COVID on the rise as new variants take over

  • by Liz Highleyman, BAR Contributor
  • Tuesday July 5, 2022
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San Francisco Health Officer Dr. Susan Philip noted that COVID cases are on the rise thanks to new variants. Photo: Rick Gerharter
San Francisco Health Officer Dr. Susan Philip noted that COVID cases are on the rise thanks to new variants. Photo: Rick Gerharter

COVID-19 cases are rising in San Francisco and nationwide as more transmissible coronavirus variants make up a growing share of new infections. Hospitalization of people with COVID is also on the upswing, but deaths remain low in the highly vaccinated Bay Area.

"People should not forget about COVID," San Francisco Health Officer Dr. Susan Philip told the Bay Area Reporter in a June 30 phone interview. "It's a challenging time because cases remain high. We're watching the newer subvariants, BA.4 and BA.5, which are increasing as a proportion of viruses sequenced in California. What we're watching most closely is hospitalizations."

COVID cases plateaued in May and June after reaching their highest-ever peak in January, but the latest numbers from the San Francisco Department of Public Health show a recent upturn. The provisional new case count on June 27, after the month's Pride events, was 596, the highest since mid-May. The city's test positivity rate — the proportion of tests that come back positive — is around 15%, but health officials acknowledge this is an underestimate because many people now test at home and don't report their results.

This puts San Francisco and the rest of the Bay Area — along with much of California and about 20% of the country overall — in the Centers for Disease Control and Prevention's "high" COVID-19 community level category. (California now follows the CDC and no longer uses a colored tier system.)

Experts attribute the rise to novel coronavirus omicron variants, dubbed BA.4 and BA.5, that now account for a majority of cases in the U.S. The new variants are both more easily transmitted and better able to escape immune protection from vaccination or prior infection, leading to a growing number of breakthrough infections and reinfections.

As of June 28, DPH reports 114 people were hospitalized with COVID, up from 20 in early April but down from nearly 300 in mid-January. Of these, 16 required intensive care. Eleven deaths were reported during the month of June.

San Francisco's high vaccination rate is a key factor in the low rates of severe illness and death, officials said. DPH reports that almost 8 million city residents have been vaccinated, with more nearly 90% of those ages 5 and older having completed their initial vaccine series.

On June 17, the federal Food and Drug Administration authorized the Pfizer and Moderna vaccines for children aged 6 months to 4 years old, and the CDC recommended vaccination for this age group the following day. Compared with the country as a whole, Bay Area parents have been eager to get their kids vaccinated as soon as possible. Three-quarters of children ages 5 to 11 have been vaccinated in San Francisco versus about a third nationwide. (DPH has not yet updated its online vaccine tracker to show how many kids in the youngest age group have gotten their first shot.)

Keeping up to date with boosters further reduces the risk of severe illness and death, especially for older individuals, because vaccine protection can wane over time. Vaccines and boosters also reduce the risk of long COVID — symptoms that persist for months or years after acute infection — although it is unclear by how much.

Currently, everyone ages 5 and older is eligible for a first booster, those over 50 are eligible for two boosters, and immunocompromised people can get five shots. Immunocompromised individuals who don't respond well to vaccines may benefit from pre-exposure prophylaxis using the monoclonal antibody cocktail Evusheld. People at risk for severe illness can be treated with the antiviral drug Paxlovid, which cuts hospitalization and death by up to 90%.

Many experts predict that new coronavirus variants will lead to ongoing waves or a steady slow rise in cases, though some expect that successive waves will be smaller and less deadly thanks to increasing population immunity. On June 30, the FDA advised vaccine manufacturers to update their vaccine formulations to include the BA.4 and BA.5 variants in anticipation of a fall surge.

Health recommendations

The CDC recommends that people in communities with high COVID levels should wear face masks indoors in public, stay up to date with vaccines and boosters, and get tested if they have symptoms.

San Francisco health officials have not reimposed a mask mandate or other legal restrictions. San Francisco and other Bay Area counties lifted their latest mask mandate on February 16. Alameda County briefly reinstated an indoor mask mandate in early June but removed it three weeks later.

Nonetheless, the health department strongly recommends wearing a well-fitted mask indoors when community transmission is high. (Loose-fitting cloth and surgical masks appear to provide minimal protection.)

"We have no immediate plan to return to masking requirements, but there's still a strong recommendation. Not having a legal requirement is different than saying it's not a good idea," Philip told the B.A.R. "When I'm in public spaces right now, I am wearing a mask, and I would really recommend others do that as well."

Philip noted that masks requirements and other restrictions are most effective if implemented on a regional basis, and DPH continues to consult with partners in other Bay Area counties and across the state.

"A legal requirement really requires an extraordinary risk of population-wide severe illness in order to take that step," she said. "If something changes with a variant in the future, we will relook at the issue of health orders. We've been very aggressive in San Francisco, and we will continue to use orders when they're appropriate."

While many San Francisco residents continue to heed the health department's masking advice, the appetite for further precautions appears to have waned, and indoor dining, large gatherings, and travel have returned to near pre-pandemic levels.

People who want to further minimize their COVID risk can avoid indoor and crowded outdoor gatherings, meet with people outdoors, and open windows to improve ventilation. Health officials urge people to stay home if they're sick, and self-testing before events can reduce the likelihood of transmission.

"COVID remains a challenge, but we have a lot of tools, vaccines being most the important," Philip said. "People should continue to think about getting their boosters when they're eligible, and if they have young children, we encourage people to talk with their providers about vaccinating them."

"People who would like to avoid infection because of their health status or that of their family really should think about high-quality masks," she added. "We're talking about N95s, KN95s — respirator-type masks. That's really the best way of protecting oneself right now."

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