Why is the COVID-19 surge kick in kicking in now? The first hint of what is going on in Europe is coming: What is happening in the U.S.?
But COVID-19 restrictions started being lifted last year. So why is the surge kicking in only now? Hensley was concerned that flu and RSV would rebound last year. But the influenza season overall was mild in the Northern Hemisphere. The summer of 2021, when the virus came down, could have helped to slow its spread, because the peak of the disease was lower than in previous years. Factors such as temperature and humidity play a part in transmitting the virus, and that peak “was not [at] a time that was environmentally favourable to RSV”, says Virginia Pitzer, an epidemiologist at the Yale School of Public Health in New Haven, Connecticut.
The first hint of what could be in store is what’s happening in Europe. Infections have been rising in many European countries, including the U.K., France, and Italy.
“In the past, what’s happened in Europe often has been a harbinger for what’s about to happen in the United States,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “So I think the bottom line message for us in this country is: We have to be prepared for what they are beginning to see in Europe.”
“We look around the world and see countries such as Germany and France are seeing increases as we speak,” says Lauren Ancel Meyers, director of the UT COVID-19 Modeling Consortium at the University of Texas at Austin. “That gives me pause. It adds uncertainty about what we can expect in the coming weeks and the coming months.”
However, it’s not certain the U.S. experience will echo Europe’s, says Justin Lessler, an epidemiologist at the University of North Carolina who helps run the COVID-19 Scenario Modeling Hub.
It’s unclear if Europe’s rising cases are related to people’s susceptibility to new subvariants they have not yet been exposed to. In addition, different countries have different levels of immunity.
“If we can get people to get the vaccine, we might be able to prevent some of the increases that happened in the past,” Lessler says. “If it is immune escape across several variants with convergent evolution, the outlook for the U.S. may be more concerning.”
Amy Kirby, national wastewater surveillance program lead at the Centers for Disease Control and Prevention, said “It’s just too early to say something big is happening, but it’s something we’re looking at.”
The Director of the PolicyLab at Children’s Hospital of Philadelphia said that infections are rising in some parts of New England, as well as the Pacific Northwest.
Rubin says that they’re seeing evidence of increased transmission in the northern part of the country. “The winter resurgence is beginning.”
It seems highly unlikely this year’s surge will have the same effect as the last two years in terms of serious disease and deaths thanks to no dramatically different new variant emerging.
“We have a lot more immunity in the population than we did last winter,” says Jennifer Nuzzo, who runs the Pandemic Center at the Brown University School of Public Health.
“Not only have people gotten vaccinated, but a lot of people have now gotten this virus. Some people have gotten it several times. It builds up immunity in people and reduces the risk of a severe illness.
The number of people who get one of the new bivalent o micron boosters to shore up their waning immunity could have an effect on how infections will affect them.
But booster uptake in the U.S. was already sluggish. According to William Hanage, a professor of epidemiology at the Harvard T.H. Chan School of Public Health, almost 50% of people who are eligible have not gotten a booster. “It’s wild. It’s really crazy.”
Demand for the newest boosters has been slow so far. Less than 8 million people have gotten one of the new boosters since they became available over the Labor Day weekend even though more than 200 million are eligible.
Given the likelihood of a surge, it’s critical people up to date on vaccines, says Nuzzo. “The most important thing that we could do is to take off the table that this virus can cause severe illness and death,” she says.
There have been about 26 flu hospitalizations for every 100,000 people – a rate that hasn’t been this high at this point in the season in more than a decade.
CNN analyzed data from the US Department of Health and Human Services and found that hospitals are now more full than they have been during the Covid-19 pandemic.
Cumulative RSV hospitalization rates have already reached levels that are typically not seen until December in the US. They’re rising among all age groups, but especially among children.
Hospitals are full more often with patients with diseases like the Respiratory syncytial virus. Almost three-quarters of children’s hospital beds and half of kids’ intensive care beds are currently used around the country, compared with an average of about twothirds full over the past two years according to data from the US Department of Health and Human Services.
Weekly cases counts are less complete for the most current weeks, but there have been more RSV cases detected by PCR tests each week in October 2022 than any other week in at least the past two years. The weekly case counts were more than double during the week of October 22.
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As of Thursday, about 10% of hospitals are reporting a “critical staff shortage.” More than 85% of hospital beds are filled in eight other states, including Massachusetts, Minnesota, Georgia, Missouri, West Virginia and Oregon.
It’s tough to predict what the new normal might look like for seasonal viruses. If a lot of individuals with immune systems get sick this year, next year’s flu season could be less severe as immunity is paid off. But it’s not yet clear whether COVID-19 will become a seasonal illness such as flu and RSV, or whether it will continue as it has been, with sporadic peaks throughout the year.
Jetelina writes Your Local Epidemiologist a newsletter about infectious disease spread. The high rates of flu-like illness could be an early peak, or an early warning of a monumentally bad season. She says, “How high it will go, and how severe it will be, is unfortunately something we have to wait and see.” “We’re at the mercy of time.”
The term immunity debt was created by researchers in France in August of 2021. On Twitter, the term has taken on a life of its own. Some people have taken it to mean that a lack of exposure to pathogens such as RSV and influenza has irrevocably damaged the immune system, an idea that Matthew Miller, an immunologist at McMaster University in Hamilton, Canada, calls “nonsense”.
Some scientists have also posited on social media that the surge in RSV hospitalizations might be the result of SARS-CoV-2 infection causing immune deficiencies that leave people more susceptible to other infections. Miller doesn’t have any evidence for that either, and the surge in hospitalizations could be related to the large number of people who missed exposures in recent years. “There’s a slightly bigger naive population, all of whom are at risk. So you’ve got more numbers going into the system.”
There is also a lot that researchers still don’t understand about seasonal viruses. For example, COVID-19 restrictions seemed to have little impact on one type of seasonal virus, rhinoviruses — which are the most common cause of colds — for reasons that aren’t entirely understood. Miller thinks that it might be because they are hardy. They can persist in the environment for a long time.
There is a question of how these viruses compete with one another. It’s possible to raise an immune response if you have one virus and another. Hensley points out that last year’s first wave of influenza declined soon after the Omicron surge began. Perhaps Omicron infection provided some short-lived protection against flu. The Omicron surge might have made people mask up and keep their distance.
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The peaks and valleys of the next year might be a lot like those that took place before the epidemic. She isn’t placing any bets. She expects this winter to be the last unusual winter.
At the end of November, 25% of US flu cases had positive tests compared to 8 percent at the same time last year. Respiratory syncytial viruses have pushed some children’s hospitals to capacity. And Covid hospitalizations are rising again. A few seasonal recurring ones and the tripledemic viruses are working together to fuel weeks of coughing, wheose noses, and fevers. If your kids, your coworkers, and everyone you know have been sick, that is why.
In a letter to the nation’s governors last week, HHS Secretary Xavier Becerra noted that flu and other respiratory viruses are “increasing strain” on the country’s health care systems. Becerra wrote that the Biden administration “stands ready to continue assisting you with resources, supplies, and personnel” – but he stopped short of making a formal emergency declaration, as requested by children’s health leaders last month.
Pediatric hospital beds also have been more full than usual for months. About 76% of pediatric hospital beds are in use, up from an average of about two-thirds full in recent years.
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“Workforce shortages have not only made it more challenging for hospitals, but also have diminished the number of patients who can be cared for in nursing homes and other post acute care settings,” the statement said. “Thus, patients are spending more time in hospitals, awaiting discharge to the next level of care and limiting our ability to make a bed available to a patient who truly needs to be hospitalized.”