COVID-19 Update for July 11, 2022-Surging Variants and Cases, What to do if You Are Sick, Return of Mask Requirements? More

Cases: California is in the midst of its third-largest Covid surge of the pandemic, with roughly 19,000 new cases being reported here each day, according to The New York Times’s tracker. The true number of people falling sick is undoubtedly even higher, since most at-home tests aren’t included in official case counts.

The good news: Most people testing positive aren’t becoming severely ill. In fact, the number of people dying from Covid in California is currently lower than at almost any point in the pandemic. (This trend holds across much of the country, as my colleague Benjamin Mueller recently explained.)

We can thank vaccines and boosters, immunity from prior Covid infections and therapeutics such as Paxlovid — all of which seem to reduce the risk of severe disease.

Now on to the bad news: Omicron subvariant BA.5 has rapidly become dominant in the United States. And it’s especially good at infecting people and bypassing their immune system’s defenses, even if they’ve been vaccinated, boosted and already had Covid, experts say.

Topol knows many people who’ve recently fallen sick with Covid in San Diego, as do I in Los Angeles, where I live. The C.D.C. considers Covid risk to be high in 38 of California’s 58 counties and recommends indoor masking in those places.

But unlike earlier in the pandemic, officials across California are reluctant to enact new restrictions. Alameda County reinstated an indoor mask mandate last month but rescinded it three weeks later.

Experts predict that without tighter rules or behavioral changes, the hyper-transmissibility of BA.5 will lead to a continued surge in cases in the coming weeks in California. There will also most likely be a modest increase in hospitalizations and deaths, said Dr. Robert Kim-Farley, an infectious disease expert at the University of California, Los Angeles, Fielding School of Public Health.

Daily coronavirus case counts in Pasadena have tripled since the Fourth of July, Public Health Director Dr. Ying-Ying Goh said Friday.
The Centers for Disease Control and Prevention estimates the number of COVID-19-positive people in the city may range in the thousands, raising the possibility of a renewed indoor mask mandate, she said.

The Pasadena Public Health Department, which is separate from Los Angeles County’s public health department, reported 107 cases on Friday — an increase of nearly 350% from Tuesday’s tally of 31.

However, it’s likely that Pasadena has far more cases than counted by Pasadena Public Health officials in recent days, since Southern California residents from different communities intertwine daily, according to Goh. Another reason for the discrepancy is most community members are opting for at-home tests.

The surge — even in a city where nearly 100% of people have gotten their first vaccination dose — prompted caution flags from Pasadena health officials.
“It’s really reasonable right now to presume when you have symptoms and a family member tests positive for COVID, then you are probably positive, too,” Goh said. But it’s imperative that residents still follow quarantine orders to prevent spreading the coronavirus to other people whether they opt to get tested or not, she said.

And while it may be challenging to adapt and put your life on pause, it’s necessary, according to Goh, who encouraged residents who don’t test positive using a PCR test to still quarantine for at least five full days when they feel symptoms after being exposed.

If an individual tests negative on the fifth day, then they’re free to roam about, according to Goh. If a test still reveals a positive, however, then one should remain in isolation. The consequences of not isolating, collectively, could include reverting to a universal mask mandate similar to one that’s currently being discussed by Los Angeles County leaders in the wake of rising hospitalizations in the region.

Los Angeles County is on pace to reach the “high” virus activity level by next week, which could equate to another universal indoor mask-wearing mandate by the end of the month, the public health director said on Thursday.

Countywide, hospital numbers have been steadily rising in recent months, an increase health officials have attributed to renewed rapid spread of the virus by the infectious BA.4 and BA.5 variants, which authorities say are highly contagious and capable of reinfecting previous patients.
The CDC doesn’t list statistics for Pasadena separately from Los Angeles County, which under the Centers for Disease Control and Prevention’s criteria is in the “medium” virus activity level. It will reach the “high” category if the seven-day average of new COVID-related hospital admissions reaches 10 per 100,000 residents.

