What public health experts expect about COVID-19 in California this winter

Two California public health experts said a wave of COVID-19 could be coming soon and urged all Californians to get vaccinated, including the elderly and young children under 5.

In a virtual town hall hosted by state Sen. Nancy Skinner on Tuesday night, UC San Francisco Department of Medicine Chair Dr. Robert Wachter and California State Epidemiologist Dr. Erica Pan addressed the current moment in the pandemic and what which can happen in California.

During the panel, Wachter and Pan discussed the high likelihood of a surge in COVID, the worrisome unknowns about long-term COVID, and low vaccination and booster rates among people who can get extremely sick.

A winter jump is possible

Both Wachter and Pan seemed confident that an impending spike in COVID-19 was likely. How big is the jump? None of the experts would hazard a guess.

“Winter will bring people inside,” Wachter said. “There are these new variants that are coming out that are at least somewhat resistant to immunity.”

Wachter added the new options aren’t “massive scary” but seem to be taking over from the BA.5 variant. And he said the virus could spread further because the “back pressure” against rising case rates has all but disappeared.

“Unfortunately, in the old days, if you start seeing a spike, people immediately start being more careful and putting on masks,” Wachter said. “I’m not convinced that’s going to happen, at least to the same degree that it happened before.”

Pan also nodded to the relative severity of other respiratory infections, including the flu, in other parts of the country. Although we haven’t seen large numbers in California, respiratory syncytial virus (RSV), which seriously affects infants and young children, is also on the rise in the U.S.

Long COVID is still a big problem

Both Pan and Wachter cited the lingering effects caused by prolonged COVID, many of which are still largely unknown, as their primary concern should they become infected again. According to a Census and CDC study conducted this summer, as many 1 in 5 infections in adults, it leads to symptoms of prolonged COVID, which are symptoms lasting three or more months after first contracting the virus.

“We are still learning about the long COVID. Even for me personally and for my own family, it still worries me the most,” Pan said.

Pan noted that while there are some predictions about who will develop lasting symptoms of COVID, there are many people who including childrenwho had mild cases but had long-lasting symptoms of COVID.

One misconception Watcher tried to correct is the notion that people can’t get long-term COVID if they didn’t get it the first time they were infected. You can, he said, and if you got a long run of COVID the first time, you can get an even worse case.

“There is always a reason to try to avoid getting [COVID]even if you’ve had it a few times before,” he said.

Boosters are key, especially for older and younger Californians

Both experts noted the relative slowness of vaccine uptake in California. According to state boardonly 11.4% of Californians over age 5 received the new bivalent booster, which targets both the original strain of the virus that causes COVID and newer subvariants.

While the state’s absorption rate is higher than the rest of the country at 7.3 percent, Wachter said it’s still too low.

“Especially if you’re in someone at higher risk over, say, 50 or you have other medical conditions and you’ve only gotten two vaccines a year ago, you’re significantly underprotected,” he said.

Wachter also cited misinformation as a reason for vaccine hesitancy.

“There will be thousands of deaths because the elderly for whatever reason chose not to keep up with their boosters, in part because of misinformation,” he said.

On the other hand, Pan said it is important to get more children under the age of 5 vaccinated. Although the bivalent booster is not yet approved for them, Pan says there is low uptake of the COVID vaccine in general, which is important to prevent severe disease.

“These extreme age ranges are at risk for more serious diseases,” she said. “I want to emphasize to all parents or grandparents, encourage your families to vaccinate their children. I speak as a mother, a pediatric infectious disease physician, and a public health worker.

As of Oct. 27 less than 6% of children under the age of 5 have received their primary doses of vaccine.

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