Week CXIII: ‘Endemicity is not a victory,’ COVID researchers say

— Map from CDC

The surge caused by new subvariants of Omicron continues to build in Albany County and across most of New York and New England while the vast majority of the rest of the nation has a low community level of COVID-19.

ALBANY COUNTY — We have entered an era when the coronavirus is widely being perceived as endemic.

That means, rather than the virus disappearing, it is hoped enough people will become immune from vaccination or infection that, although the virus continues to circulate, there will be fewer hospitalizations and deaths.

In June 2021, then-Governor Andrew Cuomo announced, after 70 percent of adult New Yorkers had been vaccinated, “The people of New York beat COVID,” and called for lit buildings and fireworks to celebrate as he lifted coronavirus restrictions.

For months, New Yorkers had focused on vaccines as “the weapon that will win the war” as Cuomo frequently termed it.

That was, of course, before new variants caused more surges. In January, under the Hochul administration, Health Commissioner Mary Bassett said that, with such a rapidly-evolving virus and emerging new variants, herd immunity no longer has meaning.

At the federal level, when Joe Biden became president in January 2021, he launched an ambitious vaccination program and predicted that by the next Fourth of July, families would be happily gathering with the COVID threat behind them.

This week, the Biden administration warned there could be 100 million COVID infections this fall and winter and a perhaps significant wave of deaths as new subvariants of Omicron can thwart immunity.

When Governor Kathy Hochul on Sunday afternoon, May 8, tweeted that she had tested positive for the virus — “Thankfully, I’m vaccinated and boosted, and I’m asymptomatic,” she posted — her followers were divided in their advice and remonstrances.

Some chided her for lifting the mask mandate while others argued masks did no good. Some mocked vaccines while others defended them. One said living in a cave was over while another said, “Everyone is pretending like COVID is over even though cases are going through the roof again.”

A paper posted this week on medRxiv, “Endemicity is not a victory: the unmitigated downside risks of widespread SARS-CoV-2 transmission,” said, “We have entered a new phase of the ongoing COVID-19 pandemic, as the strategy of relying solely on the current SARS-CoV-2 vaccines to bring the pandemic to an end has become infeasible.

“In response, public-health authorities in many countries have advocated for a strategy of using the vaccines to limit morbidity and mortality while permitting unchecked SARS-CoV-2 spread (‘learning to live with the disease’).”

An expectation exists, both in the lay public and in the scientific community, the authors write, that future waves of the virus will cause fewer infections and deaths, either because the virus decreases or because immunity is built up.

“Our modeling suggests that endemic SARS-CoV-2 implies vast transmission resulting in yearly US COVID-19 death tolls numbering in the hundreds of thousands under many plausible scenarios,” the authors write, with even modest increases in infections and deaths leading to “an unsustainable mortality burden.”

The authors of the not-yet-peer-reviewed paper conclude, “Our findings thus highlight the critical importance of enacting a concerted strategy (involving for example global access to vaccines, therapeutics, prophylactics and nonpharmaceutical interventions) to suppress SARS-CoV-2 transmission, thereby reducing the risk of catastrophic outcomes. Our findings also highlight the importance of continued investment in novel biomedical interventions to prevent viral transmission.”


WHO says death toll higher than reported

As the official COVID death toll in the United States approaches 1 million, the World Health Organization this week released a stunning report showing that, had the pandemic not occurred, the world over the last two years would have had 15 million more people.

These “excess” deaths total more than twice the 5.42 million COVID-19 deaths reported to the WHO.

“The monitoring of excess mortality provides us with a more comprehensive understanding of the impact of COVID-19 beyond the number of COVID-19 deaths reported by countries,” says the report.

“Excess mortality” is defined as the difference between the total number of deaths that have occurred and the number of deaths that would have been expected in the absence of the pandemic.

The 14.91 million deaths — and counting — includes deaths attributable directly to COVID-19 that were counted and reported to the WHO as well as those that were not counted or reported by countries.

