IIn the fourth year of the pandemic, Covid-19 is once again spreading across America, spurred by the recent holidays, fewer precautions, and the continued evolution of omicron subvariants of the virus.
New subvariants raise concerns about their increased transmissibility and ability to evade some antibodies, but the same tools continue to contain the spread of Covid, particularly bivalent boosters, masks, ventilators, antivirals and other precautions, experts said.
But the uptake of boosters is “pathetic,” said Neil Sehgal, an assistant professor of health policy and management at the University of Maryland School of Public Health. Antiviral uptake has been low and few mandates for masking, vaccination and testing have resumed with the winter tide putting renewed pressure on health systems.
According to the US Centers for Disease Control and Prevention (CDC), Covid hospitalizations are now the fourth-highest rate of the pandemic. Covid hospital admissions fell somewhat after the summer surge but never dropped to the low levels seen after previous peaks, held up through the autumn and started to pick up again with the winter holidays.
“Hospitals are at capacity,” Brendan Williams, president and CEO of the New Hampshire Health Care Association, said of his region’s current rates. “I’m not sure what the trajectory of this thing is going to be, but I’m concerned.”
The majority of Covid hospitalizations are in those over 65, although the share for children under four roughly doubled in 2022.
Over the past week, Covid deaths have increased by 44%, from 2,705 in the week ending January 4 to 3,907 in the week ending January 11.
This is one of the biggest spikes in Covid cases in the entire pandemic, according to sewage analyzes of the virus. It’s much lower than the January 2022 peak, but similar to the summer 2022 surge, which was the second largest.
And it’s not finished yet. “Certainly it doesn’t seem like we’ve reached the peak yet,” Sehgal said.
According to CDC estimates, the omicron subvariants BQ.1.1 and BQ.1 and the rapidly expanding XBB.1.5 account for the majority of cases. The Northeast, where it is estimated that more than 80% of cases are from subvariant XBB.1.5, has the highest proportion of cases according to sewage data.
“With XBB, there’s such a significant transmission advantage that exposure is really risky — it’s now riskier than ever,” Sehgal said in reference to transmissibility.
Official case numbers have risen more slowly due to the proliferation of home testing and a general reluctance to test, experts say. However, among the tests reported, positivity rates were very high, with about one in six tests (16%) being positive.
Despite Covid’s high rates of spread, hospital admissions have not yet reached the earlier peaks seen early in the pandemic, likely due to immunity to vaccination and previous cases, said Stuart Ray, a professor of medicine and infectious diseases at the Johns Hopkins University School of Medicine .
But those protections shouldn’t be taken for granted, he said, especially as immunity wanes.
“Boosters really make a difference,” he said. “The serious cases we’re seeing are probably at least somewhat preventable if people make sure they stay up to date on vaccinations, because that’s still the surest way to gain immunity.”
Boosters, especially the updated bivalent boosters, are highly 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 fighting 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, that likely killed public enthusiasm for the new booster and spurred further congressional inaction on more funds to fight the pandemic.
“It’s challenging to meet that parallel narrative that you shouldn’t be worried about Covid, you should also get a shot,” Sehgal said, calling the statement “another unforced blunder.”
While vaccines are very important, other precautions also help prevent infection, disease and death, Sehgal said — especially important during such a surge. However, due to the bad news from officials, many people may not even realize that the US is on a rebound and precautions are still needed, he added.
“I think the majority of people who don’t mask up today just don’t know they should.”
Even if the US gets to the point where power surges don’t cause a commensurate increase in hospitalizations and deaths, they will still increase the number of people sickened and disabled by long-Covid, experts said.
“There is accumulating data that repeat Covid increases the risk of short- and long-term complications, including cardiovascular, mental health and other problems,” Ray said. “We will only know in retrospect exactly how high these costs are. But developing data suggests there are additional costs as we accumulate infections.”
Williams is concerned hospitals are reaching their maximum capacity even as long-term care facilities are seeing outbreaks among residents and staff after years of labor shortages.
“In New Hampshire, nursing homes won’t admit those who feel they don’t have staff to care, which I admire, but the result is that hospitals are overwhelmed,” he said. Hospitals that may be releasing patients to nursing facilities for transitional or long-term care will see longer filled beds, adding even more pressure on the hospitals, patients and healthcare workers.
“It’s a continuum, but right now the continuum is broken,” Williams said.
Health workers have experienced burnout, disability and death for three years, and some have had to withdraw from 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 striking for safer working conditions.
Nursing homes and residential care facilities have about 300,000 fewer workers 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 care home residents and staff seeing one of the biggest spikes in cases of the pandemic.
“The first key to keeping people healthy in a nursing home is to keep the people in the community healthy,” Williams said. But “it just doesn’t seem like people are going to wear masks and get boosted – people don’t take any of this seriously. We just seemed to be declaring that when it comes to Covid mortality we are number one and that is a title we will not cede to any other country.”
Sehgal calls it a “collective forgetting” about how and why we need to protect ourselves and each other. “There are people for whom mild infection is actually not that mild, either because of their underlying health or because of social factors in their lives,” he said. “It’s just an enormous self-inflicted wound.”
And as the virus spreads, it has more opportunities to evolve and potentially pick up mutations that make it easier to overcome immunity.
But the same measures that helped contain previous waves are still working today. And they not only prevent illness and death, but also minimize social disruptions such as absenteeism from work and school. “These steps that we can take to protect ourselves and other people – they don’t seem burdensome in the face of Covid infection,” Sehgal said.
As Ray put it, “If we could wear a mask, why don’t we?”