March saw one of the lowest death tolls since the virus first overwhelmed hospitals and intensive care units in early 2020. Nearly 8,800 Americans died in March, the lowest monthly death total since last summer. But the virus continues to be a significant health threat for the elderly and others with compromised health.
Across the country, an average of nearly 300 people died from the virus every day in March. Who is dying still?
“They tend to be over 75,” said Dr. Chin-Hong, a UCSF professor of medicine who specializes in infectious diseases. “And they tend to have gotten the first two shots in December of 2020 but didn’t get a booster,” he said, reminding those who are over 65 or eligible to get the most recently available booster.
“Age is the most powerful risk factor,” said Chin-Hong. “It’s still the same group in the hospital that I’m seeing, even though it’s fewer.”
COVID hospitalizations have been declining since a winter surge, approaching but not quite reaching the lows we saw in the summer of 2021.
Along with stronger population immunity from infections and vaccinations and low community spread, Chin-Hong has noticed another factor that might be contributing to better outcomes and fewer deaths. “There’s more comfort in Paxlovid,” he said, pointing to the trend over the past six months with Pfizer’s anti-viral medication to treat the illness.
“At some points in the pandemic there were a lot of fears about Paxlovid,” he said, including high-profile reports of “rebound” infections after taking the drug. But now? New evidence suggests the rebound infections can happen at a similar rate without Paxlovid use, and primary care physicians are getting more familiar with the drug. “I think there’s more comfort in health care providers and prescribing it.”
Now, on the heels of mask mandates ending in many places, the national COVID emergency is set to end in May, and with it the availability of the free at-home test kits. You have a few days left to order more tests for your household from the federal website if you have yet to reach the limit.
Experts warn that COVID outbreaks are not a thing of the past. After mandatory masking in medical facilities was lifted in California in early April, it didn’t take long before Kaiser Permanente’s Santa Rosa Medical Center had a COVID outbreak, with more than a dozen staff and patients testing positive, prompting them to reinstate their mask mandate last week.
And as many of the structural protections disappear, it is also getting harder to track how prevalent the virus is in the community. For those who are elderly or immunocompromised or who simply would like to continue taking precautions to lower their risk of catching the virus, case data is becoming increasingly unreliable as a way to assess relative risk.
“The only parameter that I think is really good for having an idea where we are right now is the wastewater data,” said Swartzberg, referring to ongoing monitoring for the virus at community wastewater plants. Swartzberg uses that data to help influence his own choices about attending large gatherings and masking.
Despite a slight increase in positivity rates in COVID tests recently in the state, wastewater data and hospitalizations show a continued decline of community spread.
Daily COVID tests, however, are being logged in the lowest numbers since tests were being rationed in the first months of the pandemic, both because fewer people are testing when they feel sick and fewer at-home test results are being reported to authorities. That means our official counts are capturing a smaller percentage of cases. “When you can’t look up and see how much community disease there is,” Swartzberg noted, “how do you do your calculus?”
As for what to expect in the near future, we are in a good spot right now, but as Chin-Hong points out, “when you’re low like this, there’s only one way to go.”
Swartzberg is thinking much the same as during previous lulls. “Is this the calm before the storm, or is the way it’s going to be?”
The answer to that question is one thing that has stayed the same, he said: “Nobody knows.”
