Another winter surge as COVID cases spike, schools fight to stay open ,and health care workers face exhaustion. But Omicron could end the pandemic
by Mark McDermott
Only months ago normalcy appeared to have arrived. The summer surge had passed. Vaccination rates soared. COVID-19 cases in each of the Beach Cities slowed to a trickle. Schools fully reopened, public meetings resumed in person, and large gatherings once again took place over the holiday season. The pandemic had receded.
And then Omicron arrived. In late November, reports of a new, highly contagious variant emerged out of South Africa. The World Health Organization on November 26 classified Omicron as “a variant of concern.” The first Omicron case in the U.S. was identified in California on December 1. By Christmas, the largest surge of cases since the pandemic began was underway. By January 3, the U.S. set a new record, registering 1 million new COVID-19 cases in a single day.
But this surge was different, not only in the dizzying speed with which it spread, but in the potential hope that arrived with Omicron: that it might mark the beginning of the end of the pandemic.
Endgame or utter catastrophe
The numbers behind the Omicron surge are staggering locally as well nationally. On December 7, the variant accounted for only .04 percent of COVID cases in the United States. By December 18, 59 percent of all cases were Omicron, according to the Center for Disease Control. In some states, such as New York, that number was at 90 percent. The telltale sign of its arrival was an unprecedented spike in cases, far steeper than previous variants. That spike arrived locally right before Christmas. Over the week ending December 19, all three Beach Cities set new records for the number of new cases — and it wasn’t close. Redondo Beach registered 253 new cases, Manhattan Beach 190, and Hermosa Beach 108 cases. By December 26, those numbers had increased to 987 in Redondo Beach, 556 in Manhattan Beach, and 297 in Hermosa Beach.
The previous highs, during the peak of last winter’s devastating surge, were 289 cases in Redondo Beach during the first week of January 2021, 103 that same week in Hermosa Beach, and 113 in Manhattan Beach.
There was, of course, one big difference in these two winter coronavirus surges. Last year, nobody was vaccinated. This year, all three Beach Cities boast among the highest vaccination rates in the country — 82.7 percent of Manhattan Beach residents over the age of 5 are fully vaccinated, and 79.7 in both Hermosa Beach and Redondo Beach.
Another difference is nobody, locally, has died yet during this year’s surge. Manhattan Beach lost four people both in one week early last January and then again in early February, Redondo Beach lost 10 people over two weeks ending in early February, and Hermosa Beach lost two people in early February. Countywide, hospitalizations reached nearly 8,000 patients at one point last winter; this winter surge has peaked thus far at just under 2,000 hospitalizations.
Within this data is a sign of hope. Omicron is an estimated three times more contagious than the Delta variant, which was at least twice as contagious as the original novel coronavirus. But researchers across the globe are confirming that Omicron is far less lethal, and usually results in mild illness, particularly among the fully vaccinated — the CDC reports that the risk of COVID infection is eight times higher among the unvaccinated than the vaccinated, while the risk of hospitalization or death in the unvaccinated population is 25 times higher.
Dr. William Kim, the chief medical officer for the Beach Cities Health District, is cautiously optimistic that the Omicron variant will hasten the end of the pandemic. Photo courtesy of the Beach Cities Health District.
This combination, a highly contagious variant that tends to cause only mild illness, could finally be what ends the pandemic. Dr. William Kim, the chief medical officer for the Beach Cities Health District, said he is cautiously optimistic that this could be the case.
“The infectivity of the Omicron virus is tremendous, much more than Delta, which was much more than Alpha and Beta and some other variants that came through our communities and the world,” Kim said. “Omicron is extremely infectious but it’s producing a pretty mild disease. So I’m hoping this is the endgame, so to speak — that this virus has mutated itself to such an infectious agent that it produces such a mild disease that it’s going to displace the Delta variant, and then we’re just going to get on with our lives, living with Omicron.”
Kim amends this hope with a very large and somewhat terrifying caveat.
“The background hum that worries me is that it’s so infectious, who’s to say it can’t mutate again to produce a more virulent form?” he said. “That would be a problem.”
