Despite an increase of cases, there is far less of a need for ventilators for those patients that find them self ill from the virus.
Photo by Czarek Sokolowski/AP File Photo

Dr. Chakradhar Kotaru watched The Medical Center of Aurora fill up with COVID patients in waves over the past two years, but this week there aren’t any patients sick enough with the novel coronavirus to need a ventilator. 

The pulmonologist said most of the patients in the hospital testing positive for COVID actually come in for another health issue. They aren’t even aware they have the highly transmissible virus that changed the world in 2020. But even now, as cases seem to be less severe and most treatment is outpatient, Kotaru said there are a lot of unknowns about the upcoming fall season, when positivity rates typically increase, people more frequently gather indoors and other illnesses, such as the flu, become more prevalent. 

Colorado Department of Public Health and Environment spokesperson Paul Bishop acknowledged that “large, indoor gatherings, as may occur in school settings, do pose an increased risk of COVID-19 transmission this fall, especially when local community levels are elevated.”

Scientists say the latest variant – called BA.2.75 – may be able to spread rapidly and get around immunity from vaccines and previous infection. It’s unclear whether it could cause more serious disease than other omicron variants, including the globally prominent BA.5.

“It’s still really early on for us to draw too many conclusions,” said Matthew Binnicker, director of clinical virology at the Mayo Clinic in Rochester, Minnesota. “But it does look like, especially in India, the rates of transmission are showing kind of that exponential increase.” Whether it will outcompete BA.5, he said, is yet to be determined.

Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, told the Associated Press earlier this month that the U.S. has seen a doubling in the number of hospitalizations due to COVID-19 since April, reflecting the spread of the new subvariants, though deaths remain steady around 300 per day. 

Dr. John Douglas, executive director of the Tri-County Health Department, said that over the past several weeks, COVID-19 cases and hospitalizations have been fairly flat around the Aurora region. The majority of the cases in the region are believed to be from the BA.5 variant, Douglas said, the most recent of the omicron variants.

The Del Mar Park COVID-19 testing center seems a ghost town as compared to the last major outbreak in January, where there were three-hour wait times to get tested.
Photo by PHILIP B. POSTON/Sentinel Colorado

“We’ve just been taken through the omicrons,” he said.

Each of the omicron variants appears to have greater transmissibility and immune evasion, Douglas said. In terms of severity of illness, however, none of the variants have been as severe as the previous delta variant, which spiked last fall.

Although evidence is still largely anecdotal, Douglas said the newest variant appears to be infecting more people who have already had the virus or who had evaded catching it until now — including Douglas himself, who said he contracted a mild case recently while traveling for a wedding.

But though the new variant appears to be easier to become infected with even if you are vaccinated, the vaccine is still “quite protective against serious illness and death,” Douglas said.

Fueling experts’ concerns are a large number of mutations separating this new variant from omicron predecessors. Some of those mutations are in areas that relate to the spike protein and could allow the virus to bind onto cells more efficiently, Binnicker said.

Another concern is that the genetic novelties may make it easier for the virus to skirt past antibodies — protective proteins made by the body in response to a vaccine or infection from an earlier variant.

But experts say vaccines and boosters are still the best defense against severe COVID-19. Kotaru emphasized an additional booster for people who qualify, even if another round of vaccinations is around the corner. In the fall it’s likely the United States will see updated formulations of the vaccine being developed that target more recent omicron strains.

“Some may say, ‘Well, vaccination and boosting (haven’t) prevented people from getting infected.’ And, yes, that is true,” Binnicker, at the Mayo Clinic, said. “But what we have seen is that the rates of people ending up in the hospital and dying have significantly decreased. As more people have been vaccinated, boosted or naturally infected, we are starting to see the background levels of immunity worldwide creep up.”

Kotaru, in Aurora, echoes much of the same observation locally. He added that the ability to treat more patients outside the hospital has been important in keeping hospitals from becoming overburdened, like they were at the onset of the pandemic. 

Douglas also touted the usage of the antiviral therapy Paxlovid, which he took during his own bout with the illness. The three-dose drug is recommended for people over 60 and people with conditions that make them more susceptible to COVID-19, though now that there is a wider availability of the drug than when it was first rolled out Douglas said anyone who is sick and interested in receiving a prescription should call their doctor and enquire.

Bishop, from the state health department, wrote that, while the BA.5 variant has demonstrated some immune escape features, existing vaccines protect against the variant regardless and are effective at preventing serious illness and hospitalization.

Coloradans aged 6 months and older can receive the vaccine and are recommended to receive at least two doses to ensure full protection. 

The Tri-County Health Department  is continuing to work with community partners to try and encourage more people to get vaccinated, particularly the Hispanic community, whose vaccination rate has consistently lagged. It is also recommending a second booster shot for people over age 50.