As of Thursday, the county’s admission rate was 8.4 per 100,000 residents. But given the rate of increase over the past two weeks, the county is on pace to reach 10 per 100,000 residents by next Thursday, County Department of Public Health Director Barbara Ferrer said in an online briefing. She stressed that the estimate is only a projection, which could change dramatically based on admission numbers in the coming days.

If the county remains at that high level for two consecutive weeks, it will reimpose a mandatory indoor mask-wearing mandate. Under the current schedule, that would happen on July 29.

“We’re not at the point yet,” Goh said. But Pasadena is certainly being affected by a surge as officials across the country predict more waves later in the year.
Pasadena Public Health and L.A. County have synchronized their masking requirements before. And both departments opted to maintain their mandates even after the state of California lifted its COVID-19 indoor mask-wearing requirement earlier this year.

Health officials said outbreaks are being reported at summer camps, youth programs and day care sites.

County Department of Public Health Director Barbara Ferrer last week noted an uptick in infections related to workplaces and urged employers to implement infection-control measures in indoor spaces, such as masking and maintaining physical distancing in communal areas. She said one sector in particular — the TV and film industry — has already reimposed an indoor mask mandate now that the county’s hospitalization rate has reached more than 8 per 100,000 residents.

She said that given the continued high level of virus transmission in the county — particularly with more rapid spread of the highly transmissible BA.4 and BA.5 variants — people should already be masking up indoors.

From the New York Times: The troublesome hits just keep coming from the Omicron strains — and each sequel is more contagious than the last.

Just weeks after the BA.2 subvariant of Omicron became dominant in much of the United States and in many other countries, BA.4 and BA.5 took over across the U.S., showing up in more than 70 percent of samples.

The two strains are often lumped together because they have similar mutations in their spike proteins, which attach to human cells. BA.5 is pulling ahead of its sibling, according to C.D.C. data.

Many readers of this newsletter — and the people who write and edit it — know of many recent cases among friends, family and co-workers. Some scientists estimate that the current wave of cases is the second largest of the entire pandemic.

We’re going to get into the weeds about why these variants are more infectious, what type of symptoms they cause, and how public health officials are evaluating the recent turn of events.

How they work: The key advantage of the BA strains, especially the latest strains, seems to be their ability to infect people who have already been vaccinated, or have already had Covid, or both. That’s a big edge given that much of the world already has some kind of immunity. BA.4/5 are significantly more infectious than BA.2, which itself was more infectious than Omicron.

“The Omicron lineage of SARS-CoV-2 continues to evolve, successively yielding subvariants that are not only more transmissible but also more evasive to antibodies,” a new study in Nature concluded this week.

“They’re the Houdini of Covid,” Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco, told my colleague Dani Blum. “They’re the escape artists.”

Some patients are getting reinfected within just two to three months of past infections, said Dr. Stuart Campbell Ray, a professor of medicine at Johns Hopkins Medicine.

Symptoms: Experts say the subvariants have similar symptoms to Omicron, including a cough, runny nose, sore throat, fatigue, headaches and muscle pains. Patients are less likely to lose their senses of taste and smell, or to experience shortness of breath, Dr. Chin-Hong said.

People tend to experience upper respiratory symptoms, “from the vocal cords to the tip of the nose,” said Dr. Joseph Khabbaza, a pulmonary and critical care physician at Cleveland Clinic. He’s seen many patients with bad sinus congestion, and sore throats so severe they thought they had strep throat.

As is often the case with coronavirus variants, it’s unclear whether BA.4 and BA.5 are more severe than their predecessors, or just more contagious. The answer lies in the demographics of a given population, and the mix of vaccination and immunity.

New deaths have stayed below 400 per day on average, data from state and local health agencies show. That is a fraction of the thousands seen daily during the winter Omicron peak.

Testing: If you were only looking at public data, it might be hard to notice any difference. The average number of new confirmed cases per day has hardly budged for weeks, hovering between 95,000 and 115,000 a day each day in June.

But a closer look shows that we are most likely experiencing a wave of cases in the dark: Many public testing sites are closing down, and many states have also stopped giving daily data updates, creating a foggier look at the state of virus across the country.

