Dr. Matt Willis, Marin County's Public Health Officer, attends one of the first pop-up senior COVID-19 vaccination clinics, set up at the Exhibit Hall of the Marin County Civic Center in March 2021. (Photo courtesy County of Marin)

San Mateo bookstore owner Craig Wiesner feels exhausted, trapped and hopeful.

Exhausted by the pandemic that has moved into a third year, trapped by the high case counts that make it hard to plan ahead, yet hopeful that his area seems to be doing OK.

“I’m ready for this pandemic to be pushed over. I want to get back to a normal life,” Wiesner said. “I’m missing too many people that I would like to be closer to. And even though I’m an introvert, I miss gatherings.”

In San Mateo County, where Wiesner lives and co-owns the Reach and Teach bookstore with husband Derrick Kikuchi, there are signs that the COVID-19 surge fueled by cases of the more-contagious omicron variant may be declining, with cases plateauing in the last week.

Cases appear to be declining across the Bay Area but health officials aren’t yet ready to declare that the surge is over.

With cases still high across the U.S., Wiesner wants to be able to travel to attend a wedding this year but he’s not yet comfortable making travel plans. The future feels too uncertain.

“I want the science to lead me,” Wiesner said.

So what do scientists have to say about COVID cases, hospitalizations and our future with COVID?

Cases appear to be trending down but with the rise of rapid home tests, the total number of cases is probably much higher than reported.

This is no surprise for public health officials like Marc Meulman, director of public health, policy, and planning at San Mateo County Health.

“We can still look at those trends to help give us a sense of what’s going on in the community, recognizing that now and really never has it been a full accounting of disease transmission but a marker of it,” Meulman said.

He said that looking at case trends week to week can help give a sense of whether COVID risk is increasing or decreasing, but it may not be as useful to compare to last year’s data.

“It’s a little difficult to compare January of 2022 to January of 2021, because factors have changed,” Meulman said.

One of the changing factors is testing volume: more people than ever are getting tested in San Mateo County and across the state. More testing means more cases detected.

It may be the beginning of the end of the omicron surge. Wastewater surveillance — which can be an early predictor of COVID spread — showed signs that cases are leveling out, Meulman said, though he was cautious about making a declarative statement.

“It’s a little difficult to draw conclusions from the most recent data points because they’re probably not complete yet,” he said.

Non-COVID hospitalizations are up

Hospitalizations are up across the Bay Area and the state but it’s not just because of people being infected with the virus.

For one, some COVID hospitalizations include incidental hospitalizations — patients who went to the hospital for other reasons and happened to test positive for the virus.

Aside from COVID hospitalizations, more people are being hospitalized at this time of year than expected, according to Dr. Sofe Mekuria, Contra Costa County’s deputy health officer.

“The problem with this year is the hospitals are kind of just full with other non-COVID things,” Mekuria said. “So people are tired, and kind of stretched thin already.”

The high number of non-COVID hospitalizations could be due to the expected winter spike of flu and respiratory syncytial virus — or RSV, a viral infection that affects young children.

Plus, more people may be in the hospitals for elective procedures that had been previously postponed.

Dr. Sofé Mekuria, deputy health officer for Contra Costa County, at the juvenile detention clinic in Contra Costa County, Calif. where she also serves as a pediatrician. (Costa Health Services via Bay City News)

Given all those factors, public health officials are paying close attention to ensure hospitals don’t get overwhelmed, especially as they grapple with staffing shortages as workers test positive and have to stay home. Nurses and other health care workers have held protests this month around the Bay Area and country, saying there are not enough workers to take care of the influx of patients.

Roughly 82 percent of nurses surveyed across the country by the union National Nurses United between October and December said that at least half of their shifts were understaffed.

“Hospitalizations will continue to be an important factor to understand if our hospitals are being stressed, kind of how we use it … in flu season as a marker of the severity of the flu season,” Mekuria said.

What’s next for COVID?

What happens next in the pandemic depends on which variants emerge, according to Marin County public health officer Dr. Matt Willis.

“The next thing that will happen with variants is that there will be an increasing number of offspring of omicron,” Willis said. “That’s what we’re starting to track. And the critical question is always: do they behave differently?”

Willis said there’s not yet evidence that the various omicron strains behave differently from one another in terms of how easily they cause infection, severity of disease and immune evasion, the term for how well the strains can infect and cause symptoms in people who have been vaccinated or infected in the past.

But we should expect new variants to emerge, Willis said, because that’s just the way the virus behaves.

For the people wondering, “Why don’t we just let it rip?” Willis said it’s worth trying to manage case counts as long as COVID is making people sick enough to come into hospitals. Plus, quarantine and isolation protocols help manage exposure and protect high-risk individuals.

And there are still unanswered questions about the virus.

“We just don’t have enough time under our belt yet to really be able to describe long COVID for omicron because it’s only been with us for like a month,” Willis said.

One thing is for sure: health officials say vaccinations remain the number one way to protect from getting seriously sick with COVID.

Compared to fully vaccinated people, unvaccinated people were four times more likely to get COVID, seven times more likely to be hospitalized with it and 17 times more likely to die, according to state data.

“If we look at our hospitals, those that are infected with omicron who are in the hospital tend to be older residents, people with chronic medical conditions and the unvaccinated or unboosted,” Willis said.

For California COVID data, visit https://covid19.ca.gov/state-dashboard/.