Covid-19, and Omicron, is coming: How much do Europeans need now that their vaccinations are available and that their immunity is compromised?
A new Covid-19 wave is likely to be sprung in Europe as cooler weather arrives, with public health experts warning that vaccine fatigue and confusion over types of shots will likely limit booster usage.
The population landscape for a variant to emerge in is different now that lots of people have been boosted and vaccine-munished and people have immunity from an Omicron infection. There are a number of signs that indicate the best part of the scenario is not seeing massive increases in cases.
WHO data released late on Wednesday showed that cases in the European Union reached 1.5 million last week, up 8% from the prior week, despite a dramatic fall in testing. Case numbers continue to decline around the world.
In the week ending October 4, Covid-19 hospital admissions with symptoms jumped nearly 32% in Italy, while intensive care admissions rose about 21%, compared to the week before, according to data compiled by independent scientific foundation Gimbe.
The BQ subvariants of Omicron have risen to dominate transmission in the US. BQ.1 and its offshoot BQ.1.1 are descendants of BA.5; they have five and six key mutations, respectively, in their spike proteins that help them evade immunity created by vaccines and infections. Because of these changes, they’re growing more quickly than BA.5 did.
European and British officials have endorsed the latest boosters only for a select groups of people, including the elderly and those with compromised immune systems. Public health experts believe that the choice of vaccine as a booster will likely add to confusion.
“For those who may be less concerned about their risk, the messaging that it is all over coupled with the lack of any major publicity campaign is likely to reduce uptake,” said Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. I think that it’s going to be a bit lower.
Some scientists believe that the rise in RSV hospitalizations could be a result of the emergence of the coronaviruses, which can leave people more susceptible to other infections. But Miller says hasn’t seen any evidence for that either, and the surge in hospitalizations could be explained by the large number of people who missed exposures in the past few years. “There’s a slightly bigger naive population, all of whom are at risk. So you’ve got more numbers going into the system.”
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However, weekly vaccine doses administered in the EU were only between 1 million and 1.4 million during September, compared with 6-10 million per week during the year-earlier period, ECDC data showed.
“There must be some complacency in that life seems to have gone back to normal – at least with regards Covid and people now have other financial and war-related worries,” said Adam Finn, chair of ETAGE, an expert group advising the WHO on vaccine preventable diseases in Europe.
The Italian Gimbe foundation said the government was ill prepared for the fall and winter seasons and that the publication on the government’s management of the Pandemic had been blocked.
Meanwhile, British officials last week warned that renewed circulation of flu and a resurgence in Covid-19 could pile pressure on the already stretched National Health Service.
For Americans across the country preparing to gather and socialize with family and friends during the end-of-year holiday season, the White House has a clear warning: Covid-19 is not over, and you had better protect yourself.
The first thing that can be seen is what’s happening in Europe. Infections have been rising in many European countries, including the U.K., France, and Italy.
“In the past, what’s happened in Europe often has been a harbinger for what’s about to happen in the United States,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “So I think the bottom line message for us in this country is: We have to be prepared for what they are beginning to see in Europe.”
Lauren Ancel Meyers, director of the UT COVID-19 Modeling Consortium at the University of Texas at Austin says that countries such as Germany and France are seeing increases as we speak. That gives me pause. It adds uncertainty about what we can expect over the next few months.
It’s not certain if the US experience will mirror Europe’s, says a North Carolina epidemiologist who is part of the COVID-19 Scenario Modeling Hub.
That’s because it’s not clear whether Europe’s rising cases are related to people’s greater susceptibility to new subvariants they’ve not yet been exposed to. In addition, different countries have different levels of immunity.
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“We’re keeping an eye on things, but it’s too early to say that something major is happening”, says Amy Kirby, lead at the Centers for Disease Control and Prevention.
“We’re seeing the northern rim of the country beginning to show some evidence of increasing transmission,” Rubin says. The winter is beginning.
He does not believe the rise in cases that will peak around the second week of January will have a big effect on hospitalizations and deaths.
“We have a lot more immunity than we did last winter,” says Nuzzo, who runs the Pandemic Center at the Brown University School of Public Health.
