The rate of confirmed cases continues to decrease but I don't think that's an accurate indication of true community transmission. I'm more interested (concerned?) with the increase in viral concentration in wastewater data and the increase in hospitalizations. Hampshire county remains in the green "low risk" category, but several MA counties have moved back into the medium risk category. Hampden county's risk category hasn't changed, but transmission has increased back to "high" levels. I'm not surprised to see an increase after a holiday. Next week's data will be illuminating in regards to if this is a blip upwards and then cases decrease or plateau again, or if this is the start of a larger trend.

The CDC has updated their COVID-19 variant tracker with new colors to highlight the increasing importance of a few variants. We have been tracking the proportion of infections caused by BQ.1.1, BQ.1, and BF.7. Those variants, as all new variants must be to out-compete prior variants, are more contagious and evade immunity more than BA.4 and BA.5. In the past month or so, we've seen small steady increases in BQ.1.1 and BQ.1, but we've seen BF.7 become less prevalent. Small steady increases in the proportion of infections is not likely to cause a surge, so it's reassuring to see that pattern with the current variants. 

This is a good reminder of the difference between worrisome new variants to watch, which certainly included BF.7, and real-world activity. There are so many variables that influence which variant becomes dominant, including transmissibility, but it's not a straightforward prediction. In the updated CDC variant tracker, it's clear that the CDC is continuing to watch BQ.1.1 and BQ.1, but is now also watching XBB more closely. We'll keep our eye on the variants, but I don't see evidence of a variant that's positioned to cause a massive surge in the next few weeks. 

I included information this week about vaccination rates in Easthampton. The bottom line is that even in a highly vaccinated area, like Easthampton and all of Western MA, there are a whole bunch of people at every age who can and should get more vaccine protection. In some age groups, like the youngest age groups, that means getting "fully vaccinated" with the full prime series or perhaps getting one booster. For older age groups, that means getting the bivalent booster as (hopefully) your second or third booster dose. I can't say for sure what percent of each age group still needs to get the bivalent booster dose. It seems like I did in the graph in the dashboard, but there's a great deal of complication in that data as it's collected and presented right now. If you are interested in the deep dive into what I mean, check out my explanation below. If not - skip right on over to the bullet points below! 

Why is it complicated? There is a distinction between being "up-to-date" and having received all recommended boosters, but the nuance is difficult to tease apart in the data we have access to through the MA Department of Public Health. The DPH tracks how many people recieve one dose, two doses / the full prime series, one booster, and two boosters. There is no distinction in the system between type of booster, however, only the total number of booster doses received. The original version of the booster is no longer available, so the CDC will call you "up-to-date" with just one booster if that booster is the bivalent booster, regardless of how many boosters you could have received before this point. If that didn't make any sense to you, welcome to the pain this is causing inside my brain at the moment (and I'm sorry). Maybe an example will help? For example: If you are 70 years old, you were approved to get the full prime series in December 2020, you were approved to get a first booster in September 2021, approved to get a second booster in May 2022, and approved to get the bivalent booster in September 2022. That means you have been approved for the full prime series and a total of three boosters. But if you had no boosters, and you decide to get the bivalent booster tomorrow, you're "up-to-date." But - you could be MORE protected, if you had those prior boosters, but what do we do with you now? You can't go get those boosters... they're not offered. Is the bivalent booster enough? Are people with 1 bivalent booster equally protected as people with 2 original boosters and 1 bivalent booster?

See what I mean? Regardless of the nuance, the bottom line remains important (and is reflected in national and state data): there is a LOT of room for more folks to get the bivalent booster and get more protection.

- Communities around MA and the US are experiencing a post-Thanksgiving bump in confirmed cases and hospitalizations. The increase started just before the holiday, however, so it's not clear if it's a short-term increase or the start of something more. COVID-19 deaths in the US are continuing to decrease, but cases and hospitalizations are increasing (in general).

- Most COVID-19 deaths (90%) are among those who are 65 years old or older. To put it in perspective COVID-19 is 2-3x more deadly in this age group than influenza. Older adults who are unvaccinated have a far higher COVID-19 mortality rate than older adults who have any level of vaccination coverage, and there seems to be a dose-response relationship between level of vaccination and protection. Older adults with the most boosters and especially with the bivalent booster have the lowest mortality rates. 

- The "triple-demic" situation is continuing and local healthcare providers (and healthcare providers across the country) are overwhelmed with patients with "flu-like illness". The CDC tracks both the confirmed number of influenza cases and also the number of people who visit a healthcare provider with symptoms that resemble the flu. They might end up having the flu, but they also might have COVID-19, or RSV, or a yucky cold virus. Tracking visits for flu-like illnesses is helpful, because unlike the county categories based on just COVID data, flu-like illnesses encompass all respiratory diseases and provide an excellent picture of the respiratory health in the US right now. The bottom line is that there is a LOT of flu, RSV, COVID-19, and other yucky viruses spreading around right now. Epidemiologists are using words like "unprecedented" and "concerning" - which, to be frank, I find alarming coming after 2+ unprecedented years. THIS is unprecedented? Yikes. Hopefully that puts the situation into perspective - it's not good out there right now. The CDC director recently said "hospitalizations are the highest now than they have been in the past decade." 

We don't know what will happen next with COVID-19 or the other respiratory disease challenges we're facing right now. As always, there is a lot you can do to control your circumstances and to help your community: Wear a KN94 / KN95 / N95 mask, stay outside or in well-ventilated spaces whenever possible, and stay home when you're not feeling well, even if you're sure it's not COVID (or the flu. or RSV.) - bringing ANY of those viruses out into the community is unhelpful and can be dangerous to vulnerable populations. I highly recommend getting back to using rapid tests before getting together with others, every time. They aren't perfect, but combined with staying home when you don't feel well (even if you test negative), they'll go a long way to avoid being part of a chain of transmission. The easiest and most effective thing you can do is get a flu and fall COVID-19 booster. It's definitely not too late.
Megan W. Harvey, PhD (she/her)
Epidemiologist

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