A fall covid surge is possible, but unlikely to be as severe

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The cold favors the coronavirus. But as summer gives way to fall, infectious disease experts are cautiously optimistic that the spread of covid-19 this fall and winter will not be as brutal as in the previous two years of the pandemic. .

Coronavirus scenarios from several research teams, shared in recent weeks with federal officials, predict flat or declining hospitalizations in early fall. Scenarios show the possibility of a surge in late fall. A new variant remains the biggest joker. But several factors — including this week’s approval of reworded reminders and boosting immunity to the latest strain of the virus — could suppress some of the cold-season spread, experts say.

“There’s kind of an even chance that we’ll have some sort of moderate resurgence in the fall. But nothing seems to project anything like an omicron wave,” said Justin Lessler, a University of North Carolina epidemiologist who is helping lead the collection of covid-19 planning scenarios from a group of agencies. of research.

The scenarios assume that the reformulated vaccine boosters will be adopted by the public at a rate similar to that of the annual flu shots – perhaps an optimistic assumption given that more than half of Americans eligible for the boosters have not yet received their first dose.

Peter Marks, the Food and Drug Administration’s top vaccine official, said in a briefing on Wednesday that the approval of the reworded boosters comes as the agency “considers a possible fall surge, peaking around December 1.”

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Pandemic predictions rarely age well. In the United States, the pandemic seemed to run out of steam in May 2021 amid a vigorous vaccination campaign, only to pick up again with the rise of new variants.

The emergence of a new variant in September could lead to a surge of infections and severe illness in December, according to Lauren Ancel Meyers, director of the University of Texas Covid-19 Modeling Consortium. A variant emerging in October would push the peak back into January, she said.

Any new variant that could change the trajectory of the pandemic should be more transmissible than the omicron BA.5 subvariant currently in circulation. It could emerge from an obscure branch of the virus family tree – that’s exactly what happened last November, when omicron, with its astonishing set of mutations, appeared in southern Africa and immediately overtook the reigning delta strain.

Vaccines remain highly effective in reducing the death rate from infection and keeping people out of hospitals, and the Biden administration continues to rely heavily on vaccination and hardening as the most powerful weapon. against the virus. Anthony S. Fauci, the president’s chief medical adviser on the pandemic, told the Washington Post that the fall campaign against the virus will require widespread use of booster shots.

“We are not going to eradicate it. We are not going to eliminate it,” Fauci said. “But we have the ability to bring it down to a low enough level that it doesn’t continue to disrupt social order.”

The federal government, meanwhile, is handing over much of the fight against the virus to the private sector. From Friday, the government would no longer send free coronavirus tests to the public. The plan is to shift payment for treatment to insurers, drug benefit managers, hospitals and patients themselves by the middle of next year. Updated boosters have already been purchased by the federal government and will be remain free for consumers.

But so far, recall uptake has been disappointing. Of the 62 million people over 50 eligible for a second booster, only 22 million have received it to date, according to CDC data. Of the 95 million people between the ages of 18 and 49 eligible for their first reminder, only 38 million benefited from it.

Some may be waiting for the reformulated vaccine before rolling up their sleeves. But covid apprehension isn’t what it used to be, and many may think that a few injections are enough.

Additionally, some people may need help accessing an additional vaccine, Brown University epidemiologist Jennifer Nuzzo said. She would like to see stronger messages from the government to encourage vaccination.

“The most important thing we can do — top, top, top of my list — is to make sure everyone at high risk is up to date on their vaccinations,” she said.

The CDC is reporting about 82,000 new covid cases per day, on average, though the true number of infections is thought to be several times higher because so many people are testing themselves at home. The most reliable number is for hospitalizations, currently around 30,000 patients, according to the CDC. Both numbers are trending lower, as is the death toll — a daily average of 387, according to the CDC. (The average number of daily deaths peaked at more than 3,300 in January 2021, as the virus spread through a mostly unvaccinated population, and topped 2,600 a day the following winter amid the omicron wave.)