A lot of people have now gotten this virus and have gotten the vaccine. Some people have gotten it more than once. And that does build up [immunity] in the population and reduce overall over risk of severe illness,” Nuzzo says.
Another crucial variable that could affect how the impact of a rise of infections is how many people get one of the new bivalent omicron boosters to shore up their waning immunity.
booster adoption in the U.S. was slow. According to William Hanage, associate professor of epidemiology at the Harvard T.H. Chan School of Public Health, almost half of eligible people don’t get a booster. It’s crazy. It’s really crazy.”
The demand for the newest boosters is not very high at this point. Since the new boosters became available over the Labor Day weekend, less than 8 million people have gotten one, even though 200 million are eligible.
Given the likelihood of a surge, it’s critical people up to date on vaccines, says Nuzzo. “The most important thing that we could do is to take off the table that this virus can cause severe illness and death,” she says.
In August, health care providers and hospitals were warned by the CDC of an increase in hospitalizations for patients with respiratory illnesses that tested positive for both rhinovirus and enteroviruses.
There is still a lot that researchers do not understand about seasonal viruses. rhinoviruses, the most common cause of colds, seems to have no effect on COvid-19 restrictions for reasons that are not fully understood. Miller says that it might be due to their hardy nature. They’re less prone to desiccation and can persist for longer in the environment.
25% of those who have been tested positive have had rates higher than that. That is quite unusual for October, we would typically start to see higher rates in November, December and January,” said Dr. Ibukun Kalu, a specialist in pediatric infectious diseases at Duke Children’s Hospital in Durham, North Carolina.
Parents should be vigilant when treating RSV patients, as well as in the emergency room, with implications for their health care systems and for pediatric patients
It has made it more challenging for hospitals due to work shortages, but also diminished the number of patients that can be looked after in nursing homes and other post acute care settings. Patients are spending more time in hospitals, waiting to be discharged to the next level of care and limiting the ability to make a bed available for someone who really needs to be hospitalized.
In the advisory, hospitals were guided to keep heightened awareness for these more severe infections when treating pediatric patients, and parents were instructed to keep an eye out for specific symptoms, like difficulty breathing and the sudden onset of limb weakness.
“It is good for you to contact your provider and talk through symptoms,” she said. If a child has breathing problems, is throwing up, and can’t eat or drink, it’s important to check them out to see if they need oxygen or if they need help.
While RSV mostly manifests as a mild illness with cold-like symptoms in adults, it can cause pneumonia and bronchiolitis in very young children. It can be life-threatening in infants and older adults.
But just how concerned should parents be? There are many questions about who is most at risk for the outbreak and what might be causing it.
These viruses are sweeping through young children who have no prior exposure to them and no immunity. The older people and the immuno compromised are at a higher risk. Experts don’t recommend dropping all guards to build immunity. But they do note that social distancing and masking measures played a role in throwing other viruses off their historical patterns. Mary Krauland is a research assistant professor in the School of Public Health at the University of Pittsburgh. “Over time, people are a little more susceptible.”
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“My hope is that this is not the new normal,” Madhavan said on Friday. “But for this year, it is concerning because it’s still only late October and we don’t know what we’re going to see as we head deeper into fall and especially this winter.”
The problem is that their small lungs and muscles can’t muster up the power to cough up or sneeze out the increased secretions and mucus caused in their airways.
“They have trouble breathing because they don’t have enough time to get out their excess fluid and that leads to problems eating and drinking,” he said.
Health officials say handwashing, staying hydrated, keeping hands away from the face and disinfecting surfaces help to stave off RSV or keep it from becoming a serious illness.
She suggested grilling other people about how they’ve been feeling. “A lot of the time when people ask that question, the person on the other end really only thinks to mention anything if they’ve been really sick, so they don’t think to mention if they’ve had a minor cold.” But that could become a serious case of RSV for an infant or a toddler, she added.
Madhavan said the effective way for children and adults to try to stay healthy throughout the remaining fall and winter months, is to get updated COVID booster and influenza vaccines.
Anyone over six months old can get the flu vaccine. It takes a few weeks for the shot’s full protection to take effect. “If a child is under eight and has never gotten influenza vaccine before, they need two doses one month apart before getting full protection two weeks after that second dose,” she added.