“One of my favorite lines from somebody at the C.D.C. was, ‘You don’t need to count the raindrops to know how hard it’s raining,’” Walensky said.

LA COUNTY MAY REIMPOSE INDOOR MASK MANDATES: With COVID-19 hospitalizations continuing to rise, Los Angeles County is on pace to reach the “high” virus activity level by next week, which could equate to another universal indoor mask-wearing mandate by the end of the month, the public health director said Thursday.

The county is currently in the “medium” virus activity level, as defined by the U.S. Centers for Disease Control and Prevention. It will reach the “high” category if the seven-day average of new COVID-19-related hospital admissions reaches 10 per 100,000 residents.

As of Thursday, the county’s admission rate was 8.4 per 100,000 residents. But given the rate of increase over the past two weeks, the county is on pace to reach 10 per 100,000 residents by July 14, Public Health Director Barbara Ferrer said in an online briefing. She stressed that the estimate is only a projection which could change dramatically based on admission numbers in the coming days.

If the county remains at that level for two consecutive weeks, it will reimpose a mandatory indoor maskwearing mandate. Under the current schedule, that would happen July 29.

The city of Malibu announced Tuesday that masks are again being required inside Malibu City Hall due to surging cases among city staff. The building remains open, but residents are being urged to take advantage of virtual appointments and services.

And if you are infected?: (From the LA Times): Infected? Don’t try to power through-Put down your laptop: Experts say rest is key to recovery and may ward off long COVID. By Emily Alpert Reyes

As vaccines and new treatments have eased some of the alarm around a COVID-19 diagnosis, continuing to work — but from home — has become a familiar practice among professionals who can do their jobs remotely. Fauci was vaccinated and boosted and said he was experiencing mild symptoms, like other officials who said they would stay on the job from home.

Physicians caution, however, that rest is an important part of weathering a COVID-19 infection. Plugging away from home is better than putting others at risk of getting infected, but it can still strain the immune system, worsening the toll of an infection, experts say.

“Sleep equals immunity,” said Dr. Susan Cheng, a cardiologist, researcher and professor in the Smidt Heart Institute at Cedars-Sinai Medical Center. As it fights off the virus, “you want to have your immune system not distracted by anything else,” including stress from work.

People forget that COVID-19 is not the common cold, she said — and even for a common cold, “you do not want to be going 100% or even 80%.” Cheng pointed to studies done long before the pandemic that found that mice infected with “garden variety viruses” fared much worse if they were forced to swim.

“Getting adequate sleep lets the immune system rebalance,” along with hormones, said McAuley, who sees patients through the COVID Recovery Clinic at Keck Medicine of USC. In addition, “we often don’t acknowledge the fact that when we’re sick, we’re not functioning appropriately mentally as well. So decision-making may be impaired. At a minimum, you really should unplug for three to five days,” McAuley said.

The public messages from prominent officials saying they’ll keep working from home are “minimizing the risk of long COVID and encouraging others to think, ‘If I have the virus, I can just push through it,’ ” said David Putrino, director of rehabilitation innovation for the Mount Sinai Health System.

Long COVID describes when symptoms persist for months or longer beyond an initial infection. So far, data tracking rest and COVID outcomes are sparse “but point us towards the idea that individuals who did not adequately rest had a higher incidence of persistent symptoms,” Putrino said. The pressure to keep working with COVID — even if it’s from home — has also troubled labor and disability advocates who see it as normalizing working while ill.

When prominent officials test positive and say they will keep working from home, “it is a way of saying, ‘I am still a powerful person who is able to continue doing my job,’ ” said Jaime Seltzer, director of scientific and medical outreach at #MEAction, the Myalgic Encephalomyelitis Action Network. If the goal was to craft a public message based on the best evidence, “we would say that when you become ill, you should be resting.”

Healthy people are used to being able to push through fatigue, rest for the night, “and wake up more or less feeling back to normal,” Seltzer said. “But we have to recognize that when your immune system is being challenged ... that’s simply not true anymore. And we shouldn’t expect ill bodies to behave like healthy bodies.” It can also be challenging to get people to understand that mental exertion — such as the tasks done during remote work — also uses up energy, Seltzer added.

