Public health experts fear we’re headed into yet another post-holiday covid surge, based on how numbers are trending.
Covid case counts, already thought to be underestimates by a factor of 5 to 20, have turned up sharply in the last week. So have hospitalizations, the most reliable pointer to past surges in the pandemic, a 10 percent increase over the most recently reported week. According to Centers for Disease Control and Prevention data, around 350 people a day are dying of covid in the U.S. with that number turning upward in the last month. Most of the deaths are coming among those 65 and older.
All these numbers mirror the beginning of the past two winters of pandemic surges, say public health experts, and point to a need for people — however reluctantly — to take more care about indoor exposure to illnesses, getting their shots, and donning masks once again in all the old familiar places, like the store or a family gathering.
Past observations that viruses sometimes interfere with one another, a bad cold season knocking down flu rates for example, might give epidemiologists some hope against a steeper covid surge this winter, said virologist Andrew Pekosz, of the Johns Hopkins Bloomberg School of Public Health. “That might be what we are seeing in the adult population, with more flu and less covid,” he said, but that “viral interference” phenomenon doesn’t seem to be playing out this year in children.
“We don’t have to have a big winter surge. But right now, we are on track to,” said epidemiologist Eleanor Murray of the Boston University School of Public Health.
Wastewater measures of covid are up in Boston, and in other cities across the country, resembling numbers that came ahead of a summer run-up in omicron variant cases. “It is clear we had transmission at Thanksgiving,” said Murray. “That means some people will be attending funerals over Christmas. But we can reduce transmission through masking, distancing, and ventilation.”
So if covid is surging ahead of the holidays, what is the best way to protect yourselves and your loved ones?
Vaccinate and boost
The Food and Drug Administration has authorized a booster shot designed against the omicron variant for children six months and older. Uptake rates for the shot, which should lessen both the chances of infection and severe illness, remain far too low however, with only about 13.5 percent of the population getting one. Likewise, the flu shot is a good match for the influenza strains at large, but vaccination rates are lower than in past years for both children and pregnant people.
“My perspective as an immunologist is, ‘Get the friggin vaccines and boosters for flu and covid!!!’ ” said University of Arizona immunologist Deepta Bhattacharya by email. “The shots will help — please get them!”
The advent of the omicron subvariants, and this winter’s surge, likely signals that winter coronavirus seasons are ahead of us for the foreseeable future, added Bhattacharya. That means covid season will need the same approach as every flu season, with annual booster shots timed to the newest dominant variety of SARS-CoV-2.
From an evolutionary standpoint, coronavirus has now come to behave more like its kindred coronaviruses that cause colds, throwing off lineage bugs of a dominant strain, rather than wholesale new variants as it did in the first years of the pandemic. The virus has gone from evolving solely to be more infectious, as the first alpha variant was, to now evolving to evade the immunity that humanity has acquired through vaccination and past infection, a different landscape for mutations that sees many of these diverse subvariants converging on specific changes meant to defeat immune system defenses.
There are also hope that newer vaccines aimed broadly against those unchanging fundamental parts of the entire coronavirus family will also prove out, said Bhattacharya. “But those are years away.”
Test if you have symptoms
At-home covid tests still are good at detecting even the omicron subvariants, said epidemiologist Keri Althoff of the Johns Hopkins Bloomberg School of Public Health, in case there is any dispute around the holiday table. If you have symptoms and test, and it’s negative, it’s wise to wait another 24 to 48 hours to test again to be sure, she added, particularly if you have symptoms particular to covid, like the loss of taste or smell.
“As hard as it may be, normalize those last-minute holiday cancellations if someone is not feeling well,” she said. “Common sense reduces the likelihood of one of these viruses entering your household.”
Because effective antiviral medications for both flu and covid only work early in an infection, their prescription as soon as symptoms appear — rather than later in an overworked emergency room — is crucial.
At least 16 omicron subvariants are now tracked by the CDC. Their numerous changes from the original SARS-CoV-2 virus have meant that antibody treatments that were effective against earlier, less mutated, variants are no longer effective. However, the antiviral medication Paxlovid, which targets that largely unchanged reproduction of the virus, is still helpful at blocking severe disease.
This is true of this year’s flu season as well, which started early and is already filling emergency rooms, along with increases in respiratory viruses. The CDC estimates that the flu has already killed about 7,300 people this season — for context, this is about the number of people that covid now kills in three week in the U.S. — and has led to more influenza hospitalizations than at any time in the last decade.
“We all know from the last two years that when hospitals fill with sick patients and hospital workers start getting sick themselves, that is not an ideal situation for people seeking care,” said Althoff.
Masking still works
The onslaught of all those viral outbreaks looks worse because of widespread “pandemic fatigue,” acknowledged recently by National Institute of Allergy and Infectious Diseases chief Anthony Fauci.
CDC director Rochelle Walensky last week urged people to wear masks when taking public transportation, particularly in communities seeing high flu and covid case rates, and so have New York, Los Angeles and Phoenix health officials. “We’ve always known colds and flu season is more than just flu,” said Walensky. “There are other pathogens out there, [and] we want to make sure that we are on top of the ones that people can do something about.”
Thanks to Dave Tepps for copy editing this article.