The COVID bivalent boosters are available for 5 and older. And children over six months can get any of the three available COVID-19 vaccines. A booster needs to be obtained before we’re in the middle of another wave.
The palivizumab is a treatment that is available to high-risk infants. Babies with certain lung and heart conditions that can be high risk for severeRSV disease are at increased risk for receiving the injection. It is administered once a month throughout the RSV season.
“It is not a vaccine in that it doesn’t help the immune system make longer term immune protection, but it keeps giving antibody against RSV every month during those high-risk periods for those high-risk children to give them additional protection,” Madhavan explained.
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However, palivizumab isn’t usually given to all children. Part of that is due to the possible, more serious side effects associated with the drug, which include swelling of the throat, difficult or rapid breathing, muscle weakness, and unresponsiveness.
Pick up the phone and call your doctor if you think you or your child have it instead of going to a hospital where you’ll have a long wait and exposure to other viruses that you don’t have.
Madhavan said that in most cases, health care professionals can go through a checklist of warning signs and make suggestions for potential at-home treatments.
She said that they were able to recommend things like nasal saline drops, a shower, or a humidifier, to help loosen up mucus. If it’s a child older than one, they will say honey to help with a cough or give suggestions for how to bring down a high temperature.
But, Madhavan warns, it may be time to seek more intensive care when an infant or young child is working extra-hard to breath. That includes a flaring of the nostrils, grunting as they inhale and exhale, or the skin between or below the ribs or collarbone pulls in and out.
All but seven states are experiencing high or very high respiratory virus activity, according to the Centers for Disease Control and Prevention. People with high Covid-19 community levels are advised by the CDC to wear a mask.
There are less than one in five beds available in seventeen states. Five of them are more than 90% full: Rhode Island, Arizona, Maine, Minnesota and Delaware, along with Washington, DC.
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In August 2021, researchers in France coined the term ‘immunity debt’ to describe this reduction in population-level immunity. On Twitter, the term has taken on a life of its own. Some people have taken it to mean that a lack of exposure to pathogens such as RSV and influenza has irrevocably damaged the immune system, an idea that Matthew Miller, an immunologist at McMaster University in Hamilton, Canada, calls “nonsense”.
Another open question is how these viruses compete and interfere with one another. A strong immune response can occur if you get one virus and another if you get another. Hensley points out that last year’s first wave of influenza declined soon after the Omicron surge began. It might be possible that Omicron infection provided some protection against flu. Or maybe the surge convinced people to stay out of harm’s way.
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Pitzer expects that next year’s peaks and valleys might look much more like those that occurred before the pandemic. She isn’t placing any bets. She says that she expects this winter will be the last unusual one.
Experts believe that the Thanksgiving gatherings will cause social networks to open up and allow vulnerable people to be exposed to new coronaviruses. Cases and hospitalizations have gone up during the past two years because of the holiday.
“Covid positivity is going up,” said Shishi Luo, associate director of bioinformatics and infectious disease at the genetic testing company Helix, which has been monitoring coronavirus variants. “It’s increasing fastest among 18- to 24-year-olds” in the Helix sampling.
A higher percentage of Covid-19 tests returning positive results can be an indication that transmission is on the rise.
More cases should be expected, according to Luo. I don’t think it’s appropriate to measure them by how they’re measured, but I think more people should be sick. I definitely am.”
Increasing cases may not be picked up as quickly by official counts because people are mostly testing for Covid-19 at home and not reporting their results – if they test at all.
All that’s not to say that BQ.1 and BQ.1.1 won’t have any impact. They’ve shown marked resistance to the antibodies that are available to protect and treat people who are vulnerable to severe Covid-19 infections. From that standpoint, there’s good reason for people to be cautious if they have weakened immune systems or will be around someone who does.
Nobody knows exactly what will happen with the BQ variants. The Omicron variant has a peak of nearly one million daily infections, but many experts think we wont see any big waves of winters past.
Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health, thinks our behavior and our social contacts might be bigger determinants of whether cases will rise this go-round than whatever variant is in the lead.
