The official case rate in Easthampton increased sharply last week, as we knew it would from the previous week's data. The percent of tests coming back positive is well above 5%, too. This indicates to me that the virus is circulating widely in our community right now. Wastewater surveillance data confirms that viral concentration is indeed increasing in our communities. The official case count cements this surge as our second largest in Easthampton to date - and I am absolutely sure that it is a substantial underreporting of the true case rate right now. If you think about who you know who currently has COVID, I think you'll quickly be absolutely sure of this, too. How many of the cases that you are aware of are folks who tested positive on a rapid test? Most folks who test positive on a rapid test do not go on to get a PCR test and none of those folks are included in this official case count.
Official case counts have always been an underreport of the true number of cases, but this is increasingly true as rapid testing replaces PCR testing. Before the delta variant surge, case counts were estimated to be about 60% of the actual number of cases. During the delta variant, case counts were estimated to be about 45% of the actual number of cases. During the recent omicron variant surge, case counts were estimated to be about 25% of the actual number of cases. And now, scientists are estimating that the current case count is about 10% of the actual number of cases occurring. That's... quite an underreport. What that means is that we're in the midst of a "silent surge" - even though we know we're surging, we don't have a good handle on just how large the surge is. Dr. Jetelina, a trusted epidemiologist, has used this data to create an estimate of true vs. official cases. It's nowhere near the omicron surge peak, but it's much more substantial than our official metrics are showing.
This surge is likely the result of both increasingly transmissible variants along with "immune evasion" mutations, waning vaccine immunity, and waning immunity after infection. States that collect data on reinfection are finding increasing rates of reinfection among those who were infected with the omicron variant. This is especially true among those who are unvaccinated and had been infected with the omicron variant.
I have had a few conversations with folks in the past week about if the high case rate matters. Intrinsically - no. But to the degree that it overwhelms the health care system and leads to high rates of severe disease and death - yes, of course! Hospitalizations are increasing in MA, but as I was last week, I remain encouraged by the lack of parallel increase in folks in the ICU.
We've reached the milestone of one million deaths in the US. This is more COVID-19 deaths than any other country in the world. The magnitude of this loss is staggering - according to the New York Times, more people in the US have died of COVID-19 than of car accidents in the past 20 years. More people in the US have died of COVID-19 than on battlefields, ever - more than the entire list of casualties from all the wars the US has participated in since it was founded. It's... unthinkable. These deaths are mostly preventable at this point. The unvaccinated continue to experience hospitalization and death at rates many magnitudes greater than rates among the vaccinated.
We have lost our mothers, fathers, sisters, brothers, partners, children, friends, and colleagues. The fabric that makes up the people in our communities has been irreparably torn. And this is the national average - in any given community, the effects have varied. Severe disease and death from COVID-19 is not evenly distributed. Nearly 75% of those who have died are over the age of 65. Mortality rates have been higher for Black and Hispanic Americans at every stage of the pandemic. And geographic regions of the US that have a smaller proportion of the population vaccinated and looser COVID-19 restrictions over the course of the pandemic have suffered higher rates of death. To say it's tragic doesn't even begin to describe the enormity of it.
We also spend little time thinking about the other outcomes besides severe disease and death. Even mild infections are causing substantial interruptions within families and at work, including severe staffing shortages in some locations. Most distressingly - in health care and in schools! There is no question we know how to keep businesses and schools safely open at this stage - but one hurdle we can't get around is not having enough staff to be open. We're slowly learning more about long COVID, and what we've learned so far is unsettling. There is a lower risk of long COVID among the vaccinated and among those with mild or asymptomatic infection, but the risk is not zero. An estimated 35-40% of those who are infected with SARS-CoV-2 will experience long COVID. The prevalence is slightly higher - closer to 45-50% - among those who were hospitalized during their infection. The prevalence is lower among those who are fully vaccinated and even lower among those who are boosted, but again, not zero. In fact, about 8-10% of those who are triple vaccinated are reporting long COVID. There's a lot we don't know about long COVID, including what percentage of those who are experiencing it have mild / inconvenient symptoms and what percentage have debilitating symptoms. There is certainly enough evidence at this point to indicate that long COVID is more common long-any-other-virus and will require continued research and treatment.
In vaccine update news, the FDA has authorized a Pfizer booster dose for the 5-11 year old age group. The FDA review of the Moderna vaccine for children ages 6 months - 4 years is tentatively scheduled for June 8th. Finally, about two weeks ago, the FDA placed limits on use of the J&J vaccine. There is no new concerning information about the J&J vaccine - the risk of blood clots was discussed in the February 8th dashboard. The FDA has, however, updated their opinion. The J&J vaccine will only be available to those who specifically request it, after review with their provider, or for those who cannot receive any other type of vaccine. The risk of blood clots is limited to the two weeks after receiving the dose, so if you got the J&J vaccine and you're reading this more than two weeks later - you are at no increased risk of blood clots as a result of the vaccine.
That should do it for this week. Take good care and use your tools (high-quality well-fitting masks!) to keep yourself safe as needed and desired.
Stay well,
Megan W. Harvey, PhD (she/her)
Epidemiologist
