The Fourth Wave Is Here

LIKE MUCH OF THE STATE AND NATION, San Juan County is now experiencing a fourth wave of the coronavirus pandemic, but for some reason this wave has so far been confined almost entirely to San Juan Island. Since mid-March there have been at least 35 new confirmed cases of Covid-19 in the county. Meanwhile, Orcas Island has recorded no new cases in over a month. What could be happening here?

The bulk of these cases are connected with incidents involving Friday Harbor High School boys’ athletic teams — the track and baseball teams — that occurred in late March and early April. Family members and fellow students were affected, too, such that over a hundred individuals were quarantined by April 9, including the members of both teams. And one infected person had to be hospitalized, according to San Juan County Public Health Officer Frank James, who acknowledged on April 1 that “community spread is more and more likely.”

 “Worse, one of the individuals warranted testing by sequencing for possibly being a variant infection,” he added. To evaluate whether a variant virus strain is indeed involved in a specific infection, the sequence of nucleotides in a virus RNA sample has to be determined, seeking mutations from the original B.1 or B.1.2 sequences. That sequencing can be done only at specially equipped laboratories. Because this takes time and money, only a small percentage of patient samples have been sequenced thus far. 

Since the pandemic began in January 2020, 3.4 percent of the specimens from confirmed Covid-19 cases have been sequenced, while 7.6 percent of the March cases have so far sequenced, according to a 14 April 2021 Washington state Department of Health report on variants. As predicted, the B.1.1.7 variant virus that devastated Great Britain in late 2020 began to dominate Washington samples collected in late March, and the B.1.429 variant from California was close behind. Over 70 percent of the sequenced samples collected from March 14 to March 27 revealed these two “variants of concern” — as they are categorized by the Centers for Disease Control and Prevention (CDC) because of their likely adverse health impacts.

According to scientific research in England, the B.1.1.7 variant has at least 50 percent higher transmissibility, and it seems more deadly for those over 65. Less is known about the more recent B.1.429 variant — and its sister B.1.427, which is also significant in the state — but it appears to be 20 percent more transmissible. The higher transmission rate helps explain why these variants have become dominant in Washington and many other states. In early April CDC Director Rochelle Walensky estimated that 27 percent of current US cases were due to the B.1.1.7 variant. And according to the sequencing company Helix, about 50 percent of sequenced samples have revealed this variant. These percentages have probably increased since then.

What’s worrisome — and may be relevant to the San Juan Island outbreak — is that the B.1.1.7 variant seems to affect the young preferentially. In the latest state variant report, for example, 26 percent of B.1.1.7 cases occurred among those under 20 years old — and 56 percent were under age 35. These high percentages may however reflect the facts that older people are more cautious and have also been vaccinated in much greater numbers than the young, skewing the results. 

There was also a San Juan Island case where an individual came down with Covid-19 symptoms ten days after contact with an infected person, suggesting that “the patient was highly infectious,” according to Dr. James. “Transmission late in the course of infection is very uncommon and may also represent variant disease.”

Whatever the case, and we really don’t know for sure yet, it is welcome news that Governor Inslee has just extended vaccination eligibility to all individuals over age 16. But we have to stop assuming that children and teenagers are somehow less affected by the coronavirus. That may have been true for the original strains, but it is probably not true for variants of concern, given recent evidence.

It is welcome news that Governor Inslee has just extended vaccination eligibility to all individuals over age 16.

In the Friday Harbor baseball team outbreak, for example, one family held a sleepover in early April for five team members. A knowledgeable source directly involved in this outbreak told me that one boy’s mother thought that her son “just had a bad cold” at the time. The other four boys have since tested positive.

Such an unwarranted assumption and irresponsible behavior is likely the cause of that outbreak — and part of the reason why San Juan Island has been so seriously affected while Orcas Island has not. It’s reminiscent of the woman who attended a 10 March 2020 rehearsal of the Skagit Valley Chorale in Mt. Vernon thinking that she just had a bad cold and infected over 50 choir members, two of whom died. That outbreak, one of the first “superspreader” events, gave strong early evidence for airborne transmission of the SARS-CoV-2 virus.

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SOMETHING SIMILAR SEEMS TO HAVE OCCURRED in Whatcom County in late February. There was a sudden outburst of B.1.1.7 cases (25 in all) that almost as suddenly ended, according to the state variant reports. Although the county health department was understandably guarded about what was happening, it’s clear that almost all of the specimens it sent out for sequencing came back positive for this variant. At the time, it was the second largest number of such variant cases in the state, second only to much more populous King County. Since then, there have been only five more variant cases in Whatcom County, two of them B.1.1.7. This pattern is just what one would expect from a variant outbreak that was rapidly brought under control. And there has been a surge of B.1.1.7 cases in British Columbia recently, so it’s possible that the variant crept across the border from Canada in this instance.

