Has California Avoided Another Devastating COVID Winter Wave?

In the first two years of the COVID-19 pandemic, the winter holidays were marred by a pair of destructive waves that swept through California, sending cases soaring, sending residents to the hospital in droves and ultimately leaving thousands dead.

But the third winter seems to have escaped the same fate. An uptick in late-fall transmission, which picked up steam after Thanksgiving, began to dissipate in mid-to-late December instead of becoming the runaway train that public health officials feared. And in stark contrast to previous years, COVID-19 statistics have continued to improve in the weeks since.

Officials emphasize that the danger is not over — especially for those who are at higher risk of developing serious illness.

There is also a chance that another problematic variant will pop up. Officials are closely monitoring XBB.1.5, which has been described as the most contagious edition of the virus to date.

But the fact that California navigated what many consider to be the closest thing to a normal holiday season since 2019, without a record-breaking spike in infections or increases in hospitalizations, is cause for optimism — and underscores the power of the tools at our disposal, experts say.

“I’m never saying we’re cleared because there are still people for whom COVID will continue to be a very big problem, and they’re going to have to continue doing everything they can to avoid getting infected,” Los Angeles County Public Health Director That said Barbara Ferrer. “We still have a lot of viruses in our communities, but we’re definitely in a promising place.”

How did this happen?

Many residents likely enjoyed some degree of protection from the coronavirus through being vaccinated, previously infected, or both. This means that some were able to avoid becoming infected, while others’ immune systems were better prepared to ward off serious illness.

Anti-COVID drugs — including Paxlovid and another oral drug known as molnupiravir — have also likely helped by preventing those at higher risk from becoming seriously ill.

Bivalent boosters, specially formulated to help protect against the Omicron subvariants that dominated the past year, also became available in September. The uptake was too slow to the liking of some officials, but nearly 24% of eligible Californians have received the updated dose.

“Vaccinations, including bivalent boosters, can help protect you from becoming seriously ill or even dying,” says San Diego County Public Health Officer Dr. Wilma Wooten.

Behavioral changes — including moving gatherings outdoors, testing for events, wearing a mask in indoor public areas, and doubling down on handwashing and other health hygiene efforts — may also have played a role.

“While nothing can be said for sure, we are currently seeing evidence that our resources to fight COVID-19, including masks, the bivalent booster and therapies, are working,” Ferrer said Thursday.

What do the numbers show?

The number of cases across California has fallen steadily since the first week of December, as have the number of coronaviruses in sewage.

In LA County, sewage levels began to fall in early December, though in recent weeks they have plateaued at about 70% of last summer’s peak — still a major concern, as defined by health officials.

“Although the wastewater concentration is not low, at the same time we are not seeing the post-holiday peak that was expected towards the end of the first week of January,” Ferrer said.

In San Diego County, Wooten said in a statement that “the virus is still circulating in the region. We continue to see high rates of positive COVID-19 tests and detect high levels of the virus in wastewater.”

Elsewhere, recent analysis “shows that wastewater signals are declining in the Greater Sacramento, San Joaquin Valley and Southern California regions, becoming plateaus in the Bay Area” and Northern California, the State Department of Public Health wrote in an update Thursday.

Other statistics also lend credence to the concept that coronavirus activity has slowed. Modeling from the California Department of Public Health estimates that the spread of COVID-19 is likely decreasing statewide and has been on a downward or stable trend for the past month.

What about hospitals?

While many infected with the coronavirus experience mild symptoms, or no symptoms at all, any marked increase in transmission threatens to send a new wave of patients to hospitals. In 2020–21 and 2021–22, these floods were massive and put enormous strain on healthcare systems across the country.

While California saw a marked increase in coronavirus-positive hospitalizations from late October and mid-December, that count has fallen sharply since then.

On Thursday, 3,168 such patients were hospitalized statewide — a drop of 29% in the past two weeks.

That figure includes those hospitalized with COVID-19-related illnesses and those who incidentally test positive after seeking care for another reason.

Should there not be a significant resurgence of COVID-19 this winter, it will be the first time since the start of the pandemic in 2020 that a fall-and-winter surge was less severe than the previous summer’s, in terms of hospitalizations.

Continued improvements have led to a parade of California counties moving into the low level of the COVID-19 community, as defined by the U.S. Centers for Disease Control and Prevention.

Placement in that category depends on recent calculations of coronavirus cases and hospitalizations, as well as bed occupancy, and indicates that the burden on hospitals is relatively mild.

Fourteen California counties moved to the low COVID-19 community level on Thursday: Alameda, Butte, Contra Costa, Fresno, Glenn, Humboldt, Kern, Kings, Los Angeles, Madera, Marin, Sonoma, Tehama and Ventura.

With last week’s update, 71% of Californians now live in counties with low COVID-19 community levels, up from 28% the week before.

Deaths remain a concern

As of January 10, California was reporting 355 COVID-19 deaths per week. While that has increased recently, it remains below the summer peak of 396 and well below last winter’s peak, when 1,827 deaths were recorded for the week ending Feb. 27.

More than 98,000 Californians have died from COVID-19, a toll that exceeds the total population of cities like Santa Monica, Mission Viejo and Redding.

Nationally, COVID-19 is responsible for many more deaths than the flu. The CDC has reported more than 44,000 COVID-19 deaths since early October, more than double the estimated 17,000 from the flu.

What about XBB.1.5?

XBB.1.5 is one of the newest alphanumeric members of the extensive Omicron family. It is a descendant of XBB, a recombinant of descendants of the Omicron subvariant BA.2.

Much of the attention surrounding this particular sub-variant has been its contagiousness, as it is arguably the most transmissible version of the coronavirus.

XBB.1.5 now accounts for an estimated 49.1% of all new cases in the US, making it the most common edition of the coronavirus circulating nationwide, according to the CDC.

While the proportion has grown steadily, it remains much less common in the region that includes California, Nevada, Arizona, Hawaii, and the Pacific Islands. An estimated 24.1% of coronavirus cases in the past week were believed to be XBB.1.5, CDC data shows.

The ultimate effect of XBB.1.5 in terms of hospital admissions remains unclear. But current data suggests that the new variant is not causing a spike.

For example, Ferrer said Atlanta is in a region where about 31% of coronavirus cases are estimated to be XBB.1.5. That’s double what it is for the region that includes Chicago.

If XBB.1.5 caused a surge in hospitalizations, you would expect the hospitalization rate in the Atlanta area to be worse than the Chicago area. Still, the latter’s hospitalization rate — 11.1 new weekly coronavirus-positive hospitalizations for every 100,000 residents in Cook County — is higher than that of Atlanta’s Fulton County, which has a hospitalization rate of 8.8, Ferrer said.

However, she noted that “there are many underlying variables that affect hospitalization rates in different regions — including local policies, vaccination rates, and even behaviors that change depending on the weather, such as being indoors more.”

“While we need to continue to monitor the impact of the increased circulation of XBB and XBB.1.5 on disease severity, current information suggests that this strain of Omicron does not have a major impact on hospitalization rates as of this writing,” Ferrer said.

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