lIn the fourth year of the pandemic, Covid-19 is once again spreading across America, driven by the recent holiday season, less precautions and the continued evolution of Omicron sub-variants of the virus.
New subvariants raise concerns about their increased transmissibility and ability to evade some antibodies, but the same tools continue to limit the spread of Covid, particularly bivalent boosters, masks, ventilation, antivirals and other precautions, experts said.
Still, the inclusion of booster has been “pathetic,” said Neil Sehgal, an assistant professor of health policy and management at the University of Maryland School of Public Health. Antiviral use is low and few masking, vaccination and testing mandates have resumed in the face of the winter wave, which is putting new strain on health systems.
New Covid hospitalizations are now at the fourth highest rate of the pandemic, according to the U.S. Centers for Disease Control and Prevention (CDC). Covid hospitalizations fell somewhat after the summer surge, but never fell to the low levels of previous peaks, persisting through the fall and rising again with the winter holidays.
“Hospitals are at maximum capacity,” Brendan Williams, president and CEO of the New Hampshire Health Care Association, said of current rates in his area. “I’m not sure what the trajectory of this thing will be, but I’m concerned.”
Most Covid hospitalizations are over the age of 65, although the share for children under four will roughly double by 2022.
Over the past week, Covid deaths have risen 44%, from 2,705 in the week ending January 4 to 3,907 in the week ending January 11.
This is one of the largest increases in Covid cases in the entire pandemic, according to wastewater analyzes of the virus. It is much lower than the peak in January 2022, but similar to the summer 2022 peak, which was the second largest.
And it’s not done yet. “It certainly doesn’t look like we’re peaking yet,” Sehgal said.
The Omicron subvariants BQ.1.1 and BQ.1, as well as the fast-growing XBB.1.5 account for the majority of cases, according to CDC estimates. According to wastewater data, the Northeast, where more than 80% of cases are estimated to be from the XBB.1.5 subvariant, has the highest rate of cases.
“With XBB, there’s such a significant transmission advantage that exposure is really risky — it’s now riskier than ever,” Sehgal said in terms of transferability.
The number of official cases is rising more slowly, because of the prevalence of home testing and because of a general reluctance to test at all, experts say. However, among the reported tests, positivity rates were very high, with about one in six tests (16%) becoming positive.
Despite the high rate of spread of Covid, hospital admissions have not yet reached the previous spikes seen earlier in the pandemic, likely due to vaccine immunity and previous cases, said Stuart Ray, a professor of medicine and infectious diseases at Johns Hopkins University School ofMedicine.
But that protection shouldn’t be taken for granted, he said, especially as immunity wanes.
“Boosters really make a difference,” he said. “The severe cases we’re seeing are probably at least somewhat avoidable, if people make sure they stay up to date on vaccination, because that’s still the safest way to get immunity.”
Boosters, especially the updated bivalent boosters, are very effective in reducing the risk of serious illness and death. Yet only 15.4% of Americans over the age of five have received the new boosters.
“You’re just battling a lot of misinformation and also some political missteps when it comes to the vaccines,” Williams said. When Joe Biden declared in September that the pandemic was “over,” he said, it likely stalled public enthusiasm for the new supercharger and prompted Congress to do nothing further to get more funding to deal with the pandemic .
“It’s challenging to come up with that parallel story that you shouldn’t worry about Covid, but also take a chance,” said Sehgal, who called the statement “another casual mistake.”
While vaccines are very important, other precautions also help prevent infection, illness and death, Sehgal said — especially important during a wave like this. But because of poor reporting from officials, many people may not even realize that the US is going through a surge and precautions are still needed, he added.
“I think the majority of people who don’t mask today just don’t know they should.”
Even if the US reaches the point where spikes don’t trigger a corresponding increase in hospitalizations and deaths, they will still increase the number of people sick and disabled from long Covid, experts said.
“There is increasing evidence that repeated Covid increases the risk of short- and long-term complications, including cardiovascular, mental health and other issues,” said Ray. “We will only know exactly how big these costs are afterwards. But evolving data suggests there are costs that add up as we pile up infections.”
Williams is concerned that hospitals are reaching maximum capacity even as long-term care facilities see outbreaks among residents and staff after years of staff shortages.
“In New Hampshire, nursing homes won’t admit those they feel can’t provide staff, which I think is admirable, but the result is that the hospitals are stuck,” he said. Hospitals that may be transferring patients to temporary or long-term care facilities will see beds filled for longer, adding further pressure to hospitals, patients and healthcare workers.
“It’s a continuum, but right now the continuum is broken,” Williams said.
Healthcare workers have experienced three years of burnout, disability and death, and some have had to leave the workforce. Others are alarmed by unsafe working conditions and the ongoing crises caused by the pandemic. Nurses in New York reached a tentative agreement this week after a strike for safer working conditions.
Nursing homes and assisted living facilities have about 300,000 fewer employees today than in March 2020, Williams said. “It’s hard to see how it’s going to get better,” he said.
Meanwhile, Covid continues to circulate, with nursing home residents and staff seeing one of the biggest increases in cases of the pandemic.
“The first key to keeping people healthy in a nursing home is to keep people healthy in the community,” Williams said. But “it just doesn’t seem like people are wearing masks and getting a boost – people aren’t taking any of this seriously. We just seemed to declare that when it comes to Covid mortality, we are number one, and that is a title we will not relinquish to any other country.”
Sehgal calls it a “collective forgetting” about how and why we should protect ourselves and each other. “There are people for whom a mild infection isn’t actually that mild, either because of their underlying health or because of social factors in their lives,” he said. “It’s just a huge self-inflicted wound.”
And the more the virus spreads, the more opportunities it has to evolve, potentially picking up mutations that make it easier to overcome immunity.
Yet the same measures that helped curb previous increases are still working. And they not only prevent illness and death, they also minimize social disruption, such as lost hours at work and school. “Those steps we can take to protect ourselves and other people — they don’t seem heavy in the face of a Covid infection,” Sehgal said.
As Ray put it, “If we could wear a mask, why don’t we?”