Statewide there have been 1811 sequenced specimens so far of the variants of concern, mostly B.1.1.7 and B.1.429, with the former about to become the dominant species as April began. King County is by far the leader with over half the cases. Yakima County comes in a distant second, while Pierce and Snohomish Counties are vying for third place. Of course, these numbers are changing rapidly. And they may partially reflect the number of specimens that individual county health officers chose to send out for sequencing. They probably do not reflect the actual distribution of variant virus cases among these counties. But the number of sequenced samples testing positive for the B.1.1.7 variant appears to be roughly doubling every 10 to 14 days.

In the broader picture, confirmed cases statewide are surging again, back up over 1,300 new cases per day, according to the Johns Hopkins University Covid-19 web site. The number had dipped briefly below 1,000 per day in March. According to the New York Times coronavirus tracker (which puts San Juan County at a “very high risk” level), new Washington cases are up 38 percent and hospitalizations up 33 percent in the last 14 days. And the statewide positivity rating (the ratio of positive Covid-19 tests to total tests) has risen to 5.4 percent, averaged over a 28-day interval. (Over the last week, which can reflect incomplete data, the positivity is 6.4 percent.) In March the rating had dipped to 3.5 percent as we emerged from the daunting winter wave. Higher percentages indicate that community spread of the virus is likely occurring.

There can be little doubt that the state and county are now experiencing a fourth wave of the coronavirus pandemic, likely dominated by variant viruses.

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“UNFORTUNATELY, THE NEW CORONAVIRUS VARIANTS — such as the B.1.1.7 variant that has been devastating Europe and is now growing rapidly in the United States — are going to change everything,” warned University of Minnesota public-health expert Michael T. Osterholm in his March 5 Orcas Currents article, “Another Battle of the Bulge?” Although often criticized for his darkly pessimistic predictions, he has been proven right on this score.

Confirmed Covid-19 cases nationally are once again exceeding 70,000 per day after having fallen briefly below an average 60,000, and hospitalizations are rising again, too. States in the Northeast and Midwest — for example, New Jersey and Michigan — are being particularly hard hit. In Michigan, cases have exploded from about 1,500 in early March to over 7,500 in mid-April, with the surge likely due to the variants, and its positivity rating is almost 15 percent. Hospital ICU facilities are nearing capacity, with over 80 percent of them now occupied.

Fortunately, coronavirus vaccines are rushing to the rescue and will probably blunt this fourth wave. Along with the Pfizer vaccine, the Moderna vaccine being used in San Juan County appears to be equally effective against the B.1.1.7 variant — and most likely against the B.1.429 variant, too, although scientific evidence about this strain is limited. “The vaccines we are using protect very well against the most dominant variant we have right now [i.e., B.1.1.7], and to varying degrees against serious disease among several other variants,” said Dr. Anthony Fauci on April 14.

Fortunately, coronavirus vaccines are rushing to the rescue and will probably blunt this fourth wave.

But that doesn’t mean we can let down our collective guard just yet. More than 35 percent of San Juan County residents have already been fully vaccinated, one of the best records in Washington, but that still leaves most people vulnerable, especially those under 65. And it’s not yet clear whether or not vaccinated people can still be carrying (or spreading) the virus — only that they are better than 90 percent safe from serious Covid-19 disease.

For many, it’s deeply frustrating that, after more than a year of caution and keeping to ourselves and within our social bubbles, we have to continue doing so a little longer. But that is what it will likely take to keep this fourth coronavirus wave from bursting out of control in the county, state and nation. We should learn from the San Juan Island outbreak that the young are not invulnerable to this dreaded disease. And we should also continue to avoid large gatherings in confined spaces, especially with someone who has a cough or “bad cold.” Once we attain the much-heralded herd immunity in the county and state, we can finally relax our guard locally and return to what must inevitably be a new normal.

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TOP FIGURE: Number of coronavirus specimens sequenced by county during the past 60 days. (Source: Washington State Department of Health)

References

Sharon Kivisto, “10 Cases, 56 Quarantined, and a Possible Variant,” San Juan Islander (2 April 2021).

Washington State Department of Health, “SARS-CoV-2 Sequencing and Variants in Washington State,” 14 April 2021 (updated weekly).

Lenny Bernstein, et al., “Rise of Coronavirus Variants Will Define the Next Phase of the Pandemic in the U.S.,” Washington Post (8 April 2021).

Michael Riordan, “A Variant Virus Outbreak in Whatcom County?” Northwest Citizen (12 March 2021, updated 19 March 2021).

Michael T. Osterholm, “Another Battle of the Bulge?” Orcas Currents (5 March 2021).