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Your Local Epidemiologist

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COVID in China, the U.S., and everything in-between

Well, I was very much enjoying my holiday but COVID continues to do its COVID thing. It’s time for an update.

China: A humanitarian disaster

As expected, the COVID-19 situation in China is out of hand. In an interesting turn of events, China went from a “zero COVID” policy to a “let it rip” policy by dropping all mitigation measures without fully vaccinating the highest of risk or strengthening their healthcare system.

Egregiously, they stopped reporting cases, hospitalizations, and deaths, too. This looks good for them on paper, but when we rely on epidemiology 101 and anecdotal reports, which are plentiful, the situation in China is beyond grim.

Officials estimate between 5,000-10,000 people are dying per day. (At the U.S. peak, we lost 3,800 people per day). Epidemiologists expect death toll to rise in China in the coming months leading to 0.5-1 million cumulative deaths.

A humanitarian disaster.

This outbreak could have implications worldwide, like the emergence of a variant of concern.

The best we can tell, BF.7 is spreading in China, which is an Omicron subvariant about 3 evolutionary steps behind what is spreading in most of the world. But, a new variant of concern could appear.

(This is more possible than probable because transmission is high everywhere).

Just like cases and deaths, though, China is not reporting genomic data.

In other words, we don’t know if and how the virus is changing and what it may (or may not) mean to the international community.

U.S. responds domestically

So, how should the United States respond? Well, it depends on our goal: delay or decrease transmission from China? Identify variants of concern? Pressure the Chinese government to uphold international responsibilities?

Yesterday, the U.S. publicly signaled two goals:

Delay transmission. On a scale from “do nothing” to “ban all travel”, the U.S. chose something in the middle.

Travelers coming to the U.S. from China will be required to have a negative PCR test within 48 hours of departure. This starts on January 5, 2023. I assume the goal is to buy time—delay a wave in the U.S. seeded by travelers.

And this may be a legitimate concern, as Milan reported that 50% of passengers on flights from China tested positive. However, the extent to which this delays transmission, and by how much, is up for debate:

1. As Adam Kucharski pointed out, “uncontrolled domestic transmission will grow exponentially while importations grow linearly. In other words, we’re much more likely to get an infection from a fellow resident than a traveler.”
2. The policy doesn’t start until next week in order for airlines to prepare, which likely won’t help if transmission is already out of control in China.
3. To test pre-departure within 48 hours of travel is problematic. Studies have shown that this will reduce transmission by only 10%.Figure: The post-arrival transmission for pre-arrival testing. Wells et al., 2022. Int J Public Health. Source here.
4. Finally, buying time is only useful if we actually did something to prepare.

Using back of the napkin math, this policy would prevent ~10,000 infections in the U.S. If a variant of concern did pop up and was 100% immune invasive and every passenger had it (unlikely scenario), we would delay a wave by one week.

In any health crisis, policy decisions are challenging.

Risks (ethics, lack of effectiveness, potential other harms, like xenophobia) must be weighed with benefits (low cost, possibility of delay). Then politics get involved.

Epidemiologically this policy isn’t adding up for me.

Find variants of concern. The second goal is to find potential variants of concern.

Given zero data is being released by China, enhanced surveillance of PCR cases with a travel history to China is worthwhile.

The U.S. will not have access to pre-departure testing results in China, but we can do it once people arrive.

The CDC already has a great program in place (see figure below), but because of the China situation, it expanded to 2 more airports. While this program is proactive, it’s not that big: 10% of passengers at 7 airports. We should expand our capacity even more.

It would be more advantageous to sequence airplane wastewater.

A homegrown problem: XBB.1.5

Regardless of the China situation, current variants in the U.S. are likely more problematic. At least in the short-term.

Specifically, we have a new subvariant on the horizon: XBB.1.5. This is an offshoot of BA.2, which is different from the subvariant currently circulating (BQ.1.1— an offshoot of BA.5).