Omicron has over 50 mutations from the original novel coronavirus that sparked the pandemic, including 32 to its spike protein, which enables its extreme contagiousness, but thus far does so in a way that does not generally cause severe illnesses — particularly sparing the lungs, the most dangerous mode of attack for previous variants. But if it further mutated to become more lethal, the results would be utterly catastrophic, essentially returning the world to ground zero of the pandemic.
“Right now, it doesn’t seem to be doing that,” Kim said. “Almost uniquely, this mutation is so infectious but so much less virulent…I’m cautiously optimistic that this surge is the swan song of this virus. Of course, I’m an optimist. But I follow the science, I follow the mutation data. And note that the amount of mutation in this Omicron variant is amazing — 32 on the spike protein, and probably another 20 or 25 within the virus itself, which are making it less virulent. So if we can just keep the same cocktail going, the same makeup, there is a pot of gold at the end of this rainbow, so to speak.”
Less virulent, however, does not mean harmless. On New Year’s Day, the number of hospitalizations in LA County, 1,792, surpassed last summer’s Delta variant surge, which peaked at 1,790 patients hospitalized with COVID-19. However, the number of severely ill thus far has remained far less than last summer. On January 2, 278 COVID-19 patients were in intensive care units countywide — about 40 percent below last summer’s peak.
“We are seeing hospitalizations. But once again, it’s mainly in unvaccinated individuals with underlying health problems,” Kim said. “We’re not seeing this devastating surge that we had last December and January. We are seeing high numbers, but we’re not seeing the mortality and the morbidity and the sick hospitalizations that we had before.”
The new surge had its deadliest day thus far on Tuesday when 24 people died of COVID-19, according to data released by the County of Los Angeles Department of Public Health. Twenty of those who died had underlying health conditions. And though LADPH did not specify how many of those who died were unvaccinated, it did release overall ICU admission and death rates for this surge. From December 15 to 28, the risk of ICU admission was 21.3 times higher among unvaccinated individuals than among fully vaccinated. For the week of December 19 to 25, the age-adjusted death rate in unvaccinated people was 4.5 per 100,000 and 0.02 per 100,000 in vaccinated individuals, meaning the unvaccinated were 22.3 more likely to die.
“I send my heartfelt condolences to those families who have lost a loved one due to COVID-19,” said Dr. Barbara Ferrer, Director of Public Health. “Even as transmission surges, we are seeing that vaccines are doing what they were intended to do, which is protect people from getting severely ill due to Covid.”
Ferrer said that 80 percent of eligible LA County residents have received at least one vaccine dose, but noted this leaves 2 million unvaccinated people.
“Choosing not to take the vaccine during this explosive winter surge is very risky since so many of those ill with Covid in the intensive care units at hospitals are unvaccinated, and tragically, some of these individuals will not survive,” she said. “So as we start this new year, please protect yourselves by getting vaccinated and boosted…and give others around you the peace of mind that comes from reducing the risk of a terrible outcome as more and more people are infected with this virus.
LACDPH also reported a 190 percent increase in pediatric COVID admissions to area hospitals this week, including a more than 325 percent increase in kids under 5, who are not yet eligible to be vaccinated. Public health experts have long been concerned about COVID’s impact on children, who tend to experience only minor illness, but who may be subject to longer-term adverse impacts.
“The long-term effects of even mild to moderate disease in the pediatric population is still not known,” Kim said. “We do know that some of those kids don’t do well moving forward with cognitive skills, depression, and all these other things that can occur — fatigue, chest pain, shortness of breath — in kids who have really been ill, as we’ve seen in the older adults, too. We don’t have long-term data that we can really rely upon.”
But perhaps the most troubling and least contemplated aspect of the Omicron surge is the toll it is taking on a health care system that was already strained to a breaking point.
Lindsey Burrell, a registered nurse at Providence Little Company of Mary Medical Center, said the number of nurses who have left the profession over the course of the pandemic has created a shortage that has been severely exacerbated by how many nurses are now falling sick during the Omicron surge.
