Medical experts say hospital systems are better off than this time last year, although climbing coronavirus hospitalizations are worth watching.
By Marin Wolf
5:20 AM on Jan 4, 2023
North Texas COVID-19 and flu hospitalizations are climbing as the region endures an early and unpredictable respiratory virus season. No one knows whether the current case and hospitalization trajectories will continue, but experts say one thing is certain: The healthcare system is much better off now than it was a year ago.
At least 975 patients were hospitalized with COVID-19 in North Texas as of Jan. 3, a 210-patient increase from Dec. 30. About 270 were hospitalized with the flu, accounting for a 44-patient increase over the same period, according to the Dallas-Fort Worth Hospital Council.
The rising COVID-19 hospitalization count is a far cry from the more than 4,000 hospitalizations seen at the height of the omicron surge in January 2022. The quick dominance of the variant wreaked havoc on hospital systems across the country as it filled beds with critically ill patients while keeping sick healthcare professionals out of work.
In the last year, the omicron variant mutated into a growing number of subvariants, each more contagious but seemingly less severe than the last. Subvariants BQ.1 and BQ.1.1 account for about 67% of cases sampled by the University of Texas Southwestern Medical Center as of Dec. 28. Subvariant XBB — the dominant variant in parts of the Northeast — now makes up 10% of cases in Dallas.
“We’re seeing people get COVID, but we’re not seeing people get as sick with COVID as we used to. With this new XBB variant, it’s nothing like omicron last year,” said Dr. Joseph Chang, chief medical officer at Parkland Health, Dallas County’s public hospital system.
The variant breakdown in North Texas mirrors that of different COVID-19 strains prevalent across the state, according to Department of State Health Services data from the week ending Dec. 24.
Climbing numbers of COVID-19 cases could signal a shift in a respiratory illness season dominated by other infectious viruses. The flu and respiratory syncytial virus, or RSV, spiked much earlier than normal, causing a massive wave of hospitalizations, especially in children. Flu hospitalizations even outpaced COVID-19 hospitalizations for a short period in November.
Public health experts say it’s too soon to tell how much the winter holidays will impact virus cases. Chang said that incubation periods for the current COVID-19 strains and the flu are about three to six days, so people infected at New Year’s celebrations may just now be experiencing symptoms.
The number of Parkland employees calling in sick because of COVID-19 increased to a few dozen workers recently, Chang said, although that represents only about a half or a third of the number of people out with omicron last January.
Dr. Jeffrey SoRelle, who leads UT Southwestern’s COVID-19 variant tracking effort, said he expects XBB to become the dominant variant in North Texas, although it might not happen as quickly as it did in other regions.
XBB is a relatively recent addition to the circulating omicron offshoots. It’s known as a recombinant variant, or a strain made up of two other variants. In this case, XBB is a combination of the omicron subvariants BA.2.10.1 and BA.2.75.
Recombinant variants like XBB typically arise when someone has two different strains at the same time, allowing the genetic material of both strains to mix in the same cell. While getting infected with two COVID-19 strains at the same time is relatively rare, more than a dozen recombinant variants have been detected since the start of the pandemic.
The Centers for Disease Control and Prevention named an XBB spinoff, called XBB.1.5, a new variant of concern last week. According to CDC data, it represents more than 40% of cases nationwideaccording to CDC data.
SoRelle said that his team separates XBB and XBB.1.5 for surveillance projects with the state but that for general reporting he would only split the variants when there appears to be a significant difference.
“The difference in these variants is minimal, so I don’t anticipate separating them,” SoRelle said.
Most people who contract COVID-19 right now will handle the virus without any severe illness, although they will likely still feel crummy. People with compromised immune systems, however, are at much higher risk for significant complications from the weaker omicron subvariants.
The latest subvariants have forced infectious disease experts to reconsider treatment options for patients prone to severe illness. Researchers found that antiviral drugs used to treat COVID-19, like Paxlovid, are still effective against the newest omicron offshoots, but monoclonal antibodies are not.
Antivirals come with a host of problems. Paxlovid doesn’t work for every patient because of significant interactions with other medications, especially immunocompromising drugs. Antiviral Remdesivir doesn’t have the same drug interactions, but it’s given through IV infusions to non-hospitalized patients over multiple days, making it harder to administer than Paxlovid.
Potential holiday-related increases in COVID-19 and flu cases should serve as a reminder that the viruses can be dangerous for some people, said Dr. Philip Huang, Dallas County’s top health official. Hygiene measures, like hand washing and staying home when sick, can go a long way as a preventative, as does getting vaccinated.
“Right now, we’re in a better place than we were a year ago. We hope that will continue if people keep doing everything they can to slow the spread,” Huang said. “It all depends on what people do and then some things beyond our control.”