San Diego County has been moved into the high-risk level for COVID-19 by the Centers for Disease Control and Prevention as confirmed case numbers have continued to increase over the last few weeks, which has experts worried about the risk for severe outcomes as a result of infection.
The CDC Community Level tracking system is designed to determine the impact of the virus on communities and guide preventative action. While it is not clear whether San Diego County will reimplement any previous measures to slow the spread of the virus, this shift is concerning to experts, particularly given fears around the long-term implications of infection.
Post-COVID conditions, or long COVID, have been the subject of growing concern surrounding the impact that infection has on a person after recovery, as nearly one in five individuals who have been previously infected with the coronavirus have experienced prolonged conditions.
As case numbers continue to rise and reinfection becomes a growing worry, experts are concerned about the potential for increased risk of long COVID since so little is known about what causes it and how to treat it.
“It’s taking time and the endgame, I don’t know yet,” said Dr. Jignasa Puri, team physician with the Scripps COVID Recovery Program at Scripps Mercy Hospital San Diego. “The only thing we can control is prevention.”
‘A debilitating condition’
Experts are worried about the potential increase in individuals developing long COVID, which usually manifests about three months after a symptomatic infection.
Long COVID is considered a post-viral syndrome, referring to a complex combination of problems that develop after a person has fought off a viral infection. These post-COVID conditions have become a growing area of concern given the sometimes severe effect that it has on those who have it.
“It’s a debilitating condition, with a huge range of potential symptoms,” said Dr. Lucy Horton, an infectious disease specialist at UC San Diego Health. “In many patients, (it’s) a disabling condition. Many people have found it hard to return to their daily lives.”
Recent estimates say that these conditions impact nearly one in five adults who have had the virus, according to the CDC.
The same study also found that younger adults have a greater likelihood of developing long-lasting conditions, with those in age groups between 18 and 59 seeing nearly three times as many people with long COVID after infection than those above the age of 80.
Symptoms of post-COVID conditions vary from person to person, however, some of the most common ones include prolonged fatigue, decreased endurance, shortness of breath, chest pain, and brain fog.
According to experts, a COVID infection also has a strong impact on a person’s mental health, particularly when a person has long-lasting symptoms. Individuals experiencing these conditions linked with a previous infection are associated with a high likelihood for depression, anxiety, insomnia, and — in some cases — decreases in cognitive function.
One recent study from the Netherlands found that nearly 40 percent of patients with confirmed long COVID reported symptoms of post-traumatic stress disorder and anxiety at a three-month check-up, while nearly 50 percent displayed indicators of depression. The rate of these mental health outcomes remained about the same at the six-month check-up.
“Their world has been rocked in some way,” said Puri. “Most of the (patients) I’m seeing at three months, six months, nine months start showing some improvement, but they’re just so down with ‘I’m just not getting better.’”
Mental health experts express that recovering from COVID can be very traumatic for some, regardless of whether or not they were hospitalized or healing in isolation.
“I’ve had patients share with me their memories of being sick at home and feeling very traumatized by those memories,” said Dr. Arpi Minassian, a clinical psychologist and professor of psychiatry at UC San Diego.
“If you take mood symptoms and post traumatic symptoms, those definitely had a higher prevalence in the first month following infection, then sort of steady off,” Minassian continued. “Whether or not those symptoms get better after a couple more years? We’re not sure about that yet.”
Not much is known about how long COVID develops in those who have experienced a symptomatic infection, however, recent studies suggest the vaccine is effective in reducing the likelihood of lingering effects of the virus.
A joint study by the Washington School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System found that those who had been fully vaccinated were 15 percent less likely to develop long COVID in general, but the risk of severe conditions like lung and blood-clotting disorders decreased by about 50 percent.
The prevalence of long COVID has varied across the different waves of the pandemic, with earlier surges seeing more cases of prolonged symptoms than recent ones. However, given the virus’s unpredictability, experts say that it will be an important thing to monitor moving forward when looking at the probability of severe outcomes associated with infection.
The current COVID surge
The number of COVID-19 cases in San Diego County have been steadily increasing since May, with the emergence of new strains of the Omicron variant. In recent weeks, even more transmissible strains than the ones circulating in May have taken over, worrying experts about potential increases in severe outcomes related to the virus.
The high number of confirmed cases over the last few weeks prompted the CDC on Thursday to move San Diego County into the “high-risk” level of community transmission, which is guided by a number of metrics including hospital bed availability and the rate of new cases reported.
While this is concerning, experts do not believe that this move will prompt the county to reimplement any previously held public health safety measures, as the number of occupied hospital beds remains lower than the capacity.
Prior to this move, San Diego County had been at the “medium-risk” level since May when Omicron sub-variants, BA.2 and BA.2.12 emerged.
The county has confirmed 9,283 cases for the week of July 3, with as many as 2,541 counted on a single day. While these numbers alone are alarming for experts, many believe it to be an undercount due to the use of at-home testing.
Between July 11 and July 13, approximately 5,576 additional cases were reported by the county, bringing the region total since the start of the pandemic to about 857,182.
While hospitalizations and deaths remain lower than previous waves, the county has confirmed there have been 17 COVID-related deaths since July 7, all of which were people over the age of 40 who had underlying medical conditions. Of those who passed, 11 were fully vaccinated.
Experts say that the surge in cases will most likely continue over the next few weeks, as BA.4 and BA.5, continue to circulate, granted their extreme transmissibility and skill at evading antibodies.
“We’re going to see high rates of transmission for a while,” said Dr. David Smith, chief of infectious diseases and global public health at UC San Diego. “My hope that the summer surge would go away isn’t going to happen.”
The two newest Omicron strains have almost entirely taken over, accounting for about 85% of the county’s viral load tracked as of July 6 using wastewater sampling.
The prevalence and infectability of these BA.4 and BA.5 strains have county officials stressing that individuals should take preventative measures, such as getting a booster shot and wearing a mask whenever possible, to avoid infection and further spread of the virus.
“San Diegans should take every precaution necessary to slow the spread of COVID-19,” County deputy public health officer Cameron Kaiser said in a statement announcing the CDC’s move. “With this virus, and with the prevalence and infectivity of the new variants, a booster is highly recommended, especially for people who are immunocompromised or have other comorbidities.”
Given that there is still not much known about how post-COVID conditions develop in individuals, experts are stressing that this is a real hazard that comes with infection and people use caution given increased likelihood of exposure to the virus.
“Long COVID is one of the most important reasons why people should continue to protect themselves against COVID, even if they don’t consider themselves high risk,” Horton said. “It’s important for everyone to continue to get vaccinated, get boosted, and make choices that are safe in the current situation where we’re experiencing a surge.”
Even though experts reiterate that we are in a better place now than in previous waves since treatments and vaccinations are readily available, the current surge is still a cause for concern given the long-term effects of a COVID infection.
“There are people out there that have had COVID and that will say, ‘oh, you know, there’s no big deal…I got it, it was like the flu.’ Then there is a subset of people that actually catch COVID and are truly suffering,” Puri continued. “These are people that just want their life back.”
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San Diego has reached the CDC’s highest level of COVID-19 activity. The highly contagious BA.5 variant is driving the current surge of the disease, and with summertime activities in full swing — including this week’s Comic Con - health officials are bracing for what could be an even more cases.
