The official case rate declined slightly again last week, although I am sure this is inaccurate. Just like two weeks ago, the data spans another holiday which comes with dramatically reduced testing. For example, last week there were a total of 230 PCR and/or provider-based rapid tests performed on Easthampton residents. We typically average about 375 tests per week. Fewer tests means it's likely that milder cases - or perhaps even quite yucky cases, but ones where the person doesn't need supportive care from a provider - are going untested and the official case rate is the tip of the iceberg (even more than usual - we already know it's undercount!). We can see evidence of this not just in the decrease in tests performed, but in the increase in percent of those tests that are positive. Last week about 9% of tests performed were positive - a substantial increase from typical weekly Easthampton percent positivity rates that hover around 5%. Wastewater surveillance data confirms that there is no drop in community infections.

Most alarmingly, counties across the state of Massachusetts saw increases in severely ill patients in hospitals. Hampshire County is now back in the medium category, along with Hampden and Berkshire counties. The rest of Massachusetts has moved into the high category! This is not a great time to need hospital based services in Massachusetts. The best thing you can do to avoid hospitalization for COVID-19 is to get up-to-date on the vaccine, which means getting the updated bivalent booster. By the way, that's true for the flu, too! The best way to stay out of the hospital is to get the yearly flu vaccine. It's not even remotely "too late" to get either!

We've been tracking variants in the US weekly - this week I included specific information about XBB 1.5 in the US and in the Northeast in general. XBB 1.5 is not yet dominant throughout the country, but it is certainly dominant in the Northeast, which explains the surge in cases and hospitalizations. Remember, for any variant to become dominant it has to be more infectious than prior variants - so XBB 1.5 is more infectious than the very infectious original omicron variant and BA.4 and BA.5. The best protection against an XBB 1.5 infection is as much immunity specific to this variant as possible - which, hey, funny you should mention that, that's what's targeted in the updated bivalent booster! 

I haven't forgotten about discussing long COVID in the weekly update. There isn't a whole lot of new information to report. That proportion of people who get COVID-19 who end up with long COVID varies widely by dataset, anywhere from 10% to 30%. It depends on how it's being defined and over what time period. Long COVID is a collection of symptoms of varying degrees that linger months and even years after the virus has been cleared from the body. This is not unique to COVID-19 - there is "long-flu" and "long-RSV" and "long-any-virus" as well. What is unique is the high prevalence of lingering symptoms and the symptoms themselves, which include things like fatigue but also localized damage to organs (like kidneys and the heart) and lingering neurological symptoms (like loss of smell). We're not sure why long COVID is more prevalent than long-any-other-virus. Here are some other things that are fairly well established about long COVID at this point (even if poorly understood): 

• It’s more common among people assigned female at birth, compared to people who are assigned male at birth
• It seems to occur at any age
• It’s more likely after severe illness
• Vaccination reduces the risk
• Boosters reduce the risk - and probably the updated booster reduces the risk as well
• Vaccines also seem to cut long-COVID short, if a booster dose is received after infection and the start of long COVID.

Megan W. Harvey, PhD (she/her)
Epidemiologist

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