As of January, nearly 60% of U.S. workers who said their jobs could be done largely remotely were working from home most or all of the time — 2½ times the rate before the pandemic, according to Pew Research Center surveys. Working from home has been more common among people with college degrees and higher incomes.

Although the rise of remote work has blurred the lines between work and home life, prodding some employees to keep sending emails or holding Zoom meetings while sick, the pressure to stay on the job with COVID has fallen hardest on poorer workers who are less likely to have the option of working from home. In surveys of thousands of service workers this spring, the Shift Project at the Harvard Kennedy School found that among workers who reported becoming sick — with any illness — two-thirds said they had worked while ill.

As of February, roughly a tenth of workers surveyed said they had gone to work with COVID-19 symptoms or after being exposed to the virus because they couldn’t afford to take time off, Kaiser Family Foundation surveys found. Working through COVID symptoms or exposure was much more common among workers with household incomes less than $40,000 — 29% said they had done so. Only 6% of workers from households with higher incomes said the same, the surveys showed.

The California Department of Public Health generally recommends that someone who tests positive or has COVID symptoms isolate from others for at least five days, then take an antigen test. Under the guidelines, they should continue to isolate another five days if they test positive or still have symptoms.
If someone still has a fever, even after 10 days, they are supposed to keep isolating until it has been gone at least 24 hours under the state recommendations. California officials also recommend that people continue to wear a mask around others for 10 full days after a positive test result or the onset of symptoms.

McAuley, who sees patients with long COVID, said some “ essentially never really stopped working.” At Keck Medicine’s COVID Recovery Clinic, “we have a lot of patients who have very ‘Type A’ personalities, and we do frequently see it’s difficult to have them allow themselves to rest,” she said.

“To even take a week or two to sleep, when they need to sleep, and just be off of work ... for some people that is really a key factor in them recovering,” McAuley said.

As a general rule, “you should be slightly more cautious than you think you have to be,” said Seltzer of #MEAction. She recommended that people learn about “pacing,” a strategy to manage activity that she described as “being active when you’re able and resting when you’re tired — which is harder than it sounds.”

Pacing can include breaking up activities into manageable chunks to avoid too much exertion. Putrino, of Mount Sinai, said pacing “is a technique that should be applied to acute phases of COVID infection as much as it should be applied in long COVID.”
It’s not just, ‘Hey, don’t exert yourself and don’t push too hard’ — it’s an actual strategy that you can learn about how to plan your day,” including setting aside times throughout the day for rest, Putrino said.

Dr. Timothy Brewer, a UCLA professor of medicine and epidemiology, urged patients to pay attention to the signals from their bodies, even if an infection initially seems mild. With COVID-19, “people can do well for about 10 to 12 days and then get very sick,” Brewer said. “Just because you did well in the first week doesn’t mean you’re necessarily going to do well in the second or third week.”

Evictions: Eviction protections for thousands of California households still waiting in line for payments from the state’s multibillion dollar rent relief program expired June 30. Since September 2020, the Legislature has passed and Gov. Gavin Newsom has signed four laws shielding tenants who were unable to pay rent due to COVID-19 from eviction. The most recent extension shielded tenants through June 30 who had applied for rent relief from the state’s $5 billion program by the March 31 deadline but had yet to hear back or receive payments. Those tenants can now be brought to court by their landlords.

Debra Carlton, chief lobbyist for the California Apartment Association, said they have asked their members not to take their tenants with pending applications to court.

The state Department of Housing and Community Development, which administers the program through a contractor, said Friday it had approved all complete applications for eligible tenants. Geoffrey Ross, a deputy director handling the program, said they are still processing 13,000 applications that are either missing documentation or represent an appeal following a denial. They expect to clear all pending applications by early August.

The rent relief program has paid 339,000 households an average of $11,000 totaling nearly $4 billion, according to the state’s public data dashboard. Checks will soon be on their way to about 16,000 households approved last week. On Thursday, the program dashboard showed about 404,000 people had completed their applications. Late Friday morning, the dashboard was updated to show only 352,000 completed applications.

