As Covid Surges, Los Angeles County Public Health Takes a Minimalist Approach

By Lambert Strether of Corrente.

Readers, I was badly triggered by press release on Covid by the County of Los Angeles Health Department, and after I finished banging my head on my desk, I thought I’d post on it. Irritating though the press release was, it’s really isn’t worth putting on my yellow waders for, so first I’ll look at the status of Covid in LA (with special attention to wastewater), then at the many, many actions LA took to successfully bring on another surge (or, as we say, “uptick”), and then finally at the press release, which shows how little we’ve learned, three years into the pandemic.

Covid Status in Los Angeles County

Since this is the land of Freedom, we no longer have any decent case data, let alone contact tracing, so after presenting the case data, I’ll present proxies for actual infection: Hospitalization and deaths, nursing homes (famously lagging indicators), anecdotes, and finally wastewater data.

First, the case data, such as it is. From Deadline, “Los Angeles Covid Cases Rise Nearly 35% In Past Week, Test Positivity Close To Last Summer’s Peak“:

The average of 512 daily cases this week is a nearly 35% increase over last week week. Reported cases do not include home tests, so it’s fairly certain that the actual number of Covid infections is much higher.

Based on the most recent variant sequencing in Los Angeles County as of July 22, XBB.1.5 and EG.5 now account for nearly equal proportions of cases. Combined, they make up 31 percent of the total sequenced cases. XBB.2.3 accounts for the next highest proportion of sequenced cases followed by XBB.1.16.1.

Ninety-eight percent of currently circulating strains in Los Angeles County are descendants of Omicron XBB, including EG.5, which is what the fall vaccine, likely to be released next month, will target. Another variant, BA.2.86, is being closely monitored because it has many mutations that may affect how our body responds to an infection. BA.2.86 has not been detected in recent samples in L.A.

Hospitalization and death, from the Los Angeles Times:

The “Note to Readers” is amusing: “Post-emergency” status, as opposed to “post-pandemic”; the unquestioning acceptance that case counts and positivity numbers are now mysteriously broken; the submissive acceptance of CDC’s hospital-centric “hospitalization and death” metric, which ignores vascular and neurological damage, as well as Long Covid; 

Nursing homes, from the Santa Monica Mirror:

Adding to the concerns, Public Health is now reporting more new outbreaks in skilled nursing facilities, where residents are particularly vulnerable to severe illness and death from COVID-19. For the week ending July 18, Public Health initiated 11 outbreak investigations, similar to the 12 investigations opened the previous week. In comparison, one month ago, only four new outbreaks were reported during the week ending June 20.

Positivity, from the Country of Los Angeles:

Next, anecdotes. From Reddit, r/LosAngeles, the original post:

I took a COVID test 3x and they all came out negative. I’m thinking it’s just a bad cold but a lot of folks I know here in LA have been having similar symptoms

Of the responses, this one stands out:

My whole family has Covid right now. Started off with a runny nose and fever, progressed just like a typical flu so I didn’t even plan on testing until my wife tested positive. I went ahead and tested and was positive too, even though I feel almost totally better. On top of everything else it sucks because my kid’s missing the first week of school.

And this:

Covid seems to be everywhere again. Anecdotally, ‘m hearing people feeling symptoms for a week before it shows up on tests. I’m masking at work – someone’s always out with it and I don’t feel like getting a dose of it right now.

And this:

You have COVID. There’s been a major wave sweeping through LA and there’s a huge percentage of people with this new variant that test negative for up to a week but are still contagious. For the safety of yourself and everyone around you, assume you have it until you recover. Your tests should start coming in positive around day 5 at the latest

Interesting about the delayed positives, though nobody mentions RAT or PCR. (I bet a Reddit aggregation would prove an even more accurate heuristic than “Yankee Candle” reviews, if some clever person could figure out a way to scrape the site.)

Finally, we come to wastewater, where for once we have a multiplicity of sources. First, from Verily, this

(Red is Los the Los Angeles County treatment plant; orange the Los Angeles plant.) Seems to confirm all the sources! Hoo boy. Then I doublechecked the Wastewaterscan tracker (from which Verilly gets its data) and a different picture emerges. Could it be the peak has passed?

