Physicians address the coming months
As California waits for the official end of the COVID-19 state of emergency, the flu season is beginning.
Gov. Gavin Newsom announced this week that the state of emergency will end Feb. 28.
“The reason they have announced this early is so people can be prepared for provisional changes,” Paige Batson, deputy director for Community Health at the Santa Barbara County Public Health Department, told the News-Press. “They are expecting the ending of the state of emergency will have minimal impact on Caliifornians and are looking to codify provisions into legislation.
“One provision is where nurses can dispense therapeutics,” she said. “Another example is COVID testing-exclusive labs are looking to be put into legislation so testing can continue more broadly. The intention is for some of these provisions to continue, and the state is working with the Legislature on this, looking into how to codify provisions and keep them.”
“During the course of the pandemic, we mounted 569 emergency provisions,” Ms. Batson said. “There are only 27 remaining. Early notice is to allow us to start working on local impacts. The numbers have declined significantly, and community spread of COVID is low.
“The end of the state of emergency does not mean COVID is done,” Ms. Batson said. “COVID isn’t going away on Feb. 28.”
With the state of emergency being phased out, California officials are promoting what they call the SMARTER Plan.
“The plan is to be used as a resource to get ahead of future variants or surges,” Ms. Batson explained. “The ‘S’ (in SMARTER) stands for shots and vaccines. The M stands for masks. The ‘A’ stands for awareness (through surveillance and monitoring). The ‘R’ stands for readiness (speaks to using tools and resources to be ready to respond). ‘T’ stands for testing (getting the right tests to where they are needed to reduce spread). The ‘E’ stands for education (keeping schools open and children safe).
“And the ‘R’ stands for treatment (Rx),” according to Ms. Batson.
Dr. David Fisk, medical director of infection prevention control at Cottage Health, questioned Gov. Newsom’s decision to end the state of emergency.
“First, the state of emergency ending in February in California is at odds with declarations from the World Health Organization and the U.S. extending the state of emergency,” said Dr. Fisk. who is also chief medical officer for the Public Health Company. “California ending the state of emergency is, in my assessment, premature because we are still facing a situation where roughly 400 Americans a day are dying of COVID, and a surge is anticipated in the coming months.
“There is also evidence of a surge in Europe, and trends in Europe often precede the U.S.,” Dr. Fisk told the News-Press. “There are signs in the Northeast of a surge coming and rapid acceleration of variants of COVID. New variants are rapidly accelerating internationally and in the U.S.
“The CDC posted that BQ.1 variant is at 17% percent in the U.S.,” Dr. Fisk said.
He added that doctors don’t have a good measure on the ability of the new variants to cause severe infection. But he added physicians don’t expect the ability to be any less than that of the BA.5 variant.
“My opinion is that it was very poor timing for California to announce this,’ Dr. Fisk said. “It is extremely difficult to see what we will be seeing at the end of February.
“The (end of the) state of emergency takes away hospitals’ flexibility in response to case surges, which allows them to allocate space as needed,” Dr. Fisk said. “COVID is on its way up in the U.S. and could be (on its way up) in California,” he said. “We need to be more careful than most of us are being. Chances of acquiring COVID in the coming months are higher than they are today.
“Only 6-7% of the U.S. population has received a bivalent booster,” Dr. Fisk said. “The booster will radically reduce hospitalization and death. But we don’t have good information on protecting from acquiring COVID. People who have been boosted need to be careful, and those who haven’t been boosted need to be even more careful.”
Dr. Fisk addressed this year’s flu season as well.
“Influenza is already in our midst early this year,” he said. “And all signs point to this being a very intense influenza season. Local influenza numbers are increasing faster this year than most years since 1997 when records began to be kept, with the exception of the 2008 outbreak.”
But Ms. Batson said she doesn’t expect this flu season to be more aggressive than previous ones.
“Flu season usually begins the first week of October and runs through the end of May, although the state conducts surveillance through the year,” she told the News-Press. “So far flu activity has been minimal. To my knowledge, we are not anticipating this flu season to be more aggressive than any other year although there is an increase in RSV (respiratory syncytial virus) across the state.
“Adults over 65 and children under 5 are particularly susceptible to RSV. There is no vaccine for RSV,” she said.
“We are strongly encouraging individuals to get flu shots,” Ms. Batson said. “Get the flu vaccine and COVID boosters if you are eligible. There is no contraindication to receive both vaccines at the same time. The CDC recommends those six months and older get the flu shot.”
Dr. Fisk said all signs point toward this being the worst flu season in years.
“The fact that people are masking less and approaching the winter season adds fuel to fire,” he said. “Masking also reduces the risk of influenza infection.
“People should be getting influenza vaccines now. It is recommended by CDC that they get the high dose if over 65 or have a weakened immune system,” Dr. Fisk said. “People should follow advised precautions implemented during COVID-19 and wash hands regularly after contacting other individuals or surfaces in public places. They should also ask other individuals in their life to not come around when infected.
“There are already high levels of other respiratory infections such as RSV and enterovirus impacting hospitals and pediatric centers,” said Dr. Fisk.
Ms. Batson said the best defense against the flu is the vaccine.
On the COVID-19 issue, Dr. Fisk discussed the risks of ending the state of emergency in February.
“It sends the wrong message,” he said. “It sends the message that we don’t need to worry about COVID anymore. That’s not supported by science and evidence that we have about what COVID is doing and could do in the future. The provision could take effect at the end of February and leave hospitals horribly stymied in their ability to respond to not only COVID surges but hospitalizations especially with influenza season.”
Although ending the state of emergency on Feb. 8 doesn’t mean COVID is going away, Ms. Batson said, “Santa Barbara County is able to respond to any surges, and we are providing ongoing surveillance and are ready to respond to potential surges as is the state.”