On Friday, California surpassed 90,000 confirmed COVID deaths since the start of the pandemic. While that is numerically more than any other state, California is the most populous state and its death rate per 100,000 residents remains among the lowest in the country, thanks to its effective vaccine strategy.  

COVID isn’t going away anytime soon

In April, while my family was enjoying a spring break vacation – we all got COVID.  We were all double vaccinated, boosted and very careful with masking on the trip, but still succumbed to the virus. It felt like a bad flu. Though we were never in danger of needing hospitilization, we took a while to recover and the kids missed over a week of school.  It was a rough two weeks for our family. COVID infections are rising all over the Bay Area and I know many friends and family who have been infected in the past few weeks.

On Friday, in a ​​joint statement, Bay Area health officers strongly recommended that residents once again mask up indoors, amid a spike of COVID-19 cases and hospitalizations. 

Why are our numbers so high with such high levels of vaccination in California?

Health experts offered several explanations. Previous low levels of infection may have given the virus more opportunity to spread, or newer infectious variants may be taking hold. 

California’s proactive testing system allows better insight into actual infection numbers. It was simple for our family to test when we got symptomatic, because rapid tests were easily available from the government or drug stores.  Public health officials warn that actual infection rates are higher than reported because families like mine who tested at home might not show up in the system.

Why do breakthrough infections happen?

My family was vaccinated and boosted, but caught a breakthrough infection.  Why did that happen?

“I don’t know that we can ever get in front of the virus because the virus can change in practically infinite ways. But we can be quicker and more nimble in responding to changes in the virus,” said Dr. Ben Neuman, Professor of Biology and chief virologist with the Global Health Research Complex at Texas A&M University.  The speed at which the variants are evolving with an increase in tranmissibility, makes the mitigation strategies challenging. 

So announcements like the Moderna Bivalent vaccine are promising, but the viruses that they’re vaccinating against are the original strain, warned Dr. Newman. 

Public health policies have been focussed on keeping hospitilization and deaths low and prevent severe disease, and vaccinations have helped with that, said Dr. William Schaffner, a Professor of Preventive Medicine in the Department of Health Policy and Medicine in the Division of Infectious Diseases at the Vanderbilt University.

“If you look at my Medical Center, the largest proportion of people who are currently admitted with COVID illness are unvaccinated or partially vaccinated.”

But Dr. Eric Feigl-Ding, an epidemiologist and Chief of the COVID Risk Task Force at the New England Complex Systems Institute, cautioned that “the focus on hospital prevention is good but we are not going to get out of this pandemic until we actually have infection and transmission mitigation.  That’s why a vaccine plus strategy of not just testing and masking but also ventilation and air disinfection are absolutely critical going forward in stopping the pandemic.”

Making decisions about masking

The consensus among experts was clear at an April 29 briefing hosted by Ethnic Media Services – don’t stop wearing masks in public places.  

Dr. Schaffner suggested the following considerations when making decisions to mask. “Are you older? Do you have an underlying illness, heart disease or lung disease? Are you immune-compromised? Are you a person that’s providing care for someone? Continue to be very careful.” 

Dr. Feigl-Ding blamed short term thinking that led to the lifting of mask mandates. 

“We don’t just stop wearing helmets, unbuckle our seatbelts, and allow drunk driving because hospital beds are not full. I think the CDC is forgetting prevention (strategies) in trying to push for a return to normal.” 

“Adults now are going out to gatherings, parties, bars, restaurants, nightclubs, even more than before when they were precautious, ” added Dr. Feigl-Ding. “So now you’re also increasing exposure frequencies and likelihood of transmitting”  and this affects the most vulnerable – children and the immunocompromised.

When will children get their vaccine?

Moderna asked for FDA authorization for its COVID vaccine for children under 6.  The vaccine will require two doses one month apart and is expected to be authorized by the FDA in June.

Dr. Manisha Newaskar who specializes in pediatric pulmonary medicine at Standford university school of Medicine said the announcement was a positive step in combating the virus.

“Healthy kids can develop complications and multi system inflammatory syndrome. So we have to educate our young families and encourage them to get our young young ones vaccinated.” 

“Schools may have a role to play in getting the vaccine out there,” said Dr. Newman. “There are 500 deaths per year from bacterial meningitis, and that is one of the things that schools would normally require vaccination against. COVID-19 is around 350 deaths in the same age group in roughly the span of a year. This needs to be one of the vaccines to make school work.”

At her hospital, Dr. Newaskar has seen Long Covid in her pediatric patients. “Our kids have persistent headaches, fatigue, they can have sleep disturbance or concentration difficulties, stomach aches, chest tightness, pain, loss of appetite. ” She encourages her families with young children to get the vaccine to prevent these symptoms.

“A virus is not a tree that grows where it’s planted and stays where it’s rooted, ” said Dr. Newman. A virus moves with people, with the air, with all the things that we do. And the idea that we can tie down a virus to a particular piece of geography, when people move around every single day is frankly, a little bit behind the times.” 

Let’s stay safe, let’s stay informed and make smart decisions to keep our families and community healthy.

Photo by Evgeni Tcherkasski on Unsplash