California Hospitalizations Climb As COVID, Flu And RSV Infections Increase

California hospitals are seeing increased strain heading into the winter holiday season, with more than three-quarters of inpatient beds occupied and nearly 67% of intensive care beds in use, according to figures released Friday by the U.S. Centers for Disease Control and Prevention.

But for the first time in three years, the surge is not solely attributed to COVID-19, as various viral and bacterial infections, including influenza and respiratory syncytial virus, contribute to the burden on the state’s health care system.

“It’s worrisome because everything is heading in one direction, and that’s up,” said Dr. Bob Wachter, the chair of the department of medicine at UCSF. “But it’s hard to know how high it’s going to go.”

In a briefing this week, Dr. Mandy Cohen, director of the CDC, highlighted a notable rise in respiratory illnesses nationwide due to the coronavirus, flu, RSV and pneumonia, reaching levels that are “elevated” or “increasing” in most areas. Wastewater data from the CDC indicates that COVID levels across the country are “high” and trending upward, nearing the peak reached last December.

California is among the states with the highest levels of respiratory virus activity in the country, with the illnesses combined responsible for 3.3% of all emergency department visits as of Friday — the highest figure since January. Over the summer, that number had dipped below 0.7%.

The CDC’s Cohen emphasized that COVID-19 remains the largest cause of new hospitalizations and deaths. After a stable autumn following a summer wave, infections are rising, evident in the growing number of hospital admissions.

Nationwide, emergency room visits are surging, with adult admissions for COVID-19 rising by nearly 3,400 from the previous week as of Thursday, the most substantial increase since August. Influenza admissions also spiked by almost 5,000, the biggest jump in a year.

Although COVID-19 poses less of a threat than during previous pandemic waves, approximately 1,000 Americans continue to die of the virus weekly, according to CDC data. That number fell below 500 per week this summer, the lowest figure since the start of the pandemic.

California has reported a 52% increase in COVID-19 hospitalizations over the past month, totaling 2,488 in the week ending Dec. 2, according to state data. The coronavirus’ share of all fatalities doubled during this period, reaching 2.8%. Still, those numbers are far below the peaks seen in the past three years as people are protected by vaccinations and previous infections and the virus shows signs of becoming less virulent.

Most of the people getting seriously ill or dying from the virus now are older adults and those with compromised immune systems.

“Fortunately, most of the things we’re dealing with are not going to harm most people,” said Dr. Yvonne Maldonado, a pediatrician and infectious disease expert at Stanford. “I think the message is that if you’re a healthy person with no underlying conditions, you’re probably going to be OK. But you still want to avoid getting sick if you can, because some of these diseases can knock you down for days or even put you in the hospital.”

Cohen also addressed the rise in reported pneumonia cases, assuring that “we’re not seeing anything new or unfamiliar in terms of virus or sickness,” referencing a recent outbreak of unidentified respiratory illnesses reported in China.

Ahead of the holiday season, she recommended adherence to familiar mitigation measures, such as vaccination, avoiding sick people, handwashing, proper ventilation, mask wearing and regular testing. “It’s not too late to get vaccinated if you haven’t already,” she emphasized.

Yet the message may not be getting across to many Americans eager to put the pandemic behind them.

“We’re in the early part of a significant uptick,” Wachter said. “It’s certainly disappointing how few people have gotten vaccinated. I think that’s a mistake. I think it’s a no-brainer. When the risk is high, it’s prudent to become more careful.”

Wachter said that as virus levels rise, he is considering masking in more situations, especially in indoor crowded spaces where he does not have to interact with other people. He will also reconsider indoor dining, which he felt more comfortable doing after he received the updated COVID-19 vaccine in October.

Only 16% of adults and 7% of children have received the updated vaccine as of this week. Among adults ages 65 and older, considered the most vulnerable group to severe disease outcomes, only one-third have received the updated shot, compared with 94.4% who completed the primary series of the original vaccine.

“The vaccine is such an easy choice,” Wachter said. “It’s maybe two minutes to a couple of days of discomfort, but zero ambiguity that it’s going to markedly lower your chances of dying, the chance that you go to the hospital, and somewhat diminish your chance of long COVID — and do it at essentially zero risk.”

California falls behind the national average on vaccinations, with just 27% of older adults having received the new COVID-19 shot, according to state data. However, uptake is higher in the Bay Area, where vaccination rates for seniors in the region’s nine counties range from 36% to 40%.

Meanwhile, two new immune-evasive coronavirus variants, HV.1 and JN.1, now account for more than half of the COVID-19 cases in the United States.

JN.1, recently classified as a variant of interest by the World Health Organization, exhibits an alarming number of mutations in its spike protein, potentially reducing the effectiveness of current vaccines. The variant, an offshoot of BA.2.86, comprised 21.4% of new COVID-19 cases in the U.S. last week, more than double the 8.1% reported over Thanksgiving.

Scientists warn that JN.1 might lead to another surge of infections around the new year, similar to the first omicron wave, but there is also a good chance it will fade away like predecessors that raised alarms when they emerged.

“It doesn’t look like we’re on the way to seeing a massive surge like in December 2022, but it’s too early to tell,” Wachter said. “The odds are it’s not going to be devastating, but we have to keep our eyes open. There is no guarantee that the next one will be the same.”


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