“It’s a very clear reality that we don’t have enough nursing staff to meet the demands of what is coming in,” Burrell said. “At the beginning of this pandemic, we didn’t have enough PPE, right? That was the big headline. Then we didn’t have enough ventilators, that was the big thing. Well, if you don’t have the nurses to take care of you, we all know the results. I mean, there is only so much we can do, and then it makes no difference. If it’s taking me so long to get you up to intensive care to treat you because you’ve sat in the ER for 12 hours, you’ve already begun to spiral. And that is the stress we, as a nursing staff, are facing.”
Dr. Anita Sircar and Registered Nurse Lindsey Burrell in the ICU. Photo courtesy Providence Little Company of Mary
Forgotten heroes
Something else was different early in the pandemic. Nurses and other medical workers were lauded as heroes working on the frontline. News stories highlighted their work, and nonprofits organized to deliver meals and show appreciation for the sacrifices these workers were making. This storyline has largely ceased.
“The word hero doesn’t exist anymore,” Burrell said. “We feel like it’s nurse fatigue. No one wants to hear about us anymore. Everyone has just kind of forgotten. We have physical fatigue, emotional fatigue, mental fatigue, and now we don’t have the pillars of support around us that we want to have. We’re still in it to win it, but we are on our own.”
Health care workers have endured an unimaginable amount of stress, loss, and sheer physical exhaustion. Now they are leaving the profession in droves. Nearly a half-million healthcare workers have quit their jobs since the pandemic began, according to the U.S. Bureau of Labor Statistics. A survey by research company Morning Consult found that 18 percent of health care workers have quit, while 12 percent have been laid off (the pandemic brought many of the most profitable parts of the healthcare industry to a standstill, including elective surgeries, and threw it into an economic spiral). Just as Omicron hit, the industry was on a cliff — the same Morning Consult survey found that 31 percent of remaining health care workers were considering quitting.
And if health care workers represent the frontline of the pandemic, nurses are at the very front of that line. They are the ones who care for COVID patients from morning till night, who turn their bodies to prevent bedsores, who monitor their signs every minute of every day, and who bear the bulk of communicating with patients’ families.
Nurses are also the ones who are invariably there when a patient dies, often FaceTiming or Zooming in distraught family members (who are unable to enter ICU units under safety protocols), or otherwise just trying to make that dying person not feel alone. A survey by the American Association of Critical-Care Nurses found that two-thirds of these nurses are considering quitting the nursing profession. It’s a global phenomenon. The International Council of Nurses, even before the pandemic hit, calculated a shortage of 6 million nurses worldwide, with another 4 million about to retire. ICN now estimates that over 200,000 nurses have died of COVID-19 and a third of nurses globally are considering quitting.
What this shortage means during the Omicron surge is that already overtaxed nursing staffs are being asked to do more. They work more days, and longer hours, and care for more patients. When they fall ill — which with Omicron’s extreme contagiousness, or just the general crushing fatigue the entire profession is facing, is almost inevitable — they are asked to return to work often within a few days.
Providence Little Company of Mary has tried to fill the gaps with traveling nurses. But even so, Burrell said it is not uncommon for a shift that typically would have 16 nurses to be short at least three. It means the nurses on duty have to cover more patients and rarely have time for anything longer than a five-minute break to eat.
“What does that translate to? It means having a nurse to cover breaks and lunches usually doesn’t exist, that we’re just kind of helping each other,” Burrell said. “It means that while the ICU has beds physically open, we just don’t have the nurses to take those patients and fill the beds.”
For Burrell, like many in her profession, nursing is more than a job. It’s a calling. At Providence Little Company of Mary, she works alongside her mother, Julie Baker, who has been a nurse for 49 years. Burrell did not intend to follow in her mother’s footsteps. She was studying law when she took time off to care for a dying neighbor, who the day before she died told Burrell, “You have missed your calling. You need to be a nurse.” Burrell has spent her entire 10-year career at LCM.