BQ.1’s advantages are probably because they are incremental rather than drastic, which is what Andrew Pekosz believes.
The gradual replacement of cases without a huge change in the number of Covid-19 cases is what we are seeing.
The scientists at Los Alamos National Labs studied what drove the effects of 13 different types of coronavirus as they transitioned from one to another. The study includes data up to the end of September and was published as a preprint ahead of peer review.
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The number of previous cases in a country, the percentage of people who wore masks, average income and the percentage of the population older than 65 ran a distant second, third, fourth and fifth, respectively.
A senior study author says the number of other variant in the mix when a new one rises is important.
When Alpha arrived in the United States, we were modifying our variant out of California and New York that was more competitive than the one it faced in England.
Korber is not making any predictions. She says it’s just too difficult to know what’s going to happen, pointing to Asia as the source of her uncertainty.
A subvariant of the XBB has been driving waves in Asian countries and hasn’t had much presence in the US. She says the B Q variant looks impressive against XBB, which is highly immune-evasive.
“To me, it’s a good time, when it’s possible, to wear masks,” she said. Masks protect the wearer as well as others around them. “And get the booster if you’re eligible and it’s the right moment for you,” especially as we gather around the table to feast with our friends and family.
Korber said to exercise a little additional caution to prevent the wave that we don’t want to see happening.
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What are they? There is no single solution to the problem, which may be why we have spent more of our time on the need for vaccine than on the problem of older adults (although the fix is more straightforward). It is possible that clearer communication from public health officials to politicians and the media would help, emphasizing that more shots are good but that different groups probably need different approaches, and that even with up-to-date vaccination and bivalent boosting, infection represents a considerable threat.
As a country, we prefer to not see the deaths that occur in a country as a sort of background noise or morbid wallpaper. We don’t need to understand who is dying or why, because we don’t want to think about how many people are dying from Covid-19 every day. This is normalization at work, but it is also a familiar pattern: We don’t exactly track the ups and downs of cancer or heart disease either.
The country has struggled to consider both individual risk and social risk in the same way. In the first year of the Pandemic, we seemed to build our sense of individual risk back from the social need to limit spread, focusing instead on universal measures such as social distancing and masks. We began to build a collective picture of social risk from a different point of view after the arrival of vaccines.
Flu shots are important. The CDC estimates that at least 13 million Americans have already been infected with the flu this season, and over 100,000 hospitalized — a caseload much larger than last winter, when many Americans were still following COVID-related precautions.
The Walgreens data shows that flu activity spread from El Paso to southwest Virginia.
Rates of Covid-19, flu and R.S.V. “may be more intense or a little bit less intense in some parts of the country, but really, the entire country is being affected,” said Dr. William Schaffner, a professor of preventive medicine at the Vanderbilt University School of Medicine. As a result, he urged anyone who lives in a high-risk household to “put your mask back on” when in public spaces. High-risk households would include those with adults over the age of 65, pregnant women, people with a pre-existing condition such as heart disease, diabetes or lung disease and anyone who is immune-compromised.
Across the country, overflow health care workers are struggling to catch their breath as hospitals fill with sick patients battling a trifecta of respiratory illnesses – Covid-19, RSV and the flu.
The hospital at UC San Diego Health found a way to make space for patients by using other unconventional spaces and setting up tents in parking lots. The hallways in the emergency department are also full of temporary beds for patients who were admitted but are awaiting hospital beds.
“We have not had to reconfigure conference room space to care for patients even during the Covid pandemic,” said Longhurst, who explained that UC San Diego Health has experienced an equal number of Covid patients as patients with other respiratory viruses. “These are really unprecedented times.”
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“The most powerful factor by far is probably the vaccines, but the other one is the cumulative number of infections we have all had which is now called natural immunity,” said Dr. Edward Jones-Lopez, an infectious disease specialist at Keck Medicine of the University of Southern California.
The reason people aren’t getting the vaccine is due to all the evidence of safety and efficacy.
One case of three infections occurring at the same time is what I have seen, said Jones-Lopez. These are independentviruses that can cause diseases if they are not stopped early enough, and the higher the amount of virus you have, the more serious the disease is.
