ANAs the BA.2 wave peaks in the UK and begins to taper off in some European countries, US health officials are looking ahead to an uncertain future, even as US lawmakers have delayed renewing funds to address the pandemic.
While the Omicron subvariant now accounts for about 72% of Covid cases, the US has not seen a nationwide increase in cases. Covid hospitalizations are now at the lowest point of the pandemic.
But scientists warned this week that the coronavirus will continue to evolve to evade immunity, causing surges in the future that will be difficult to predict.
Covid-19 has evolved faster than expected, and “we should expect a lot of evolution in the future,” Trevor Bedford, a professor of biostatistics at the Fred Hutchinson Cancer Center, told a panel of independent FDA advisors on Wednesday. “Those viruses will work better and spread locally and maybe regionally and maybe globally.”
The US has generally followed the UK surges three to four weeks later, but reported cases are holding steady at an average of around 26,000 a day. Although deaths have dropped significantly since Omicron’s peak, more than 500 Americans are still dying every day.
“I think we’re going to see some cases on the rise in some places,” said Benjamin Linas, a professor at Boston University School of Medicine. Removing precautions will likely result in future spikes, he and others wrote in a study published earlier this month.
“We are not in the crisis that we were in 2020, but we have to be realistic that we are not completely finished either,” Linas said.
Some regions in the Northeast, including New York and Massachusetts, are beginning to see signs of the upside. Philadelphia is considering going back to wearing masks indoors next week.
In Washington DC, where confirmed cases have jumped 135% in the past two weeks, several high-level politicians tested positive Thursday, including House Speaker Nancy Pelosi.
It is difficult to analyze the extent to which surges elsewhere have been driven by behavioral changes, increased BA.2 transmissibility, and decreased immunity, and whether factors in the US might suppress such a surge.
As the pandemic progresses, changes in the way cases are reported and counted may also cloud the picture.
Home tests are often not counted in official counts, making it increasingly difficult to understand how widespread infections are. Wastewater monitoring could be useful to fill in the gaps, but many places are still ramping up these types of programs.
Several states have moved to weekly or twice-weekly case reporting, rather than daily, reflecting a similar change in June 2021 during a lull before Delta’s surge. Oklahoma is changing the way it reports its seven-day case average.
Changes in the definitions of Covid hospitalizations and deaths may also complicate tracking of the pandemic.
Some states have also narrowed their definitions of COVID hospitalization to focus only on patients receiving COVID-specific medications, while others have changed how they define COVID deaths.
Last Monday, US lawmakers reached a deal for $10 billion in Covid funds, some of which has already expired. But on Thursday, several senators confirmed the vote won’t take place until after the next two weeks of spring break.
This amount was less than the $15 billion previously cut from a general spending bill or the $22.5 billion requested by the White House.
The new bill will not cover tests and treatments for uninsured people who lost that coverage in March. More than 30 million Americans are uninsured, and a lack of affordable and accessible testing and treatment could further affect the country’s ability to track and address serious cases and illnesses.
The new funding package would also reduce spending for global Covid campaigns, including vaccination, potentially prolonging the pandemic by allowing new variants to emerge and spread.
“This is a global health problem, and if we continue to cut the budget for vaccines in developing countries, we will get the next Omicron,” Linas said. “Because we have these pockets where the virus breeds, it has already extended the epidemic for at least a year, and if it keeps happening, we are going to be haunted indefinitely.”
About half of Americans may have been infected with Omicron in a 10-week period, a “remarkable number,” Bedford said. By comparison, the flu typically infects 10-20% of the population in about 20 weeks.
But that would also mean that about half of Americans weren’t infected in Omicron’s first wave, which could leave them vulnerable to another wave now. The coronavirus, as it spread around the world and infected millions, mutated two to 10 times faster than influenza usually does, Bedford said.
Future variants of Omicron are likely to emerge, even surpassing immunity from previous Omicron cases, he added.
But there is also the possibility that a new variant of an old strain, such as Delta, will emerge as a wild card. Omicron appears to have evolved from a much older version of the virus in the summer of 2020 before exploding around the world in late 2021.
It is also difficult to understand whether Covid-19 will eventually become a seasonal virus, like influenza or respiratory syncytial virus (RSV).
“It is not clear to me if it is actually related to the months of the year, or if that is confused with the virology that has been going on,” Linas said. Influenza, for example, is “highly seasonal,” but “I don’t think we know that yet about Sars-CoV-2.”
A major treatment has been halted in the US amid doubts about its effectiveness. The US Department of Health and Human Services (HHS) withdrew authorization for sotrovimab, a monoclonal antibody, because studies show it is less likely to be effective against Omicron. Recent research also indicates that this treatment could create resistance, a major concern with other monoclonal antibodies and antivirals.
Vaccines and treatments help, but they are not enough to stop the pandemic on their own and must be accompanied by measures such as ventilation and masking during times of high transmission, Linas said.
Overvoltages are also highly dependent on human behavior.
“There is no virus epidemic outside of the context of how people behave,” Linas said. “It would be a big mistake to let ourselves and our leaders take the lead… The actions we take or don’t take are very important.”