The pandemic has had three distinct phases for Burrell, and the team of nurses she works alongside. In early 2020, when the ICU first began filling with COVID-19 patients, and the magnitude of the pandemic was freshly dawning on everyone, it was a feeling of all hands on deck — ICU nurses, after all, are uniquely prepared for emergencies, for matters of real life or death, and at that point their efforts were celebrated almost like first responders during 9/11.
By last summer, the seemingly unending sacrifices each had made — time apart from family, the risks, and endemic Post Traumatic Stress Syndrome so many suffered — gave way to what became known as “compassion fatigue.” The reality was that last summer’s surge was due to a choice so many patients had made not to get vaccinated, and the nurses were keenly aware of this.
Now, with the onset of Omicron, life in the ICU has taken on the feel of the late stages of a losing war. The sense of devastation is so pronounced it has become almost surreal. Nurses keep showing up because of their sense of calling, and because of their bond with each other.
“You show up at seven o’clock in the morning to start your shift, and you have this overwhelming sense of anxiety and frustration, just to start off,” Burrell said. “It’s like you’ve shown up, and that’s half the battle, and now you’ve got 12 hours ahead of you to fight it all out. And the fact that at the end of the shift we can still walk away with smiles on our faces and high fives among the nurses, because that’s what we do — above any occupation you could possibly name to me, I just think that that’s just the greatest thing. We’re a family, and that’s how we get through this.”
Following the 2020 holiday surge in COVID-19 cases, hopes were raised that the pandemic was receding. But COVID-19 cases following the recent holidays surpassed those of last December and January. Chart courtesy of Beach Cities Health District. Data source: Los Angeles County of Public Health
No leadership, no societal praise, and no amount of financial compensation can match what this comradery has meant for nurses entering their third calendar year fighting a pandemic.
“It’s my coworkers,” Burrell said. “It’s the nurse sitting next to me that looks at me and says, ‘No matter how hard this is, I have your back.’ I mean, some of the nurses I work with are travelers I’ve only met two hours prior. And guess what, no matter how hard my day is, or if my patient is coding, no matter what, that nurse has my back.”
The challenges are nonetheless mounting, even as the pandemic’s end, just maybe, is in sight. Burrell cannot count the number of people she has seen die, and their faces, unbidden, at home or at work, sometimes flash through her mind. From afar, observers look at the mortality rates and see smaller numbers — only two deaths in LA County Sunday, eight on Monday — as signs of hope. But when you are the nurse holding that patient’s hand as he or she breathes a final, labored breath, it’s much harder to find hope.
“When somebody asks me how many people have I seen die from COVID it immediately brings up a sense of severe PTSD,” Burrell said. “People think that we just forget about them because we see so many. We don’t. My mind and my heart can flicker to one individual almost every minute, very quickly. I’ve seen so many people die of COVID that I don’t even know how many. I have no idea.”
The mounting deaths have been harder to bear since last summer when nearly every one of those who died had chosen not to be vaccinated.
“The deaths that we’re seeing right now are preventable,” Burrell said. “They just are; we see it. I just worked and saw it. I saw the devastating effects of an unvaccinated individual and the end of their beautiful life. And COVID, what a terrible way to go. Of all things, that’s how it ends — you got a virus they offered you a vaccine for, and you refused, and you died because of it. Yeah, go ahead, go to war with no bulletproof vest on. You can run and dodge those bullets all you want, but eventually, it’s going to get you, and you are going to die. If somebody told me that, why would you think twice? Just get vaccinated.”
“You would have thought two years in that we wouldn’t be having this conversation, that this would just be a proof in the pudding type thing, where you say, ‘Okay, we’re proving that vaccines will lessen your time of being sick and most likely eliminate your need for hospitalization. Or even if you’re hospitalized, you’re probably only getting hospitalized for a day or two as a precaution.’ That’s what it is, but people don’t buy it.”
Another challenge is the anger many of the patients’ families express towards their caregivers. They are going through an awful experience, knowing that their loved one is desperately sick and possibly dying, yet they cannot be by their side. And when treatment isn’t working, the frustration grows more intense. Nurses bear the brunt of all this frustration.