Finally, I checked Biobot, which sides with Wastewaterscan:

The origin of the the discrepancy? The first Verily graph is “Raw Data” (see greyed button at middle left). If we use “Normalized” data, Verily, Wastewaterscan, and Biobot all concur:

About normalization: Pepper mild mottle virus (PMMoV, see the greyed out button above) “was recently found to be the most abundant RNA virus in human feces,” and so its used to normalize SARS-CoV-2 data from waste treatment plants nationwide (a matter of some controversy; see here, here, here, and here. I don’t really want to do a deep dive into human fecal matter — I already do election coverage, after all — but it looks like I’m going to have to understand normalization a lot better. After all, we normalize a lot of data (think unemployment, GDP) and in many contexts, “normalize” is a synonym for “game.” Not that I’m foily.

If I had to guess, and guess is all any of us are doing at this point, I’d say Los Angeles County’s Covid surge has not peaked, and that the normalized Covid data is a temporary plateau.

What Los Angeles Did to Bring On a Covid Surge

Now let’s look at the many actions Los Angeles took that — most likely — combined to bring about the current surge.

First, Los Angeles eased Covid “restrictions” (i.e., people were told they should no longer protect others or themselves). From the Los Angeles Times:

The steady unwinding of COVID-19 emergency declarations has ushered in a slate of changes to Los Angeles County’s pandemic guidance, including when to mask, quarantine or isolate, as well as the reporting of new infections and outbreaks.

The most significant — the easing of government-issued masking orders for patients and visitors in healthcare settings — took effect Monday in L.A. County. In other California counties, masking orders for doctors and nurses also have expired.

The tweaks are the latest reflection of a broad new phase of the pandemic, one characterized more by individual risk assessment and targeted intervention than sweeping measures or restrictions.

So, when Deadline’s reading says that “Cases Rise,” that’s like saying the offense make a comeback when the defense left the field.

Second, the Los Angeles Unified School District asked children to come to school even if they were sick:

In a reversal from recent pandemic-era school years, Los Angeles schools Supt. Alberto Carvalho is urging students to come to school sick — at least if they are just a little sick — to combat high rates of absences that officials fault for harming mental health and holding back learning.

If a student has a fever, however, they need to stay home.

For parents and employees, the reversal is a sort of cognitive whiplash for a school system that took pride in having among the strictest school safety protocols in the nation: mask mandates, 10-day illness quarantines, weekly COVID-19 testing — and directives to keep students home at any sign of illness.

County health officials put the current risk from COVID as low based on hospital admissions, although there’s been a recent uptick in hospitalizations and in measures of the virus in wastewater. County health officials warn that the start of school has led to increased COVID outbreaks in recent years and could do so again. The first day of school in L.A. Unified is Monday.

Note the doublethink of “county health officials” relying on a lagging indicator, even though less ladding indicators are flashing yellow! Looks like LAUSD relaxed at exactly the wrong time (which is what always happens; “nobody could have predicted”). But then, we have budgets to worry about:

The change is part of the district’s strategy to boost attendance — which took a deep hit during the pandemic and has not fully recovered — as well as funding.

School districts in California are funded based on average daily attendance, rather than the total number of students who are enrolled — a system Carvalho says is “flawed.”

Hence, minimization:

The guidelines encourage families to use “parental instinct” to determine whether a child is too sick to come to campus, and say children “can wear a mask” when attending with mild symptoms.

Not “must” but “can”?

“I met students who were out 72 days, 40 days, 50 days, 27 days – and when you ask the parents or the students the reasons, one of the reasons that was conveyed to us was that ‘my [child] had the sniffles, and therefore I didn’t think I could send them to school,'” says Carvalho.

“The sniffles.” What if my “parental instincts” are telling me I don’t want my child to be brain-damaged because other parents are reckless?