“I certainly would recommend that if you are elderly or have an illness that makes you immunocompromised or particularly susceptible to infection, I would encourage wearing a mask now,” said Smith of Cedars-Sinai Medical Center. It is the best protection we have for people who are concerned about transmission.
The number of hospital beds that are occupied is at its highest level since last winter, but it’s not as high as earlier this month.
As a matter of fact, many of us who have given up on traveling for a couple years are prepared to do as much as we can in the holiday season. We have to navigate a new normal where we have to do what we want to do.
Now’s the time to look ahead and think about what plans you have for the holidays, Wu said. Which events are the most important to you? Who do you want to see?
Then do a risk assessment. Think about how much you’re willing to risk getting sick — and same for the people you plan to see. Are you a young adult doing a small gathering with other young adults? Are you planning to go to a large family reunion with children and older people in the same house?
You can decide on which safety measures to take if you think through those questions. “Every family and every individual is going to be a little different,” Wu said.
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But flu shot uptake this year has been low. Only about a quarter of American adults have been vaccinated, according to the CDC. Someone who hasn’t gotten their shot should seek one soon, according to a University of Michigan infectious disease specialist.
“The sense is that this year’s vaccine is actually a pretty good match to the strain circulating. A flu vaccine can help prevent hospitalizations, deaths, as well as transmission, and it doesn’t prevent all infections, but it can help, according to an interview with NPR.
He is encouraging Americans to follow this simple rule of thumb, whether you have Covid-19 or something else: “If you are feeling sick, you should stay home.”
It has been found by a scientific review that the risk of contracting an infectious disease is much lower from someone with no symptoms than from someone with symptoms.
If you do feel sick, get tested — COVID tests are widely available this year at pharmacies and grocery stores. The flu test can be arranged by health care providers.
Respiratory diseases such as COVID have a difficult time spreading outdoors, where natural airflow is remarkably effective at dispersing droplets and pathogens.
Not everything can realistically be moved outdoors. The religious services and social gatherings will be indoors. Spending time indoors together is inescapable for family members traveling long distances to see each other.
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For more flexible plans, like catching up with an old friend from high school, you could consider outdoor activities if the weather allows — like a walk in the park, ice skating or strolling an outdoor holiday market, rather than getting together at a bar or restaurant.
Gandhi suggests doing what you can to improve the indoor environment. Open windows if the weather allows. If not, broken windows and ceiling fans can help as well.
The strongest non-pharmaceutical intervention that has been revealed during the Pandemic has been the elimination of respiratory pathogens.
In crowded indoor spaces, a lot of people are sick right now. So put that mask on,” Malani said.
“I don’t think a mask is a difficult thing to do,” said Wu. When you are in a crowded and poorly ventilated indoor space, I encourage people to keep the mask handy and use it.
In an interview with CNN, the White House said it was launching a public campaign on Thursday to prepare Americans for a rise in Covid-19 cases this winter.
The Biden administration’s renewed push to encourage people to use all of the necessary tools available to keep Covid-19 at bay – getting vaccinated and boosted, making use of tests and treatments and masking up when necessary – are all part of achieving what Jha said is the White House’s ultimate goal: preventing serious illness, hospitalizations and death.
The administration is making it easier for American households to order up to four free Covid-19 tests by restarting the free at- home test program. It is also offering federal resources to local health departments, putting an extra focus on high-risk individuals including by providing a winter playbook for nursing homes and other long-term care facilities, and permitting nursing home staff to administer vaccinations.
Data from the past few weeks makes clear that numbers have been on the rise, possibly due to people indoors during the holiday season and the beginning of the winter season.
People will have protection by Christmas if they get a vaccine tomorrow. It isn’t the last day people socialize over winter. Getting a vaccine as quickly as possible will give you protection for as long as you need.
There are currently specific and more conservative guidelines from the CDC for what an individual should do if they test positive for Covid-19, including isolating from others, than for if one catches the flu or RSV. It has to do with the fact that when a person has no symptoms at all, the spread of the disease largely happens when they do.
In other words, don’t cough your way through a family holiday dinner even if you don’t believe you have Covid-19: “You don’t know what virus you have and there’s no value in spreading it to other people,” Jha said.