What public health experts expect for COVID-19 in California this winter

Two California public health experts said a surge of COVID-19 could be coming soon and pleaded with all Californians to get vaccinated, including older adults and young children under 5.

At a virtual town hall hosted by state Senator Nancy Skinner on Tuesday night, UC San Francisco Department of Medicine Chair Dr. Robert Wachter and California State Epidemiologist Dr. Erica Pan addressed the current moment in the pandemic and what might be coming up in California.

During the panel, Wachter and Pan discussed the high probability of a COVID surge, the worrying unknowns of long COVID and low vaccination and booster rates among people who can get extremely sick. 

A winter surge is possible

Both Wachter and Pan seemed confident that an upcoming surge of COVID-19 is likely. How big of a surge? Neither expert hazarded a guess.

“Winter will drive people inside," said Wachter. “There are these new variants that are coming out that are at least somewhat immune evasive.”

Wachter added the new variants aren’t “massively scary” but seem to be taking over from the BA.5 variant. And he said the virus may proliferate more, because “back-pressure” against rising case rates is mostly gone. 

“Unfortunately, in the old days, if you started to see a surge, people immediately started being more careful and putting masks on,” Wachter said. “I'm not confident that will happen, at least to the same degree that it used to happen.”

Pan also nodded to the relative severity of other respiratory infections, including the flu, in other parts of the country. Although we haven’t seen high numbers in California, respiratory syncytial virus (RSV) which seriously affects infants and young children, is also surging in the U.S. 

Long COVID is still a big concern

Both Pan and Wachter cited the lasting effects brought on by long COVID, many still largely unknown, as their chief concern if they were to become infected again. According to a survey conducted by the Census and CDC conducted this summer, as many as 1 in 5 infections in adults result in symptoms of long COVID, which are symptoms lasting three or more months after first contracting the virus.

“We're still learning about long COVID. And to me, personally even, and for my own family, that is still what concerns me the most,” Pan said. 

Pan noted that while there are some predictors about who will get lasting symptoms of COVID, there have been many people, including children, who had mild cases but experienced long COVID symptoms.

One fallacy Wachter sought to correct is the perception that people cannot get long COVID if they didn’t get it the first time they were infected. You can, he said, and if you did get long COVID the first time, you can get an even worse case. 

“There is always a reason to try to avoid getting [COVID], even if you've had it multiple times before,” he said. 

Boosters are key, especially for older and younger Californians

Both experts noted the relative sluggishness of vaccine uptake in California. According to the state dashboard, only 11.4% of Californians over 5 years old have received the new bivalent booster, which targets both the original strain of the virus that causes COVID, and more recent subvariants. 

Although the state’s rate of uptake is higher than the rest of the country, which is at 7.3%, Wachter said it’s still too low. 

“Particularly if you're at someone at higher risk over, let's say 50, or have other medical illnesses and you have only gotten two vaccine shots a year ago, you are markedly under protected,” he said. 

Wachter also pointed to misinformation as a cause for vaccine hesitancy. 

“There will be thousands of deaths because elderly people have, for whatever reason, chosen not to stay up to date on their boosters, in part because of misinformation,” he said. 

On the flip side, Pan said it’s important to get more children under the age of 5 vaccinated. Although the bivalent booster is not yet authorized for them, Pan says there has been low uptake in the COVID vaccine all together, which is important to prevent severe illness. 

“It's these sort of extremes of age that are at risk for more serious illness,” she said. “I want to emphasize to all the parents out there or grandparents, encourage your families to get your kids vaccinated. I'm speaking as a mom, as a pediatric infectious disease doctor and a public health official.”

As of Oct. 27, less than 6% of children under 5 years old had received their primary doses of vaccine.