Both lab and epidemiological data show XBB.5.1 may be cause for concern:

• In the “real world,” and particularly in New York, cases are exponentially increasing.
• Currently XBB.1.5 has a 120% weekly growth advantage, which equates to, on average, 1 infected person infecting 2 others.
• This rate is higher than we’ve seen with any other subvariant this year given our immunity wall.Source: Graph from JWeiland, Analysis from Trevor BedfordSo, as expected, we see a clear uptick in Northeast wastewater.
• This is unwelcome given that admissions for people over age 70, for example, are the third highest since the pandemic began. This doesn’t reflect the new variant or impact of holidays, yet, either.

• In the lab, XBB.1.5 is presenting a more confusing picture.
• It has a similar ability to escape our immunity as other subvariants. Because of this, we wouldn’t think it would cause a massive wave compared to what is circulating right now.
• XBB.1.5 does have higher ACE2 binding affinity—it allows it to latch onto our cells better; it’s more sticky—but that wouldn’t necessarily cause it to be more transmissible.
• So something else may be going on—another part of the virus may have changed that influences transmission. We need to look into this more.

Bottom line

We should be very concerned for the people of China. And it is possible that a variant of concern will arise from their disaster. But the U.S. already has a problem of its own.

I was hoping for a quieter 2023. There may still be a chance, but these are not welcome developments going into the New Year.

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WPCNR SUPREME COURT SURVEILLANCE. From the New York Immigration Coalition. December 27, 2022 updated December 28, 2022;

Today, the Supreme Court of the United States ruled that the Biden administration cannot end the implementation of Title 42. Title 42 was originally slated to end on December 21, before Chief Justice John Roberts granted an appeal to pause the termination on December 19.

The New York Immigration Coalition denounced this decision from the Supreme Court, which they say will continue to jeopardize the safety of asylum seekers, and demanded that President Biden secure additional protections for new arrivals.

Murad Awawdeh, Executive Director, New York Immigration Coalition:

“The Supreme Court’s decision today to prohibit the termination of Title 42 is a devastating failure of justice for the thousands of people and families who have been continually subjected to violence and cruelty because of this policy. For years, Title 42 has proven to be a horrifying distortion of American values, existing as a front for xenophobia and racism.

As Title 42 continues to be shuttled through the courts, it has resulted in untold pain and lives lost for those who are simply seeking freedom and safety in the United States.

This is morally and ethically unacceptable, and the Supreme Court should be ashamed that they continue to sustain such an unsparing policy. We urge the Biden administration to take meaningful action and secure additional protections for asylum seekers, such that a humane and fair asylum system can finally be achieved for all.”

In its order, the high court said it would hear arguments in the case in February. 

Supreme Court Judge Neil Gorsuch wrote in his dissenting opinion (Justices Sonia Santomayor, Elena Kagan, and Ketanji Brown Jackson also dissented) to end Title 42,

“The current border crisis is not a Covid crisis. And courts should not be in the business of perpetuating administrative edicts (Title 42) designed for one emergency only because elected officials have failed to address a different emergency (migrants massing at the border) We are a court of law, not policymakers of last resort.”

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Eighteen minute news conference from the Governor, Mayor of Buffalo, County Executive Everybody pitching in for everyone else. Click RED highlighted white > arrow to view.

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AS ON SATURDAY EVENING, GOVERNOR HOCHUL DEPLOYED NATIONAL GUARD AND ADDITIONAL STATE AGENCY RESOURCES TO AREAS IMPACTED BY HISTORIC WINTER STORM 

Statewide State of Emergency Remains in Effect as Historic Winter Storm Continues to Heavily Impact Western New York and Beyond 

National Guard Soldiers Deployed to Western New York to Assist New Yorkers Unable to Travel for Emergencies; State Agencies Surging Additional Assets to Western New York, Including Plow Trucks, Dump Trucks, UTVs and 4×4 Vehicles 

NYS Thruway (I-90) Remains Closed to All Traffic between Exit 46 (Rochester, I-390) and the Pennsylvania Border; Canadian Border Crossings at Peace Bridge, Lewiston-Queenston Bridge and Rainbow Bridge All Remain Closed 

Numerous State Highways and Interstates in Erie and Genesee Counties Closed Due to Blizzard Conditions; Several Counties in Western New York, Finger Lakes Region and the North Country Under States of Emergency with Local Travel Bans 

Less than 60,000 Power Outages Across the State as of Saturday Afternoon, 35,000 Outages Remain in Western New York Region 

Governor Kathy Hochul LAST NIGHT announced deployments of additional personnel and assets to areas in Western New York impacted by a historic blizzard causing impossible travel conditions in the Buffalo area and beyond. Governor Hochul declared a statewide State of Emergency ahead of the event, on Thursday.