Ross said more than 70,000 applicants were cleared from the queue and issued denials because of account inactivity. These applicants with incomplete applications were contacted at least three times and given at least 20 days to respond, many times longer, he said.

As of June 30, the Pasadena's rent moratorium ended and now local renters have just six months to pay back rent or face eviction.

Under the rules of the moratorium, which was enacted as part of the local emergency at the beginning of the COVID-19 pandemic, a landlord could not impose or seek to recover late fees, pass-throughs, or interest for rent that was delayed or unpaid due to the financial impacts of the COVID-19 pandemic.

The moratorium also encouraged partial payment of rent if tenants could not pay the full rent, and prohibited landlords from harassing or intimidating tenants who exercised their protections under the moratorium.

A total of 52 city and county jurisdictions in California enacted emergency eviction moratoria in response to the COVID-19 pandemic, according to data from Nolo website. Many of those jurisdictions have already lifted the moratorium on residential and commercial tenants.

Most local jurisdictions that currently have COVID tenant protections in effect have set the expiration of their eviction moratoria to coincide with the anticipated lifting of their local emergency, as per a city staff report.

Locally, the City Manager’s office contacted several commercial real estate brokers in Pasadena and their overall observation is that the lifting of the city’s eviction moratorium will have a minimal impact.

Several local tenant advocates groups have successfully gathered the required signatures to get a rent control initiative on the November ballot.

The EconomyUS economy added 372,000 jobs in June amid red-hot labor demand. High labor demand stoked another strong month of US jobs gains, defying expectations for a sharper slowdown and dampening fears of an impending recession. 

More Americans applied for unemployment benefits last week — and while layoffs remain low, it was the fifth consecutive week that claims topped the 230,000 mark and the most in almost six months. Applications for jobless aid for the week ending July 2 rose to 235,000, up 4,000 from the previous week and the most since mid-January, the Labor Department reported Thursday. First-time applications generally track with the number of layoffs. Until early June, claims hadn’t eclipsed 220,000 since January and have often been below 200,000 this year.

The four-week average for claims, which evens out some of the week-to-week volatility, inched up by 750 from the previous week, to 232,500. The total number of Americans collecting jobless benefits for the week ending June 25 rose by 51,000 from the previous week, to 1,375,000. That figure has hovered near 50-year lows for months.

Employers posted 11.3 million job openings at the end of May, down from nearly 11.7 million in April. Job openings reached 11.9 million in March, the highest level on records dating back more than 20 years. There are nearly two job openings for every unemployed person.
Many small businesses had openings in June, report says

Half of U.S. small-business owners said they had open positions they could not fill in June, down slightly from a record high, and nearly as many reported raising compensation, indicating persistent hiring challenges and a still-tight labor market.

Fifty percent of firms had vacancies, down 1 percentage point from May, according to data out Thursday from the National Federation of Independent Business. A near-record 48% of small-business owners said they raised compensation, a slight softening from the prior month, but 28% say they intend to increase pay in the coming three months — a pickup from May.

Even so, there were some signs of softening. A net 19% of small-business owners said they plan to create new jobs in the next three months, down 7 percentage points from May.

The rent has come due for America’s small businesses and at a very inopportune time. Landlords were lenient about rent payments during the first two years of the pandemic. Now, many are asking for back rent, and some are raising the current rent as well. Meanwhile, most of the government aid programs that helped small businesses get through the pandemic have ended while inflation has sharply pushed up the cost of supplies, shipping, and labor.

Thirty-three percent of all U.S. small businesses could not pay their May rent in full and on time, up from 28% in April, according to a survey from Alignable, a small business referral network. And 52% said rent has increased over the past six months.

Data from the commercial real estate financing and advisory firm Marcus & Millichap shows rent rose 4.6% in the first quarter of 2022 compared with the year-ago quarter as the vacancy rate dropped to 6.5%, the lowest since before 2015. But Daniel Taub, national director of retail sales at Marcus & Millichap, said inflation will make it harder for landlords to impose rent increases as the consumer begins to feel squeezed.