California faces triple threat of respiratory illnesses

Forget “twindemic” — California may be in for a three-headed Cerberus of respiratory illnesses this winter as the flu, respiratory syncytial virus and COVID-19 collide.

Orange County on Monday declared a local public health emergency over RSV, a common cause of pneumonia in babies that’s contributed to a record number of pediatric hospitalizations and daily emergency room visits in the county.

• Early phases of RSV can present flu-like symptoms, and young children and seniors are most at risk of complications, according to the U.S. Centers for Disease Control and Prevention. 

San Diego health officials warned last week that “a sharp increase of flu and RSV cases” could have “a severe impact on people’s lives and the county’s medical resources this fall and winter.” At one point in October, about 1,000 of 2,600 students at a local high school were absent due to an outbreak of respiratory illnesses.

CalMatters health reporter Ana B. Ibarra takes a closer look at where California stands on the RSV, flu and COVID fronts:

1. RSV: The state’s surveillance shows that 15.3% of specimens tested in the third week of October came back positive for RSV, up from 9.8% during the same period last year.

• Providers say the uptick could be due to the fact that children were less exposed to the normal circulation of respiratory viruses over the last two years due to such pandemic restrictions as school closures and mask mandates.
• Dr. John Mourani, medical director of infectious disease at Pomona Valley Hospital Medical Center: “School got disrupted, we were social distancing and that means immunity goes down.”

2. Flu: Influenza surveillance data reported by the state starting the first week of October shows flu cases trending up earlier compared to the last five years. More flu earlier in the year usually means a more severe season. 

In the third week of October, 6.6% of flu tests came back positive. That’s a higher rate than the state recorded during the same week of the 2017-18 flu season, which peaked in late December with a 41% positivity rate.

During that flu season, some hospitals were so overwhelmed they had to treat patients in tents and hire temporary staff from out of state. About 61,000 people died from the flu nationwide, according to the CDC. The California Department of Public Health tallied 329 deaths, though that’s likely a severe undercount because providers were only required to report deaths for people under 65 and most flu-related deaths are among seniors.

So far this season, five residents have died of the flu, according to the state’s latest surveillance report published Friday. 

3. COVID: If the last two years are any indication, COVID infections tend to creep up soon after Halloween. 

Health experts said that while they certainly expect an uptick in COVID cases this winter, it’s less clear what hospital admissions will look like. 

• Dr. Jess Mandel, a pulmonologist at UC San Diego Health: “I think we’re in a much better position for COVID than we have been in years past. In terms of having more effective therapies, more access to vaccines and more exposure in the community from prior infections.”
• Still, Mandel recommends that people be cautious and protective of high-risk individuals.  

California, anticipating a possible winter wave of infections and hospitalizations, plans to wait until Feb. 28, 2023 to end its COVID state of emergency. Hospitals, which have relied on provisions of the emergency order to better accommodate patients during surges, are warning that even this end date may be too soon because the flu can also affect capacity and flu season typically runs through May. 

The best thing people can do to keep their local hospitals from maxing out is to get immunized against the flu and get an updated COVID booster shot, Mourani and Mandel said. There is no vaccine for RSV.

So far, only about 11% of eligible Californians have received the recommended bivalent COVID booster meant to provide better protection against the omicron variant.

Time to vote: Find out everything you need to know about voting before California’s election ends Nov. 8 with the CalMatters Voter Guide, which includes information on races, candidates and propositions, as well as videos, interactives and campaign finance data.

