Epidemiology
The downward trend in case numbers throughout the Americas has continued, with the 7-day average of cases in the US at 16, down 30% in the last week, and continuing to move steadily lower throughout the Americas. In Europe, the continent has experienced a fairly steady 3-week downward trend, including both the UK, Eastern Europe, and even Russia. The only area of the world continuing to experience issues is east Asia. There, the major economically dominant countries with the exception of Hong Kong all have flat to slightly downward trends. The situation in Hong Kong continues to deteriorate with serious consideration being given to a full lockdown of the city as cases reached 810 cases per 100K per day and that’s despite many choosing not to report because of fear of families being separated and people being sent to a quarantine camp. This is likely just omicron doing what omicron has done elsewhere but demonstrates why a zero-covid policy over the last two years may not have been the best approach. At this point, mainland China is probably very concerned as to what could happen if omicron was to get a foothold in any major cities there.
CDC Risk Ranking
But this discussion of cases counts as the measure of disease risk is exactly what the US CDC is trying to get away from with its new risk ranking system. The CDC, rightly in our opinion, is making a major effort to get people to move away from focusing on simple case counts because the same number of cases of omicron are significantly less impactful than that number of delta cases. Instead, CDC is basing their semi-objective risk reporting on 3 separate characteristics: Incidence (still case counts), Severity (as represented by hospitalizations per 100,000), and impact on health systems (as represented by the percentage of hospital beds occupied by COVID patients). While there is no perfect system, we do applaud the CDC’s work to come up with a balanced assessment that has real-world applicability and educational value.
We won’t go deep into the mechanics, but the system first looks at case counts and divides a location into either greater than 200 cases per 100K per day or less than 200. Then once that division is made, the system looks at severity (hospitalization rates), impact (% of occupied beds), and takes the higher of those two parameters to assign low, medium, or high risk. While the system is obviously designed only for the US, it is actually fairly applicable around the world, although the percentage of beds occupied by COVID patients is a bit challenging in many locations. A subjective assessment through review of government announcements and news reports is a good stand-in, though.
But once you know which high, medium, or low category you’re in, what does it mean? The first mitigation recommendation affected is masking. At low levels, no one needs to wear a mask, although the CDC acknowledges that people at high personal risk may continue to be comfortable masking. At the medium level, people vaccinated or otherwise at low risk do not need to mask, but anyone with risk factors or expected to be around someone with risk factors should wear a mask. At the high-risk level, everyone should continue to wear a mask indoors, at least in areas where you do not know that everyone else in the area is vaccinated.
Applying this to the US population, about 25% are in low-risk counties, 45% in medium-risk counties, and 30 % remain in high-risk counties, at least as of last week. Counties will be rescored weekly, and the last scoring was a week ago, so with cases dropping by 30% over the last week, by the end of this week, it is likely that a much lower percentage of the population will be in high-risk areas.
While this same system has not been adopted around the world, the logic is applicable around the world and would not be a bad way for people to start recalibrating how they think of risk.
However, this new risk stratification does not mean that COVID is completely over and that everyone in a low or medium risk area can get back to completely normal activities. Keep in mind the “Swiss Cheese” approach to risk reduction that we have discussed in previous weeks. While you may be comfortable in removing your mask or allowing masks to be removed in your workplace, you should consider a stepwise approach to removing other mitigations such as social distancing, extra ventilation, checking for vaccine status, etc. If you are deciding how to do risk mitigation at your business, it’s probably best to remove one mitigation at a time and monitor for any new cases, then continue to peel back mitigations slowly. This will reduce the risk of surprise events and likely make your employees more comfortable. Of course, some mitigations may never come off, good ventilation and extra cleaning for high touch points are effective tools for reducing rates of respiratory diseases all the time.
If you were checking the vaccination status of workers and guests, you may want to keep that in place for another couple of weeks until we confirm that opening up is not leading to more cases. One thing that should not ever change is eliminating the attitude that people need to come to work regardless of how sick they feel. Coming to work with an upper respiratory infection is not a sign of strength!
Treatments
Over the next month, you should expect that at least one local drug store near you that should have treatments available. Additionally, the White House announced mid-week that the FDA is initiating a program where you will be able to go to your local drug store to get a test, and if positive, treatment, all in one spot without the need for a clinic visit. The details of this, which may run into some snags with state medical practice laws, have not been released. As is often the case, this may be a situation of spending a lot of money to close the barn door after the horse has already escaped, just as it was with the distribution of half a billion “free” tests after the surge has passed.