The Big Picture: Covid-19 Update

Across the nation the COVID virus continues to circulate, mutate, kill, and disable. As of today, nearly 1.2 million people have died of COVID-19 in the U.S. and this year alone, according to the CDC, nearly 26,000 Americans have died from the virus. And let’s not forget the 17 million Americans living with the challenges associated with “Long Covid.”

This summer the nation has experienced a surge in infections. Although the COVID disease reporting infrastructure is no longer in place, we know from very accurate sampling of human wastewater that infections are as widespread now as they were in the winter. Unlike Flu and RSV, Covid-19 is now in constant circulation and does not go quiet in the summer. Wastewater sampling in Washington DC has begun to show an uptick beginning in August.

Across the nation, hospitalizations and deaths due to covid have trended upward as well but, thankfully those rates are well below those seen previously. This summer, approximately 4 out of 100,000 people are being hospitalized for Covid which is up from a low in May of about one Covid hospitalization for every 100,000 people.

Across the nation, more than 2,000 people died of covid in July, which is high, but well below the 25,700 covid deaths in July 2020.

DC has been fortunate in that we are not currently experiencing hospitalizations that result from COVID infections. However, there are hospitalized patients who have COVID but were admitted for other reasons.

The Current Variants
As we learned in the past, viruses, including the SARS-CoV-2 virus, regularly mutate and alter their form. The current variants are referred to as “FLiRT” which derives from the structure of their amino acid components.

The KP.2 variant in this family became the dominant variant in the U.S. last month, and then KP.3 took over in early June. KP.3 and KP.2 now account for more than half of the new Covid infections in the US. While they are effective in causing illness, fortunately, the severity of illness is less than what people previously experienced from other strains. This may be explained by the combination of a less “virulent” profile of the new variants and that almost all of our immune systems have been exposed to the virus multiple times through vaccination, infection or both.

How To Know If You Have COVID: Diagnosis
The challenge for diagnosis is that approximately 45% of COVID infections in the U.S. are asymptomatic…they occur without symptoms. However, it is important to remember that the virus can still spread without symptoms! Once exposed to COVID-19, it takes two to three days of incubation to show symptoms. You’re most contagious when symptoms start and the virus level (viral load) in your body is highest.

Typically, asymptomatic individuals shed the virus for about six days, while symptomatic individuals shed it for an average of nine days. The good news is that asymptomatic cases are generally less severe and have a lower viral load.

One of the challenges associated with the current variants is that it’s symptoms are very typical, almost indistinguishable, from other viral illnesses.

They include:
1. A temperature or feeling feverish..shivering (chills)
2. A new, continuous cough
3. A loss or change to your sense of smell or taste
4. Shortness of breath
5. Feeling tired or exhausted
6. An aching body
7. A headache
8. A sore throat
9. A blocked or runny nose
10. Loss of appetite
11. Diarrhea
12. Just feeling sick

Since it’s not possible to diagnose a COVID infection based on symptoms alone, if you’ve been exposed to COVID-19 or feel symptomatic, it’s important to test yourself to avoid spreading the virus. It’s also recommended that you test if you plan on attending a large gathering where elderly or immunocompromised people will be present.

If you test positive, try to isolate for a few days and then wear a mask for several days while avoiding crowded rooms or vulnerable individuals. You can expect to be contagious for about one to two days before symptoms appear and stay contagious for up to eight to 10 days after the symptoms start. The contagious period might be shorter if you are asymptomatic or vaccinated, and longer if you have severe symptoms or a weakened immune system.

A word about masks: they work! Scientists have not been able to prove that population level mask wearing had an overall society protective effect (the variables in studying this are complex and challenging) but we do know that at the individual level, properly worn masks do prevent the escape of the virus into the air of another person and they do prevent the virus expulsion form another coming into your body.

The CDC has modified it’s previous guidance for infected persons. Now, if a person does test positive, there is no longer a mandatory five-day isolation period. Instead, the CDC advises that people stay home when they’re symptomatic, but can return to school, work and social activities once they’re feeling better and after being fever-free for 24 hours without medication.

The Health and Human Services Department is making four free covid tests available to anyone who requests them starting in late September through covidtest.gov.

Vaccination
Recently, the Food and Drug Administration approved new, updated vaccines against COVID-19 from both Pfizer and Moderna and health officials are recommending everyone 6 months and older get a dose. The challenge for you is to decide WHEN (not if) to get your shot. Here is one approach to thinking through this:

1. Based on the data presented to the FDA and the CDC by the Pfizer and Moderna vaccine manufactures, the new vaccines are both safe and effective.

2. If you are in a high risk group and have been either vaccinated or infected within the last few months, you might decide to get vaccinated as soon as they are available in a few weeks, which is strongly recommended by many experts. They can then make a later decision about a second dose, based on the applicable evidence-based guidance that will be available at that time.. However, given the potential for a more severe fall surge, some may elect to wait and try and time their dose for maximum protection for later in the season such as around the middle of October. Consulting with your health professional on this decision is strongly advised.

3. If you are generally healthy, not in a high risk group and were infected over the summer, you may decide that your current “natural immunity” will lead you to wait until later in October as well, depending on your personal level of risk tolerance.

4. If you are currently infected, the CDC advises you to wait until all your symptoms are resolved, you’re feeling better, and out of isolation before getting your shot.

5. Those whose risk tolerance is lower, and who want to get vaccinated as soon as the vaccines are available, are also encouraged to do so.

DC has benefitted greatly from its dedicated community and faith-based organizations that work tirelessly to protect and advance the health of their neighbors. Nowhere has this been more important, or impactful, than in the East Of The River community. However, the city as a whole, and Anacostia in particular, has a way to go in achieving optimal COVID vaccination rates. This simple chart provides an example of our challenges: