It May Be Time to Pay Attention to COVID Again

More than 3 years into the COVID-19 era, most Americans have settled back into their pre-pandemic lifestyles. But a new dominant variant and rising hospitalization numbers may give way to another summer surge.

Since April, a new COVID variant has cropped up. According to recent CDC data, EG.5 — from the Omicron family — now makes up 17% of all cases in the U.S., up from 7.5% in the first week of July.

A summary from the Center for Infectious Disease Research and Policy at the University of Minnesota says that EG.5, nicknamed “Eris” by health trackers, is nearly the same as its parent strain, XBB.1.9.2, but has one extra spike mutation.

Along with the news of EG.5’s growing prevalence, COVID-related hospitalization rates have increased by 12.5% in the last week — the most significant uptick since December. Still, no connection has been made between the new variant and rising hospital admissions. And so far, experts have found no difference in the severity of illness or symptoms between Eris and the strains that came before it.

Cause for Concern?

The COVID virus has a great tendency to mutate, says William Schaffner, MD, a professor of infectious diseases at Vanderbilt University in Nashville.

“Fortunately, these are relatively minor mutations.” Even so, SARS-CoV-2, the virus that causes COVID-19, continues to be highly contagious. “There isn’t any doubt that it’s spreading — but it’s not more serious.”

So, Schaffner doesn’t think it’s time to panic. He prefers calling it an “uptick” in cases instead of a “surge,” because a surge “sounds too big.”

While the numbers are still low compared to last year’s summer surge, experts still urge people to stay aware of changes in the virus. “I do not think that there is any cause for alarm,” agreed Bernard Camins, MD, an infectious disease specialist at Mount Sinai Hospital in New York City.

So why the higher number of cases? “There has been an increase in COVID cases this summer, probably related to travel, socializing, and dwindling masking,” said Anne Liu, MD, an allergy, immunology, and infectious disease specialist at Stanford University. Even so, she said, “because of an existing level of immunity from vaccination and prior infections, it has been limited and case severity has been lower than in prior surges.”

What the Official Numbers Say

The CDC no longer updates its COVID Data Tracker Weekly Review. They stopped in May 2023 when the federal public health emergency ended.

But the agency continues to track COVID-19 cases, hospitalizations, emergency department visits, and deaths in different ways. The key takeaways as of this week include 9,056 new hospitalizations reported for the week ending July 29, 2023. That is relatively low, compared to July 30, 2022, when the weekly new hospitalization numbers topped 44,000.

“Last year, we saw a summer wave with cases peaking around mid-July. In that sense, our summer wave is coming a bit later than last year,” said Pavitra Roychoudhury, PhD, an assistant professor and researcher at the University of Washington School of Medicine’s Vaccine and Infectious Disease Division.

“It’s unclear how high the peak will be during this current wave. Levels of SARS-CoV-2 in wastewater, as well as the number of hospitalizations, are currently lower than this time last year.”

For part of the pandemic, the CDC recommended people monitor COVID numbers in their own communities. But the agency’s local guidance on COVID is tied to hospital admission levels, which are currently low for more than 99% of the country, even if they are increasing.

So, while it’s good news that hospitalization numbers are smaller, it means the agency’s ability to identify local outbreaks or hot spots of SARS-CoV-2 is now more limited.

It’s not just an uptick in hospitalizations nationwide, as other COVID-19 indicators, including emergency room visits, positive tests, and wastewater levels, are increasing across the United States.

In terms of other metrics:

• On June 19, 0.47% of ER visits resulted in a positive COVID diagnosis. On Aug. 4, that rate had more than doubled to 1.1%.
• On July 29, 8.9% of people who took a COVID test reported a positive result. The positivity rate has been increasing since June 10, when 4.1% of tests came back positive. This figure only includes test results reported to the CDC. Results of home testing remain largely unknown.
• The weekly percentage of deaths related to COVID-19 was 1% as of July 29. That’s low, compared to previous rates. For example, for the week ending July 30, 2022, it was 5.8%.

What About New COVID Vaccines?

As long as you continue to make informed decisions and get the new Omicron vaccine or booster once it’s available, experts predict lower hospitalization rates this winter.

“Everyone should get the Omicron booster when it becomes available,” recommended Dean Winslow, MD, a professor of medicine at Stanford University in California.

In the meantime, “It is important to emphasize that COVID-19 is going to be with us for the foreseeable future,” he said. Since the symptoms linked to these newer Omicron subvariants are generally milder than with earlier variants, “if one has even mild cold symptoms, it is a good idea to test yourself for COVID-19 and start treatment early if one is elderly or otherwise at high risk for severe disease.”

Schaffner remains optimistic for now. “We anticipate that the vaccines we currently have available, and certainly the vaccine that is being developed for this fall, will continue to prevent severe disease associated with this virus.”

Although it’s difficult to predict an exact timeline, Schaffner said they could be available by the end of September.

His predictions assume “that we don’t have a new nasty variant that crops up somewhere in the world,” he said. “[If] things continue to move the way they have been, we anticipate that this vaccine…will be really effective and help us keep out of the hospital during this winter, when we expect more of an increase of COVID once again.”

Asked for his outlook on vaccine recommendations, Camins was less certain. “It is too soon to tell.” Guidance on COVID shots will be based on results of ongoing studies, he said. “It would be prudent, however, for everyone to plan on getting the flu shot in September.”

Stay Alert and Stay Realistic

Cautious optimism and a call to remain vigilant seem like the consensus at the moment. While the numbers remain low so far and the uptick in new cases and hospitalizations are relatively small, compared to past scenarios, “It makes sense to boost our anti-Omicron antibody levels with immunizations before fall and winter,” Liu said.

“It’s just advisable for everyone — especially those who are at higher risk for hospitalization or death — to be aware,” Camins said, “so they can form their own decisions to participate in activities that may put them at risk for contracting COVID-19.”

We have to remind ourselves that whether they’re for the flu, COVID, or even RSV, these respiratory virus vaccines work best at keeping us out of the hospital. They’re not as good at preventing milder infections.

Schaffner said, “So if we don’t expect perfection, we won’t be so disappointed.”

Sources:

CDC: “Monitoring Variant Proportions anchor link,” “United States COVID-19 Hospitalizations, Deaths, Emergency Department (ED) Visits, and Test Positivity by Geographic Area.”

Center for Infectious Disease Research and Policy: “WHO adds Omicron EG.5 to variant monitoring as global COVID markers decline further.”

William Schaffner, MD, professor of infectious diseases, Vanderbilt University, Nashville.

Bernard Camins, MD, infectious disease specialist, Mount Sinai Hospital, New York City.

Anne Liu, MD, clinical associate professor, Department of Medicine, Division of Infectious Diseases, Stanford University, Palo Alto, CA.

Pavitra Roychoudhury, PhD, assistant professor, researcher, Vaccine and Infectious Disease Division, School of Medicine, University of Washington, Seattle.

Dean Winslow, MD, professor of medicine, Stanford University, Palo Alto, CA.