“Staying up to date with all recommended doses is the best way to keep up protection for you, your loved ones, and the community,” Bishop wrote. “Most people need three doses for the highest level of protection. Some people may need to get four or five doses depending on their age and medical conditions.”

Back in session

Some school systems around the country have moved to bolster staffing to minimize disruptions, but many are hoping for the best without doing much else differently compared with last year.

Even some of the districts that had the most disruptions to in-person schooling amid the spread of the highly contagious omicron variant point to few specific changes in their prevention efforts.

Among them are Aurora schools. Local school districts are still operating similarly to where they were at the end of the previous school year.

“Although there is still transmission of COVID-19, we are not seeing the high levels of hospitalizations and severe illness that we were throughout the pandemic,” APS Superintendent Rico Munn said in a recent message to district families. “Thankfully, we will have fully in-person learning and we will continue to focus on safety, consistency and stability in our learning environments.”

Masking will not be required in APS buildings or school buses, though those that would prefer to mask still can. Students and staff who test positive for COVID-19 must isolate themselves for five days, and wear masks for the five days following that as per current CDC guidelines.

The district is also asking families to keep students home if they are sick with any potential COVID-19 symptoms and to get a test as soon as possible.

Students are safely spaced in a kindergarten class, May 18, 2021, at Aurora Quest K-8. Photo by PHILIP B. POSTON/Sentinel Colorado

Vaccines continue to be required for all district employees who have not received an approved exemption, and are encouraged for students. The district will be partnering with local health providers to host a number of free vaccine clinics during the upcoming school year.

Teacher shortages remain a major concern, even bigger than COVID-19 itself, said Dan Domenech, executive director of AASA, an association of school superintendents.

“That is the greater concern – that they will have the necessary staff to man all the classrooms, to man all the programs – which will only be made worse if there is an outbreak of COVID,” he said.

While information about outbreaks in K-12 schools is no longer being made available on the state’s data dashboard, schools are still required to report outbreaks of COVID-19. Bishop said schools should “encourage vaccination and implement disease control strategies including response to clusters and outbreaks.”

Since February, schools have also had the option of handling infections under a more routine disease control model rather than focusing on the investigation of individual cases and contact tracing.

The Tri-County Health Department is also continuing to work with local schools in preparation for the upcoming school year, and is waiting to see if the CDC issues any new guidance. Douglas said that he believes that it is very unlikely that any new masking public health orders will be issued in the future unless there is a new variant that is extremely effective at infecting people who already have prior immunity.

“I wouldn’t see us reintroducing that unless things get substantially worse,” he said of mask mandates.

That’s less because of their efficacy — Douglas said masking, particularly with KN95s and N95s — continues to be an effective way to reduce the spread of the disease and recommends it for people who want to protect themselves in crowded venues. But the mandates proved to be divisive and caused a lot of extra work and political turmoil for school districts (and the health department itself). 

“We’re trying to get schools the tools they need without introducing requirements since that ended up being difficult and controversial,” he said.

Tri-County will continue to be in charge of the pandemic health response through the end of this calendar year, when the department will officially dissolve and the separate Adams and Arapahoe county health departments come online. Douglas said that until then its pandemic mitigation efforts will continue as usual. As director, his main focus over the next five and a half months will be to help ensure a smooth transition between the outgoing and incoming departments.

“It’s not going to work perfectly but I think it’s going reasonably well,” Douglas said of the transition. The COVID-19 response has much more funding than some of the department’s other public health programs, so Douglas said switching over those functions should be relatively easy.

COVID fatigue 

In addition to the challenges a new variant and indoor gatherings bring, health experts, and even federal officials, are battling what they’re calling COVID fatigue. People’s willingness to listen to warnings and concerns about the virus and the danger it poses is wearing thin. 

For months, the White House has encouraged Americans to make use of free or cheap at-home rapid tests to detect the virus, as well as the free and effective antiviral treatment Paxlovid that protects against serious illness and death.

The Del Mar Park COVID-19 testing center seems a ghost town as compared to the last major outbreak in January, where there were three-hour wait times to get tested.
Photo by PHILIP B. POSTON/Sentinel Colorado

The flip side, however, is that with the rise in at-home rapid antigen tests, data gaps arise. While the state urged Coloradans to report positive results to health care providers, local public health agencies or through CDPHE’s online portal, no mechanism exists to mandate the reporting of test results.

Rates of COVID-19 detected in wastewater, in hospitals and in tests that are reported are some other sources of the data that the state may use to extrapolate the spread of the disease within the community.  Wastewater has the special benefit of being available without anyone being required to submit to a test, Bishop wrote in his email.

In the weeks and months to come, Douglas said that flexibility will be important as the situation continues to evolve and change. The virus is not as severe of a health concern as it was in the days before the vaccine, but it will still cause disruptions in day-to-day life.

“Everybody’s got to be nimble and be prepared to change plans,” he said.

— THE ASSOCIATED PRESS contributed to this report

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