COVID update March 23, 2022: If We Don't Learn From History, We Are Doomed to Repeat It.

The historical view through wastewater testing.

Mar 23, 2023

The CDC's wastewater PCR testing is showing that nearly 90% of testing sites are positive for COVID. This virus is everywhere, but does that mean it is endemic or that the public health emergency is over? The short answer is NO.

Good News and Bad News

The Good News

The map below shows us the prevalence of COVID at the testing sites and as we can see, the east coast is blue or light blue, which means lower prevalence. The upper mid-west is lower than it has been but there is still a high prevalence in a lot of areas. The northwest is also maintaining a high prevalence in many spots, while the Southern half of the U.S. is largely at a low prevalence.

The Bad News

The map below shows the percentage change from the prior 15 days. This is letting us know that there are a lot of hotspots popping up that will likely spread outward over the next several weeks. We have a number of mutated XBB.1.5 sub-variants that are gaining ground in certain areas, and we also have seed cases of the more concerning variants coming in from India, the U.K. and other countries. We will discuss that in a little more detail below.

The Number of Wastewater Testing Sites with Increasing Prevalence, 2022-2023

The graph below shows the number of testing sites that are showing an increase in prevalence. The arrow on the left indicates mid-March 2022. Looking to the right brings us to where we are now, in mid-March 2023. Looking to the right of the arrow, we can see that the decline has reversed. There are more testing locations with an increasing prevalence. The top yellow line is currently near the top of the orange, and the lower yellow line is near the top of the red. We can see that it is nearly identical to this time last year. Last year, the number of sites with increasing prevalence increased for the next month before remaining higher for the remainder of the year. This has been an accurate predictor of what will happen, and we can expect COVID to become more prevalent for the rest of the year, as it did last year. Given this, and the fact that the new XBB.1.16 is surging in India, with an estimated 190% growth advantage over XBB.1.5, we should be bracing for another surge in cases, hospitalizations, Long-COVID, and deaths. Let us hope for the best while preparing for the worst. Are hospitals stocking up and preparing?

Historical Perspective - 2020 through 2023

Looking back over the past four Marches, we can see two important points. The first is that mid-March has been the lowest point of prevalence of the entire year, every year. The second point is that the prevalence is higher in 2023, than in any of the prior years. When thinking about the metrics that the governments and media pundits use to surmise that the pandemic is over and that we can end the emergency, it is hard to understand how they do not take so many obvious factors into consideration.

The graph below is the same as above but looks at only the past six weeks. We can see that the mid-west and northeast are taking a turn toward increasing prevalence again.

U.S. Hospitalizations 2022 and 2023

March 15th, and there are almost the same number of people hospitalized both years. This doesn’t show that we are doing better, and it shows that we can expect hospitalizations to surge again just like the wastewater data is already suggesting.

U.S. Hospitalizations Mid March 2022 and 2023

Canada, Australia and the U.K. Hospitalizations 2022-2023

The hospitalizations remain high and, like in the U.S., will likely increase over the next few weeks, especially if the newest variants can evade prior immunity. These variants are arriving as natural immunity from prior infections is waning and the vaccine-induced immunity is nearly gone for most people.

U.K., Canada, Australia Hospitalizations Mid-March

CDC Transmission Level

This is showing that 57% of the U.S. remains at High or Substantial Transmission. This is likely the lowest we will see for the rest of the year. These data points do not show the public health emergency is over.

XBB.1.16 and XBB.1.16.1 are the most concerning variants in front of us at the moment. India does not have great surveillance or reporting, but despite this, they are reporting a 279% increase in cases and a 238% increase in deaths over the past 14 days. India has the most cases of XBB.1.16. This likely started in Maharashtra, India.

Vipin M Vashishtha, the former convenor of the Indian Academy of Pediatrics and a consultant pediatrician at the Mangla Hospital and Research Centre, Bijnor., is saying that “All eyes should be on India.”

“If XBB.1.16 aka #Arcturus could succeed to wade through the ‘sturdy’ population immunity of Indians that successfully resisted the onslaught of variants like BA.2.75, BA.5, BQs, XBB.1.5, then the whole world must be seriously worried!”

We can see from the map below that XBB.1.16 has been sequenced in the multiple states.

Prime Minister Narendra Modi held a high-level meet to review the situation and take stock of public health on preparedness. The “PM advised authorities to continue focusing on the 5-fold strategy of test-track-treat-vaccination & COVID-appropriate behavior, enhanced lab surveillance & testing of all Severe Acute Respiratory Illness (SARI) cases”, reported on Firstpost.com

This is not a time to let our guard down. It is time to prepare for the next surge, which we can confidently predict will occur. We need to keep a close eye on the situation to see how far this variant can go in suppressing our immune system, infecting our organs, including the brain, and causing long-term damage to all of us. We should be most concerned about the children who lack adequate protection, and without adequate monitoring, this could rip through schools and homes long before we do anything to stop it. This is not the situation we should be in. We should have learned from our mistakes, put our knowledge to use, and become better prepared. Instead, we have less surveillance, almost no treatments for the initial infection or for Long COVID. We haven’t upgraded HVAC systems. We don’t have any updated vaccines. We are not ready. The public health crisis is not over. We need to make sure that our representatives and the President understand this.

Creating a Sustainable Path to Living with COVID

When kids thrive, all of society thrives. Our collective future depends on the decisions we make today. Investing in kids now is not just the right thing to do, it’s a down payment on our future that will bear enormous social and economic dividends for years to-come.

We must demand that we are provided the protections and assurances because they won’t be given freely. Making sure “Clean Air for Kids” is a requirement that must be met before ending the emergency. The funding to install new HVAC systems or upgrade existing systems to monitor CO2, the air exchange rate, and install filtration that can remove 99% of pathogens from the air hasn’t been approved or promoted. Updating building codes is another path to ensuring that children have the protection they need.

The only sustainable path out of this requires that we significantly reduce transmission, protecting educators, parents, grandparents, and the entire community. Importantly, it protects the children of today and for generations to come, from COVID and other airborne pathogens, ensuring they do well in school, grow up to live happy and healthy lives, capable of leading the world into the future.

See how you can help. tActNow.info/clean-air-for-kids

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