Editor’s note: This article was updated to include additional information from Dr. Gellert. Last updated Feb. 1 at 4:48 p.m.
BenitoLink spoke with San Benito County Public Health Officer Dr. George Gellert on Jan. 25 about the county’s COVID-19 numbers and other topics residents say are confusing.
Apparent discrepancies in the number of new cases and active cases was the basis for the first question. For example, on Jan. 17, following a three-day weekend, 496 new cases and 230 active cases were reported. But on Jan. 18, the number of new cases was only 104, and the active cases remained at 230.
Gellert explained this as lag in receiving data. He said the county’s Public Health Department gets information from many different places including Hazel Hawkins Memorial Hospital, the jail and schools, and the lag time can vary.
Given how agencies report data at different times, often when a positive case is recorded, the patient is no longer considered “active.” He said the weekend can also cause lag. Gellert noted that cases are active for “roughly 10 days, with the most infectious time being the first 72-96 hours after infection.”
BenitoLink asked Gellert to address the Public Health Department’s biweekly statistics report for Jan. 20, in which 449 vaccinated people and 225 unvaccinated people tested positive for COVID. He said that, though the vaccine is one of the most effective vaccines we have to prevent severe sickness and death, it does not stop infection.
He continued to say that among those who get infected, the vaccinated typically have a mild course, and the “overwhelming majority” of hospitalizations and deaths are among the unvaccinated.
Gellert added that because Omicron is very transmissible and that 70% of county residents are fully vaccinated, most of those testing positive will be vaccinated. He noted that being positive does not equate to being sick.
He said with the availability of home tests, positive case numbers are being skewed, as those aren’t reported to the Public Health Department. As a result, he continued, the actual level of community infection and transmission likely exceeds that reported to and by the Public Health Department.
Gellert said there is underreporting, which can happen for various reasons:
- People don’t want to report
- People don’t know how to report
- Many people are asymptomatic
He added that underserved communities can be reluctant to report for fear of deportation or losing their jobs.
Using the same biweekly statistics report, Gellert explained why there were only eight reported Omicron cases, even though it’s the dominant variant.
He said there are two technologies used in testing for COVID: the rapid test which looks for the presence or absence of antibodies; and the much more accurate PCR test that checks for the presence or absence of the virus RNA in the nasal passages.
To identify the virus variant type, he said the PCR sample is sent to a state lab for genome testing. This is an in-depth look at the genetic material from which the variant can be determined.
Gellert said this testing is costly, and since Omicron is the dominant strain throughout the nation there is no reason to think it would not be the dominant strain in San Benito County, so few tests are sent for genomic testing.
As to why people are considered fully vaccinated (two weeks after the second dose of Pfizer or Moderna and two weeks after the single dose of Johnson & Johnson) without a booster, Gellert stressed that although we have had many coronaviruses in the past, this one was new and public health officials might have been too quick to determine how many doses were enough, though initial data showed two would be sufficient.
He said this is not uncommon with new vaccines, as we can only observe the long-term effectiveness of a vaccine by observation and follow up of large vaccinated populations in the real world, beyond the time window of the vaccine manufacturer’s original clinical study observation period.
Boosters are recommended by the Centers for Disease Control and the Food and Drug Administration five months after the second dose of Moderna and Pfizer, and two months after Johnson & Johnson.
Gellert said it was discovered that antibody levels dropped after initial vaccinations. He noted that the medical community could have been “more tentative with the public” and should have said something like, “we think two doses will do it, but this is a new virus, this is a new vaccine, we might need an additional dose.”
Gellert also addressed reinfections.
“Reinfection with the identical variant of the virus is unlikely for a period of one to three months because infected individuals will have developed some natural immunity to that variant from the infection. However, the natural immunity from infection declines more rapidly than that provided by immunization. It is not entirely clear to what extent infection from one variant provides natural immunity to another variant, though we have been fortunate in that with most COVID-19 variants of concern thus far, while having increased ability to evade current vaccines, the vaccines have continued to be highly effective in protecting against severe disease, hospitalization and death. Given that new variants are likely given that over 40% of the world population remains unvaccinated, especially in the developing nations, it is best to assume that it is a low level, if any, immunity.”
Gellert added that reinfection with a different variant is more likely than from the original variant that caused the first infection because of natural immunity and different variants become dominant with time. “For example, the Omicron variant has almost completely displaced the prior Delta variant and is now responsible for 99%-plus of COVID-19 infections in the United States.”
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