If no new coronavirus variants emerge, the numbers should remain stable or decrease until the new year, the report of The Lessler Prediction Group states.

The most pessimistic scenario is that a new variant will appear and the recall campaign will be delayed, resulting in 1.3 million hospitalizations and 181,000 deaths projected over a period of nine months (August 2022 to May 2023), against 700,000 hospitalizations and 111,000 deaths in the most optimistic scenario, with no new variant and early start of the recall campaign.

Dylan George, director of operations at the CDC’s newly established Center for Epidemic Prediction and Analysis, compares disease modeling to weather forecasting. The agency looks at many models, incorporating many variables to create a wide range of plausible scenarios. Right now, he said, the CDC thinks the BA.5 subvariant is peaking in most of the country.

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Behavior is another variable in the equation. Precautions have been largely relaxed for much of the country. Many companies require workers to report to the office, but no longer require vaccinations or provide regular coronavirus testing. Schools have dropped mask mandates.

“People don’t wear masks,” George said. “People run in large groups. People travel more. Schools don’t have any sort of mitigation. Will this impact also spread more significantly? »

Waves of infection are to some extent self-limiting. The virus “burns all the susceptible”, as George said, lose momentum. But time passes and immunity decreases. Vaccine immunity to infection appears to drop significantly within months, even as protection against severe disease continues.

Another complication is the presence of other viruses in circulation, including influenza, which also has a seasonal signature in cold weather.

“There are all kinds of respiratory issues, especially as the school season approaches,” George said. “How is the flu going to play out now that we are all coming together? … We have always worried about the “double epidemic”. ”

Fauci noted that, following a cascade of new subvariants earlier this year, the BA.5 omicron subvariant and the nearly identical BA.4 were not challenged by a new strain this summer. Immunity against BA.5 and BA.4 has gradually built up in the population as people become infected and then recover. This immunity should get a significant boost thanks to the new boosters that have been designed to fight not only the original strain of the virus, but also BA.5/BA.4.

“I don’t think it will be a major increase if he stays BA.5,” Fauci said of the hypothetical wave of case drops.

Amid a broader return to normal behavior, there remains a large contingent of people who are cautious – aware that hundreds of people a day are still dying from the virus – and continue to wear masks indoors or limit contact with others.

Millions of people are currently living “long covid” health crisis, an array of post-infectious symptoms that include severe fatigue and brain fog. It is a slippery disease to diagnose conclusively as many symptoms could signal a long covid or different illness. A CDC report said 1 in 5 infected people develop long covid.

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Marks, the FDA official, said he routinely fielded calls from people in their 20s and 30s with long-lasting covid symptoms, and said the disease posed a serious public health challenge. “Brain fog, in some cases, mood changes – people who were very bright and happy, now are anxious and depressed – these things seem to be very real,” he said.

Some patients have been struggling with long covid for more than two years and have not been able to return to work or resume their pre-pandemic lifestyle.

“Some are young, healthy, athletic, and they can’t even go back to work,” said Akiko Iwasaki, an immunologist at Yale University School of Medicine. “People should know the risk before they take off the mask and stop getting their reminders.”

Evidence indicates the virus is settling into a seasonal pattern, said Columbia University epidemiologist Jeff Shaman. Viral transmission is enhanced by the low humidity of the indoor environment during winter as well as the decline in sunlight and its sterilizing ultraviolet radiation, Shaman said.

He fears the virus will continue to sicken and kill people at higher rates than seasonal flu, which according to CDC data claimed between 12,000 and 52,000 lives a year between 2010 and 2020. If covid mortality continues at the same rate as over the past five months, this would amount to around 120,000 deaths per year, Shaman calculated. If this is the new normal, sobering, he said.

Infectious disease experts don’t want to tempt fate with a sunny forecast. The coronavirus continues to adapt to people as it mutates randomly, and natural selection favors the most immunocompromised strains.

“My prediction is you can’t really predict,” Fauci said. “It’s such an unpredictable virus in the sense that we’ve been duped before, and we’ll likely continue to be duped.”


Washington

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