The expected winter wave of respiratory viruses in California is steadily receding, with hospital admissions for COVID-19 and influenza falling back to levels seen before Christmas, according to figures reported by the state Friday. Health facilities and the public have fared much better this winter compared with the previous three seasons of the pandemic.
Yet amid the substantial decline in serious illnesses and deaths, critics are concerned that a new state policy easing isolation recommendations for people exposed to or infected with the coronavirus could potentially reverse the progress.
There have indeed been significant improvements in several key metrics, including a 53% reduction since the start of the year in weekly emergency department visits nationwide attributed to the “tripledemic” of COVID-19, influenza, and respiratory syncytial virus.
In California, COVID-19 hospital admissions have fallen to an average of 419 per day, down 27% from their peak on Jan. 3, according to the latest health department data.
Over the past week, an average of 2,332 people have been in the hospital each day with COVID-19 in the state, down from nearly 2,800 at the start of the year. California’s test positivity rate has fallen to 10.6% from a recent peak of 12.3% just after Jan. 1.
Though more than 1,700 Americans are still dying each week from the virus, that figure is much lower than it was during the first winter wave in 2021, before vaccines were widely available, when approximately 26,000 people died in the third week of January. Last year, weekly deaths peaked at just over 3,600 during the same period.
Wastewater samples from around the Bay Area also signal reduced coronavirus levels in local sewage, aside from a couple of hot spots in San Francisco and Napa.
Set against this backdrop of encouraging trends, the state’s new COVID-19 guidelines are meant to reflect diminished risk to the public. Rolled out this month, the revised policy from the California Department of Public Health significantly reduces the recommended isolation period for infected individuals.
Californians with mild and improving symptoms can return to work or school after being fever-free for just 24 hours, although they’re advised to continue masking and to maintain distance from individuals at high risk for severe illness for 10 days. Individuals with no evident symptoms are no longer required to undergo isolation.
The state’s move has sparked substantial concerns and discussions among experts and the public, with some worried it could lead to an increase in infections.
Guidance faces backlash: ‘It is outrageous’
California is the first state to diverge from guidelines established by the U.S. Centers for Disease Control and Prevention, which still advocate for a minimum of five days of isolation after initially testing positive for the coronavirus or experiencing symptoms.
The California Department of Public Health justifies the change, stating that the state is now at “a different point in time with reduced impacts from COVID-19” due to broad immunity from vaccination and natural infection, along with readily available treatments for infected individuals.
“Previous isolation recommendations were implemented to reduce the spread of a virus to which the population had little immunity and had led to large numbers of hospitalizations and deaths that overwhelmed our health care systems during the pandemic.”
The agency declined to elaborate on the science behind its decision, which has drawn condemnation from some infectious diseases specialists.
Dr. Michael Mina, an epidemiologist and former assistant professor of epidemiology at Harvard T. H. Chan School of Public Health, is among those expressing strong criticism, stating that the guidance “essentially encourages” infectious people to return to work and school, potentially spreading the virus to others.
“It is outrageous,” he said in a social media post.
Mina emphasized the importance of rapid tests over relying solely on fever as an indicator of infectiousness. He also underscored the need to balance societal limitations with mitigating the spread of the disease, endorsing the CDC’s five-day rule.
“We no longer live in a world where we have to guess on this issue,” Mina wrote. “We have very simple and increasingly affordable diagnostics that can provide people (including school nurses and the like) to see what used to be invisible and thus not put others at risk.”
The concerns raised extend beyond immediate infection risks. Experts such as Dr. Steven Deeks, a professor of medicine at UCSF, highlighted the lingering threat of long COVID.
“Long COVID is real and although all the signs suggest it is less common now than it was back in the beginning, it has not gone away,” Deeks said. “This needs to be part of the discussion as to when and how to relax guidance around masking and returning to work or school.”
Dr. Peter Chin-Hong, also of UCSF, said the updated recommendations were reasonable, given the high level of COVID-19 immunity now present in the community. But he cautioned that the effectiveness of the new rules also depends on individual behavior. Few people, especially children, are up to date on their vaccinations or willing to wear a mask for 10 days after testing positive for the coronavirus.
As of Jan. 13, only 21.5% of adults and 11% of children in the U.S. had received the latest updated COVID-19 vaccine, per CDC data.
New dominant variant no more severe, CDC finds
On a more positive note, early data from the CDC has found that the most prevalent variant of the coronavirus currently in circulation in the U.S. is likely no more virulent than its predecessors. The JN.1 variant is now estimated to be responsible for about 86% of COVID cases nationwide. But the CDC said this past week that there’s no evidence it causes more severe illness.
During a webinar with lab officials, the CDC’s medical epidemiologist, Dr. Eduardo Azziz-Baumgartner, highlighted that the data so far indicates JN.1 — an offshoot of the BA.2.86 omicron strain — could even be less severe than previous variants. But he warned that it could still be deadly for some individuals.
“It’s important to remember that how a virus affects an individual is unique,” he said. “It could be very severe. People could die from a virus that, to the general population, may be milder.”
The CDC seeks to gather more data on this variant over the next few weeks to provide a more comprehensive risk assessment.