Friday evening, Governor Hochul deployed more than 50 soldiers from the New York National Guard to assist New Yorkers facing emergencies and unable to travel. The Governor surged additional assets and personnel from numerous state agencies involved in the emergency response to assist these efforts and remove stranded motorists from their vehicles.

As temperatures remain well below freezing across the state today, with the threat of flash freezing and icy road conditions, Governor Hochul urged New Yorkers in heavily impacted regions to stay home and to take measures to safely stay warm. 

“New Yorkers are used to winter storms, but this one packed a punch and caused complete whiteout conditions in Western New York however, additional help is on the way,” Governor Hochul said. “Our state agency personnel and local emergency responders have been coordinating throughout the storm and we thank them for being away from their families this holiday weekend as they work to keep our communities safe. Please stay home if you are in areas experiencing blizzard like conditions and know that roads will be icy across the state as we continue to experience freezing temperatures in the teens and single digits.” 

The North County, Finger Lakes and Central New York regions all experienced peak wind gusts of more than 60 miles per hour during the event. In Western New York, peak wind gusts reached 79 miles per hour. The Buffalo and Watertown areas are expected to see snow totals of 3-5 feet by Monday, as a result of the storm. 

Across the state, temperatures remain below 20 degrees and several regions are experiencing single digit temperatures and subzero windchills. This creates the risk for flash freezing and icy road conditions that will continue to impact statewide travel. 

Snow and strong winds of more than 60 miles per hour will continue in Western New York and the North Country, creating blizzard-like conditions and zero visibility. Lakeshore flooding is expected to continue in areas off of Lake Erie and Lake Ontario. 

Blizzard Warnings, Lake Effect Snow Warnings, Lakeshore Flood Warnings, Wind Chill Warnings, and Winter Storm Warnings are currently in effect for various counties across the state. For a complete list of weather watches, warnings, and advisories across New York, visit the National Weather Service website. 

New York State Division of Homeland Security and Emergency Services Commissioner Jackie Bray said, “Remain vigilant today as temperatures continue to stay well below freezing across the state. Take all necessary precautions if leaving home, check your local forecast and pay close attention to travel restrictions from local officials. Utility crews are working across the state to restore widespread power outages throughout the weekend. State agencies are also sending additional help to areas most in need. No matter where you live it will be dangerously cold, so check on your neighbors and loved ones this weekend.” 

Agency Operations 

Division of Homeland Security and Emergency Services 

The State’s Emergency Operations Center and the Fire Operations Center are fully staffed and actively monitoring weather reports and incidents across the state to facilitate the State’s response to the storm. 

The Office of Emergency Management and The Office of Fire Prevention and Control have deployed personnel and equipment (UTVs) to remove stranded New Yorkers from vehicles in Western New York, along with resources to support warming shelters. DHSES is prepared to respond to additional requests for assistance from local governments across the state. 

Across the State’s Ten Stockpiles, DHSES has the following deployable items to support storm-related needs: 

• 1,487 generators 
• 985 pumps 
• 528 chainsaws 
• 250 light towers 
• Cots, pillows, blankets, water, and MREs

Division of Military and Naval Affairs

The New York State Division of Military and Naval Affairs is providing 53 soldiers from the New York National Guard to Western New York to assist New Yorkers with emergency medical appointments and search and rescue operations. These personnel and assets are all expected to arrive Saturday by 2pm.

