January 13, 2024 - The Big Question

The Big Question

January 13, 2024

The CDC has released its national and state Covid data for the week ending January 6. Normally, that happens each Monday but the CDC must have accelerated the process this week in recognition of the MLK holiday.

Before addressing the latest hospitalization data, I’d like to remind you that the CDC stopped reporting case numbers long ago due to the prevalence of at-home testing. Wastewater surveillance is believed to be a valuable tool, perhaps the only tool we have, for measuring the prevalence of the virus at a given time and place. But, wastewater monitoring has its challenges. For example, wastewater is complex and variable, containing compounds that can interfere with RNA quantification methods. Seasonal or population changes can affect a particular watershed where wastewater is being monitored. It is also site-specific; for example, there are just 5 wastewater treatment plants being monitored in Alabama, and all of them are located in Jefferson County. 

Despite those caveats, the national wastewater viral activity level for COVID-19 is considered very high. For the week of January 6, the level in the United States measured 11.79 compared to just 7.53 during the same week last year. In the South region, the level was 14.54 compared to 9.52 last year. In the West region, it was 13.22 compared to 7.09 last year at this time. In the Midwest, it was 11.67 compared to 6.68. And in the Northeast, it is 10.32 compared to 6.81.

In central Alabama, where our only stations are located, the viral activity level is alarming. The latest report reflects that Alabama’s viral level was twice what it was at this time last year - 14 compared to 7. On August 26, 2023, just before a mini-surge of infections that I wrote about in September, the viral level got as high as 11. Apart from that brief episode, the level remained below 6 all year long until it rose to 12 in late December. These data reflect that the Covid-19 virus must be circulating widely in central Alabama and probably throughout the State. 

Of course, pervasiveness is not necessarily indicative of severity. The Omicron variant, which circulated during the winter of 2021-22, was far more pervasive than the Delta variant, which burned out after the summer of 2021; yet, Omicron tended to be less severe. Nevertheless, the Omicron variant caused just as many people to be hospitalized simply because Omicron cases were so ubiquitous.

So, where are we now in terms of hospitalizations? Nationally, new hospital admissions for the week of January 6 rose 3.2% compared to the prior week. In Alabama, they rose 6%. There were 556 new hospital admissions in Alabama versus 525 in the prior week. During this same week last year, Alabama hospitals admitted 736 new Covid patients, so we can take heart that 25% fewer patients were admitted than at the same time last year. 

The big question on the table is whether Alabama’s hospitalization rate has now peaked or will it continue to rise, at least through January. To answer this question, it may be helpful to examine the pattern during the last three winters. Nationally, peak wintertime hospitalizations have occurred on or about the first week of January for three years in a row. In 2021, the national peak occurred the week of January 9. In 2022, it was the week of January 15. And in 2023, it was the week of January 7. In each case, new hospital admissions dropped precipitously every week after they peaked.

In Alabama, that same pattern held true, except for the Omicron winter in 2022, when the peak in hospital admissions occurred on January 29, two weeks later than the national rate. Importantly, hospitalizations tend to rise one to two weeks after a rise in infections. Therefore, if Alabama’s wastewater data is a future indicator of rising hospitalizations, then we can expect admissions to rise for a while to come. 

For these reasons, I believe the watchword must continue to be “caution”. Though I am confident we will not see an outbreak which approaches the levels reached during the winters of 2021-22 or 2022-23, it would not be at all surprising to see hospital admissions resemble last year’s. 

Fortunately, I know I’m preaching to the choir. If you are still reading my letters, you have likely been vaccinated multiple times. The likelihood of you landing in the hospital with a bad case of Covid-19 is probably quite low. However, since only an estimated 8% of Alabama residents are currently up to date on their vaccinations (ranking the State ahead of only Mississippi and Texas in that category), you may know others who will not not be so fortunate. Therefore, it's important to speak up and spread the word that the mRNA vaccines work and it is never too late to head to the nearest pharmacy.