It also includes deaths indirectly associated with COVID-19, due to other causes and diseases, resulting from the wider impact of the pandemic on health systems and society.

Finally, the number is minus any deaths that would have occurred under normal circumstances but were averted due to pandemic-related changes in social conditions and personal behaviors, such as fewer traffic deaths or influenza deaths due to local lockdowns and less travel.

The report covers the 24 months between Jan. 1, 2020 and Dec. 31, 2021, representing 9.49 million more deaths than those globally reported as directly attributable to COVID-19.

“The impact of the pandemic has been over several waves with each characterized by unique regional distributions, mortality levels and drivers,” the report says.

Twenty countries, representing about half of the global population, account for over 80 percent of the estimated global excess mortality.

These countries are Brazil, Colombia, Egypt, Germany, India, Indonesia, the Islamic Republic of Iran, Italy, Mexico, Nigeria, Pakistan, Peru, the Philippines, Poland, the Russian Federation, South Africa, the United Kingdom of Great Britain and Northern Ireland, Turkey, Ukraine, and the United States of America.

Where there were gaps in underlying data, statistical methods were used to derive the expected and total deaths based on the levels of data available for countries; this is why these figures are called “estimates,” the report says.

The report shows marked differences for various geographic areas. In the Americas, for instance the number of excess deaths more closely mirrors the number of reported COVID-19 deaths than in South-East Asia.

The same is true of high-income areas — where the gap is 2.16 million deaths — as compared to lower-middle-income areas, where the gap is 7.87 million deaths.

The red lines in the accompanying graphs chart the excess deaths while the solid blue shows the reported COVID-19 deaths. The line for excess deaths dips below zero because lives were saved during pandemic lockdowns when there were fewer than typical car crashes, for instance, or deaths due to other infectious diseases.


Mental health help

On Friday, both the state and Albany County announced initiatives to help with mental health and substance abuse challenges.

Hochul signed legislation on May 6 to provide firefighters and people providing emergency medical services with training.

“The pandemic has only made things harder for New Yorkers, and it is critical that our first responders and emergency services personnel have the proper training, tools and resources to help keep our streets and subways safe,” said Hocul in a release announcing the legislation.

That same day, she also announced New York City subways carried 3.5 million riders, the highest number since the start of the pandemic.

Drug overdoses and suicides have overtaken traffic accidents as the two leading causes of death among Americans ages 25 to 44, according to the National Council for Behavioral Health.

Suicide is the 12th leading cause of death in New York, according to the American Foundation for Suicide Prevention. In 2020, for every 100,000 New Yorkers, about eight people lost their lives to suicide; it is the second leading cause of death for people between the ages of 10 and 34 years old; and for people between the ages of 35 and 54, suicide is the fourth leading cause of death.

New York State has developed a comprehensive mental health crisis response system, which includes short-term crisis residences, crisis respite services, comprehensive psychiatric emergency programs, mobile crisis teams, and crisis intervention training, the governor’s office said.

Also, in 2020, Congress enacted the National Suicide Prevention Hotline Improvement Act, which established 9-8-8 as the universal dialing code for the National Suicide Prevention Lifeline. This new hotline is expected to be set up in New York by July 2022.

In Albany County, Executive Daniel McCoy on Friday announced a new social media campaign and video series to raise awareness for mental health and substance abuse challenges while connecting to programs and resources to help.

The theme of the campaign is one of McCoy’s favorite phrases: “We are all in this together.”

“One of the most devastating impacts COVID has had is on our collective mental health, and we continue on the difficult path of breaking down the stigma of asking for help,” McCoy said in a statement, launching the campaign.

“Beyond that, as we continue to see reports of how social media can harm the emotional well-being of our young people, it’s critical that we find creative solutions to help those who are struggling,” he went on.

“A good cry is good,” McCoy says in the first video; others will be posted later on the county’s website.

The video says residents who are struggling may call 518-447-4555, and press 0 during regular workday hours. After hours, people in crisis may call psychiatric crisis services at 518-549-6500.

