Wastewater levels continue to increase in all four regions of the United States, and the national average continues to increase as well. Although some public health departments are warning their communities, not every government agency across the country is similarly sharing this important information. It is important that we hold them accountable, especially when the risk of an infection is increasing.
The current variant landscape remains a mix of nearly equally dominant strains since the last variant update we gave on July 22, 2023 (CDC now updates every 2 weeks). EG.5 nicknamed “Eris,” a descendant of XBB, is growing in proportion and has become the dominant strain at 17.3% and XBB.1.16 is now the second most dominant strain, representing 15.6% of infections. Due to local health departments being no longer obligated to share data as a result of the end of the public health emergency, the CDC has limited its regional-level reporting of variant proportions through its Nowcast estimates, currently available for only three out of ten regions.
BlackStar Film Festival 2023 in Philadelphia, PA, occurred this past weekend August 2-6th. As a part of their wellness and safety guidelines, they specified that “masks are required at all indoor events, except when actively eating or drinking” and that “masks must remain on while inside theaters.” The festival also facilitated a hybrid virtual/in-person program, with the option to exchange in-person tickets to virtual. This option was important especially if prospective attendees began to experience symptoms after ticket purchase, deterring them from attending the festival on-site if they had a potential illness. This is another example of a large event that ensures safety precautions for its visitors and participants.
Cases, Hospitalizations, and Deaths:
Given the many reductions in COVID surveillance with the end of the public health emergency on May 11, 2023, it has been more difficult to get an accurate picture of COVID cases, hospitalizations and deaths. For this reason, we are reporting these data less frequently and with more caveats. Epic, a company that specializes in an electronic medical record system for healthcare systems serving over a hundred million patients, has been recently reporting on COVID through their research department. In the past six months, their team has reported over 1 million clinically diagnosed COVID cases within health systems with the Epic electronic medical record system. Cases in the Epic dataset reflect predominantly testing in a subset of medical settings, and we note that recent rollbacks in preadmission hospital testing will lead to undercounting. Although the Epic data cannot be used as broader transmission data, it clearly demonstrates that a high volume of COVID transmission continues to occur in the US in this past year. During the week of July 22nd, the CDC reported over 8,000 Americans newly admitted to the hospital for COVID, an increase of 33% compared to the previous week. In the meantime, across the entire month of July, the CDC reports over 1,000 individuals have died from COVID, almost certainly an undercount due to reporting delays as noted by the CDC in their footnotes on death tracking.
COVID Testing and Treatment:
As an increased level of COVID infections persists, it is important to be aware of how best to detect an infection. Use PCR testing sites where available, and when using rapid antigen tests, we additionally recommend swabbing the throat and cheeks, as well as re-testing in the following days for more effective results. Retesting is especially important within the first few days of exposure, before symptoms arise. It is also important in asymptomatic cases, as recent studies have shown rapid antigen tests miss 90% of asymptomatic cases, especially when taken only once as opposed to serially over multiple days. We include a video on how to properly conduct a throat and cheek swab.
If you or someone you know develops COVID, treatment options are available that can reduce the risk of severe disease. Paxlovid as well as Lagevrio (molnupiravir) are both options that may help treat this infection and may also reduce the risk of Long COVID. Lagevrio is usually considered for those who cannot receive Paxlovid for medical reasons. See these links to studies on Paxlovid and Lagevrio and Long COVID prevention. We strongly recommend that you request one of these options after testing positive. If you are having trouble getting access due to potential eligibility recommendations, you can go here to find places that will “test to treat,” and if you face resistance from these healthcare providers, CVS pharmacies are much more willing to provide access to these invaluable treatment options through telehealth and after a positive COVID test.
The NIH recently updated their considerations regarding COVID-19 among children with additional details around Long COVID. They specifically warn that the “burden of post-COVID conditions in children may be quite large.” They specifically recommend that certain symptoms should be monitored such as “persistent fatigue, headache, shortness of breath, sleep disturbances, gastrointestinal symptoms, and an altered sense of smell.” A recent review published in Pediatrics also found that symptoms among children and adolescents may persist past 3 months, and approximately up to 16.2% of kids may suffer from Long COVID.
Across the Atlantic, the UK continues to take Long Covid seriously as a condition after a COVID infection. Their healthcare system, National Health Service, has added it onto a current list of conditions ineligible for blood donation. Although there is no official statement from NHS on this decision to limit blood donation from those with Long COVID, a 2022 pamphlet from The ME association of the UK states that the decision to ban those with myalgic encephalomyelitis and chronic fatigue syndrome (ME/CFS), a condition that many with Long COVID suffer from, was made “on the grounds of donor safety.”
As COVID infections continue, there are multiple approaches to lower the risk of an infection and protect yourself and those around you. During this summer season, many gatherings occur; learn more here about how to ensure a safer on-site gathering together. We also provide a summary on the different layers of protection here. If you are unfortunately infected with COVID, we also provide a comprehensive set of guidelines of what to do when testing positive.
The Department of Health in New York City (NYC) has continued to offer two types of no-cost COVID testing, at-home rapid antigen tests and PCR tests. At-home rapid antigen tests are available for pick up at several locations or PCR testing is available at the following on-site locations, appointments required. Although this is a significant cut in the level of access to COVID testing in NYC, we strongly urge that you contact your state and local public health departments to demand for ongoing equitable and no-cost access to COVID testing.
This is a reminder that we need your help to tell the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) that we need N95 respirators as part of the standard in infection control for COVID and other airborne pathogens. Take action today to stop this dangerous shift and to reinstate universal masking in healthcare. Written comments can be submitted to firstname.lastname@example.org by August 25. You can ask your local representative in Congress through these instructions and demand for transparency with HICPAC. You can send them an email asking that the CDC maintain strong standards with infection control in healthcare settings.
During these challenging times, we are also calling out for solidarity among healthcare and public health workers for equitable and universal care. Learn more about this effort and join this collective action with more instructions here.
Notes: 1) The numbers in this report were current as of 8/4/2023. 2) Changes in testing access as well as data reporting have led many federal data sources to become less reliable. Fewer federal data sources may be included in current and upcoming Weather Reports, and we will do our best to provide context regarding the representativeness of limited data. 3) Check out the links throughout & see our website for more! https://peoplescdc.org