In various parts of the country, there is a slow increase in coronavirus infections, which could indicate a potential fall and winter surge, similar to patterns observed in previous years. However, experts believe that the number of cases will not reach the alarming levels seen in past winters. Data from wastewater monitoring, test positivity rates, hospitalizations, and emergency room visits have shown a four-week upward trend in infections. These figures provide researchers and public health officials with a glimpse of the coronavirus as a seasonal threat, permanently present in the infectious disease landscape.
Wastewater analyses indicate the highest increases in the Northeast and the South, followed by the West and Midwest. Hospitalizations, after reaching a low point at the end of June, have slowly started to rise again. Test positivity has also increased to 7.6 percent, which was last observed in November 2021 before the Delta variant surge. Epidemiologist Caitlin Rivers from the Johns Hopkins Center for Health Security noted that this is the fourth consecutive summer where a wave begins around July, typically starting in the South.
Due to repeated infections and vaccinations, the majority of Americans have developed multiple layers of immunity, and therefore, the virus is unlikely to cause the same level of harm seen in previous seasons. However, older adults, pregnant women, individuals with weakened immune systems, and those with certain chronic conditions may still face a significant risk from the virus. The number of deaths is currently at its lowest since the start of the pandemic, making up only a small fraction of the levels seen in January. Nevertheless, the true toll will only become apparent at the end of the year, after the fall and winter respiratory season.
Katelyn Jetelina, a public health expert and author, emphasized that COVID-19 is still a concern and should not be dismissed. She stated that it will likely be disruptive during the winter and result in deaths, which is unacceptable in the public health realm since it is preventable. Researchers have been evaluating how updated COVID vaccines and emerging variants could impact the course of the pandemic. In the worst-case scenario, without a vaccine and a variant that can evade immune defenses, COVID could lead to approximately 839,000 hospitalizations and 87,000 deaths between September and April. However, in the best-case scenario, with widespread vaccination and a susceptible variant, COVID might cause 484,000 hospitalizations and 45,000 deaths, similar to a severe influenza season.
Justin Lessler, an epidemiologist at the UNC Gillings School of Global Public Health, who coordinated the research, stated that based on these projections, COVID is likely to remain one of the leading causes of death in the United States for the foreseeable future. The estimated range of deaths would place COVID between liver disease and diabetes in terms of the causes of death. Concerns arise regarding the convergence of COVID with respiratory syncytial virus (RSV), influenza, and other pathogens. Last year, hospitals struggled to cope with the triple threat of COVID, flu, and RSV, even though the waves of these infections were slightly staggered. RSV peak hospitalizations doubled compared to pre-pandemic years, primarily affecting children, while the flu led to an estimated 58,000 deaths.
This fall, epidemiologists are closely monitoring the potential interactions among these viruses. Although the peaks of each viral wave may occur at different times compared to last year, the healthcare system may still face challenges. Dr. Rivers noted that even before COVID, health care systems found it difficult to handle sudden surges of patients. To accommodate this increased load, adjustments may need to be made within the healthcare system if this becomes a recurring pattern.
Compared to the other two respiratory infections, flu and RSV, COVID remains a more potent threat. While flu and RSV tend to dissipate in warmer months, COVID infections have been observed to increase from July and remain high until February. Dr. Rivers stressed the need for vigilance during a significant portion of the year.
One notable change from previous years is the presence of several viral types derived from the Omicron branch, rather than a single dominant coronavirus variant. The virus is constantly mutating, similar to the flu virus, according to Dr. Lessler. The upcoming vaccine is designed to target the XBB.1.5 variant that was prevalent in the spring. Even if the vaccine does not perfectly match the circulating variants, it is expected to prevent severe illnesses and deaths, if not infections. Vaccinating Americans of all ages could potentially reduce hospitalizations and deaths by approximately 20 percent.
Experts do not anticipate a return to the worst days of the pandemic. However, they advise that if the number of cases increases, people should consider wearing masks again in crowded indoor spaces, get tested if they experience symptoms, and be mindful of high-risk individuals around them. Dr. Rivers believes that while we may have transitioned out of the pandemic and settled into a seasonal routine, surprises are still possible since the virus has exceeded expectations in the past.
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