California's COVID booster rates are dismal as new shot debuts. More sickness ahead?

It’s September! That means Christmas trees are twinkling at Big Box stores (despite the heat), Jack Skellington and Oogie Boogie rule the holiday makeovers at Disney (and have since well before Labor Day), rejiggered vaccines are landing at pharmacies and officials are bracing for the fall/winter waves of COVID, flu and other respiratory ailments.

A big summer spike in COVID cases sent many more people to emergency rooms in California and nationwide than at any time since last year’s holiday season, according to state and federal data. The percentage of COVID tests coming back positive jumped significantly as well, and less-than-glamorous measures of COVID virus in sewage clocked spikes in parts of Orange, Los Angeles, Riverside and San Bernardino counties.

“The spike in cases we’ve seen this summer is the largest summer wave we’ve seen in at least two years,” Dr. Elizabeth Hudson, regional chief of infectious diseases with Kaiser Permanente Southern California, said by email. “It has been far more long-lasting and impactful than the past two summer waves, with this wave akin to the summer 2022 wave. Most of these cases have occurred among our outpatient population, but we have seen some people sick enough to require hospitalization due to COVID.”

Those spikes may have reached their peaks and may be on the wane in many places — though Los Angeles County’s superior data-keeping suggests we may not be out of the woods just yet.

Average daily COVID cases dropped from 479 at the beginning of August to 410 at the end of August, while the percentage of all deaths due to COVID jumped from 1.3% to 3.5% over that same time period, according to the Los Angeles County Department of Public Health (which continues to closely track the metrics while many other counties have eased up).

Mortality, UC Irvine epidemiologist and demographer Andrew Noymer points out, is a lagging indicator of what’s happening. It takes time to pinpoint the cause of death.

“We’re in terra incognita here,” Noymer said after poring over graphs of latest trends. “During the Delta surge — remember the Delta surge? — it was clear COVID was going hell-for-leather. Now we get these surges, and it’s less predictable.”

Will there be rebound infections now that schools are open and Labor Day gatherings are behind us? Will the new COVID boosters be embraced before the post-Thanksgiving spikes, despite a distinctly unenthusiastic populace?

A paltry 15.3% of Californians are up-to-date on their COVID boosters — meaning they got last fall’s shot — and it’s worse in Orange and Los Angeles counties (both 14.3%), worse still in Riverside County (9.1%) and grim in San Bernardino County (7.9%).

The crystal balls are murky, but this much is clear: The latest COVID variants are much more contagious than their predecessors, though less likely to cause severe illness. And the people who are most vulnerable to serious illness and death continue to be those who are older, and/or have underlying health conditions.

“Unlike 2020 and some extent 2021, most people have had a COVID vaccine by now,” Noymer said. “For the people who haven’t had a vaccine, or who haven’t taken boosting seriously, most of them have had at least one COVID infection by now.”

That translates into a measure of immunity. It’s largely people who don’t meet either of those descriptions who have died, he said.

Updated COVID boosters are already at pharmacies like CVS and will be landing at doctor’s offices soon. Kaiser Permanente expects to begin administering updated shots by mid-September.

Vaccine protection wanes over time, so it’s important to stay up to date, the CDC says. Everyone aged 6 months and older should get this year’s vaccine, which helps protect against severe disease, hospitalization and death. It’s especially important for those who are 65 and older, at high risk for severe disease, or have never had a COVID-19 vaccine.

Kaiser serves about 4.8 million members in SoCal, and Hudson echoes the CDC’s advice. “Vaccination remains the best protection against COVID-19-related hospitalization and death,” she said. Getting the new version “can restore and enhance protection against the most recent virus variants responsible for most infections and hospitalizations in the United States. Staying up to date on COVID-19 vaccination also reduces the chance of suffering the effects of long COVID following acute infection.”

Since cases have risen, people have been asking about the shots at CVS Pharmacy and MinuteClinic, said Diana Ibrahim, pharmacy regional director at CVS Health.

“We saw demand even before it was available,” she said.

If uptake is sour once again, though, Noymer won’t be terribly surprised. “A lot of people feel like they’ve been sold a bill of goods with the COVID vaccine because it doesn’t prevent infection,” he said. “I still believe it reduces severity. I’d advise readers who haven’t gotten any to get on board. You could be saving your own, or someone else’s, Nana.”

Data holes

Some might argue it’s “see no evil.” Others might argue there’s no point wasting limited resources tracking the heck out of a disease that’s becoming less and less severe.

But the COVID data sure isn’t what it used to be.

Several counties pointed out that the vast majority of cases are now diagnosed by home testing and aren’t reported, making the true number of average daily cases a mystery.

And officials don’t have complete data on COVID hospitalizations either; national guidelines were revised in the spring and hospitals were no longer required to report that information to public health agencies. However, these guidelines were recently revised again and individual hospitalization reporting will be nationally mandated starting again in the fall, said O.C. Health Care Agency spokeswoman Ellen Guevara.

Wastewater monitoring is not universally reported either. In South Orange County, for instance, the wastewater agency serving hundreds of thousands of residents hasn’t been testing or reporting since July. They had worked with WastewaterScan, but funding was cut.

In the northern realms, the Orange County Sanitation District — which treats sewage for the majority of the county, some 2.6 million people — works directly with the state’s Drinking Water and Radiation Laboratory, which funds the testing. Data goes back to 2020.

“The dataset has been invaluable for the public health response to COVID-19,” said OCSan’s Jennifer Cabral by email. “Thanks to our ongoing collaboration with CDPH’s leadership team and scientists, our public health officials are able to monitor the fluctuations in COVID-19 virus levels across the state, and adjust statewide and local public health strategies as needed to protect our community.”

The public health strategy now is GET PEOPLE VACCINATED.

“Right now we’re entering respiratory illness season,” said CVS’s Ibrahim. “Not only COVID, but flu, pneumonia, RSV. Get vaccinated as soon as you can; it takes time for your body to build immunity.”

How to protect yourself? This advice doesn’t change much.

In addition to getting the updated vaccines, wash your hands frequently with soap and water or an alcohol-based cleanser and consider wearing a mask in crowded indoor environments and when traveling, said Kaiser’s Hudson.

Being careful is still justified, UCI’s Noymer said. Take advantage of the free COVID tests that will be available at the end of September (order at https://aspr.hhs.gov/COVID-19/Test/Pages/default.aspx) and use them. Work from home when you’re sick. Avoid others as long as you still test positive — not just for 24 hours after the resolution of symptoms. And for goodness sake, wear a mask.

“You could be saving some grandma’s life,” he said.

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