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After what seemed a relatively stable fall season, COVID-19 is on the rise once again all across the United States, just before Americans prepare to celebrate the holidays.
In the past two weeks, COVID cases and hospitalizations have jumped more than 25%. Test positivity rates, ICU admissions and the levels of virus detected in wastewater have also increased at a national level. These are signs, experts say, that we may be entering a new COVID wave.
Rochelle Walensky, director of the Centers for Disease Control and Prevention, said at a press briefing on Monday that “this rise in cases and hospitalizations is especially worrisome as we move into the winter months, when more people are assembling indoors with less ventilation, and as we approach the holiday season, where many are gathering with loved ones across multiple generations.”
The timing of this uptick in COVID activity is also concerning given that many health systems across the U.S. are already dealing with an overwhelming number of patients stricken with RSV and influenza infections.
Why are COVID-19 cases on the rise?
Winter is typically a busy time for hospitals, because it is when many respiratory viruses emerge and more people, especially in cold weather areas, spend more time indoors. This gives respiratory viruses, including COVID-19, more chance of spreading.
Before Thanksgiving, many experts predicted that an uptick in cases after the holiday could be expected, especially since many people have stopped taking measures to mitigate the spread of the virus, such as masking.
Dr. Michael Chang, a pediatric infectious disease expert at UTHealth Houston and Children's Memorial Hermann Hospital, told Yahoo News that while gathering for Thanksgiving may have contributed to the recent rise in COVID-19 cases, changes in the virus itself are probably driving this wave of infections.
The coronavirus has continued to mutate, and two new Omicron subvariants — known as BQ.1 and BQ.1.1 — have now become dominant in the U.S. Both of these have replaced BA.5, the Omicron subvariant that had dominated infections in the U.S. since the summer. Together, they now account for 62% of cases nationwide.
“These variants are much more contagious than Omicron BA.5. They are even more immune-evasive than Omicron BA.5, unfortunately,” Chang said. This means the new variants have the ability to bypass immunity acquired by vaccination, treatments and prior infection.
But Chang is optimistic that BQ.1 and BQ.1.1 won’t have as severe an impact as previous variants. Based on other countries' experience of them, he said, it appears “there isn’t as much severe illness and hospitalization associated with them.”
He also explained that many Americans have some immunity from vaccination, a recent Omicron infection or both. Although this immunity may not be as strong against these new variants, he said that for many people, particularly the young and healthy, it will still be enough protection against the most severe outcomes of the disease.
“Over the last few surges, what we've seen is a decreasing trend. So even though we have a large number of cases, the number of cases that results in hospitalization and severe illness is not as high, and I think that's going to be true for these new variants as well,” Chang said.
Another factor experts say is contributing to the recent spike in COVID hospitalizations is waning vaccine protection. The shots have been shown to lose their effectiveness over time. This is why boosters are necessary to restore protection and are particularly important for those with the highest risk for severe COVID outcomes. So far, only 12.7% of eligible Americans have gotten the new bivalent booster, according to CDC data.
Those 65 and older are most at risk of hospitalization
Although a rise in hospitalizations has been noted in all age groups, the majority of COVID-19 hospitalizations in recent weeks have been among older adults, particularly those who have not received a booster shot in the past six months.
“Older people in our population above 65, especially those above 85 years of age," Chang told Yahoo News, "we're starting to see an increasing percentage of severe illness and hospitalizations and deaths in that age group again.”
Immunity from the vaccines is not long-lasting in this age group because of how the immune system works and “an unfortunate consequence of aging,” Chang said.
In a recent Kaiser Family Foundation analysis of CDC data, researchers found that more of the deaths in recent months have been among seniors who were vaccinated but not boosted. According to CDC data, only 32.6% of adults 65 and older have received the bivalent booster since it became available three months ago.
“I think certainly, older Americans who are not up to date on their vaccinations need to get up to date on their SARS-CoV-2 vaccinations as soon as possible, including [getting] the bivalent booster,” Chang said.
The bivalent booster offers the highest protection against COVID right now
On Monday, Walensky emphasized how important it is for all Americans who are eligible for the bivalent booster to receive it this season. She said those who have received only their primary series are considered fully vaccinated, but they are “not considered fully protected against severe disease this winter.”
The new bivalent booster, she said, is the highest defense against COVID-19 severe disease at the moment. The shot, approved in September by the CDC, was developed to target the BA.4 and BA.5 Omicron variants, as well as the original strain of the virus.
According to the agency, people 12 and older who have had a bivalent booster shot have a 15 times lower risk of death than an unvaccinated person. A recent CDC study also showed that the bivalent booster provided “significant additional protection” against infection in people who had previously received two, three or four doses of the original vaccine (monovalent). Although it isn’t clear yet how effective the shot is against BQ.1 and BQ.1.1, vaccine manufacturers Moderna and Pfizer have said their updated boosters work against these new variants.
The CDC recommends that people 5 years and older receive the bivalent booster if it has been at least two months since their last vaccination, whether that was the last dose of a primary series or an original booster.
On Thursday, the Food and Drug Administration also authorized the bivalent booster shots from Moderna and Pfizer for children as young as 6 months. The FDA said in a statement that it is important to get young children vaccinated ahead of the holidays and winter months.
Children between 6 months and 5 years old who received the Moderna two-dose primary series can now receive Moderna’s bivalent booster two months after their second shot. Similarly, kids between 6 months and 4 years of age who have received two doses of the Pfizer-BioNTech vaccine can get the companies' bivalent booster as a third shot. Children in the same age group who have completed Pfizer’s three-dose primary series, however, are not eligible to get this booster right now. The FDA said it needed to evaluate more data to approve the shots for children in this group and that an update could come after January.
The bivalent booster shot ramps up to a high level of protection in about a week and offers the highest protection within two weeks, so experts recommend that people get vaccinated as soon as possible to be best protected before they travel and gather for the holidays.
Other ways to stay protected against COVID-19 this winter
Besides being up to date with their COVID-19 vaccinations and getting the bivalent booster, Chang said there are other steps people can take to prevent infection.
One is staying home if you feel sick. “I know most people are looking forward to visiting with their friends and family, but if you're symptomatic at all — you know, sore throat, runny nose, even if you think it's just a cold — I strongly recommend trying to stay home, trying to avoid going out again,” he said.
According to CDC guidance, everyone who tests positive for the virus, regardless of vaccination status, should isolate at home for five days. If symptoms resolve after that time, you can leave isolation, but should consider wearing a mask around others for five additional days.
The CDC continues to recommend masking for residents of counties that have high community levels of COVID-19, as well as for anyone who may be immunocompromised or at increased risk of severe disease. People traveling by plane or taking any form of public transportation should also consider masking, Walensky said.
Improving ventilation and minimizing the size of gatherings whenever possible is also wise, Chang advises.
Finally, Walensky encouraged Americans if they test positive for COVID-19 to reach out to their health care provider immediately for early care. Some treatments are available, including the antiviral medication Paxlovid, which, if given within the first few days of illness, can shorten the duration and severity of the disease. All adults and children ages 12 and older are eligible for Paxlovid, but the CDC recommends first consulting a doctor to help decide which of the treatments available, if any, is right for you.
If you are still not sure what to do if you test positive for COVID this holiday season, the CDC has a step-by-step guide with advice on what to do and a list of resources available to everyone, for protecting against the virus.