A year after the omicron began its assault on humanity, the ever-changing mutant coronavirus has caused a surge in cases of COVID-19 in many places, just as Americans have gathered for Thanksgiving. It was the prelude to a wave that experts expect will soon sweep the US
Dr. Nicholas Vazquez, a Phoenix-area emergency physician, said his hospital has seen critically ill patients and nursing home residents with severe COVID-19 this month.
“It’s been a long time since we’ve had to have COVID wards,” he said. “It makes an obvious comeback.”
Nationally, new COVID cases averaged about 39,300 a day as of Tuesday, far lower than last winter, but a significant undercount due to reduced testing and reporting. About 28,000 people were hospitalized with COVID-19 per day, and about 340 died.
Cases and deaths increased two weeks ago. However, one-fifth of the US population has not been vaccinated, most Americans have not received the latest boosters, and many have stopped wearing masks.
Meanwhile, the virus continues to find ways to avoid defeat.
The Omicron variant arrived in the US just after Thanksgiving last year and caused the largest wave of outbreaks. Since then, it has given rise to a large extended family of subtypes, such as the most common in the US now: BQ.1, BQ.1.1, and BA.5. They outperformed the competition by getting better at avoiding vaccines and immunity from previous diseases and sickening millions of people.
Kerry Johnson’s family received two blows. He contracted COVID-19 during the first omicron wave in January, suffering flu-like symptoms and excruciating pain that kept him up for a week. His son, Fabian Swain, 16, had much milder symptoms in September when the BA.5 variant was dominant.
Fabian recovered quickly, but Johnson had headaches for weeks. Other problems took longer.
“I was saying: “I can’t get it together.” I couldn’t get my thoughts together. I couldn’t get my energy back,” said Johnson, 42, of Germantown, Maryland. “And it went on like that for months.”
Some communities are particularly hard hit right now. Tracking by the Mayo Clinic shows cases rising in states like Florida, Arizona, Colorado and New Mexico.
In Navajo County, Arizona, the average daily case rate is more than double the state average. Dr. James McAuley said 25 to 50 people a day are testing positive for the coronavirus at the Indian Health Service facility where he works. Before, they only saw a few cases a day.
McAuley, clinical director of the Whiteriver Indian Hospital, which serves the White Mountain Apache tribe, said they are “basically back to where we were at our last big peak” in February.
COVID-19 is part of a triple threat that also includes the flu and a virus known as RSV.
B. Dr. Greg Martin, past president of the Society of Critical Care Medicine, sees a similar trend elsewhere.
Emergency departments and urgent care clinics at children’s hospitals are busier than ever, said Martin, who works primarily at Grady Memorial Hospital in Atlanta. “This is a record compared to any month, any week, any day in the past,” he said.
Looking ahead, experts see the seeds of a U.S.-wide wave. They point to what’s happening internationally: an increase in BA.5 in Japan, a combination of options driving cases in South Korea, the start of a new wave in Norway.
Some experts say the wave in the US could start during the holidays, when people gather indoors. Trevor Bedford, a biologist and genetics expert at the Fred Hutchinson Cancer Research Center, said it could reach about 150,000 new cases a day, about what the nation saw in July.
The new wave will be rough, said Dr. Mark Griffiths, medical director of the emergency department at Children’s Healthcare of Atlanta-Spalding Hospital. “So many systems are just on the brink of being completely overwhelmed that if we get another spike in COVID on top of this, it’s going to crash some systems.”
One bright spot. Death rates are likely to be much lower than in earlier pandemics. About 1 in 2,000 infections now result in death, Bedford said, compared with 1 in 200 in the first half of 2020.
The same widespread immunity that reduced deaths also drove the coronavirus to mutate. Late last year, many people were infected, vaccinated, or both. That “created the initial spread of omicron,” Bedford said, because the virus had evolved significantly in its ability to evade existing immunity.
Omicron flourished. Mara Aspinall, who teaches biomedical diagnostics at Arizona State University, noted that the first omicron strain represented 7.5% of circulating variants by mid-December, and 80% just two weeks later. US cases at one point reached a million a day. Omicron generally caused less severe disease than previous versions, but hospitalizations and deaths increased due to the sheer number of people infected.
The giant wave died down in mid-April. The virus quickly mutated into a series of subtypes adept at evading immunity. A recent study in the journal Science Immunology says this ability to evade antibodies is due to more than 30 changes in the protein that coats the surface of the virus.
Bedford says Omicron has evolved so much in a year, it’s now “a meaningless term.”
That rapid mutation is likely to continue.
“There’s a lot more pressure for the virus to diversify,” said Shishi Luo, head of infectious diseases for Helix, a company that provides virus sequence information to the US Centers for Disease Control and Prevention.
Doctors said the best protection against subspecies bubbling stew remains vaccination. And officials said Americans who received a new combination booster that targets the omicron and the original coronavirus are currently better protected than others from symptomatic infection.
Dr. Peter Hotez, co-director of the Vaccine Development Center at Texas Children’s Hospital, said getting a booster, if you’re eligible, is “the most impactful thing you can do.”
Doctors are also urging people to continue testing, adhere to preventive measures such as wearing a mask in crowds and staying home when sick.
“Covid is still a very significant threat, especially for the most vulnerable,” said Dr. Laolu Faianju of Oak Street Health in Cleveland, which specializes in geriatric care. “People should continue to think of each other. We are not completely out of this yet.”
Associated Press writer Heather Hollingsworth contributed from the Kansas Mission.
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