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1 Roundup of California health news

Let’s dive into another trifecta of California health news nuggets:

• Tuesday marked the start of open enrollment for Covered California, the state’s health care insurance marketplace. Among those attending the launch ceremony in Los Angeles: U.S. Health and Human Services Secretary (and former California attorney general) Xavier Becerra; Dr. Mark Ghaly, California’s top health official; Los Angeles Mayor Eric Garcetti; and U.S. Rep. Karen Bass, who’s running against billionaire businessman Rick Caruso to replace Garcetti as mayor. “This is not a political event but there is an election out there, be sure to vote,” Garcetti said when introducing Bass. “People who have medical knowledge, I think, probably can be great leaders, I’ll just throw that out there too.” (Bass is a former physician’s assistant.) Although Covered California rates are set to increase by an average of 6% next year, extended federal subsidies will help offset some of that, officials said. Around 1.7 million residents are currently enrolled in Covered California, and officials estimate 1 million uninsured people are eligible for coverage either through the state marketplace or Medi-Cal, the state’s health care program for the poor.
• Sexual assault survivors can now track the status of their rape kits using a new online portal unveiled Tuesday by Attorney General Rob Bonta. The Golden State also announced its first sexual assault evidence outreach coordinator, Dr. Sarai Crain, who Bonta said will work with medical facilities, law enforcement and other organizations to remove barriers to testing, track and process sexual assault evidence and help clear rape kit backlogs. “After they have already been sexually assaulted — and after they have bravely endured a long and invasive rape kit exam — it is crucial that we enable survivors to track the status of their rape kit securely whenever they wish,” said Democratic state Sen. Connie Leyva of Chino, who authored the bill requiring the establishment of the portal.
• San Francisco’s monkeypox (MPX) state of emergency ended Monday, about three months after it was first declared. The rollback was the result of “effective public health” measures such as “strong outreach and education, partnership between public health officials and the community, and a community stepping up to protect itself,” Democratic state Sen. Scott Wiener of San Francisco said in a statement. He added, “We need to remain vigilant, however, and continue the work. Though case rates have lowered significantly, the virus is still with us and still poses risk.” Statewide, California has reported 5,450 MPX cases and 224 hospitalizations, with cases falling precipitously in recent months.

2 How state laws are impacting youngest, oldest students

How are education policies crafted in Sacramento shaping up on the ground for the state’s youngest and oldest students? Two CalMatters stories dig deeper:

• This school year, more districts began offering transitional kindergarten as part of California’s multibillion-dollar, multi-year effort to expand it to all 4-year-olds. The biggest challenge thus far: staffing, CalMatters’ Elizabeth Aguilera reports. Although some districts managed to meet most of their needs this year by shifting existing teachers’ roles, many are worried about finding qualified educators for the next few years of the expansion. The scramble for instructors has also strained California’s already understaffed child care programs and preschools, whose teachers are ideal candidates for higher-paying roles in transitional kindergarten classrooms. “All of the districts are hiring. We are competing for the same teachers and that is a concern,” said Noemy Salas, senior director of early childhood education programs for San Diego County’s Chula Vista Elementary School District.
• Starting next fall, California colleges will be banned from reducing financial aid to certain low-income students who also earn private scholarships, a move advocates say will help them cover such expensive non-tuition costs as housing, books, food and transportation, Alyssa Story reports for CalMatters’ College Journalism Network. The catch: The law only applies to students who qualify for a federal Pell Grant or state financial aid under the California Dream Act. And students still need to be informed the law exists so they can monitor their financial aid packages and ensure colleges are complying. The critical next step is “focusing on the implementation … figuring out if these bills, and these efforts, are actually reaching the students that they were intended to reach,” said Dixie Samaniego, a Cal State Fullerton student who said she experienced scholarship displacement.

3 A California workers’ guide to dealing with wage theft

Does it seem like the hours you worked and your paychecks aren’t adding up? Is your employer taking the tips you earned on the job? Is your boss denying you legally required meal or rest breaks? Are you wondering why your boss is paying you with personal checks, instead of using a payroll system with the usual paycheck deductions?

If you answered yes to any of those questions, your employer may be stealing your wages. As CalMatters’ California Divide team has reported in its ongoing series, “Unpaid Wages: A Waiting Game,” wage theft is common in California: Last year, more than 19,000 workers filed wage theft claims with the state totaling more than $338 million.

But what should you do if you find yourself in this situation? Speaking out about wage theft can feel intimidating and risky — so CalMatters’ Lil Kalish asked workers’ advocates and community organizers for best practices and advice and put together a California Workers’ Guide to Wage Theft, complete with a resource library of worker centers across the state. Check it out.

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