Don’t Celebrate Too Early
It was one of those weeks. I really don’t remember what I did. I think that when a bunch of letters come in (content!), one has a tendency to take the foot off the pedal. Especially when they’re good letters. So thank you to the Sheet community for picking up the slack.
As a counterpoint to much in this paper regarding getting towns and businesses open, here are a few notes of dissent.
Inyo County Public Health Officer James Richardson told Inyo Supervisors Tuesday that if one of these new, more infectious Covid strains takes hold, there is exponential impact.
If a strain is 50% more infectioous, he said, you’ll have twice the number of cases in two weeks and a four- to five-fold increase in cases within a month. This courtesy of Harvard epidemiologist Marc Lipsitch, one of the experts Richardson says he relies upon.
The problem is the viral load in a new, more infectious strain. Places that may have been generally safe previously (like the grocery store, if everyone’s masked), may not be as safe now, said Richardson.
As it stands, “Transmission risk is 20 times higher in an indoor setting,” he said,
And so the issue you have, as Supervisor Jeff Griffiths said, is that the rescinding of the stay-at-home order sends a confused message. People will thinking the lifting of the order means its time to party – and the Super Bowl is just around the corner.
“Gatherings are a huge issue,” said Richardson. “People are doing what they want and ignoring basic guidelines.”
From Lipsitch courtesy of a January 8 story which appeared on vox.com: A 50 percent more transmissible virus, Lipsitch says, means “we need to cut our contacts down by another third compared to the already strong restrictions [already in place] in order to get back to the same place where we were.”
Richardson isn’t the only one. Another public health official, speaking on condition of anonymity, said, “You can learn a lot by looking around the globe … by getting your head up and looking down range once in awhile.
Germany, Sweden, Denmark, Israel, the U.K. … their numbers are down but they’re all extending [strict]public health orders. It looks like the water’s receding, but don’t be fooled. There’s a big wave coming.”
A critical issue for the United States, said this official, is that we have “some of the worst genomic surveillance on the planet.”
What is genomic surveillance? It’s essentially the detective work scientists do to track a virus and its various mutations.
The first two paragraphs of an article which appeared two weeks ago on Nature.com:
2021 is shaping up to be the year of COVID-19 variants. In the past two months, scientists have identified several fast-spreading variants that have prompted government restrictions in many countries — and new variants are being detected more frequently.
The pandemic has ushered in an era of genomic surveillance in which scientists are tracking genomic changes to a virus at a speed and scale never seen before. But surveillance is patchy globally, particularly in the United States, which has the world’s largest COVID-19 outbreak, and in many low- and middle-income countries. Scientists warn that worrying variants are probably spreading undetected in these regions.
… The number of SARS-CoV-2 genomes that the United States has shared on GISAID (a non-profit online database) is less than 0.3% of its total number of COVID-19 infections. That compares with nearly 5% for the United Kingdom, 12% for Denmark, and almost 60% for Australia … This is a problem because the more a virus circulates, the more opportunities it has to change.”
It would be one thing if the pace of vaccination was proceeding like gangbusters. It’s not. Inyo County has 8,000 people classified in its Tier 1B which is getting vaccinated now. Inyo County Health and Human Services Director Marilyn Mann said the county is receiving 100-300 vaccine doses per week. That’s a lousy equation.
Infectious disease expert Michael Osterholm, Director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said Tuesday in an interview with Anderson Cooper that he fears the United States is about to enter its “darkest weeks” of the coronavirus pandemic yet. Specifically, the next six to fourteen weeks.
Richardson’s best advice: Staying away from people is 100% effective.
A few odds and ends. Bishop Chamber of Commerce Executive director Tawni Thomson presented room occupancy numbers to Bishop City Council in her report on Monday. Bishop’s room occupancy rate was 45% in December, as compared to 59% the previous year. In January, the number was trending at 47%, down from 53% in 2020.
Mammoth Hospital held its annual strategic workshop on Friday, January 22. Which is worth a more in-depth future story, but a couple points which I found powerful and unnerving.
*That in-patient growth will be driven by chronic disease admission, principally via advanced liver disease (drinking) and diabetes (obesity).
Jeff Moser of SG2 Consultants, which facilitated the workshop, also referenced increasing behavioral health impacts, which he said, “You’ll be dealing with tangentially with co-morbidities.”
Moser said the data indicate “this is not a good story.” Further, he said we’ve been, as a country, dismantling mental health infrastructure and care since the ‘90s.
To which Dr. Yuri Parisky piped up, “The dismantling of mental health services began in the ‘80s.”
Moser also said the Covid pandemic has led to medical coverage erosion, accelerated utilization decline (people are skipping the doctor) and accelerated “site of care” shift. Meaning, more at-home and virtual care.
Between 2018 and 2020, Medicare and MediCal payers rose from 42% to 45% while commercial payers declined from 56$ to 53%.
Challenging times in the medical profession.
More soon.
