After three years, COVID continues to slowly recede in both numbers and impact. While we should not expect COVID to disappear, it continues to be more likely than not that it will become only slightly more concerning than the other 4 coronaviruses that routinely circulate around the world every year. In fact, at this juncture, healthy people who are not in a high-risk category based on age (greater than 65), or at high risk from having other health issues, have the risk of serious disease due to COVID are comparable to the risk of severe disease from the flu during peak flu season each year (which is not to say zero risk, as every year there are a small number of people without any known risk factor who do have a bad outcome after contracting flu).
COVID cases and hospitalization rates demonstrated a relatively small peak in early January but have been steadily down in North America since then. This is very much in contrast to the predictions from the White House COVID Task Force last fall that the US should prepare for 100M COVID infections this winter. The combination of widespread immunity and the lower virulence of the current variants prevented that from happening. While there were likely many more COVID infections than were reported, the US did not see the predicted impactful wave. Currently, the predominant variant that is preventing further significant declines in rates is XBB 1.5, and like predominant variants over the last few months, it is slightly more infectious than the previous, but not significantly more virulent.
Deaths have shown an unstable curve over the last several weeks, but CDC recently announced problems with their system for receiving and reporting deaths throughout the first two months of the year accounting for this instability. At worst deaths are statistically flat and at a low level and nearly all are associated with advanced age or other diseases. Of note, the death rate for unvaccinated without a booster is nearly 10 times that of fully vaccinated and boosted individuals, and the death rate for those over 75 is nearly 140 times the rate for 18-29-year-olds and 14 times the rate for 40-49-year-olds, with those age rates being without regard to vaccination status. If you are vaccinated and not in a significant risk group, your risk of a bad outcome from COVID is exceedingly low.
Globally, reported cases experienced a small peak in late December, resulting in a small peak in COVID deaths in early January. Since then, both cases and deaths have been steadily down, with both now at the lowest levels since reporting started 3 years ago. The only countries in the world with COVID at levels that are considered high are Austria and New Zealand. Even China, which many expected to have a major disruptive outbreak with the sudden reduction in control measures in January, has very little current evidence of a significant outbreak and no evidence of the feared new variants that could emerge if they were to have a severe outbreak. And the last major country to have widespread mask requirements, Japan, removed masking guidance as of Monday, March 13, although the difference may not be that noticeable as culturally in Japan, masks are commonly worn in crowded spaces and it is often considered disrespectful to not wear a mask if someone has any signs of a cold or allergies.
The only major risk for an increase in cases is the emergence of a new variant that is significantly different that the current Omicron family of variants. Mostly because the transmission efficiency of Omicron is so high, it would be difficult for another, potentially more virulent strain, to get a foothold. While always possible, at this point, it is no more likely that a severe flu strain emerging or one of the older circulating coronaviruses developing a concerning variant, neither of which are considered to be at high risk of happening, although there are some flu concerns as we have discussed in previous updates.
However, with all that being said, the disease is still circulating and is causing infections very commonly. Causing an infection and causing a bad outcome, however, are very different issues. Over 90% of North Americans and over 95% of Europeans demonstrate immunity. This immunity is either natural from having been infected with SARS-CoV2 or from immunization. While we know that neither natural infection nor vaccine-induced immunity is highly effective in protecting against mild symptomatic infections more than 3-5 months after vaccine or infection, the relative immunity from either, coupled with fairly easy access to antiviral medications, means that most people do not need to consider special measures to minimize the risk of hospitalization or death. People who are at risk or who live in a household with others at risk should consider continuing to apply multiple layers of risk mitigation, but for others, it is reasonable to do whatever you would do during a routine flu season.
For those who are more risk-averse and want to minimize their risk of contracting COVID for whatever reason, there are a few simple things they can do including minimizing attendance at crowded locations such as bars or meetings in overcrowded rooms, and efficient use of in-office portable air filtration, and avoiding others who are ill. But what about masking? If you wear an N95 or equivalent mask that is relatively new and clean, and you are diligent about ensuring a good fit and not fiddling with the mask, then it can reduce risk. It is important to contrast that, however, with widespread mask programs which have now been fairly conclusively shown not to have a significant effect on protection against COVID, as was discussed in the last update in reviewing the Cochran Library meta-analysis of masking studies. For COVID or for future respiratory disease outbreaks, it is important to separate the individual use of masks from the population health effects of masks. While intuitively, it would seem that what makes sense for an individual should make sense for the population, for mask programs, that does not appear to be the case, especially when combined with some of the psychologic and developmental effects of widespread masking, especially as we are now seeing with children.
The biggest COVID news over the last couple of weeks has been renewed attention on the origin of the virus. Multiple US agencies have now said that they believe the origin was, in fact, the Wuhan Institute of Virology in China. These findings do not address whether or not the virus was engineered there, merely that it went from there to infecting the public and the rest is history. Many believe the inquiry should stop there and not attempt to determine whether or not the virus was intentionally engineered. The decision process here has major international security implications which are better left to international security experts, but if we do not get more public details, that may not be a bad thing.
There will continue to be ups and downs in news regarding COVID, so this update will continue on an every-other-week basis, although we plan to continue to include other breaking health issues, as has been done over the last year. There are a couple of key points that both individuals and organizations should keep in mind, however. First is that this was not a one-off. While this pandemic has been worse than any since Influenza for the past hundred years, the fact is that there has consistently been a major outbreak concern about every 7 to 10 years. Unfortunately, that’s just enough time for the lessons of one to be forgotten in responding to the next. On an organizational level, it is very important to document what worked well and what did not and to maintain a framework for critical incident response and business continuity.
Several financial industry studies are beginning to emerge looking at performance data for companies that had response frameworks in place as compared to those that did not and found that those that did have response frameworks in place performed much better than those that did not. Now is the time to develop these planning documents, including a means to periodically refresh, pressure test, and exercise their contents. Remember that the process is often more valuable than the product when it comes to critical incident preparation. As an old Army saying goes, “No plan survives contact with the enemy,” but the process of building, testing, and exercising the plan means that the people involved in managing a response understand the issues and what to expect from other actors, both internal and external to the organization.
One non-COVID note for this week is a warning from US health authorities about counterfeit drugs around the world, especially in Mexico. Many Americans travel to Mexico for less expensive drugs, as well as procedures. However, over the last few months, there have been many incidents of these counterfeit drugs, especially pain and anti-inflammatory medications, being laced with fentanyl. The availability of fentanyl is so widespread in some areas, that it is cheaper to add a small amount to these counterfeit medications to achieve the sensation of pain relief. Unfortunately, this fuels addiction, but even more importantly, the quality control on the amount of fentanyl is not good, so there have been many cases of unintended overdoses by people who were just trying to save some money. Counterfeit medications are an increasing problem in much of the world, and this just adds to the danger.