The personnel and assets from this deployment include:

• 18 general purpose soldiers with 5 humvees 
• 14 military police with 2 humvees and 2 LMTVs 
• 21 engineers with a 2.5 yard loader, 3 skid steers, and 3 dump trucks

Department of Public Service

New York’s utilities have approximately 7,700 workers available statewide to engage in damage assessment, wire guarding, response, repair, and restoration efforts. External resources secured previously by New York’s Utilities are being released and directly to National Grid and Avangrid to assist with their restoration efforts National Grid has restored more than 86,000 customers, since the onset of the weather event, impacted by the various weather situations. They currently have 2,731 Line, Tree and Service FTEs engaged in response, repair and restoration throughout their service territory. The additional 270 Line FTEs, released from Con Edison will also be prepared to begin work this morning. 

NYSEG/RG&E have restored more than 130,000 customers, impacted by the various weather situations, since the onset of the statewide weather event.  They currently have 2,141 Line, Tree and Service FTEs engaged in response, repair and restoration throughout their service territory.  The additional 270 Line FTEs, released from Con Edison will also be prepared to begin work this morning.

Department of Transportation

The State Department of Transportation is monitoring weather conditions and is responding with 3,450 supervisors and operators. Additionally, 75 ICS personnel are available to support the response to this event. All affected residency locations will be staffed for 24/7 operation throughout the duration of the event. Staff can be configured into any type of response crew that is needed such as snow and ice, flood, chipper, load and haul, cut and toss, traffic signal, etc. All available equipment is fully engaged or ready to deploy.

A driving ban has been issued in Erie County and the City of Buffalo; and the following roads in Erie County are closed to all traffic until conditions improve:

• State Route 400
• State Route 219 
• I-290 
• I-190
• State Route 5 (Big Tree Road to I-190)

Additionally, the Peace Bridge, Lewiston-Queenston Bridge and Rainbow Bridge border crossings are all closed.

A restriction for trucks “Trucks Use Right Lane” on Interstate 81 from Exit 32 (Central Square) to Exit 51 (Alex Bay) starting at noon Friday. Additionally, several roads in the Hudson Valley are closed to do flooding or downed trees. NYSDOT crews are fully engaged in debris removal, assessing the situation and will re-open the roads as soon as conditions permit.

Regional crews continue to engage in all-hazards preparations. Drainage structures are being checked and cleared of debris.  To support response activities in critical areas, a total of 71 staff, including 65 plow truck operators, 4 supervisors, 1 assistant manager, 1 ICS support specialist, 13 plow trucks, 2 snow blowers, and 1 grader are being deployed to Western New York and the North Country. They are distributed as follows:

Western New York

• 3 plow trucks from Central New York 
• 2 plow trucks, 2 snow blowers, and 1 grader from the Finger Lakes 
• 4 operators and 2 plow trucks the Western Southern Tier 
• 26 operators, 2 supervisors, and 1 assistant manager from the Mid-Hudson Region 
• 10 operators, 1 supervisor, and 3 plow trucks from the Southern Tier 
• 19 operators and 1 supervisor from Long Island 
• 1 ICS specialist from the Capital District

North Country 

• 2 operators and 1 plow truck from the Capital District 
• 2 operators and 1 plow truck from the Mohawk Valley 
• 2 operators and 1 plow truck from Central NY

The need for additional resources (Operators, Trucks, Mechanics, EOI’s) will be re-evaluated as conditions warrant throughout the event. Generator stockpiles are being readied for deployment to support dark signal response. Fleet mechanics in affected areas will be staffing all main residency locations 24/7 to perform repairs and keep trucks on the road.  Statewide equipment numbers are as follows: 

• 1740 large and medium duty plow trucks
• 52 tow plows 
• 37 snow blowers 
• 338 loaders 
• 13 tree crew bucket trucks 
• 78 chippers 
• 32 traffic signal trucks 
• 20 graders 
• 73 excavators 

For up-to-date travel information, call 511, visit 511NY.org or download the free 511NY mobile app.

