It seems I am not destined to lay down my COVID pen just yet.  After a very rapid decline in September and October all COVID metrics began to move sideways in November, giving somewhat mixed signals about the course of the pandemic.

Hospitalizations

New hospitalizations, which I have concluded is the best indicator of the current level of serious COVID cases, ended October at just over 5,000 per day.  That was down from a peak in late August of nearly 13,000.  But shortly after the first of the month, new hospitalizations reversed and began to gradually increase throughout the month, eventually going back over 6,000. 

Generally speaking, the increases in new hospitalizations are in northern states while southern states are holding even or slightly declining.  Some have suggested this may be the beginning of a seasonal endemic phase for COVID.

New Texas hospitalizations hit a low of 265 on November 7 but have steadily drifted higher since then, finishing the month at 432.  That is still only about a quarter of new daily COVID admissions that peaked at the last surge at just over 1,900.  Total daily hospitalizations have held fairly stable, reaching a low on November 20 of 2,610 and only slightly increasing since then.  Interestingly, COVID ICU and COVID pediatric hospitalizations both continued to slightly decline throughout November.

The increases have mostly been spread out around the state.  I cannot detect any discernable pattern.  In Harris County, hospitalizations rose slightly during the middle of month but have since turned down again.  At the end of the month only 4.5% of hospital patients were positive for COVID.  COVID patients requiring ICU in Harris County steadily declined during the month and are now only 8.8% of all ICU patients.  These are the lowest levels since last July.

Fatalities

The CDC data continues to show that fatalities peaked around the middle of September but has increased the peak to just over 1,900.  By the end of November, the seven-day average had fallen to about 800 per day, after moving in a range from 1,000 to 1,100 for most of November.  Again, the CDC data is based on when the fatality is reported, so it is both a lagging indicator and will be significantly revised upward in future reports.

The Texas date of death analysis shows a more distinct downward trend.  It is still showing that daily fatalities peaked in the first week of September at 341.  Its seven-day average dropped by about half (~100→~50) from mid-October to mid-November (the latest data the DHS believes is “complete”). 

The CDC Excess Death Analysis continues to show that the Delta surge drove excess deaths in late August and early September to about 35-40% above what would be normal for that time of year.  For October it shows about a 20% increase.  That analysis shows that fatalities in Texas for September were 70% above normal, which is the highest level of the pandemic.

Vaccines

The number of vaccines being administered daily spiked in late October and throughout November with more Americans lining up for their boosters.  By the end of the month, the daily average for shots was nearly 1.5 million.

But the percentage of the US population fully vaccinated only rose slightly, reaching 59.4% for the entire population and 86.3% for seniors.  But the number of seniors who have received a booster jumped from 25% to 45%.  Incredibly, 99.9% of seniors have received at least one dose. The percentages in Texas for the general population and seniors also gradually increased, now at 54.8% and 83.1%, respectively.

Testing Results

Nationwide, testing picked back up somewhat.  During the month, it has been in the 1-1.5MM tests per day range.  After bottoming out at about ~70,000, the CDC’s “new case” count increased to about 94,000 just before Thanksgiving.  It shows a big drop after Thanksgiving but that is probably due to testing disruption around the holiday weekend.  The current nationwide positivity rate jumped a little over 2% during the month (5.28%→7.42%).

Texas’ seven-day average for “new cases” has held pretty steady during the month at about 3,000 per day.  The positivity rate for the State’s date of specimen testing has also increased by just over 2% for the month (5.27%→7.67%).

Breakthroughs

Unfortunately, the data on breakthrough cases is coming in very slowly and is not comprehensive.  The CDC has a chart which shows the hospitalization rate per 100,000 by age group but the data only comes from twelve states and was last updated at the end of September.  There are a number of states that publish more updated and comprehensive information.  Everything I have seen convinces me that vaccinated people are going to the hospital with COVID about 10% as often as unvaccinated people are.  This chart from New York is typical of some of the state data.

Conclusion

Many analysts have suggested that the flattening out of the decline in COVID suggests that it is transitioning into a seasonal endemic disease associated with colder weather, in much the same pattern we see with the flu.  Certainly, the regional pattern we are seeing with hospitalizations seems to support that view.

There is some indication that COVID is becoming less serious.  The fatality rate continued to fall through November even though cases and hospitalizations have increased.  The Texas numbers are supportive of that thesis with ICUs making up a smaller percentage of hospitalizations and the fatality count continuing to steadily decline.  That trend would be consistent with wider vaccination rates which reduces serious disease and better therapeutics.

Of course, all the news over the last week has been about the Omicron variant, first detected in South Africa.  The media breathlessly reported their stock-in-trade doom-and-gloom regarding its potential impact.  In a knee jerk reaction, the US and other countries banned travel from southern Africa (which, by the way, is a terrible idea) and markets plummeted.  However, since the early reports and speculation, many have questioned the seriousness of the new variant.

An intriguing theory has been presented that the COVID variants may be evolving the immune-compromised individuals.  This paper focuses on an HIV patient.  And it is hard not to notice the coincidence of HIV cases in southern Africa and the emergence of this highly mutated strain.  If true, it would suggest that we should have been paying more attention to intense prevention and treatment of those with compromised immune systems and that there may not be that much benefit from vaccinating people with fully functioning immune systems with respect to mitigating variants.  Of course, today, with widespread HIV and extensive use of radiation and chemotherapy, we have more people with compromised immune systems than ever before.  That may explain why COVID has mutated so rapidly in the face of the generally accepted notion in the early days of the pandemic that coronaviruses tend to be more stable.

We will not know much about the impact of Omicron for a few more weeks.  So far, all of the variants, with the exception of Delta, did little to change the trajectory of the pandemic.  It appears the more significant driver across the world and, to some degree within the US, is the toll Delta is still taking on the unvaccinated and those in which immunity may have waned.