A year after the start of the omicron attack on humanity, the constantly mutating coronavirus has led to a surge in coronavirus cases in many places, just as Americans gathered for Thanksgiving. It was a precursor to a wave that experts expect the United States to wash away soon
Phoenix-area emergency physician Dr. Nicholas Vasquez said his hospital has admitted an increased number of chronically ill people and nursing home residents with severe COVID-19 this month.
“It’s been a long time since we’ve needed COVID wards,” he said. “It’s a clear comeback.”
Nationwide, new COVID cases averaged about 39,300 per day as of Tuesday — far fewer than last winter but a much smaller number due to decreased testing and reporting. About 28,000 people with COVID are hospitalized each day and about 340 people have died.
Cases and deaths are higher than they were two weeks ago. Yet a fifth of the US population has not been vaccinated, most Americans haven’t had the latest boosters and many have stopped wearing masks.
Meanwhile, the virus continues to find ways to avoid defeat.
The omicron variant arrived in the United States after Thanksgiving last year and caused the largest wave of epidemic cases. Since then, it has spawned a large extended family of sub-variants, such as those most popular in the US now: BQ.1, BQ.1.1, and BA.5. They’ve outdone competitors by getting better at evading immunity from previous vaccines and diseases — and infecting millions.
Carrie Johnson’s family has been hit twice. She contracted COVID-19 in January during Omicron’s first wave, and experienced flu-like symptoms and terrible pain that left her feeling down for a week. Her son, Fabian Swain, 16, experienced milder symptoms in September when variant BA.5 was dominant.
Fabian recovered quickly, but Johnson had headaches for weeks. Other problems lasted longer.
“I was like, ‘I can’t collect it.'” I couldn’t get my energy together,” said Johnson, 42, of Germantown, Maryland. “And it went on for months like that.”
The appearance of hot spots
Some communities are being hit hard right now. Tracking by the Mayo Clinic shows cases are on the rise in states like Florida, Arizona, Colorado and New Mexico.
In Navajo County, Arizona, the average daily case rate is more than double the state average. Dr James McCauley said 25 to 50 people a day are testing positive for coronavirus at the Indian Health Services facility where he works. Before, they only saw a few cases per day.
They are “basically back where we were with our last big peak” in February, said McCauley, clinical director of Whiteriver Indian Hospital, which serves the White Mountain Apache tribe.
COVID-19 is part of a triple threat that also includes influenza and the virus known as RSV.
The system’s children’s hospital in Orlando is nearly full with children infected with these viruses, said Dr. Vincent Hsu, who oversees infection control at AdventHealth. Dr. Greg Martin, former president of the Association for Critical Care Medicine, sees a similar trend elsewhere.
Emergency departments and urgent care clinics at children’s hospitals are busier than ever, said Martin, who works mostly at Grady Memorial Hospital in Atlanta. “This is a record high compared to any month, any week, any day in the past,” he said.
Looking ahead, experts see the seeds of a widespread American wave. They point to what is happening internationally — the increase of BA.5 in Japan, a host of variables driving cases in South Korea, the start of a new wave in Norway.
Some experts said a US wave could start over the holidays as people congregate indoors. It could peak at about 150,000 new cases per day, said Trevor Bedford, a biologist and geneticist at the Fred Hutchinson Cancer Research Center, about what the nation saw in July.
The new wave is going to be brutal, said Dr. Mark Griffiths, medical director of the emergency department for Children’s Healthcare at Atlanta Spalding Hospital. “There are so many systems that are about to be completely overburdened that if we get another surge of COVID on top of this, it will break some systems.”
One bright spot? Fatalities are likely to be much lower than earlier during the pandemic. Bedford said about 1 in 2,000 injuries now lead to death, compared to about 1 in 200 in the first half of 2020.
Omicron General era
The same widespread immunity that reduced deaths also prompted the coronavirus to mutate. By the end of last year, many people had been infected, vaccinated, or both. This “created the initial niche for Omicron’s spread,” Bedford said, because the virus has evolved greatly in its ability to escape existing immunity.
Omicron prospered. Mara Aspinall, who studies biomedical diagnostics at Arizona State University, noted that the first Omicron strain accounted for 7.5% of circulating variants by mid-December and 80% after just two weeks. Cases in the United States at one point rose to 1 million a day. Omicron generally caused less severe disease than previous variants, but hospitalizations and deaths rose due to the huge numbers of people infected.
The giant wave receded by mid-April. The virus quickly mutates into a series of sub-variants that are skilled at evading immunity. A recent study in the journal Science Immunology says that this ability to escape antibodies is due to more than 30 changes in the spike protein that coats the surface of the virus.
Omicron has evolved so much in a year, Bedford said, that it is now “a nonsensical term”.
This rapid boom is likely to continue.
“There is a lot more pressure on the virus to diversify,” said Shishi Lu, chief of infectious diseases at Helix, which provides viral sequence information to the US Centers for Disease Control and Prevention.
Doctors said the best protection against the bubble soup subspecies is vaccination. Officials said Americans who got a new booster kit targeting Omicron and the original coronavirus are now better protected than others from symptomatic infection.
Getting the booster drug, if you qualify, is “the most impactful thing you can do,” said Dr. Peter Hotez, co-director of the Center for Vaccine Development at Children’s Hospital of Texas.
Doctors are also urging people to continue testing, to continue preventive measures such as masking in crowds, and to stay home when sick.
“COVID continues to be a very significant threat, especially for the most vulnerable,” said Dr. Laolo Fayango of Oak Street Health in Cleveland, who specializes in senior care. “People need to keep thinking about each other. We’re not quite off the hook on this yet.”
Associated Press writer Heather Hollingsworth contributed from Mission, Kansas.
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