EXPERTS DEMAND DISCIPLINE AS COVID-19 CASES EASE

Though vaccines have helped greatly, variants a concern

Restoring San Diego County’s long-severed social connections is starting to feel less and less risky now that nearly 80 percent of its residents age 65 and older are vaccinated.

The state’s tiered reopening system rests on emergency powers Gov. Gavin Newsom granted himself on March 4, 2020, and used to put and keep in place the stay-home order that, to this day, declares COVID-19 a public menace.

Under state law, only the governor may declare that the pandemic is no longer a public health emergency and, so far, it has technically remained so. Despite mounting public pressure to pull back on emergency powers, the state has followed a cautious path, allowing a gradual return from hibernation that will reach its broadest point Thursday with the return of fans in stands at outdoor entertainment venues and visitors to amusement parks.

While many, pointing to much lower Covid-related hospitalizations, are demanding that the state go faster still, those who understand pandemics best continue to warn that this is not the moment to head to the bars sans masks.

Dr. Chip Schooley, a nationally known infectious disease expert at UC San Diego, said that while he knows the temptation to start partying has seized many, such exuberance should, for the moment, be reserved for those who are fully vaccinated.

“To have people who aren’t vaccinated going out to indoor places without masks, it just gives the virus more shots on goal, and that’s really not what we want to be doing in this moment,” Schooley said. “It’s not like we’re in a situation where we hope to get a vaccine some day and we’re asking people to wait for an indeterminate amount of time.

“We have one, we know that it works, and we need just a few more weeks to put this thing back in the bottle.”

Many will note, though, that the main stated goal of the massively disruptive public health campaign that began unfolding one year ago was protection of hospital capacity. If the pandemic began producing too many simultaneous infections, it

would not have been long before every hospital bed was full and doctors were practicing “crisis” medicine, granting access to lifesaving care based on a person’s overall probability of benefiting from access to resources such as mechanical ventilators, intravenous medication and the attention of trained specialists.

It nearly came to that in California just after the holidays with many emergency departments so inundated that they were temporarily forced to turn away new patients.

But the demographic most likely to produce such a surge is now in a very different place.

Though they make up 16.5 percent of the population, Americans age 65 and older comprise 46 percent of Covid-related hospitalizations and 80 percent of coronavirus-linked deaths, according to the U.S. Census Bureau. Local statistics show roughly the same proportions in San Diego County.

Age, many researchers have found, is COVID-19’S clearest risk factor. The chronic diseases that make severe illness and death more likely — diabetes, heart disease, high blood pressure — are more common as we get older.

A study published in September found that those younger than 65 have a “30to 100-fold lower risk of COVID-19 death” than those age 65 and older.

According to the county’s most recent tally, released Saturday, 364,052 of the 473,003 people age 65 and older who live in San Diego County have been vaccinated.

That’s 77 percent, surely enough to have significantly helped drive the region’s collective hospital census, the number of people with COVID in beds on any given day, down 67 percent over the past 30 days as indicated in the county’s most-recent tracking report.

But experts caution against reducing the pandemic picture to hospitalizations alone.

The virus itself is changing, mutating into “variants of concern” that have been spotted in the United Kingdom, South Africa, Brazil and California. Many of these show a greater ability to infect than the initial group of pathogens that first spread across the globe from Wuhan, China.

Last week, San Diego County reported the nascent presence of P.1, the more worrisome of two mutated types first detected in Brazil. That viral version is distinguished by its ability to reinfect those already sickened in the first wave. Locally, said Dr. Kristian Andersen, an immunologist at San Diego’s Scripps Research whose lab is conducting genetic surveillance of COV-2, said in an email last week that the U.K. variant, formally called B.1.1.7, now likely represents half or more of all new cases.

Because it spreads more quickly than initial versions, 117 presents a greater threat as communities allow greater levels of social gathering, especially if that gathering is among people who are unmasked and unvaccinated.

Dr. Paul Offit, the outspoken director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said that vaccination remains the most potent anti-variant weapon.

“At least from the studies that have been done in places like South Africa and Brazil, where these variants are more common, it looks like, even if you do become infected, you’re likely to suffer only mild or moderate, but not severe disease,” Offit said.

He should know. Offit is a member of the independent panel of experts that has reviewed and approved all three novel coronavirus vaccines.

He and Schooley note that the current crop of variants are their own kind of warning that must be heeded in a moment when the overall risk of hospitalization and death has decreased. Every time the virus replicates itself, they note, there is a chance that, in copying its genetic material, mistakes will be made, leading to the kinds of mutations that make P.1, B.1.1.7 and others.

So, it remains vital that as the world starts to wake up again, unvaccinated people continue doing whatever they can to avoid getting infected. Every generation of viral replication inside humans rolls a set of unpredictable genetic dice very capable of landing everyone in a tougher spot.

“The goal is to stop replication of this virus as much as we can, knowing that we’ve already generated a series of variants,” Offit said. “The degree to which we can slow this virus is the degree to which fewer variants will be generated.”

While vaccines appear capable of crushing the types of virus now circulating, there are no guarantees. It’s necessary to squash this bug before it escapes.

“We just don’t want to be in a situation where we have a variant emerge that we can’t control with the vaccines that we have available,” Schooley said. “We don’t want to have to start over.”