Sunday, Jan. 23, 2022

No show.

I did not see My Fair Lady last Sunday. It was canceled “due to COVID”. Even though we didn’t know it was canceled until we arrived at the box office, I wasn’t surprised. This is a time of changing plans.

Only the day before, we had received a detailed list of instructions for the check-in process. “We wanted to remind you that your tickets to see My Fair Lady are for tomorrow,” they wrote,” and to let you know what to expect when you arrive.” You are told to arrive early and allow time for three check points. Check Point One: vaccination card and id card inspection. Check Point Two: security check and bag inspection. Three: touchless ticket check. Present the QR code on your phone for scanning. It’s a dynamic code that changes every 60 seconds, so don’t try taking a screen shot or sending it to someone else. And wear your mask at all times.

Last time I did all that, I went to Europe!

This is a winter of cancellations, of understaffing, empty shelves, and early closures. And no wonder. We had a combination of a record number of quits called, “The Great Resignation,” and now, a record number of absences due to illness. “The Great Sick-in?”

During most of 2020 I didn’t know anyone who was sick. This winter most people I know are either sick or have recently been sick. Last year, I remember people not going out much and taking precautions because of Delta. We also had a light flu season last winter, either due to these precautions or just because sometimes it’s just light.

Why is this year different? It started with Delta in October, which has overlapped and then been replaced by Omicron, a more contagious variant. And, of course, it’s flu season as well. The symptoms are almost identical. For COVID-19, the CDC lists, “fever, chills, cough, shortness of breath, fatigue, muscle aches, headache, loss of taste or smell, sore throat, nasal congestion or rhinorrhea [runny nose], vomiting or diarrhea, and skin rashes.” Many of these symptoms also occur with flu, whether respiratory or intestinal.

Omicron (purple) replaced Delta (Orange) a month ago. CDC Data Tracker.

Our first U.S. Omicron case was only announced on Dec. 1, 2021. It spread fast, in spite of a CDC reset on Dec. 21 when the CDC lowered its estimate of Omicron from 73% of new cases to 23% of new cases. (See NPR below). Since this was only a month ago, some of the numbers for the lagging indicators of hospitalizations and deaths may still be due to Delta. As recently as ten days ago, CDC director Rachelle Walensky announced that most COVID deaths we were seeing at that time were probably due to Delta. (NBC, below). It will be a few weeks before we know how these metrics are affected by Omicron.

The CDC gets the variant numbers for the U.S. from sequencing genomes of 750 samples a week sent from all the states. In addition, some states have independent or university laboratories that report sequencing. While hospitals test patients for COVID, they do not usually do genomic sequencing on individual patients because generally this would not affect treatment. (See Conversation article below).

Hospitals do not test every patient for flu and of course people who stay home with a mild illness do not get reported to the CDC for either flu or COVID, even if they manage to test for COVID at home. So basically, the statistics we have can give us trends, not exact numbers. Right now, according to the CDC Influenza Surveillance Report, respiratory flu numbers are elevated but declined slightly this week. The data includes positive tests from laboratories and hospitals as well as outpatient visits for respiratory illness. Let’s look at outpatient visits–how many people feel sick enough to go to the doctor?

The red triangles on the chart below show this season’s outpatient visits for influenza-like respiratory illness. Notice that the downward slope for week 2 of this year mirrors the slopes in 2018-19 and 2019-20. If it continues to track the two years prior to the pandemic, we can expect the number of people going to the doctor for respiratory symptoms to go back up in February and March.

CDC Weekly Influenza Report

It’s also clear that this flu season is not at all like last year. The pink line shows that our first pandemic winter of 2020-21 had the fewest outpatient visits for respiratory illness since 2011-12. Did fear of COVID cause people to avoid the doctor’s office? Were they being so careful about staying in and wearing masks that colds and flu couldn’t spread? (There was no vaccine yet). Or was it just a very mild flu season anyway?

What about that gray line that peaks in October? That was the H1N1 influenza pandemic of 2009. It started with a wave in the spring and then had a higher wave in the early fall. That should remind us that flu can cause pandemics too and that we shouldn’t count too much on the seasonality we’ve come to expect.

This is a winter of cancellations and changing plans. The coronavirus is different from last year. The flu is different from last year. As my dad used to say, “Hang on to your hat–we’re in for a ride!”

Today’s Notable Headlines

“2 ‘My Fair Lady’ dates in Costa Mesa postponed due to COVID-19′” OC Register, Jan. 14, 2022. https://www.ocregister.com/2022/01/14/2-my-fair-lady-dates-in-costa-mesa-postponed-due-to-covid-19/

“Stay Home or Work Sick? Omicron Poses a Conundrum,” US News & World Report, Jan. 9, 2022. https://www.usnews.com/news/us/articles/2022-01-09/stay-home-or-work-sick-omicron-poses-a-conundrum

“The CDC slashes estimates of omicron’s prevalence in the U.S.,” NPR, Dec. 28, 2021. https://covid.cdc.gov/covid-data-tracker/#variant-proportions

“As Covid deaths rise, many still caused by delta variant, CDC says,” NBC News, Jan. 12, 2022. https://www.nbcnews.com/health/health-news/omicron-covid-deaths-rise-many-are-still-delta-cdc-says-rcna11924

“From delta to omicron, here’s how scientists know which coronavirus variants are circulating in the US,” The Conversation, Jan. 7, 2022, https://theconversation.com/from-delta-to-omicron-heres-how-scientists-know-which-coronavirus-variants-are-circulating-in-the-us-173971

Other Sources

Clinical Care Quick Reference for COVID-19, CDC, updated Jan. 14, 2022. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care-quick-reference.html#:~:text=%E2%80%A2%20Signs%20and%20symptoms%20of,%2C%20and%20skin%20rashes.

“Weekly U.S. Influenza Surveillance Report,” CDC, Updated Jan. 21, 2022. https://www.cdc.gov/flu/weekly/index.htm#ILIMap

Covid Data Tracker, CDC. Jan. 22, 2022. https://covid.cdc.gov/covid-data-tracker/#variant-proportions

Summary of the 2009-2010 Influenza Season, CDC, https://www.cdc.gov/flu/pastseasons/0910season.htm

Why am I doing this?

The coronavirus pandemic will be written on our memories just as the 1918 Flu Pandemic, the Great Depression, or the Cold War left their mark on past generations. Since March 11, 2020, this blog has examined the modern pandemic experience both in the media and in everyday life, drawing on my experience as a medical technologist, a historian, and an ordinary person living through an extraordinary world crisis.

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