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California, the hotspot for the U.S. coronavirus earlier this year, has seen some of the lowest case rates in the country in recent weeks.
How did it happen? And why does he seem to have reversed positions with the states that have withstood the winter push better?
A clear example is that of the states of Vermont and Maine in New England. Relatively immune to the worst of the country’s previous outbreaks, they battled the delta variant, which drove their case rate up.
Both states have higher vaccination rates than California, experts say, but weaker natural immunity.
As gruesome as the winter wave is, with overwhelmed hospitals and death rates reaching pandemic peaks, experts say California has emerged with a relatively large amount of natural immunity. And that, combined with vaccination levels above the national average, now plays a major role in keeping case rates so low.
Experts point out that case rates are just a data point – and that more revealing metrics at this point in the pandemic are hospitalizations and death rates, which are low overall in California and Nova Scotia. -England because of the potency of vaccines.
However, “there is a lot of naturally acquired immunity since last January,” said George Rutherford, infectious disease expert at UCSF. “Maybe it’s not the end, but it really works in the short term.”
Comparing the data: Maine and Vermont struggling
Adding to the success in California, Rutherford said, relatively strict health policies, particularly in the Bay Area, but also in other more populous areas, including Los Angeles County. Vaccination warrants and mask rules have proliferated in Bay Area counties and across the state, which is even the first in the country to require schoolchildren to be vaccinated, when full federal approval is given for injections.
All of these factors are reflected in the coronavirus numbers in California: This week, state data – reflecting daily single-day averages, unlike the one-week averages from the Centers for Disease Control and Prevention – showed that the The average daily rate of new cases was 18 per 100,000 people, the second lowest rate in the country behind Connecticut. The case rate for the bay area alone was even lower, at 10 per 100,000.
Like California, many New England states are also known for their pandemic severity. Five of New England’s six states have the highest vaccination rates in the country, with Vermont topping the list with 70% of its total population fully vaccinated. California’s rate is less than 59%.
And yet, in states like Maine and Vermont, which had long avoided the worst of the pandemic, the delta variant clung to unvaccinated pockets. Maine, with a slightly lower vaccination rate than Vermont at 69%, has been the hardest hit in the region, breaking its one-day record of new daily cases last week. Its most recent case rate was 44 per 100,000 population.
Maine and Vermont, like California, recommend universal indoor masking and have instituted certain COVID-19 vaccination requirements for state and health workers.
But they lack a higher level of natural immunity than California’s, experts said.
“Maine is paying the price for not having had a large number of cases,” said Dr. Shira Doron, infectious disease physician and hospital epidemiologist at Tufts Medical Center in Boston. “They don’t have natural immunity to help.”
While Maine CDC director Nirav Shah said on Monday cases were on a downward trend, he expressed concern that they could settle at a “very high plateau,” according to Maine Public.
Vermont also experienced a higher peak during the delta surge, reaching a pandemic peak of 35 cases per 100,000 per day on September 21. Although cases are also starting to drop, the rate remains relatively high at 30.
Data comparison: Connecticut
The southernmost state of New England, Connecticut, has drawn a different coronavirus curve from the rest of the region – one more similar to California, due to some of the same factors, including the natural immunity, according to experts.
Connecticut was hit hard at the start of the pandemic as cases exploded in neighboring New York, Doron said. The pandemic curve then followed a trajectory roughly similar to that of California. Connecticut this week had the lowest seven-day daily average of new cases among U.S. states, at 12 per 100,000, according to state data.
The state also has a high vaccination rate, with 69% of the population fully vaccinated, and like California, it has a universal indoor masking recommendation.
Connecticut also requires that all state employees, day care centers and employees of K-12 schools be fully immunized or undergo weekly testing. Health care workers must be vaccinated, without exception.
But another key difference for Connecticut, like California, is its natural immunity to previous surges, experts say. The state was hit hard in both spring 2020 and winter, and Doron said “it probably makes a difference.”
Hospitalizations, deaths down for all
While California’s low case rates have received a lot of attention in recent weeks, experts point to other figures that they believe should guide the future course of pandemic policy, namely hospitalization rates. and mortality.
These numbers are low overall in California and New England – a sign that while cases may increase in areas of highly vaccinated states, vaccines offer strong protection against serious illness and death, according to the reports. experts.
According to the New York Times COVID tracker, all New England states except Maine topped the list of the lowest hospitalization rates in the United States, ranging from 7 per 100,000 in Massachusetts at 10 per 100,000 in New Hampshire and Rhode Island. California is the 7th lowest in the country at 13 per 100,000. Maine is not far behind at No. 11 in the country, with 16 hospitalizations per 100,000 population.
Death rates in New England states and California are also among the lowest tens in the country: Daily deaths per 100,000 in New Hampshire are lowest at 0.14, followed closely by Maine at 0.15. California is No. 12 in the country with a rate of 0.24, but is half the national average of 0.54.
Doron pointed out that in the Delta era, case rates are no longer the most important metric.
“We are always trained to focus on cases,” she said. “We’re going to have to shift our focus from cases to hospitalizations. With vaccinations, there will come a time when cases will no longer matter. They are not the yardstick against which the policy should be developed.
Kellie Hwang is a writer for the San Francisco Chronicle. Email: [email protected] Twitter: @KellieHwang
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