Here’s a view of what’s happening in the Northeast followed by a local update. Courtesy of the New York Times and the San Antonio Report.
A Covid uptick
|Covid outbreaks in elite circles in Washington, D.C., and on Broadway have received a lot of media attention in recent days, but they appear to be only one part of a broader regional rise in infections: States in the Northeast are now reporting an uptick in cases.|
|Last week, this newsletter covered what seemed like a mystery at the time: Covid cases were not broadly rising across the U.S. despite the emergence of the BA.2 subvariant of Omicron. But the Northeast’s continued increase has driven a new round of concerns, with nationwide cases up 10 percent over the past two weeks.|
|What is less clear is whether the regional rise will amount to a much larger Covid surge. “There’s definitely something coming,” William Hanage, an epidemiologist at Harvard, told me. “But depending on all the moving parts it might be a ripple relative to previous waves.”|
|So far, recorded cases are up slightly, standing at about 6 percent of where they were during the peak of the Omicron wave in the Northeast. (More cases are probably going undetected, as more people use at-home tests without reporting them to public health officials.)|
|Hospitalizations are also relatively low in most Northeastern states, and deaths are actually down. Both lag behind cases, typically by weeks. “So it could be too early to see a rise,” Jennifer Nuzzo, an epidemiologist at Brown University, told me.|
|But some experts believe an increase in hospitalizations should have started showing up in at least some places, based on how previous waves played out. “This is something of a head scratcher,” said Robert Wachter, chair of the medicine department at the University of California, San Francisco. “It makes me think that the prior relationship between cases and hospitalizations may not be holding, which would be very good news.”|
|Any wave would have to contend with recently built-up immunity, both from the vaccines and the Omicron surge that infected potentially 45 percent of Americans this winter.|
|Not all regional outbreaks grow into national ones. Around this time last year, the Alpha variant struck hard in Michigan and Minnesota but ultimately fizzled out. Experts still do not really know why — another example of how much we still do not understand about Covid (an issue we have covered in this newsletter).|
|Still, we do know that BA.2 is spreading rapidly, now making up the vast majority of U.S. Covid cases. Experts worry that could lead to a spike, as it has in other parts of the world.|
|Britain and other European countries, which have often been ahead of the U.S. in Covid waves, saw a recent surge in Covid cases, fueled by BA.2. But that increase is receding and did not lead to a sharp rise in deaths in Europe.|
|We do not know what that means for the U.S., which has sometimes seen bigger waves than parts of Europe — but not always. As has been true since the start of the pandemic, a lot of uncertainty surrounds Covid.|
What we do know
|For all of Covid’s unpredictability, we do know some things can help prevent or mitigate another big surge.|
|The first is vaccination. To the extent that built-up immunity is keeping another wave at bay, more vaccine-induced immunity can help. “The most serious consequences will, as ever, be mostly determined by how many people are vaccinated/boosted,” Hanage said in an email.|
|New treatments can help, too. Some are already available: The drug Evusheld can help prevent a Covid infection, particularly for immunocompromised people. And the antiviral medication Paxlovid helps treat infections. (Here’s a guide for where to get it.) More treatments are in the works, such as a drug called sabizabulin aimed at treating critically ill people.|
|Public policy and individual measures, like masking and social distancing, can help, too. Yesterday, Philadelphia announced it was reinstating its indoor mask mandate. Some universities have done so, as well, including American and Georgetown in Washington, D.C., and Columbia in New York City.|
|But in much of the U.S., policymakers and the general public seem less willing than before to take such steps. As Katherine Wu wrote in The Atlantic, America may be looking at its first “so what?” wave — “a surge it cares to neither measure nor respond to.”|
|“I’m guessing we’ll be performing a natural experiment — seeing what happens when a significant uptick in cases doesn’t lead to a significant change in behavior or policies,” Wachter told me.|
The bottom line
|We do not know whether the Northeast’s uptick in cases will translate to a major Covid wave. But there are steps we can all take to help prevent an increase from becoming something bigger.|
BA.2 infections now make up more than half of COVID cases in Bexar County
San Antonio could see a “short-lived” spike in COVID-19 cases due to the BA.2 subvariant of omicron, according to Dr. Bryan Alsip, chief medical officer at University Health.
However, cases and hospitalizations aren’t rising at the rate they were compared to the previous wave, he said.
BA.2, which the World Health Organization classifies as a variant of concern, now makes up an estimated 86% of infections in the U.S., according to data from the Centers for Disease Control and Prevention.
Locally, BA.2 made up 53% of samples sequenced in Bexar County from March 20 through April 4, said Dr. Marjorie David, director of the Molecular Diagnostic Laboratory at UT Health.
That’s up from less than 8% at the beginning of March, according to the lab’s COVID-19 genome sequencing surveillance dashboard.
The lab, within UT Health’s Department of Pathology, is the only one in the county where pathologists perform genome sequencing to determine variants of the coronavirus.
David said it tests 200 samples every two weeks, randomly selected from area hospital and testing sites, including UT Health San Antonio, University Health System, Community Labs, San Antonio Metropolitan Health District and Methodist Hospital.
“We know it’s here and we know it’s spreading,” said Alsip. However, he pointed out, “Our susceptibility to the virus has probably changed.”
The variant, immunity and vaccines all play a part in that change, he said.
Variants’ symptoms present differently as they evolve. BA.2’s symptoms are mild, similar to a cold, he said. Some may experience sore throat or congestion. Other times, there may be a low grade fever or more severe symptoms, such as shortness of breath.
This can be confusing as some experience cold or allergy symptoms, which is similar to what may present in the BA.2 subvariant.
“The good news is we have these rapid tests that you can take at home,” said Alsip. “More people can check and make sure they don’t have COVID, so that they’re responsible for addressing their infection.”
San Antonio was widely impacted by the omicron variant, which drove a surge of cases and hospitalizations. Alsip said this could be an advantage as areas that were significantly impacted by the omicron surge do not seem to be as affected by BA.2.
“The good news is [the vaccine] really does prevent severe illness, and then you add on top of that, there is some natural immunity conferred from previous infection,” said Alsip.
Alsip warned against depending on that immunity, however, as it wanes over time.
Some groups remain at risk, even during low levels of transmission, including the severely immunocompromised and children under the age of 5, who are not yet eligible for vaccines.
According to the Metropolitan Health District’s COVID-19 weekly vaccination report, only 35.7% of the population aged 5 years and over have received a booster dose in Bexar County. That mirrors nationwide booster rates, Alsip said.
Unlike live virus vaccines, such as measles or mumps vaccines, the COVID-19 vaccine is an inactive vaccine that does not host a live virus. For that reason, it doesn’t last as long as other vaccines, Alsip explained, encouraging booster doses of the covid vaccine.
Lack of interest in booster doses could lead to more infections, he warned.
As of April 5, Metro Health is reporting Bexar County’s risk level as low and steady. Cases continue on a mild, two-week decline, and average case rates, positivity rates and hospitalization trends remain low.