Thruway Authority  

Thruway Authority maintenance facilities are staffed around the clock and responding to the storm with 678 operators and supervisors statewide. Thruway has shifted and deployed additional staff and equipment from its New York and Albany Divisions to support snow and ice operations in Western New York. Deployed resources include large plow trucks and operators. Additional resources are on standby and ready to shift as needed.

ALL VEHICLES are banned on the New York State Thruway (I-90) from exit 46 (Rochester I-390) to the Pennsylvania border, and on the Niagara Thruway (I-190) from I-90 to exit 22 (Route 62) until further notice.

Thruway statewide equipment numbers and resources include:

• 364 large and medium duty plow trucks 
• 10 tow plows 
• 66 loaders 
• More than 123,000 tons of salt on hand 

Variable Message Signs and social media are utilized to alert motorists of winter weather conditions on the Thruway. Follow the Thruway Authority on Twitter: @NYSThruway & @ThruwayTraffic and on Facebook: NYS Thruway Authority.

The Thruway Authority encourages motorists to download its mobile app which is available for free on iPhone and Android devices. The app provides motorists direct access to real-time traffic information, live traffic cameras, and navigation assistance while on the go. Motorists can also sign up for TRANSalert e-mails which provide the latest traffic conditions along the Thruway.

New York State Police

State Police have deployed extra personnel and assets in the areas being most affected by the storm. Troopers are working with partner agencies in the extreme conditions to reach approximately 10 vehicles stranded on the NYS Thruway between Exits 49 and 52, but efforts are being hampered by whiteout conditions with zero visibility. So far, at least 45 people have been rescued from their vehicles. Troopers are also attempting to reach more than a dozen stranded motorists on I-81 and other secondary roads in Jefferson County. So far, State Police has responded to approximately 700 storm-related crashed statewide.

Office of Parks, Recreation and Historic Preservation

New York State Park Police and park personnel are on alert and closely monitoring weather conditions and impacts. Park Police have four Motorist Support Teams (MSTs) using UTVs and 4-wheel drive trucks available for deployment to assist stranded drivers. Parks Operations staff have three Motorist Support Teams available for deployment. Two sawyer crews are on standby to assist with clearing downed trees and branches from roadways. Park visitors should check parks.ny.gov or call their local park office for the latest updates regarding park hours, openings, and closings.

Department of Environmental Conservation

DEC Environmental Conservation Police Officers, Forest Rangers, Emergency Management staff and regional staff are on alert and monitoring the developing situation and actively patrolling areas and infrastructure impacted by severe weather. DEC is coordinating resource deployment with agency partners and all available assets, including sawyers, are positioned to assist with any emergency response.  

DEC is advising backcountry users to be aware of and prepared for winter conditions, including high winds and extreme cold temperatures. Conditions are expected to be even more severe at high elevations. Winter hiking and skiing safety and preparedness are extremely important no matter your physical ability or destination. Properly preparing for winter conditions is essential for a more enjoyable and safer experience. During and immediately following periods of heavy snowfall, avoid open, exposed areas like bare summits and use extreme caution when traveling on or near open slopes. Additional information is available at https://www.dec.ny.gov/outdoor/112826.html  

DEC reminds those responsible for the large-scale removal and disposal of snow to follow best management practices to help prevent flooding and reduce the potential for pollutants like salt, sand, oils, trash and other debris in snow from affecting water quality. Disposal of snow in local creeks and streams can create ice dams which may cause flooding in nearby areas. Public and private snow removal operators should be aware of these safety issues during and after the storm. Additional information is available at https://www.dec.ny.gov/docs/water_pdf/togs5111new.pdf

Port Authority of New York and New Jersey

The Port Authority is monitoring weather conditions. Speed restrictions may be in effect at the bridges, as well as along roadways to and from the crossings. Passengers through the Port Authority’s facilities are encouraged to reach out to carriers and airlines directly for the latest information on delays and cancelations. For the latest information about Port Authority facilities, please check social media, sign up for PA alerts or download one of the PA mobile apps, including RidePATH which provides real-time updates and alerts for PATH service.   

