During the past four weeks, new cases of COVID-19 have decreased significantly in Borrego Springs. The post-holiday surge of Omicron appears to be ending. Cases will likely remain low in Borrego Springs, especially after the seasonal residents leave, fewer tourists visit, and permanent residents circulate less due to the heat of summer. However, another surge is possible in the fall because almost one-third of our population remains susceptible, and more infectious variants of COVID-19 could arise. So, it is useful to review our current and possible future situation.

During the first year of the COVID-19 pandemic, when the entire population was susceptible, we had fewer means of protecting ourselves and others. On an individual level we used physical distancing, masks, hand washing and ventilation. On a community basis, we used lockdowns (to force distancing) and mask mandates. Since the vaccines have become available, about 70% of our population has gotten vaccinated, which is by far the best protection against COVID-19. Nonetheless, a significant portion of our population remains skeptical of vaccination. Another significant portion either cannot be vaccinated (e.g., children ages 0-4) or do not receive significant protection from vaccination (e.g., immunocompromised).

Fortunately, more protections are being discovered for such people. Recently, a number of pre-exposure, post-exposure and therapeutic treatments have been found effective to provide some protection to those who remain susceptible and to better treat those who become ill.

New Cases Have Decreased Dramatically

According to official counts from the County (based upon PCR test reports), the number of new cases of COVID has been decreasing in Borrego Springs. During the 10 weeks of the Omicron surge, our residents experienced 135 cases of COVID. During the past four reporting weeks, residents have had 2, 1, 4 and 0 new cases, respectively.

Is the Threat of COVID Over?

No, the County’s reporting of new COVID cases based upon PCR testing is certainly an undercount. Lately, rapid or home testing has become much more frequent. Positive cases found via home testing are not generally reported to the County. Two-thirds of our residents are fully vaccinated and some have had booster shots. When they become infected, their COVID case tends to be relatively mild. Vaccine induced antibodies tend to wane. However, recent studies of long-term immunity are finding that a booster shot activates memory cells that produce new antibodies or attack and destroy infected cells when the virus is encountered again. These memory cells appear to be long lasting, perhaps for a lifetime.

Which Residents Remain at Significant Risk?

Other residents remain at much higher risk of infection and more severe illness. County statistics show that unvaccinated residents are five times as likely as fully vaccinated residents to become infected, seven times as likely to be hospitalized and nine times as likely to die. Omicron still is a significant threat to them. Other subgroups of our population who remain at significant risk of severe illness are those who are immunocompromised, children ages 0 – 4 who are not yet eligible for vaccination, residents who were infected with COVID more than five months ago and who have not gotten vaccinated, and fully vaccinated residents with certain co-morbidities (e.g., frail elderly, obese, diabetics, those with COPD, hypertension, heart disease, etc.) that have been associated with 78% of deaths among fully vaccinated people infected with COVID.

What Can You Do to Protect Yourself?

Get fully vaccinated and boosted. Although antibodies wane after 5 – 6 months, vaccine induced antibodies are effective for many months in protecting you from severe illness, hospitalization and death. They become much less effective in protecting against infection, especially against infection from Omicron, which is now the primary variant. Long term immunity is more difficult to study – blood must be drawn repeatedly from large groups and the very specialized expertise and special lab equipment is only available in a few locations. So, it is an exciting recent development that studies of long-term immunity from B cells and memory T cells have found that two shots of an mRNA vaccine plus a booster shot appears to provide long-term immunity to severe illness, hospitalization and death due to COVID. Experts believe B cells, which are long-lasting, may quickly produce antibodies when again exposed to the SARS CoV2 virus. Memory T cells which are very long-lasting will attack infected cells and allow them to be removed from our bodies.

The risk of becoming infected, whether vaccinated or unvaccinated, is relatively low outdoors, except in crowded venues. If you are fully vaccinated plus boosted in a geography with low transmission and you are with other vaccinated/boosted people indoors, your risk of becoming infected is low. A mask is not needed. In a high transmission geography or when around unvaccinated people indoors, a mask will help protect you from infection.

If you are not fully vaccinated, a mask will help protect you from infection. N95, KN95 and KF94 masks provide about 83% protection. Surgical masks provide about 50% protection. Cloth masks provide very little protection and are considered face decorations by experts.

