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Fewer Dying, but COVID Cases Sweeping Calif. Bay Area

Whether the relatively low and stable death rate will continue to hold by the time the omicron wave subsides remains to be seen. But Omicron deaths will likely peak in the Bay Area this week or next.

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(TNS) - It may seem like everybody’s suddenly getting the coronavirus as the highly contagious omicron variant sweeps through the Bay Area, but the good news is that people are dying at a far lower rate than they were during previous pandemic surges.

Credit high vaccination rates among Bay Area residents and better treatments that have slashed COVID-19 mortality since inoculations became widely available last year.

Whether the relatively low and stable death rate will continue to hold by the time the omicron wave subsides remains to be seen. But we should know soon: Omicron deaths will likely peak in the Bay Area this week or next, according to estimates from local health officials and doctors.

Statewide, the number of people dying from COVID-19 has ticked up since Jan. 1, from 58 per day to 120 per day as of Monday, according to state data on seven-day averages of new daily deaths. The Bay Area is also seeing an upturn in deaths, from four a day to 11 over the same period due to omicron’s rapid spread.

But that upward slope is not nearly as steep as the near-vertical climb in new cases that immediately preceded it, nor the rise in hospitalizations that followed soaring cases. The statewide death rate hovers around 2 per 100,000 people over the past seven days, according to the Centers for Disease Control and Prevention. That’s roughly the same as it was last September at the peak of delta deaths, but many more people have been infected with omicron — about 117,000 new cases a day compared with 13,000 at the peak of each respective surge.

The current death rate is about one-fifth what it was at the height of last winter’s surge — before vaccines were widely available — when it reached nearly 10 per 100,000 people.

In one stark illustration of vaccines neutralizing the threat of the virus, 165 San Franciscans died in January 2021, the deadliest month of last winter’s surge. So far in January 2022, only 15 people have died from COVID-19, according to preliminary figures. While that number will likely go up because of reporting lags, health officials still expect overall deaths to be lower than in previous surges.

“Our deaths thankfully are not anywhere near where they were in 2021,” San Francisco Health Director Dr. Grant Colfax told supervisors Tuesday. “We do not expect nearly the magnitude that we saw last winter.”

San Francisco has consistently reported one of the lowest COVID-19 death rates among major U.S. cities throughout the pandemic. The city’s cumulative COVID-19 death rate is 81 per 100,000 people, the lowest in the country, according to data shared by city health officials Tuesday. The next closest is Seattle at 101 deaths per 100,000 people; New York City, by comparison, is at 450 per 100,000 people.

One reason COVID-19 is less deadly now is that omicron, though far more transmissible, also produces milder illness and doesn’t infect the lungs — especially the lower respiratory tract — as severely as did earlier variants. Combined with relatively high vaccination rates in California and the Bay Area and better treatments for hospitalized patients and outpatients, infected people are less likely to die from the coronavirus.

Mortality will become an increasingly important metric to watch as the coronavirus becomes endemic and the priority shifts from preventing cases to preventing hospitalizations and deaths.

“Omicron is less severe, relatively, but causes a lot more cases. So your absolute number of deaths is still high and concerning, but the percentage (of cases who die) is going to be lower,” said Dr. Abraar Karan, an infectious disease doctor at Stanford.

Karan and other doctors who’ve been treating COVID-19 patients during the past few weeks saw that more people than ever have the virus, but a smaller proportion of them needed intensive care and ventilation compared with previous surges. Most of the people dying now are unvaccinated. And most of those who need intensive care are severely immunocompromised.

“The case mortality rate is a lot lower,” said Dr. Robert Rodriguez, an emergency medicine physician at Zuckerberg San Francisco General Hospital.

This is “far and away” because so many more people are vaccinated now compared to previous surges, Rodriguez said.

More people now are also boosted with a third shot of the Pfizer or Moderna vaccines, which recent studies show reduces the risk of hospitalization and death from omicron by 90%.

Even aside from vaccines, doctors also know better today than they did in the spring of 2020 how to manage COVID-19 patients in the hospital. Laying them on their stomach, or proning, helps prevent the need for intubation, which reduces the number of deaths. And the steroid dexamethasone, which is given to some hospitalized patients, has been shown to lower mortality, too.

“Medical care has consistently gotten better in learning how to save people’s lives,” said Dr. John Swartzberg, an infectious disease expert at UC Berkeley’s School of Public Health. “We’ve learned a lot of things medically we can do that we weren’t able to do the first six months of this pandemic.” Independent of everything else, he says, that reduces mortality rates.

Some high-risk patients can now get monoclonal antibody infusions and antiviral pills if they are early enough in their disease progression. Both types of treatments, though in short supply, dramatically reduce the risk of hospitalization and death.

Whether mortality rates stay relatively low and stable in the future depends on what variants may gain dominance, how virulent and contagious they are, and whether they will evade immunity from vaccines or prior infection.

“I’m relatively confident mortality is going to decrease over the rest of the year. And cases are going to decrease over the rest of the year,” Rodriguez said. “But again, the wild card is the variants.”

Omicron is less virulent than delta, but that’s no guarantee the next variants will become progressively more benign.

“I don’t think we can count on good news,” Swartzberg said. “There’s evidence in nature where viruses and bacteria do evolve toward being more benign over time, but it may take years to do that. But there’s also evidence in nature where viruses become more virulent over time. Nature hasn’t given us a guarantee which direction this virus is going to evolve.”

Catherine Ho is a San Francisco Chronicle staff writer. Email: cho@sfchronicle.com Twitter: @Cat_Ho

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