Infectious Disease

Low hospitalizations, more treatments temper alarm as COVID cases rise across Northeast

April 14, 2022

2 min read

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Adalja reports no relevant financial disclosures.

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Northeastern cities, including New York and Washington, DC, have seen a surge in COVID-19 cases, but increased immunization, low hospitalization rates and a growing armamentarium against infection may serve to temper calls for alarm.

“Cases were never going to inevitably just plummet forever,” Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, in Baltimore, told Healio. “COVID-19 is not something that can be eradicated or eliminated, and cases are going to ebb and flow as it settles into endemicity. A more contagious variant like BA.2 coupled to changes in behavior is definitely going to drive cases to increase.”

According to Adalja, increasing case numbers alone are not cause for alarm. Instead, he advised that officials would be better served by tracking hospitalizations and hospital capacity.

“The rise does not concern me because it is occurring in the context of a highly immune population that has access to antivirals and monoclonal antibodies,” Adalja said. “Cases are increasingly decoupled from hospitalizations. The metric to follow is hospitalizations as a percent of hospital capacity.”

As cases throughout the region continue to rise, Philadelphia became the first major city to announce a return to mask mandates. Beginning April 18, people in Philadelphia will be required to wear masks in restaurants, shops, offices and other indoor spaces, according to a report in The Philadelphia Inquirer.

However, Adalja argued that a return to masking indoors is not the way forward — as long as hospitals maintain ample capacity.

“I do not think that there is justification for the government of Philadelphia to institute this measure,” Adalja said. “So long as hospitals have capacity, these types of measures have little value, in my opinion.”

Instead of recommending a city-wide mask mandate, Adalja said individuals should continue to mask at their own discretion. He recommended that at-risk individuals continue to mask in situations that could be considered high-risk.

“Cities like Philadelphia need offramps and should move away from cases being the impetus for action,” Adalja added.

Philadelphia in March instituted a system using case counts, hospitalization rates and the rate of case increases to decide which safety measures are appropriate at any given time. Although other cities may implement similar restrictions in the coming weeks as cases potentially rise, Adalja does not believe it will become the norm nationwide.

“I do not think that this uptick is going to substantially change the trajectory of this pandemic, which is being driven more by the immunity in the population and people’s individual risk calculation than the virus at this point,” Adalja said.

No other cities have yet announced a return to mandatory masking. In Boston, although cases are on the rise, hospitalization benchmarks remain below the standard that would be needed to meaningfully reinstate mandatory masking and other restrictions, the Boston Herald reported.

“Individuals are free to mask if they choose to and I would advise high-risk individuals to think about doing so in high-risk conditions,” Adalja said.

References:

An uptick in US virus cases is concerning but not surprising, Fauci says. https://www.nytimes.com/2022/04/10/health/fauci-ba2-omicron-covid.html. April 10, 2022. Accessed April 12, 2022.

Philly will require masks in indoor public spaces again as COVID-19 cases rise. https://www.inquirer.com/health/coronavirus/live/covid-philadelphia-mask-restrictions-pa-nj-de-cases-20220411.html. April 11, 2022. Accessed April 12, 2022.

Boston ‘not there yet’ on mask mandate — which now is health board decision. https://www.bostonherald.com/2022/04/12/boston-not-there-yet-on-mask-mandate-which-now-is-health-board-decision/. April 12, 2022. Accessed April 13, 2022.

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COVID-19 and Rheumatology

COVID-19 and Rheumatology

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