Yes, the first official day of spring is today, Sunday, March 20. To be more precise it occurs at 11:33 AM EDT. (Note, after reading last Sunday's Washington Post comics section, I realized I erroneously referred to EDT as Daylight Savings Time, rather than Daylight Saving Time, in last week's posting.) While we await further results for COVID-19 vaccine trials in younger children as well as possible EUAs for 4th doses of vaccine for adults, let's see what else spring has to offer.
COVID-19 Hospitalization Rates in 0 - 4 yo Children
CDC released new data on March 15 confirming what everyone working in a children's hospital already knew: the omicron surge was bad news for young children, even though overall the variant did not appear to be more virulent than its predecessors. Hospitalization rates were higher in young children than at any time during the pandemic. One picture says it all.
Meanwhile, I remain focused on Europe as a possible harbinger of things to come for the US. Certainly as COVID-19 restrictions relax across the world we can expect an uptick in cases, but the real question I have is whether the uptick now in Europe is simply that or represents another surge due to the BA.2 subvariant. I am closely following my daily reports from uk.gov and have noticed a drifting up of the weekly reproductive number. At the last update a few days ago, the R value is estimated at 1.1-1.4. As explained in their helpful report, " An R value of 1 means that on average every person who is infected will infect 1 other person, meaning the total number of infections is stable. If R is 2, on average, each infected person infects 2 more people. If R is 0.5 then on average for each 2 infected people, there will be only 1 new infection. If R is greater than 1 the epidemic is growing, if R is less than 1 the epidemic is shrinking. The higher R is above 1, the more people 1 infected person infects and so the faster the epidemic grows." Note this week's number really represents transmission that happened 2-3 weeks ago, it takes time for reporting and tracking to be reflected in R values. In my opinion, this currently reported R rate is consistent with just relaxing of restrictions, but if it goes much higher it probably means we're headed for a more significant surge that might call for going back to masking and other nonpharmaceutical interventions.
Remember Tickborne Diseases?
Yes, it's hard to think about anything but COVID sometimes, but spring also brings us into tick season. (Note that climate change increasingly allows for tick survival throughout the year, but there will be more of them around now, for the next several months.) In the DC area of course we need to continue to be on the watch for Lyme disease; providers should make use of excellent guidelines for management.
Recently another tickborne disease appeared in the news as Heartland virus, aka HRTV, was detected in lone star ticks (Amblyomma americanum) in Georgia. HRTV is still rare, only about 40 cases reported in the US since first described in 2009, but it is serious. Clinically it is a hemorrhagic fever with thrombocytopenia syndrome with a high fatality rate, though the rate is probably falsely elevated a little bit because milder cases would not have resulted in detailed investigation for causes.
While we are on the subject, keep in mind Bourbon virus, named for the county in Kansas where it was first discovered in 2014. It isn't as severe as HRTV and has not been reported in the DC area.
Remember to advise your patients and their families about prevention and management of tick bites. However, don't let this keep anyone from enjoying the outdoors!