Miscellaneous COVID News

[edschweppe]

A fair bit of news today on the COVID front, with local, national and global stories.
The local story, on the front page of today's Boston Globe: Most major health care systems in Massachusetts will lift their mask requirements next week:

Most major health care and hospital systems across Massachusetts will end or substantially modify their policies on wearing masks next week, on May 12, after the federal public health emergency for COVID-19 officially comes to a close.

In conjunction with the end of the federal emergency, the state mandate for masks in health care facilities, including doctors' and dentists' offices, also expires next week, along with most of the state's other pandemic-related rules.

Several organizations said they based their decisions to not require masking on a number of factors, including the declining rates of reported COVID cases, as well as the widespread availability of vaccines and treatments, and a desire to align their policies with federal guidance.

But the news worries some health advocates and lawmakers, who say the changes will leave older people and those with compromised immune systems vulnerable to severe complications if they're infected, and they are urging state health officials to continue requiring masks in health care settings.

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The move by many hospitals to drop masking is concerning, said Carlene Pavlos, executive director of the Massachusetts Public Health Association.

"Simply put, masking increases safe access to life-saving care for those with health conditions that make them more vulnerable to COVID," Pavlos said. "We know hospitals are a place where those with COVID seek care. People who are more vulnerable will be put at greater risk, which undermines our shared goal of health equity."

The Massachusetts Coalition for Health Equity also urged state officials to retain masking rules in health care settings as well as universal screening for COVID upon hospital admission and before procedures.

"People should not have to take their baby in for a well child visit and come out with COVID," said Dr. Lara Jirmanus,a primary care physician and instructor at Harvard Medical School who cofounded the coalition.

[ ... ]

Not all Massachusetts hospitals are dropping their masking rules outright. UMass Memorial Health, for instance, noted in its announcement to employees that caregivers will need to still wear a mask during patient encounters in its emergency department and oncology clinics at each facility, as well as in the bone marrow transplant unit, oncology infusion center, and with transplant patients at the Medical Center.

It said masking will be optional but encouraged in all other areas for caregivers, patients, and visitors.

"We will plan to reevaluate this policy after four weeks to see if further adjustments need to be made based on COVID-19 activity," UMass Memorial said. "We will continue to monitor the level of COVID-19 activity in our patient populations as well as with all caregivers at each entity, so that we can continue to adjust as needed."

[ ... ]

Despite the low adoption rate of the booster, Mayor Michelle Wu announced that Boston is formally dropping its vaccine requirement for city workers on Thursday. Her announcement comes as the amount of COVID-19 detected in Boston-area waste water has been ticking up over the past two weeks, according to data from the Massachusetts Water Resources Authority.

The idea that declining rates of reported cases is a good reason to drop mask requirements strikes me as silly, since the drop in reported cases is directly tied to the drop in reported tests. Color me cynical, but I rather suspect the real reason for dropping mask requirements is an epidemic of the Dont-Wannas, as in "I don't wanna wear a mask anymore!".

Nationally, the Centers for Disease Control and Prevention will lose their test and case count data once the federal public health emergency declaration expires next Thursday. so their plan is to track weekly hospitals and deaths instead:

On January 31, 2020, the U.S. Department of Health and Human Services (HHS) declared, under Section 319 of the Public Health Service Act, a U.S. public health emergency because of the emergence of a novel virus, SARS-CoV-2. After 13 renewals, the public health emergency will expire on May 11, 2023. Authorizations to collect certain public health data will expire on that date as well. Monitoring the impact of COVID-19 and the effectiveness of prevention and control strategies remains a public health priority, and a number of surveillance indicators have been identified to facilitate ongoing monitoring. After expiration of the public health emergency, COVID-19–associated hospital admission levels will be the primary indicator of COVID-19 trends to help guide community and personal decisions related to risk and prevention behaviors; the percentage of COVID-19–associated deaths among all reported deaths, based on provisional death certificate data, will be the primary indicator used to monitor COVID-19 mortality. Emergency department (ED) visits with a COVID-19 diagnosis and the percentage of positive SARS-CoV-2 test results, derived from an established sentinel network, will help detect early changes in trends. National genomic surveillance will continue to be used to estimate SARS-CoV-2 variant proportions; wastewater surveillance and traveler-based genomic surveillance will also continue to be used to monitor SARS-CoV-2 variants. Disease severity and hospitalization-related outcomes are monitored via sentinel surveillance and large health care databases. Monitoring of COVID-19 vaccination coverage, vaccine effectiveness (VE), and vaccine safety will also continue. Integrated strategies for surveillance of COVID-19 and other respiratory viruses can further guide prevention efforts. COVID-19–associated hospitalizations and deaths are largely preventable through receipt of updated vaccines and timely administration of therapeutics (1–4).

Although COVID-19 no longer poses the societal emergency that it did when it first emerged in late 2019, COVID-19 remains an ongoing public health challenge. By April 26, 2023, more than 104 million U.S. COVID-19 cases, 6 million related hospitalizations, and 1.1 million COVID-19–associated deaths were reported to CDC and summarized on CDC's COVID Data Tracker.† COVID-19 was the third leading cause of death during 2020 and 2021§ and the fourth leading cause during 2022 (5). To mitigate the consequences of the pandemic, approximately 675 million COVID-19 vaccine doses were administered, including 55 million updated (bivalent) booster doses. Based on seroprevalence data, infection- and vaccine-induced population immunity in the United States was 95% by December 2021 (6). As a result, rates of COVID-19–associated hospitalizations and deaths have declined substantially since March 2022 (7). This report describes changes to the national COVID-19 surveillance strategy, data sources, and indicators that will be made after the public health emergency declaration expires; these indicators will be displayed as weekly or otherwise scheduled updates to CDC's COVID Data Tracker.

