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No COVID bump so far this winter?

It made great sense to get vaccinated during the early, more lethal, stages of the pandemic.

Should everyone continue to get boosted now? Perhaps. Data shows that the chance of having future respiratory issues after contracting COVID is not insignificant. How does that compare with the chances of having vaccine-related heart issues? That's a tough one. Recent Rasmussen polling shows that almost half of Americans are concerned about the latter risk. Sadly there's no good data in this country. Most of the studies on such are coming out of Germany and Israel.

My take? Hey, I'm no doctor, I just play one on TV. As I was saying, if you're in a at-risk cohort, getting boosted still likely makes sense. If your a 5-year-old, where the chances of serious COVID issues are practically zero? Tougher call?

January 17, 2023

By German Lopez, WSJ

Recent winters have brought the worst of Covid, but this season has not so far.

Covid testing in Salt Lake City last month.Rick Bowmer/Associated Press

A bump, not a surge

Some of the worst days of Covid in the U.S. have come as winters have settled in, and surges led hospitals to overflow and caused hundreds of thousands of deaths.

A comparable surge has yet to materialize on a similar timeline this winter. By now, hospitalizations in particular would have started to sharply rise. Instead, data suggests that more of a Covid bump than a surge has emerged. Recent hospitalization figures are much lower than the past, largest surges, as this chart by my colleague Ashley Wu demonstrates:

There is some geographic variation. Covid hospitalizations have risen more quickly in the Northeast and South in recent weeks, potentially driven by a new Omicron subvariant. But even there, hospitalization levels are closer to the summer increase caused by the Delta variant in 2021 than to the following winter surge caused by the Omicron variant.

Some Western states are reporting among their lowest hospitalization rates since the pandemic began.

After years of winter surges, the absence of one translates to potentially tens of thousands fewer deaths and is worth celebrating, even if it ends up being a temporary reprieve. Today’s newsletter will look at the lack of a winter surge so far and what that means for Covid’s future.

Population immunity

Why have we avoided the typical winter surge? Because the U.S. population has, collectively, built up immunity to the virus. Much of that is thanks to vaccines and boosters. But repeated exposure to the virus and infections have played a significant role, too.

Anecdotally, experts and others still report a lot of sickness around them — but not hospitalizations or deaths. This is the outcome you would expect to see with Covid in a population with higher levels of immunity: Vaccines and past infection seem to offer strong protection from the worst outcomes of the virus, but they don’t fully prevent infection and milder disease.

“What you’re seeing is a transition to ongoing transmission but much milder infections,” said Dr. Céline Gounder, a senior fellow at the Kaiser Family Foundation.

People’s actions may have suppressed a winter surge, too. In the fall, experts and news outlets warned of a possible simultaneous surge of Covid, flu and R.S.V. Some Americans may have responded by behaving more cautiously — for example, by wearing masks in public and avoiding larger gatherings. But those behavior changes are not widespread, certainly not to the levels of 2020.

An important caveat to all of this: The data is messy. Covid case totals in particular are unreliable because fewer people are testing and reporting results.

Even the counts for hospitalizations and deaths are less accurate than they once were. For example, someone may show up to the hospital for an issue unrelated to Covid, test positive for the virus and get marked down as a Covid hospitalization. Massachusetts officials estimate that only about one-third of people hospitalized with Covid are actually there for Covid-related illness.

But that phenomenon indicates that Covid hospitalizations are overcounted, which would mean that, if anything, the data overstates the size of the current bump.

It amounts to a victory for public health: Vaccines have managed to tame Covid, relative to 2020 and 2021.

Future risks

The good news does not mean that Covid is now a concern of the past.

Older and immunocompromised people are still at significant risk. More than 90 percent of deaths are now among Americans 65 and older. Hospitalizations are nearly five times higher among Americans 70 and older than among Americans of all ages.

If public health interventions helped tame Covid this winter, then relaxing too much could lead to a surge. But experts aren’t envisioning a return to 2020-style lockdowns or constant masking and testing.

Their recommendations are less demanding: Get boosters, isolate when sick and mask in indoor public spaces if the virus is quickly spreading. And medications like Paxlovid should be available for those who are sick. (They aren’t currently available enough because doctors are still too reluctant to prescribe Paxlovid, especially to older patients, experts warned. I’ll write about that issue in a future newsletter.)

“We’ve made progress. We are getting ahead of this. People know what to do,” said Saskia Popescu, an epidemiologist at George Mason University. “But it worries me, because people also use that progress as an excuse to not be as vigilant and not take it so seriously.”

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