High risk individuals, such as those immunocompromised, now have an option referred to as pre-exposure prophylaxis (PrEP). One form of PrEP is a medication that is taken by individuals who are not currently COVID-19 positive and have not had a recent exposure to a COVID positive individual to prevent COVID-19 disease. Evusheld (tixagevimab and cilgavimab) is a medication that combines two long-acting monoclonal antibodies, administered together every six months.

What Can We Do to Protect Each Other?

The most effective thing we can do to protect others, as well as ourselves, is to get fully vaccinated plus boosted. Next most important is to wear a mask as described above. Last, being in well ventilated places helps reduce transmission of the virus.

What Can We Do If We Are Exposed or Become Infected?

If we are exposed to an infected person, we should quarantine. Recommendations for quarantine can be found here: https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html. If we are infected, we should isolate ourselves. Recommendations for isolation are also in the link above. If infected, we now have post-exposure prophylaxis tools to stop or slow the progression of COVID or to reduce its severity. We have drugs like Paxlovid which is about 90% effective in preventing severe illness, hospitalization and death.

We also have monoclonical antibodies which are also about 90% effective in preventing severe illness, hospitalization and death. Improvements to treatment have made death much less likely. Currently, Remdesivir (an anti-viral) is the only FDA approved drug to treat severe COVID-19 cases.

However, the FDA has authorized use of other anti-virals and monoclonal antibodies that are still being studied, to treat severe COVID-19 illness. Knowing the appropriate options given ones’ state of illness and knowing where and how to access them is summarized here: https://www.fda.gov/consumers/consumer-updates/know-your-treatment options-covid-19

Last, claims have been made that hydroxychloroquine, ivermectin, and supplements such as zinc, vitamin C, and vitamin D are effective in treating COVID-19. Twenty-one clinical trials are producing evidence that these substances are not effective treatments.

Current State of Knowledge about COVID Vaccines

The CDC is no longer recommending the J&J/Janssen vaccine when either the Pfizer or the Moderna vaccine is available, and each is readily available now. The mRNA vaccines (Pfizer and Moderna) have been proven very safe and two primary vaccinations plus a booster are proving very effective against severe illness, hospitalization and death due to COVID.

Safety: Anaphylaxis is a very rare serious adverse reaction to the vaccines. A study by CDC after 1.9 million doses had been administered found only 21 cases. Most reactions were recognized soon after administration of the vaccine (median interval of 13 minutes). And most (17 of 21) had a history of allergic reactions, so it might have been predicted. Follow-up information was available for 20 cases, which were all treated and discharged home. Myocarditis and pericarditis are very rare side effects (16 cases per 1 million shots administered) of the mRNA vaccines which occur primarily to male teens and young men after the second shot of the vaccine. Most of the young adults who experienced myocarditis recovered quickly, though three needed intensive care and rehabilitation after their episodes. Among cases with known outcomes, 81% got better and 19% had ongoing symptoms.

Reports have suggested that there is an increased risk of thrombosis with thrombocytopenia syndrome (TTS) in adults who have received the J&J vaccine, which is no longer recommended. Very rarely has the Moderna vaccine been associated with TTS. TTS is a rare but serious condition that causes blood clots in large blood vessels and low platelets. Women aged 30 to 49 years should be aware of the increased risk of this rare event.

Recent studies have demonstrated that increasing the time interval between COVID-19 vaccination shots appears to not only increase the duration of protection but also reduce some of the rare but severe adverse reactions (i.e., myocarditis). Some studies in people older than 12 have shown “the small risk of myocarditis associated with mRNA COVID-19 vaccines might be reduced and peak antibody responses and vaccine effectiveness may be increased with an interval longer than four weeks,” according to the CDC. Many other assertions of adverse effects of vaccination have been rejected as impossible or ludicrous (the vaccines cause the virus, vaccines change peoples’ DNA, vaccines cause COVID variants, injection of microchips, making people magnetic, etc.). Some conspiracy theories have not been supported with existing data (e.g., CDC is over reporting COVID cases, flu cases are attributed to COVID, doctors and hospitals are over reporting and over treating COVID cases as money-making schemes, etc.) Studies have not supported other assertions of adverse events, such as claims that the vaccines cause infertility, harm pregnancies, cause long term illness, etc.

In fact, studies have found that being ill with COVID threatens pregnancies, causes erectile dysfunction, causes loss of smell, causes long term illness, causes heart conditions, etc. To date, COVID has caused 79 million infections, an estimated 3 million hospitalizations and 957,000 deaths in the U.S.