What to expect from COVID this winter

Last winter the highly-transmissible Omicron variant upended the holiday season and sent COVID-19 cases soaring well into the new year. What should we prepare for this time around? Here's everything you need to know:

How bad will COVID get this winter?

COVID cases and deaths are on the rise, thanks in part to cold weather forcing people to mingle inside just as holiday gatherings began with Thanksgiving. "We know that the virus will circulate more quickly and easily as folks gather indoors for the winter holiday season," a senior Biden administration official told NBC News. But not all experts agree on whether this uptick is worrying. Infectious diseases expert Susan Kline tells The Atlantic she has "not seen a big enough change to call it a wave." The real trouble might hit after Christmas, when travel will "pour more gas on the fire," Gregory Poland of the Mayo Clinic said.

The senior administration official notes that "COVID isn't the disruptive force it once was." Indeed, those who do get sick can hopefully expect a milder case, thanks to prior infection, some degree of vaccination, or both. That said, U.S. booster uptake has been devastating low, long COVID is a growing issue even for asymptomatic cases, and "any sort of wave would in all likelihood lead to an uptick in deaths," writes Yasmin Tayag at The Atlantic. As of Dec. 14, just 44.2 million people over the age of 5 — 14.1 percent of the U.S. population — had received their updated bivalent dose, which protects against both the original COVID strain and the Omicron variant, according to the Centers for Disease Control and Prevention. Even the elderly appear uninterested in the double shot, further driving home "the fact that we have not really done a good job of targeting the right people around the country," epidemiologist Denis Nash added.

When taken alongside the rise in flu and RSV cases (RSV being a respiratory virus for which kids are especially prone), White House officials fear a winter COVID surge could give way to a so-called "tripledemic" — or a concurrent pileup of all three viruses, The New York Times reports. For weeks, pediatric hospitals were overrun by RSV cases, though cases appear to have peaked — and are now pivoting to the flu, which is ramping up alongside COVID.

The surge in the three viruses "is almost predictable at this point in the pandemic," Dean Blumberg, MD, of the University of California Davis Health, told WebMD.  "All the respiratory viruses are out of whack," in large part because we basically missed two regular seasons of them.

Is the administration doing anything to head off a COVID surge?

As part of its "winter preparedness plan," the White House relaunched its free COVID test program, which offers U.S. households four at-home test kits free of charge. Interested parties can request a package at covidtests.gov; orders began shipping the week of Dec. 19. The administration is also planning a vaccination and prevention push among high-risk individuals, and is working to distribute and pre-position N95 masks and other PPE from the Strategic National Stockpile around the country. Additional at-home tests will be shipped to food banks and low-income housing programs.

The White House is also asking "states to play a role, urging governors to set up mobile and pop-up vaccination and testing sites, along with more test-to-treat sites where patients can be tested and get Pfizer's Paxlovid treatment if they are infected," NBC News reports.

Are there any new variants to worry about?

Unlike variants past, the latest strains of concern aren't that of a new Greek letter, The Washington Post reports. Rather, they're a "group of immune-evading Omicron spinoffs ... popping up all over the world." Each represents a different "flavor" of the virus, "adorned with a similar combination of mutations" that, most concerningly, appears consistently successful in blocking humans' main line of immune defense. Perhaps most adept at doing so is the XBB variant, a strain formed from a combination of Omicron subvariants B.A.2.75 and BA.2, according to the Japan Times. XBB arrived in the U.S. after tearing through the largely vaccinated Singapore, per The New York Times. According to CDC estimates for the week ending Dec. 17, XBB comprised roughly 7.2 percent of the country's cases.

Otherwise, U.S. health officials have said they're "very carefully" monitoring emergent subvariants BQ.1 and BQ.1.1, the San Francisco Chronicle reports. The two strains are "our greatest concern right now, both for the number of mutations, but also for the impact and the phenotype that we are worried that they may imply," CDC Director Dr. Rochelle Walensky said at the end of October. Taken together, BQ.1 and BQ.1.1 made up roughly 69.1 percent of U.S. cases as of Dec. 22 for the week ending Dec. 17, per CDC estimates. The subvariants do not seem to cause more severe illness than their parent strain BA.5, which they overtook in prevalence some time in mid-November, but they are thought to be better at evading immunity, per Yale Medicine.

Also creeping into case counts is BF.7, the subvariant currently spreading across China and wreaking havoc in Beijing. Also a descendant of BA.5, BF.7 seems to have the "strongest infection ability" out of any subvariants in China, is able to transmit faster, has a shorter incubation period, and is more able to infect those who have been previously infected, are vaccinated, or both, CBS News reports. Symptoms seem consistent with other variants: cough, sore throat, and fatigue, among others.

Though its been detected in several other countries around the world — including India, the United Kingdom, and Germany, CBS News adds — BF.7's growth appears far less exponential elsewhere than it does in China. The CDC estimates the variant comprised roughly 4.9 percent of cases in the week ending Dec. 17.

What can I do to protect myself from getting sick this winter?

Get vaccinated for both the flu and COVID-19. Even if you get infected, the bivalent booster and/or primary series of COVID vaccinations will protect you from serious disease and death. Wash your hands often, and always stay home from work or school if you're feeling sick. Wear a mask if you can.

If you're relatively healthy, "none of those viruses is a big threat to you necessarily," explained the Times' Apoorva Mandavilli, but they are "a threat to our health-care system, which is already so stretched." So do your part to ensure hospitals remain accessible for those most vulnerable to COVID and the "tripledemic," like children, pregnant people, and the elderly. "The boosting is the thing that has to get buckled down," cardiologist Dr. Eric Topol told the Times. "As a nation, we are terribly under-boosted."

Meanwhile, play it safe with your holiday gatherings. "If you are feeling sick, you should stay home," said White House COVID-19 Response Coordinator Ashish Jha. "You don't know what virus you have and there's no value in spreading it to other people."

Update Dec. 22, 2022: This piece has been updated throughout to reflect the latest COVID-19 data.

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