“You have to truly love what you do to be able to deliver the type of care that we do with our unit,” Burrell said. “It’s difficult sometimes when you get this type of emotional, and verbal abuse from family members because you know, in your heart, you’re trying so hard. Sometimes you just want to hear the words that are very simple, just ‘Thank you,’ and very seldom do we hear that. We don’t necessarily need it, but it’s nice to hear. Because we’re only human.”
Omicron has been different in that many patients’ stays have been brief, only a day or two. The seriously ill who remain tend to have been in the ICU since before Omicron arrived, some who are just barely being kept alive because their families understandably are holding out for every last hope. Something else that has changed is that some patients who arrive in the ICU are vaccinated.
“It would be a lie to tell the general public that we don’t see vaccinated patients coming in intensive care who are being intubated,” Burrell said. “Because absolutely, it’s happening. The difference, though, is there’s a missing element in each and every case that we see — either they’re not vaccinated, or they’re partially vaccinated, meaning they’ve probably gotten the first, and the second shot, or just Johnson & Johnson, but they haven’t gotten a booster. It’s clear as day that’s what we’re seeing. I haven’t seen anyone who’s been fully vaccinated, including the booster, who has gotten intubated. Do I know people who have gotten COVID? Absolutely, but it’s just a very mild case.”
Maybe the most remarkable thing about what is occurring among nurses and other healthcare workers is that, at the end of the day, they have managed to keep believing that better days are coming. This has been possible because they have seen the goodness in each other.
“It’s the small things,” Burrell said. “Just recently, when a COVID patient passed in our unit…. Well, first I have to paint a picture of how busy it was during this shift. Most of us hadn’t taken a break. We just had been covering for each other for five minutes here and there. It’s like going on hour 12, and you’re running around like crazy. You’re trying to organize Zoom calls and calm family members down, you’re trying to inform families of what’s going on, and then all the while in the back of your mind, you’re looking at your COVID patient who’s circling the drain and slowly dying. And it doesn’t matter how old you are, it doesn’t matter how you got COVID. Because I don’t care how you got COVID. It is our job to take care of you, and if we can’t save your life, then we make sure that we transition you as beautifully as possible.”
Burrell looked over at the nurse overseeing this passing. She had allowed the family members to gather at a nearby window so they could watch their loved one pass.
“She’s standing right next to them, and she puts her arm around the daughter,” Burrell said. “And to see the compassion, that no matter how tired you are, or hungry, or frustrated, that the sense of compassion that a nurse can have towards a family member, I think it’s just nothing short of beautiful. And it’s my co-workers who drive me and motivate me to want to be an even better nurse because of moments like that. Yes, we’re frustrated. Yes, we are tired. And yes, we are sad. But most of us, we can push that aside, and still show utmost compassion to family members during this time. And we do and we deliver. So, yes, let’s see the good.”
In that compassion, Burrell believes, is the hope that everyone can do better — that people can realize that vaccinations are not only to protect themselves, but to protect each other, even someone you have never met. Burrell has two young children, and has experienced the strain of being apart from them so much during the pandemic, and for being so tired or stressed even when they are together. But she was recently uplifted when she heard her five-year-old son express why he is a diligent mask wearer. “It’s not because I am afraid of getting it,” he said. “It’s because I don’t want anybody else to get it.”
Maybe Omicron will be the end of the pandemic. But Burrell’s larger hope is that all of us will have learned what her little boy inherently understood.
“My hope that we will win this still is very much alive,” Burrell said. “I think that’s exactly what keeps us going. Every loss still sticks with us. They are frustrating, especially when they are unvaccinated, and it was completely preventable. But I think that my definition of winning is a little bit different. My definition of winning is being able to say I work with a group of nurses who never gave up on me, I never gave up on them, that we never gave up on a single patient, and they fought long and hard for as long as they could. And that at the end of this, rather than having these huge political winds that divide us all, maybe we’ll find one common ground.” ER