FOver the last two decades, the U.S. was stuck in a cycle with COVID-19 spikes or lulls. Cases rise dramatically, then drop off—and the process repeats.
Several times, these surges have been preceded by rising case rates in Europe—such as before last year’s Delta wave and the start of last winter’s Omicron spike—which is why experts have been carefully monitoring a recent increase in cases there. According to data from the World Health Organization, more than 5.2 million COVID-19-related infections were recorded in Europe over the week ended March 20. Other countries such as the U.K. also saw an increase in hospitalizations.
This spike may have been partly caused by Omicron’s BA.2 variant. Studies suggest that it is 30% more contagious than Omicron. The number of cases reported in Europe was roughly the same during the week ending March 20 compared to the prior week—suggesting a possible plateau—but countries including Germany, the Netherlands, and the U.K. are still reporting high levels of infection.
The question now is whether the U.S. will follow in Europe’s footsteps, as it has before. The U.S. Centers for Disease Control and Prevention data show that about 35% of COVID-19 sequences in the U.S. since March 13-19 involved BA.2. The variant is now responsible for more than half of the cases within the CDC Monitoring Region, which covers Maine, New Hampshire Vermont, Massachusetts Rhode Island and Connecticut. Data from wastewater surveillance also shows that virus levels have been rising in some parts of the nation, especially the Northeast.
No one knows for sure what will happen next, and some experts are somewhat split in their predictions—but the consensus seems to be one of cautious optimism.
Dr. Anthony Fauci, White House chief medical advisor and head of the U.S. National Institute of Allergy and Infectious Diseases, said on March 20 there will likely be an “uptick” in U.S. cases this spring, but “hopefully, we won’t see a surge. I don’t think we will.”
Syra Madad, an epidemiologist with Harvard’s Belfer Center for Science and International Affairs, agrees that there will likely be an increase in cases and possibly hospitalizations due to BA.2, but she is hopeful that widespread population immunity—through either vaccination or prior infection with Omicron—will prevent a major spike.
Although Dr. Eric Topol is optimistic about the impending BA.2 boom in the U.S., despite his recent forecasts, Topol of Scripps Research Translational Institute says that he remains cautiously optimistic. It could take a few more weeks to see what BA.2 will do in the U.S., so nothing is certain—but if the U.S. were going to follow trends in Europe, Topol says he expects that case counts would have started to rise significantly by now, since BA.2 is already prevalent in the U.S. The U.S. reports approximately 27,000 new infections each day. That’s the lowest rate since 2021.
“The fact that we’re not seeing anything is surprising,” Topol says. “It’s very gratifying, in my view, because I love to be wrong when I’m trying to predict that something bad could happen.”
Ali Mokdad from the Institute for Health Metrics and Evaluation, who is professor of health metrics sciences, believes the U.S. Omicron storm may provide some defense against a new wave. Some estimates, at least 40% of the U.S. population was infected during the Omicron wave, though it’s hard to say for sure since many people used at-home rapid tests that aren’t included in official case counts. Some preliminary research suggests that people infected by the original Omicron variant are unlikely to get sick from BA.2—so high levels of natural immunity, combined with coverage from vaccines, may help stave off a surge, Mokdad says. (Vaccines didn’t hold up as well against Omicron as previous variants, but they do still provide strong protection: while the original Omicron variant was circulating, fully vaccinated people were about 2.5 times less likely to test positive for COVID-19 than unvaccinated people, and mRNA-based shots were still at least 90% effective at preventing death and disease severe enough to require mechanical ventilation.)
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Hence, BA.2’s success in Europe was not due to Omicron surges that occurred over fall and winter. These countries also have higher vaccine and booster rates than the U.S. It’s still unclear, but timing may have played a part. BA.2 was first discovered in Europe in the winter when many people were indoors, and it is easy for pathogens to spread. Mokdad also says that many European countries have recently relaxed restrictions on mask use, which has led to an increase in infection rates. He suggests that weakened immunity due to prior infections and waning immunity may also have played a role.
But—for better or worse—many parts of the U.S. have been living largely without COVID-19 precautions for many months, so Mokdad doesn’t expect BA.2 to cause a big shock to the system here. The U.S. is expected to see a steady decline in cases over the summer and winter, then pick up in the winter as people return indoors. However, if a new type of case is developed, it could change the projections.
Whether or not there’s a “next” surge, we’re still in one, says Dr. Ebony Hilton-Buchholz, an associate professor anesthesiology and critical care medicine at the University of Virginia. The COVID-19 baseline level remains high with many people still dying every day. “We’ve never left the first wave,” she says. “We need a peak and a trough, and we haven’t reached the trough. We keep creating new peaks.”
Hilton-Buchholz says U.S. policymakers should focus less on gaming out the pandemic’s timeline and more on promoting things that are proven to work, such as wearing a high-quality mask, improving indoor ventilation, and encouraging people to get vaccinated—including with boosters, which have so far failed to catch on widely in the U.S.
Madad agrees that it’s too soon to let up on infection-prevention measures. “There’s this dangerous narrative that cases don’t matter and it’s all about hospitalizations,” she says, but that ignores complications, such as Long COVID, which can strike people who experience even mild cases. To help prevent infections that could lead to complications, individuals may want to keep wearing masks even if they aren’t mandated, she says.
Mokdad as well As Topol both believe the U.S. has let public-health funding and pandemic funds lapse far too quickly despite their optimism over BA.2. Even if BA.2 does not lead to a surge, a totally new variant—one to which people do not have some natural immunity—could emerge at any time, and the U.S. would not be prepared to fight it. The White House claims that the lack of additional COVID-19 funding in Congress’ March spending bill will put at risk ongoing treatment and testing. Biden’s Administration requested an additional $22.5 million to fund these programs. It also warned it doesn’t have the money needed to buy additional vaccine booster doses, should that be necessary.
Inadequate funding could also make it harder to track the virus through testing, genomic sequencing, and wastewater surveillance, Topol notes, and there’s little hope of preventing surges if you can’t see the virus coming. Madad recommends that you order more rapid, at-home COVID-19 test kits from the government right now to prevent surges.
“We need to keep our eyes on the ball,” Mokdad says. “We need to make sure we’re doing enough testing in order to understand if we have a new variant, and if we have a surge.”
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