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After the expiration of the public health emergency on May 11, 2023, authorizations to collect certain types of public health data expire (Table 1). The COVID Data Tracker includes a page for accessing archived data. HHS can no longer require reporting of negative SARS-CoV-2 testing results via CELR reporting. This change removes the ability to monitor the national percentage of positive SARS-CoV-2 test results using the CELR data source. CELR data served as a useful early indicator of SARS-COV-2 transmission during the pandemic. However, since a peak of approximately 17.4 million NAATs performed weekly in January 2022, coinciding with the SARS-CoV-2 Omicron variant surge, the reported weekly volume of NAATs performed declined to less than 1 million by April 26, 2023. This decline is related in part to increased use of antigen tests as well as at-home testing.**** The CELR data have become more variable in quality or altogether unavailable in many jurisdictions over time. CDC's COVID-19 Community Transmission Levels, which were derived, in part, from CELR data, also will be discontinued.

National reporting of aggregate weekly counts of COVID-19 cases and associated deaths, which CDC compiles using automated data extraction from jurisdictional websites and dashboards and direct submissions, will also be discontinued with the expiration of the public health emergency. This transition is consistent with many state and local health authorities' decisions to discontinue public reporting of these data. Aggregate counts of COVID-19 cases have been useful for monitoring changing trends in incidence but have become less representative of actual rates of SARS-CoV-2 infections or levels of transmission over time, related to decreased laboratory testing, increased home testing, changes in reporting practices, and asymptomatic infections. Early in the pandemic, aggregate reporting from health departments provided more up-to-date counts of total deaths than did NVSS, but the timeliness of NVSS is now comparable with that of the aggregate counts (8,9). As part of the shift from reporting of aggregate death count data to use of NVSS data, date of death will be used rather than report date.

CCLs are based on a composite metric that includes COVID-19 hospital admission rates, inpatient bed utilization among patients with COVID-19, and case rates derived from aggregate reporting of case counts by jurisdictions. Because aggregate weekly case counts will end, CCLs also will end on May 11, 2023. Hospital admissions levels from NHSN closely align with CCLs (8) and will replace the CCL metric. Monthly reporting of case, hospitalization, and mortality rates by vaccination status will end with the expiration of the public health emergency.

Frankly, dropping the "COVID Community Level" isn't much of a loss. On the other hand, hospitalizations and deaths are very much trailing indicators of new surges; those numbers only go up once a whole lot of people are infected.

And, in global news, the World Health Organization is officially declaring that COVID-19 is no longer a global health emergency:

GENEVA (AP) — The World Health Organization said Friday that COVID-19 no longer qualifies as a global emergency, marking a symbolic end to the devastating coronavirus pandemic that triggered once-unthinkable lockdowns, upended economies worldwide and killed at least 7 million people worldwide.

WHO said that even though the emergency phase was over, the pandemic hasn't come to an end, noting recent spikes in cases in Southeast Asia and the Middle East. The U.N. health agency says that thousands of people are still dying from the virus every week.

"It's with great hope that I declare COVID-19 over as a global health emergency," WHO Director-General Tedros Adhanom Ghebreyesus said.

"That does not mean COVID-19 is over as a global health threat," he said, adding he wouldn't hesitate to reconvene experts to reassess the situation should COVID-19 "put our world in peril."

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WHO made its decision to lower its highest level of alert on Friday, after convening an expert group on Thursday. The U.N. agency doesn't "declare" pandemics, but first used the term to describe the outbreak in March 2020, when the virus had spread to every continent except Antarctica, long after many other scientists had said a pandemic was already underway.

WHO is the only agency mandated to coordinate the world's response to acute health threats, but the organization faltered repeatedly as the coronavirus unfolded. In January 2020, WHO publicly applauded China for its supposed speedy and transparent response, even though recordings of private meetings obtained by The Associated Press showed top officials were frustrated at the country's lack of cooperation.

WHO also recommended against members of the public wearing masks to protect against COVID-19 for months, a mistake many health officials say cost lives.

Numerous scientists also slammed WHO's reluctance to acknowledge that COVID-19 was frequently spread in the air and by people without symptoms, criticizing the agency's lack of strong guidance to prevent such exposure.

From WHO's official statement:

The WHO Director-General concurs with the advice offered by the Committee regarding the ongoing COVID-19 pandemic. He determines that COVID-19 is now an established and ongoing health issue which no longer constitutes a public health emergency of international concern (PHEIC).

Well, okay, then.

One thing I didn't see in any of the above stories: any mention at all about dealing with long COVID and its potentially crippling effects. The WHO did recommend that nations "continue to support research ... to understand the full spectrum, incidence and impact of post COVID-19 condition", which I suppose is better than nothing. But, for those with long COVID and those who develop it in the future, it's not much better than nothing.