“Don’t be afraid to call …,” says McCoy in the video. “Let’s figure it out together.”

“If the last two years have shown us anything, it has shown us how resilient we are; though it has also reminded us all just how vulnerable we can be,” said Stephen Giordano, the county’s mental health director. “These are two important truths that are too often overlooked, forgotten or denied …. 

“On average, one in five individuals will experience a diagnosable mental health condition in a given year. The largest obstacle we face is not funding, but rather it is stigma. That’s why I’m proud to join County Executive McCoy in this initiative to bring greater awareness to the fact that mental health challenges can affect anyone at any given time and we need to see ourselves in the struggles of others.”


Albany County surge continues

Two more Albany County residents succumbed to COVID-19 this week — a woman in her sixties and a woman in her eighties — bringing the county’s death toll from the virus to 553.

The surge caused by new subvariants of Omicron continues to build in Albany County and across most of New York and New England while the vast majority of the rest of the nation has a low community level of COVID-19.

The CDC’s designation of Albany county as “high” means face masks are to be worn indoors in public.

Nationwide, the CDC on Tuesday labeled just 79 counties, or 2.45 percent, “high” for community level of COVID while 2,827, or 87.69 percent, are labeled “low.” That leaves 318 counties, or 9.86 percent, labeled “medium.”

As of Tuesday, as a seven-day average, Albany County had 54.2 cases per 100,000 of population.

This compares with 43.7 last week, 37.7 two weeks ago, 28.3 cases three weeks ago, 21.1 cases four weeks ago, and 11.0 cases per 100,000 five weeks ago — a steady progression upward.

Statewide, the seven-day average is 47.96, up from 38.16 cases per 100,000 a week. Western New York has the highest count at 62.43, up from 58.15 cases last week, and the North Country has the lowest at 37.75 cases per 100,000.

Similarly, the less reliable infection rate — the percentage of positive test results — is now at 12.2 percent for Albany County as a seven-day average.

This compares to 10.0 percent a week ago, 13.5 percent two weeks ago, 9.1 percent three weeks ago, 7.5 percent four weeks ago, 3.5 percent five weeks ago, and 2.6 percent six weeks ago.

Statewide, as a seven-day average, the infection rate is 70.3, up from 6.79 percent last week. The region with the highest rate is Western New York at 18.25 percent, up from 17.45 percent last week while the region with the lowest infection rate is New York City at 4.67 percent up from 4.18 percent last week.

McCoy reported on Tuesday that there are 51 county residents hospitalized with the coronavirus, with four in intensive-care units.

This compares to 34 last week, 31 two weeks ago, 30 county residents three weeks ago, 21 county residents hospitalized four weeks ago, and 13 hospitalized with the virus five weeks ago.

On Friday, May 6, in his twice-weekly press release on COVID, McCoy said, “This is one of the most concerning updates I’ve provided in a long time. The daily average of new COVID infections continues to increase and has now trended above 200; the number of residents currently in the hospital with the virus is now the highest it’s been since February 17; and sadly, individuals continue to succumb to COVID complications.”

 Still just over a quarter of Albany County residents are not fully vaccinated against the virus.

“I continue to encourage everyone to get vaccinated and get the booster shot if they haven’t yet,” said McCoy, “as this is the best protection from serious illness if the virus is contracted. We also need people to continue getting tested and reporting at-home COVID tests to the County Health Department so we can get a better understanding of the level of community spread.”

Guilderland’s supervisor, Peter Barber, who continues to inform residents with daily COVID updates — he’s sent close to 800 — reported on May 9 that, for the month of April, the town’s ambulances transported five residents with COVID-19 to area hospitals, including three from senior care facilities, one from a home, and one from a doctor’s office. Four of the five transports were in the second half of the month.

In the first week of May, there were two transports. In March and February, there were three transports, both marked decreases from 10 transports in January and nine in December, Barber reported, concluding, “The total COVID-19 pandemic transports by EMS ambulances to area hospitals is now at 330 residents.”

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