Orange County residents find themselves in the midst of another COVID-19 wave, largely fueled by new Omicron sub variants that are much more contagious than previous strains.

But, local experts say, the county is in a much better position to handle the new wave of cases thanks to increased vaccination rates, the availability of anti-viral medication to treat infections and some signs the new Omicron strains – BA.4 and BA. 5 – can potentially cause less severe illness. 

Yet because the new strains are even more contagious than previous ones, there’s worries the virus will find its way to immunocompromised people and residents with comorbidities like heart disease, lung disease and diabetes – all of whom have an increased chance of hospitalization and death from COVID-19, despite being fully vaccinated. 

“Even if the virus is less potent for most, you still have a smaller cohort of patients who are immunocompromised to begin with and they’re the most susceptible,” said Dr. Lance Brunner, physician director of patient safety and quality at Kaiser Orange County.

In a phone interview last week, Brunner said elderly people are also at high risk for severe impacts. 

What Does the Latest COVID Wave Look Like?

According to state data, Orange County sits at an 18.5% positivity rate as of Tuesday – something not seen since the wave that began last December and stretched into January. 

But hospitalizations are far lower this time.

As of Monday, 298 people were hospitalized in Orange County, including 45 residents in intensive care units, according to state data

A month ago, 178 people were hospitalized.

“We’re definitely in a surge, we’re going to see increases but I don’t think it’s going to be as dramatic an increase as we saw with the winter Omicron wave,” said Sanghyuk Shin, a UC Irvine epidemiologist and public health expert. 

More than 1,200 people were hospitalized in the last wave. 

Shin said although countries like the U.K. and South Africa didn’t see the Omicron sub variants produce a wave of hospitalizations, other places did. 

He cited Portugal’s struggle with the BA.5 sub variant. 

‘It did in fact create a very significant surge in hospitalizations and deaths. It did significantly stress their health care system.” 

According to John Hopkins University, 87% of Portugal is fully vaccinated, compared to 67% of the United States.

Unlike the previous surges, public health messaging around COVID has largely died off. There used to be news conferences held by state and local public health officers about the scene of the previous waves – there hasn’t been one during this latest surge. 

“Unfortunately the public health agencies at all levels have sort of dropped the ball on this. So we’re caught — the public — are caught off guard by this,” Shin said. 

[Read: End of Pandemic Outreach Leaves Some OC Residents in a Difficult Spot]

Brunner and Shin said the lower hospitalization rate during this surge stems from increased vaccinations and antiviral treatments. 

Shin also said it’s likely someone inside a crowded market or other packed indoor spaces is carrying the virus. 

“It’s almost guaranteed that somebody is going to be breathing out the virus into the air and there’s a good chance that you might be inhaling somebody’s air that they just breathed out that may contain SARS-COV2 virus in the aerosol,” he said in a phone interview last week, urging people to wear masks indoors when outside of their homes. 

Along with Shin, everyone else interviewed for this story said people should wear masks if they head into indoor places outside of their homes. 

What To Do If You Test Positive For COVID-19

Dr. Charles Bailey, medical director for infection prevention at St Joseph’s and Mission hospitals, said people should contact their primary care doctor immediately after testing positive. 

“Following that encounter, if they’re not deemed in need of admission (to a hospital), then their outpatient options can be improved. They can be set out with an outpatient monitor to gauge which way the disease is going,” Bailey said, adding that it depends on the initial symptoms.

He also said if the symptoms worsen, people should get treatment within five days of the positive test. 

“There are outpatient treatments available for people who have a positive COVID test and are what they call at-risk of progressing. So this would be elderly people, people who aren’t fully vaccinated and people with comorbidities – obesity, diabetes, heart disease or lung disease,” Bailey said in a phone interview last week.  

People should also test while they’re quarantined after a certain amount of time, experts say. 

The recommended isolation time from the Centers for Disease Control and Prevention went from 10 days to five days in December, after the CEO of Delta airlines lobbied the public health agency to reduce quarantine time.

“The answer is it depends. So for the general population, non-health care workers, for everyone regardless of their vaccination status or previous infection or symptoms, they should isolate for 5 days,” Brunner said. 

Brunner said people should use the at-home tests beginning 5 days after their first positive to see if they can come out of quarantine. 

But, he warned, “most people are not going to have their symptoms disappear in 5 days.” 

Dr. Jay Lee, chief medical officer at community health clinic, Share Our Selves, also said people should test negative at least five days after their first positive test before they come out of quarantine. 

“If you continue to have positive COVID rapid antigen tests but you’re feeling okay, it means you still have a sufficiently high viral load to infect someone else. So it would behoove you to quarantine until you have a negative test,” Lee said in a phone interview. 

Lee also said antiviral drugs can help reduce the amount of virus someone carries. 

“The nice thing with the antivirals is that they can reduce viral load quickly and really can help shorten the duration, much in the same way antivirals do for flu. But they’re way more effective. tamiflu for flu is maybe about 50% effective for flu and paxlovid, that’s closer to 90% effective,” he said.  

But, like his colleagues at the hospitals, Lee said people should speak with their doctor to make sure the treatment won’t have a negative drug interaction with other medications they’re taking or if it will impact an existing medical condition. 

Living With COVID

All three doctors interviewed said they attribute the relatively low hospitalizations in OC – despite a nearly 20% positivity rate – to a mix of increased vaccination rates and antiviral treatments. 

Shin, the UCI epidemiologist, also warned against using a five-day quarantine window as the standard rule. 

“Since the CDC released those guidelines, there’s been numerous studies that show, on average, people still tend to be infectious for seven to eight days after the symptoms onset,” he said. “It could be a little longer with Omicron compared to the prior variants.” 

Lee said people should get vaccinated because it not only lowers the risk of going to the hospital and potentially dying, but it also helps curb the symptoms of COVID-19. 

He cited his own battle with the virus a couple months ago. 

“Even as a vaccinated person, the symptoms were terrible. I can’t imagine what it would be like without it,” Lee said. “So please, I implore you if you haven’t gotten the vaccine, and you’re on the fence, please do.” 

Spencer Custodio is the civic editor. You can reach him at scustodio@voiceofoc.org. Follow him on Twitter @SpencerCustodio.

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