Metropolitan Transportation Authority

Metropolitan Transportation Authority is closely monitoring weather conditions to ensure safe, reliable service. MTA employees will be poised to respond to any weather-related issues and remove any downed trees that may fall across tracks.

MTA Bridges and Tunnels banned empty tractor-trailers and tandem trucks through 8:00 p.m. Friday. Pedestrian walkways at the Cross Bay Bridge and Marine Parkway Bridge will be closed during this same time period; pedestrian walkways at the RFK Bridge and Henry Hudson Bridge may close depending on weather conditions.

Customers are encouraged to check new.mta.info for the latest service updates, and to use caution while navigating the system. Customers should also sign up for real-time service alerts via text or email. These alerts are also available via the MTA’s apps: MYmta and TrainTime.

Safety Tips

Winter Travel Safety

The leading cause of death and injuries during winter storms is transportation accidents. Before getting behind the wheel, review these safety tips: 

• When winter storms strike, do not drive unless necessary. 
• Make sure that your vehicle is clear of ice and snow; good vision is key to good driving. 
• Always match your speed to the road and weather conditions. Plan your stops and keep more distance between cars. 
• Be extra alert and remember that snowdrifts can hide smaller children. 
• Make sure your car is stocked with survival gear like blankets, a shovel, flashlight and extra batteries, extra warm clothing, set of tire chains, battery booster cables, quick energy foods and brightly colored cloth to use as a distress flag. 
• If you have a cell phone or other communications device such as a two-way radio available for your use, keep the battery charged and keep it with you whenever traveling. 

Extreme Temps 

• Be aware of wind chill – wind in combination with the actual temperature – that can cause an increase of heat loss to the human body. 
• Dress appropriately and avoid staying in the cold too long. 
• Wear a hat and gloves when appropriate with layers of clothing. Avoid unnecessary exposure of any part of the body to the cold. 
• Drink plenty of warm fluids or warm water but avoid caffeine and alcohol. Stay active to maintain body heat. 
• Take frequent breaks from the cold. 
• If signals of hypothermia or frostbite appear, get out of the cold, slowly warm the individual and seek medical assistance: 

• Frostbite: Symptoms include loss of feeling, a white or pale appearance in fingers, toes, ears, and nose. 
• Hypothermia: Symptoms include uncontrollable shivering, slow speech, memory lapses, frequent stumbling, and drowsiness. 

Heavy Exertion 

Heavy exertion, such as shoveling snow, clearing debris or pushing a car, increase the risk of a heart attack. Follow these tips to stay safe after the storm: 

• Stay warm, dress warm and SLOW DOWN when working outdoors. 
• Take frequent rests to avoid over-exertion 
• If you feel chest pain, shortness of breath, or pain in your jaw radiating down your arm — STOP and seek help immediately. 

Power Outages 

Winter storms can cause power outages. Review these safety tips before the lights go out so you know what to do in an emergency: 

• Call your utility provider to notify them of the outage. 
• Avoid all downed power lines and report them to your utility provider for repair; assume all downed lines have live electricity. 
• Use only flashlights for emergency lighting – candles pose the risk of fire. 
• Keep your refrigerator and freezer doors shut to keep food from spoiling.  When in doubt, throw it out! 
• Do not use a charcoal grill or generator indoors and do not use a gas stove for heat-they could give off harmful levels of carbon monoxide. 
• Turn off major appliances to prevent damage from a possible surge when the power comes back on-keep one light turned on so you know when power returns. 

Home Heating 

Heating equipment is one of the leading causes of home fire deaths. Keep loved ones safe by following these important steps: 

• Keep all combustibles at least three feet away from heating equipment. 
• Always plug appliances including space heaters directly into a receptacle. Never plug appliances into a power strip or extension cord. 
• Make sure there is a working smoke alarm in each bedroom, outside sleeping areas and on every level of your home. 

For all non-emergency service needs before, during or after a storm, call 211 or visit 211nys.org. 

For more safety tips, visit the New York State Division of Homeland Security and Emergency Services Safety Tips web page at www.dhses.ny.gov/safety.