Living with — not vanquishing — the COVID-19 virus is likely to become the norm, with people getting booster shots to protect themselves much like they do an annual flu shot, Dr. Sara Cody, Santa Clara County's health officer, told members of the Palo Alto Rotary Club on Monday afternoon.
Cody, who spoke for 45 minutes during a virtual meeting, touched on multiple aspects of the ongoing pandemic, including vaccinations for children, how the virus has changed to become more infectious, which groups are currently most vulnerable to hospitalization, and the impacts of the pandemic on public health and health care systems, especially their ability to confront the next major public-health emergency.
With a current push to get booster shots in the arms of adults, Cody noted that the number of county residents who've gotten another dose has been low, but it is slowly rising. The boosters are now available to those 18 and older in the county.
Getting a booster shot after six months of the initial vaccine series (and after two months for those who got the Johnson & Johnson vaccine) is important as people's immunity starts waning, she said.
Of the county's new COVID-19 cases, the rate among those who are fully vaccinated is 6.2 per 100,000 people — low, but not zero.
It's likely that one booster shot isn't going to protect people indefinitely, either, she noted.
"If I had to guess and put money on it, I'd say (there will be) more boosters," she said, adding that people will end up living with the COVID-19 virus present in the world the same way they do influenza.
Asked if immunity among those who got COVID-19 and recovered is sufficient to ward off another recurrence, Cody said it is not, urging anyone who has had the disease to get vaccinated starting as soon as 10 days after recovery.
Cody also clarified how transmissible the virus is among children. Discussing the recent Food and Drug Administration approval of the Pfizer vaccine for children ages 5 to 11, Cody cautioned that it's a misconception to think children aren't as susceptible to getting COVID-19.
Part of the confusion for parents stems from changing viewpoints as researchers learn more about the virus.
Health officials initially thought COVID-19 would spread much like the flu, starting with children who would then pass it to adults. Later, they believed children were less likely to catch the coronavirus.
"Now it looks like kids are just as likely to get infected as adults," Cody said.
Nationwide there have been nearly 2 million cases among children. More than 8,000 children have been hospitalized, with one-third needing intensive care. At least 94 children have died.
In Santa Clara County, few children have been severely ill.
"The vast majority who required hospitalization had a chronic illness or complications that put them at risk," Cody said.
The initial infection isn't the only thing parents should consider, she said. Children can also get long COVID, a syndrome that can cause many long-term complications, including to the heart, lungs and brain. Scientists don't yet know if long COVID will affect learning or a child's future development.
Parents need to know that, in contrast to the risks of infection, shots are safe and effective. The children need a two-dose series for full protection, she added. It's also important for women who are pregnant, breastfeeding or who are trying to become pregnant to get vaccinated, she said.
The delta strain has added another level of urgency that people get vaccinated, Cody said. Delta is as transmissible as chicken pox and is more easily transmissible than other communicable viruses such as MERS, SARS, ebola, the common cold, seasonal flu and the 1918 influenza and smallpox. Delta is also many times more transmissible than the ancestral strain of SARS-CoV-2, she noted.
"Vaccines are the bedrock of protection," Cody said, and the county numbers seem to prove it.
Unvaccinated Santa Clara County residents ages 12 and older have a substantially higher case rate — nearly 5½ times higher — than fully vaccinated residents, she noted. Once the numbers are adjusted for age, Cody thinks they could be higher.
Cody said her experiences with the COVID-19 pandemic have been sobering.
A highly vocal group of people, who are in the minority, has been spreading an enormous amount of misinformation in this country, she said. They have been loud and disruptive and "just angry" over everything from testing and contact tracing to masks to vaccines. Public health officers have become the targets in unprecedented ways, she said.
"Most of my colleagues in public health have experienced a level of vitriol that I have never experienced before," she said.
For two years, protesters have demonstrated against her decisions and at times it's gotten personal. One sign depicted Cody's head decked in a colorful coronavirus headdress.
"I thought it quite attractive," she said.
The situation hasn't always left room for levity. In September 2020, the Santa Clara County Sheriff's Office arrested a man with connections to the far-right "Boogaloo" group who allegedly wrote Cody 24 threatening and profane letters.
More broadly, she said, health care and public health workforces are exhausted by this pandemic and the constant battle against hostility and disinformation. It will take resources — including financial — to rebuild a robust public health system for when the next pandemic strikes.
Cody has great concerns regarding the future should another global health crisis emerge.
"It's the decay in public trust and government that troubles me," she said. People might be less willing to listen to their leaders, she said.
As the Thanksgiving holiday approaches, Cody said people need to use good sense regarding whether to gather with family and what precautions to take. Cases are again on the rise. The county never completely got out of the summer's surge, she said.
If people do plan to gather, they should probably do a rapid at-home COVID test before getting together. If they are sick, they shouldn't attend a gathering. Unlike last season when there was a huge spike in winter cases, Cody isn't imploring people this year to stay home. With vaccines readily available and other precautions such as masking and social distancing well-publicized, Cody said it's up to individuals to assess the risk.
"It's like driving in the winter. We don't tell people not to drive in the winter," she said. But if one has an old car or would be traveling in deep snow or a blizzard, they might consider limiting their travel or not going out at all.
"You adjust your risk to the circumstances," she said.