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By J. Emory Parker and Andrew Joseph Sept. 1, 2022
As the country heads for its third autumn and winter with Covid-19, the forecasts are not auspicious. Given how transmissible the SARS-CoV-2 virus is, models anticipate more than 100,000 additional deaths by the time next summer rolls around.
The toll will depend on whether new variants emerge and how humans behave. Will many Americans, for example, decide to get the new, Omicron-tailored booster that could be available as soon as this weekend? Will we continue to see a shapeshifting of the Omicron variant, or will something entirely different appear that’s not as good a target for the vaccines?
The charts and text below show where things stand now with the pandemic, and who is being hurt the most. Even as death rates overall have fallen dramatically, there has been a steady stream of lives lost and a stealthy increase in children hospitalized for Covid this summer. And as colder weather arrives, schools start, and more workers return to the office, SARS-2 could be primed to surge yet again.
The charts above provide a big-picture glimpse of what the landscape looks like now. The United States is coming off the latest bump in cases driven by yet another Omicron subvariant, in this case BA.5. And as cases recede, many experts think that the country could in the near term enjoy a bit of a reprieve. There’s no clear successor yet for which lineage of the virus will snowball to dominance next and potentially drive up cases again. (One note about case tallies: infections are vastly undercounted at this point, given how many mild infections go untested and all the home tests people are doing.)
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But with Covid, a reprieve is a relative state: Even as hospitalizations and deaths fall, more than 400 people are still dying a day. It’s also expected to be temporary: Most experts envision cases to start increasing again as the factors that encourage spread — from more people going back to work and school to people spending more time indoors — mount. The country as a whole is no longer taking the steps to reduce spread that it once was. Federal health officials have in effect blessed that by rolling back their guidelines, signaling that such measures are too costly societally and economically to continue with at this point, given that nearly everyone has some protection against Covid-19.
That last point is crucial. Despite how many deaths may occur this winter, by no means is the United States in a situation like earlier in the pandemic. Even though several hundred people are dying a day — and not to minimize the tragedy of that — overall, the number of deaths are near all-time lows even as transmission has been skyrocketing. That shows both how death rates have dropped as population immunity has grown, and simultaneously how even with lower death rates, the country can still lose thousands of people each week when millions of infections are occurring.
Since the country marked 1 million Covid deaths in mid-May, another roughly 41,000 people have died.
For all that has changed in the pandemic, one thing has been consistent since early 2021: as the charts above show, people who are unvaccinated continue to die at higher rates than people who’ve been vaccinated.
These charts also highlight the protection provided by booster doses, which became all the more important last winter as the power of the primary doses waned and the Omicron variant arrived, with its broad suite of mutations.
The comparatively low booster rate in the United States has been one of its biggest vulnerabilities throughout the Omicron era, as the country has racked up deaths at higher rates than nations with better uptake of the additional shots. While 92% of people 65 and older and 77.3% of all adults got their primary series of shots, only 70.6% and 51.6% of those vaccinated people, respectively, have received an initial booster dose. People 50 and older — as well those with certain health conditions — became eligible for another booster in March, but only a third of those who received a first booster have received a second booster.
The dwindling of interest with each additional shot comes as federal health officials plan to roll out updated vaccines this month that target both the original SARS-2 strain and the BA.5 Omicron subvariant. It’s an attempt to broaden people’s protection against the virus heading into the winter, and the hope is that the shots could also restore protection against infection for a longer period of time. While the original shots, particularly with subsequent doses, continue to provide strong protection against severe disease, their ability to block the virus entirely is not long lasting, particularly in the face of an evolving pathogen. If more infections are prevented entirely, the booster shots could also take a bigger bite out of transmission generally. But it’s a major question just what percentage of people will roll up their sleeves once more.
Throughout the pandemic, age has been the major risk factor for severe Covid outcomes, a trend that continues today even with some layers of protection against the virus. The oldest adults — as well as those who have certain underlying health conditions — have a harder time building up immunity and maintaining it, which is why booster shots have been more crucial for them.
In a way, some physicians have said, Covid is becoming more like the other respiratory pathogens that most of us shake off but that can occasionally cause severe illness and death among the oldest adults or people who are already sick. So many more people are dying from Covid than from those other viruses, however, because of the massive number of cases that are still occurring overall.
Another trend that has continued into 2022 has been the racial and ethnic disparities associated with Covid. The gaps between different demographic groups’ death rates have shrunk over time, but at the peak of this summer’s wave, for example, death rates by age group among Hispanic adults were notably higher than those among white adults, federal data indicate.
One of the silver linings of the pandemic is that, unlike with some viruses, SARS-2 did not pose a particularly serious threat to children. That’s not to minimize the hospitalizations and deaths — as well as incidents of long Covid and MIS-C — that the virus did cause in pediatric populations. But overall, kids have faced much lower risks of severe outcomes from Covid than adults.
Still, something worrisome occurred this summer with kids and Covid, as hospitalizations reached their second highest peak of the entire pandemic, surpassing last summer’s Delta wave and only trailing the initial Omicron spike early this year.
Hospitalization data has become murkier over the course of the pandemic, particularly since the beginning of this year. So many people have Covid at any point that some people who show up to the hospital for other reasons test positive, adding to the tally of Covid positive hospitalizations. These “incidental” hospitalizations have made it harder to track the true impact of Covid on the health care system.
But pediatric infectious disease experts said the bump in Covid hospitalizations this summer was real, and was a result of several trends. One was that transmission levels were so high generally that even if a tiny fraction of cases resulted in a hospitalization, there were enough cases in total to create a wave of hospitalizations.
“With people relaxing restrictions and there being a lot more mingling, I don’t think it’s hard to imagine infection rates would go up, and once infection rates go up, hospitalization rates do too,” said Mary Caserta, a pediatric infectious diseases physician at the University of Rochester and a member of the American Academy of Pediatrics’s infectious diseases committee.
Pediatricians pointed to another reason as well: low vaccination rates. Fewer than one-third of kids ages 5 to 11 have had their primary series of shots, and fewer than two-thirds of kids from 12 to 17 have. A single-digit percentage of kids from 6 months to 4 years have received their shots, which were authorized for this age group in June.
The fall presents a major chance for pediatricians to make up some ground on the low vaccination rates. Between back-to-school season, sports leagues starting, and flu shot campaigns, pediatricians are seeing lots of patients whom they can recommend the Covid shots to at this point.
In the Southeast, hospitals are seeing fewer pediatric hospitalizations than they did during the Delta wave, which hit that region particularly hard. Andrea Shane, the medical director of infectious diseases at Children’s Healthcare of Atlanta, said the hospital saw a bit of an increase in Covid hospitalizations in mid-August, but has since seen a decline — a positive sign given that area schools started in early August.
But Shane said kids who are not vaccinated are still sometimes getting hospitalized. She said it appears that Covid is exacerbating existing medical conditions in unvaccinated kids, though she acknowledged it’s hard to tease out exactly what role Covid is playing in each case. But she’s not seeing kids with medical conditions get hospitalized with Covid if they’ve had their shots.
Her message to parents is simple: “Vaccination prevents hospitalization.”
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Andrew covers a range of topics, from addiction to public health to genetics.
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A third Covid autumn is upon us. Here's a look at where we stand – STAT
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