Third, a ginormous Taylor Swift concert was a potential superspreading event. From Self (!):

And while most of the social media coverage has featured Swifties dancing and belting out bops like “Cruel Summer” and “Lavender Haze,” some attendees of last week’s SoFi Stadium shows in Los Angeles have been posting about a less joyful effect of their concert euphoria: a positive COVID-19 test. And yes, some of these fans claim they took standard safety precautions like wearing a mask and quarantining before and after the concert.

Here we have Reddit anecdotes as well:

3 coworkers, all who went to the concert separately during the weekend, have tested positive for COVID and are out sick this week. Most tested positive on Tuesday.

And:

Superspreader event gonna spread. Also, tens of thousands of infected flew in from elsewhere, so they inevitably flew back home to share it.

And: 

Yep i went to the Aug 4th show at Sofi and tested positive on Monday the 7th and have been horribly sick and down for the count since then.

It was worth it to see her but crap I feel bad and I had made it all these years without it.

Interestingly, this thread doesn’t mention waiting a week, while sick, to get a positive. Different strains?

Finally, unmasking in health care settings:

Starting Friday, healthcare workers across Los Angeles County will no longer be required to mask up in hospitals.

The Los Angeles County Department of Public Health announced the county’s mask mandate for employees in health care settings will end – effective Friday, August 11.

The order was put in place in April and was set to be reconsidered later in the year, but LA County Public Health decided to end the policy as early as the end of this week.

And just in time!

County of Los Angeles Public Health Press Release

So, after that Luis Tiant-like windup, the press release. On nursing homes:

Public Health currently strongly recommends[1] masking for staff in skilled nursing facilities and requires it during outbreaks. All residents should have access to clean well-fitting[2] masks with good filtration[3] and these should be worn by anyone suspected positive[4] when not in their rooms[5]. It is also strongly recommended[6] that all residents, staff, and visitors remain up to date with COVID vaccines. Visitors should test before going into a skilled nursing facility and should strongly consider[6] wearing a mask while inside.

[1] Why this pissant weasel-worded deference to people who want to risk infecting helpless elders? Just require masks ffs.

[2] Will there be actual fit-testing?

[3] Is a “Baggy Blue” “good”? Why not just require N95s?

[4] The County of Los Angeles Public Health Department does not, after three years, understand that Covid transmits asympotically. Masks should be required for all, at all times.

[5] The County of Los Angeles Public Health Department does not, after three years, understand that Covid is airborne. It moves like smoke. Like smoke, it does not confine itself within a facility. Masking should be required, for all, at all times, throughout the facility (most definitely including the hallways).

[6] Less deference, more public health, please.

And on schools:

With increased COVID-19 transmission in the community, schools are another place where outbreaks are possible due to large groups of people being indoors together[1] for extended periods of time. And while many children may not experience severe illness associated with a COVID-19 infection, other family members and school staff may be at higher risk.

Parents and guardians are encouraged to keep children home if they are sick, including when they have a fever, bad cough, extreme fatigue, or a sore throat[2]. Those with respiratory symptoms or a known exposure should test for COVID-19; many school districts have already received test kits for free distribution to students and their families. If a child tests positive for COVID-19, it is important to[3] report that to the school as soon as possible so that others can be informed of the exposure. Anyone who tests positive for COVID-19 needs to[4] isolate at home for a minimum of 5 days[5].

[1] Now would be a good time to mention ventilation, HEPA filters, and Corsi-Rosenthal boxes. And masks.

[2] Once again, Covid can spread asymptomically. That is why the entire facility should have layers of protection.

[3] More deference.

[4] Ditto.

[5] No, ten ffs. CDC’s guidance is wrong. Also, it sure is weird that the same logic and standard isn’t applied to nursing home personnel.

Conclusion

Los Angeles County does provide free testing; I’m sure other localities are doing much worse than Los Angeles. But IMNSHO, our entire society should be a  giant non-pharmaceutical intervention, if not for this pandemic, than the next one. Our operational capability is very far from that. Also, celebrities could help by wearing masks in public. Thanks, Taylor, good job.