of disease. How do you advise about risk assessment in a pandemic?

There’s always a spectrum of people who are ready to loosen the restrictions and those who are not. Have a conversation of the relative risk of getting COVID from not wearing a mask, or getting into a car accident. Comparing the risks, people are able to better assess their comfort level. Risk assessment needs to be relatable. Accessible and understandable.

Q: Do you feel prepared if there’s a new variant? How to shift quickly back to pandemic mode?

We need to be better prepared, big learning from this pandemic. Hopefully the PREVENT Act will move forward – better prepared public health infrastructure. We are re-evaluating what we need to spring into action. Now we have experience and can anticipate. These are the conversations we have – how can we turn on the pandemic response as a part of normal health care response rather than as an emergency response.

Volume One: Air Date 3.16.22. “A Return to Caution”

Just when all things COVID seem to be looking up, the story from U.S. wastewater testing and from the UK and Europe tells us that we should still be cautious.

About a third of wastewater sampling sites across the U.S. are showing an uptick in COVID-19 cases, according to the CDC. From Feb. 24 to March 10, more than a third of 401 wastewater sampling sites showed an increase of 10 percent or more in coronavirus levels. Sixty-two sites showed an increase of 1,000 percent or more, while 48 increased anywhere from 100 percent to 999 percent.

Perhaps even more concerning is that two weeks after the United Kingdom dropped its remaining COVID-19 mitigation measures that country is seeing cases and hospitalizations climb. COVID-19 cases were up 48% in the U.K. last week compared with the week before. Hospitalizations were up 17% over the same period.

The UK’s daily case rate is still less than a third of the omicron peak, but cases are rising as fast as they were falling just two weeks earlier, when the country removed pandemic-related restrictions.

Daily cases are also rising in more than half of the countries in the European Union. They’ve jumped 48% in the Netherlands and 20% in Germany over the past week. The situation in abroad has the attention of public health officials for two reasons: First, the U.K. offers a preview of what may play out in the United States, and second, something unusual seems to be happening. In previous waves, increases in COVID-19 hospitalizations lagged behind jumps in cases by about 10 days to two weeks. Now, in the U.K., cases and hospitalizations seem to be rising in tandem.

They have pegged the rise in cases to a combination of three factors:

  1. The BA.2 variant, which is more transmissible than the original omicron
  2. The opening of society, with people mingling more indoors without masks
  3. Waning immunity from vaccination or prior infection

BA.2 has been growing steadily in the U.S. and is currently at about 23%. BA.2 now accounts for more than 50% of cases in the U.K. and several other European countries. Although the U.K. may provide a glimpse of the future, there are differences that may affect how BA.2 plays out in the United States. In the U.K., 86% of eligible people are fully vaccinated, and 67% are boosted, compared with 69% of those eligible vaccinated and 50% boosted in the U.S. So, let’s be aware that this is an ever-changing situation.