In July, COVID-related hospitalizations began trending upward for the first time in seven months, according to the Centers for Disease Control and Prevention. WSHU spoke with public health experts to find out what yet another COVID wave could mean for late summer on Long Island and in coastal Connecticut.
How serious is the uptick?
According to CDC data, COVID-related hospitalizations for the week of July 16 have increased:
- Nationwide: 12.1% week-on-week, totaling 8,035
- New York: 33.7% week-on-week, totaling 535
- Connecticut: 22.8% week-on-week, totaling 97
Officials warned that this bump could be indicative of a “late summer wave,” but medical experts say the concern is not immediate. Despite the increased numbers, they say the rates are still far below what they’ve seen from previous major waves of the virus.
“We've had a very slight uptick, but it's really been overall very low and really has not significantly impacted us in the hospital,” said Dr. David Hirschwerk, the medical director at North Shore University Hospital in Manhasset, an 800-bed hospital that is part of the Northwell Health network. “Currently, we have roughly 10 to 15 patients that we know are positive for COVID and they're in appropriate isolated rooms for that, but we have not had a steady increase.”
Dr. Sharon Nachman, chief of the division of pediatric infectious diseases at Stony Brook Children's Hospital, echoed Hirschwerk’s attitude, but added that a minor bump in summer may be indicative of a larger wave later in the year.
“When we see an uptick in the summertime, it is a sentinel event for us,” Nachman said. “It tells us that what we're seeing now is just sort of a snapshot of a warning that the winter will have a much larger uptick.”
Why is the increase happening now?
This rise in hospitalizations comes at a time of waning immunity for the general public. Most people who contracted COVID in the recent wave last winter have had significant time to recover, and the immediate natural immunity they may have developed from the virus has worn off. Additionally, new cases may be a result of the dwindling effectiveness of the last vaccine booster, which first became available last fall and targeted Omicron subvariants BA.4 and BA.5. Since then, more contagious XBB subvariants have become the dominant strains of COVID across the U.S.
“These are just part of natural fluctuations that might occur on a virus that remains present in the community in some people who have incomplete immunity,” Hirschwerk said, “but it hasn't been severe because most people do have some degree of immunity.”
A confluence of external factors also may have helped to bring about this increase, including extreme weather that has driven people indoors this summer and a relaxing of precautions as the pandemic entered its third year.
“There's no one right answer except to say, clearly, people are congregating together, and that's how the virus passes,” Nachman said.
How much will COVID continue to mutate and create new transmissible variants?
Importantly, this bump is not associated with a new variant of concern, as most major waves of the past three years have been. More contagious Delta and Omicron variants of COVID led to sudden upsurges in infection numbers. The mix of Omicron variants currently reported by the CDC has held steady for months, although a new Omicron subvariant known as Eris has been on the rise in recent weeks.
New variants have made COVID more infectious, but possibly less lethal, allowing the pandemic response to shift and involve less stringent precautions. Nachman flagged an upcoming fall or winter wave as a time when potential new variants of concern could emerge.
“Viruses, when they're exposed to more and more people, do change,” she said. “And that means there's going to be a much more increased risk of changing or new variants popping up with more people getting infected.”
Hirschwerk said that until a new variant emerges, the spread of the virus should remain stable.
“In cases over time, we probably will have, you know, some increased numbers through the fall and the winter, just as immunity starts to wane in some individuals, but most of these cases will be relatively mild, except in people of advanced age and those who are immunocompromised,” he said.
So, how do I protect myself and my family?
Last spring, the Biden administration announced that it would let the public health emergency declaration for COVID-19 lapse in May, cutting off emergency funding for pandemic response tools like testing and vaccines. At this stage of the pandemic, fatigue over community precautions and the evolution of the virus have shifted the risk assessment to the individual level. Nachman recommends that people looking to continue to stay COVID-free evaluate their individual and community circumstances and tailor the precautions they take accordingly.
“What I tell families is that there are two issues at hand here. The first is, who are you, and how am I going to best effectively protect you? And the second issue is, who are you in your community? Who's your family in the community? Are your kids in school? Are you at work? Is there an elderly parent or grandparent living with you? And that's sort of the bigger question of who else you want to protect.”
