The holidays in the northern hemisphere are over and, once again, North Americans are facing a wave of respiratory illnesses, including Covid-19. But so far this winter’s disease surge appears less deadly than last year, and much smaller than in 2022, when the omicron variant outbreak paralyzed the country.
“We’re not seeing signs that make me think we’re headed for another severe wave,” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “So far, we are in relatively good shape.”
Still, there are few masks in sight, and only a fraction of the most vulnerable people have received the latest Covid vaccines, she noted.
“It’s not too late,” Rivers added. “We haven’t reached the peak of Covid yet, and when you reach the peak, you still have to come down the other side.” This leaves plenty of time for the vaccine to provide some protection.
Federal authorities are relying on limited data to measure the spread this year. After the public health emergency ended in May, the Centers for Disease Control and Prevention (CDC) stopped monitoring the number of Covid infections. The agency now has only partial access to information from states on vaccination rates.
But trends in wastewater data, positive tests, emergency room visits, hospitalization rates and deaths point to rising infections in every region of the United States, according to the CDC. These standards have led many hospitals to reinstate the use of masks, after initially resisting a return to them this fall.
As in previous years, numbers have been steadily increasing during the winter and are expected to grow even more following holiday travel and gatherings. Many infections are caused by a new variant, JN.1, which has spread rapidly around the world in recent weeks.
“I think there’s no doubt that it’s helping to drive, in a pretty substantial way, this winter surge,” said Katelyn Jetelina, a public health expert and author of a widely read newsletter, “Your Local Epidemiologist.” “Unfortunately, this is coming at the same time as we’re expanding our social contacts due to the holidays,” she said, “so there’s kind of a perfect storm going on.”
Some scientists have pointed to rising levels of the virus in sewage samples as an indicator that infections are at least as high this year as they were this time last year. But Rivers urged caution in interpreting wastewater data as an indicator of infections and said hospitalizations are a more reliable metric.
In the week ending December 23, hospitalizations increased by almost 17% compared to the previous week. There were about 29,000 new hospital admissions, compared with 39,000 in the same week last year and 61,000 in 2021. And weekly hospitalizations are increasing more slowly than in previous years, Rivers said.
Covid is still claiming at least 1,200 lives a week. But this number is about a third of the number of victims recorded last year and an eighth of that recorded in 2021.
“We have a huge increase in infections right now, but what’s really interesting is how hospitalizations have decoupled and continue to decouple from infections,” Jetelina said.
She said she worries more about hospitals buckling under the weight of multiple Pandemics at once. Even in the years before the pandemic, outbreaks of just the flu and respiratory syncytial virus could overwhelm hospitals; rising rates of Covid now overlap both diseases, increasing the burden.
The JN.1 variant is responsible for nearly half of all Covid cases in the United States, nearly six times the prevalence just a month ago. The variant has a mutation that gives it a greater ability to evade immunity than its progenitor, BA.2.86, whose spread has been limited.
JN.1 may, in fact, be less transmissible than previous variants. But its immune evasion, along with the disappearance of preventive measures including masks, may explain its exponential growth around the world, said Dr. Abraar Karan, an infectious disease doctor and postdoctoral researcher at Stanford University.
Still, JN.1 does not appear to cause more severe illness than previous variants, and current vaccines, tests and treatments work well against all current variants.
Experts have urged all Americans — including those not at high risk for severe illness — to get Covid and flu vaccines, wear masks and air purifiers to prevent infections, get tested and treated, and stay home. if they get sick.
Even those who don’t become seriously ill are at risk of long-term complications with each new viral infection, the researchers noted.
“To be honest, I’m not at high risk — I’m young and I’m vaccinated,” Rivers said. “But I continue to take precautions in my personal life because I don’t want to deal with this disruption and the risk of developing a long-term illness.”
But few Americans are following that advice. As of December 23, only 19% of adults had received their last Covid vaccine and around 44% had opted for the annual flu vaccine. Just over 17% of adults aged 60 and over have received the RSV vaccine.
Even among those 75 and older, who are most at risk of contracting Covid, only about one in three has received the last dose, according to the CDC.
Many people don’t realize that vaccines are available that protect against the newer variants, or that they should get vaccinated even if they aren’t at high risk, said Gigi Gronvall, a biosafety expert at the Johns Hopkins Center for Health Security.
Even though the Covid vaccine does not prevent infection, it can shorten the duration and severity of the illness and minimize the risk of long-term symptoms such as mental confusion, fatigue, movement problems and dizziness – collectively known as long Covid.
“I’m sure there are also a lot of people who are actively against the idea, but most people I meet simply don’t even know about it,” Gronvall said.
Low availability of vaccines, especially for children and older adults, has also limited vaccination rates.
Gronvall struggled to find a Covid vaccine for her teenage son. Jetelina has yet to find any for her young children. She said her grandparents, both in their 90s, also went through “incredibly challenging times.”
One of them is in a nursing home and has not yet been immunized because he was sick on the day the vaccines were administered.
Many nursing home residents and staff remain unvaccinated because staff do not understand the benefits, said Karan, who has worked in nursing facilities in Los Angeles County.
Financial incentives can improve vaccine coverage, but a lack of awareness about the benefits “is a big problem,” he said.
Experts also recommend that people who develop symptoms get tested and ask for antiviral medications — Tamiflu for flu, Paxlovid for Covid — especially if they are at high risk of complications.
Paxlovid is still available free to most people, but many patients and even doctors avoid it because they believe – wrongly – that it causes Covid symptoms to return, experts said. Recent studies have found no relationship between antiviral medications and the reappearance of symptoms.