Individual protective measures include frequent testing, wearing high-quality filtering masks and avoiding high-risk situations like large indoor gatherings. Although these practices are no longer funded under the public health emergency, you can still seek free or low-cost testing and get free masks through government programs — but Nachman said the decision will still have downstream public health effects.
“When people have free testing — cheap, available, I can get it anyplace and pick it up — they were more prone to test with any cough, fever or respiratory illness,” she added. “The end of the ability to get free tests turns into more people with respiratory illnesses kind of going back to work or school, and then increasing the potential to pass more virus around."
What about the vaccine?
A new booster shot targeting the Omicron XBB.1.5 subvariant, which makes up 12.3% of current COVID cases, is nearing release, with FDA approval coming as soon as the end of August. Since last year’s booster, which targeted the BA.5 subvariant, that strain has been overtaken by newer mutations. Although XBB.1.5 is not the single predominant subvariant today, experts say keeping up with the latest shots is crucial to outpacing major waves of virus.
“The older prior boosters are four steps or 10 steps away from the new variants,” Nachman said. “The new booster vaccine is one or two steps away from the new variants. So that results in a better protection for the patient.”
In April, the CDC allowed immunocompromised individuals and those over 65 to receive a second dose of last year’s booster. If you are considering whether to get a second dose of that shot or hold off for the new one, speak with your doctor to coordinate the timing of your doses with your medical needs.
Sluggish booster adoption rates have become a particular concern for the pandemic response, with only 17% of Americans receiving last year’s booster, as of May.
“I think what we're going to see in the fall is that key populations that are the highest risk are the ones that are going to get the boosters, and the routine[ly] well children and adults are probably not going to get it,” Nachman said. “Does that allow us to have more COVID circulating? It probably does. But we're hoping that amongst those healthy populations that did have COVID plus vaccines in the past, they will have some… immune memory, and when they do get sick, they will do okay.”
“Usually the fall is the time that people start to try to get their flu vaccine as well,” Hirschwerk said. “So hopefully, as people are getting a flu vaccine, they'll also at the same time get the COVID vaccine.”
How do we know about the uptick?
Since at-home testing became the norm, daily case number tallies have fallen away. Still, some indicators remain, including wastewater analysis, which experts have found to be an accurate predictor of future COVID upsurges. Hospitalization and death numbers are still available via the CDC’s COVID data tracker, and these metrics reflect the national shift to target severe disease, rather than elimination of the virus.
You tested positive. Now what?
Three years into the pandemic, we have multiple pathways to COVID treatment. Thanks to remote healthcare options, someone with COVID can still consult a doctor without coming into their office and exposing others. In 2022, Paxlovid, an antiviral pill, was introduced to decrease the severity of a COVID infection if taken in its early stages. If you are immunocompromised, a doctor might consider Paxlovid as a good option to prevent severe disease before it gets to that point. Still, if symptoms worsen to the point of extreme fever or shortness of breath, in-person medical options are best for immediately assessing a patient’s condition and providing on-site care.
Nachman recommends that patients take time to evaluate their condition before taking action.
“It's not at the first sign of a cough that you should run, but really take a step back, see how you're doing, speak to your doc, and then go from there,” she said.
How concerned should I be about long COVID?
On July 31, the Department of Health and Human Services began an initiative to investigate long COVID, a condition in which one or more symptoms linger for months after an initial COVID diagnosis. This announcement marked a turning point in the study of the mysterious illness, which has various symptoms that can affect nearly every part of the body. While some medications have helped long COVID patients, particularly those with respiratory complications, there is no universal treatment for it.
Nachman and Hirschwerk both stressed the number of unanswered questions about long COVID, but Nachman still encouraged people to lessen their odds of contracting it by getting vaccinated.
“Amongst the data for those who have long COVID, those who are vaccinated were less likely to develop long COVID — not zero, but less likely compared to those who were never vaccinated.”
Is this the new normal?
With COVID, RSV and the flu, three highly infectious respiratory diseases, public health experts say we may be in for bad fall and winter waves of illness for the foreseeable future. Living with these diseases requires self-evaluation, risk assessment and the use of key precautions like masking and frequent testing.
“I think that this is going to be where we are,” Nachman said. “We're going to have multiple circulating respiratory viruses all the time, and it's up to us to figure out the best way forward.”
Correction 8/14/23: This guide has been updated with information about the new EG.5 "Eris" Omicron subvariant of the virus.
