A surge in COVID-19 infections has swept across the country this summer, disrupting travel plans and bringing fevers, coughs and general fatigue, with no signs of abating soon.
While most of the country and federal government have put the pandemic behind them, the virus is mutating and new variants are emerging.
Although the Centers for Disease Control and Prevention (CDC) is no longer tracking individual cases, experts believe this could be the biggest summer wave yet.
So far, the variants have not proven to cause more severe illness and vaccines remain effective, but there is no certainty about how the virus will change or what will happen next.
According to CDC wastewater data, while virus activity is currently highest in the West, nearly every state has detected “high” or “very high” levels of the COVID-19 virus in wastewater, and virus levels are higher nationwide than they were at this time last year and began to increase at the beginning of the summer.
Because so few people are being tested, wastewater data is the most reliable way to track levels of virus activity but cannot pinpoint specific numbers of infected people.
The decline in testing is partly due to pandemic fatigue, but experts say it’s also due to an access problem: Free at-home tests are becoming harder to find, the government is not distributing tests, and private insurance plans are not required to cover them until 2023, when the public health emergency ends.
The coronavirus has surged every summer since the pandemic began, a surge that experts say is driven by predictable trends like increased travel and hot weather that keeps people indoors, as well as three new variants that account for about 70% of all infections.
Vaccines and antiviral drugs can blunt the worst symptoms of the virus, and hospitals are no longer overwhelmed as they were early in the pandemic.
But there are still significant numbers of people who are not up to date on their vaccinations, and there are concerns that reduced testing and low vaccination rates could allow more dangerous variants to spread more easily.
“One of the things that’s been unique about this summer is that the variants are so extraordinarily contagious that they’ve spread so widely, and testing has been greatly reduced, so a lot of people have mild infections that they often don’t even know they have,” said William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University.
Its contagiousness means the virus is more likely to infect those who are most susceptible: people over 65, those with certain pre-existing medical conditions, or those who are immunocompromised.
In an interview with MedPage Today’s editor-in-chief in July, Anthony Fauci, the nation’s former top infectious disease doctor, said people in high-risk groups needed to take the virus seriously, even if the general public did not.
“You don’t have to limit your movements and isolate yourself from society,” Fauci said, “but no matter what the current recommendations are, if you have an 85-year-old with chronic lung disease or a severely obese 55-year-old with diabetes and high blood pressure who are in a crowded enclosed space, they should be wearing a mask when they’re in an indoor enclosed space.”
Schaffner said he was surprised to see hospitalizations increasing in the region for at least the past five weeks.
“I thought maybe last week would have been the peak, but I was wrong. It went up again this week, so at least locally, we haven’t peaked yet. I was expecting the rise this summer would plateau and maybe start to decline, but that hasn’t happened yet,” he said.
Still, much of the country has recovered from the pandemic and responded to rising cases with a shrug of the shoulders, with COVID-19 being treated like any other respiratory virus, including by the White House.
President Biden was infected in July and returned to campaign activities after isolating at home for a few days and taking the antiviral drug paxlovir.
Biden, 81, is considered at high risk for severe illness. He received the latest version of the COVID-19 vaccine in September, but it is unclear whether he has received the second dose as recommended by the CDC for older adults.
Updated vaccines targeting current variants are expected to be rolled out later this fall, and the CDC recommends they be given to everyone 6 months of age or older.
As of May, just 22.5% of U.S. adults reported receiving the updated 2023-2024 vaccine, which was released last fall and tailored to the then-dominant XBB variant.
Immunity from older vaccines wanes over time, so people aren’t completely immune, but those most vulnerable should be cautious, Schaffner said. Many people who are currently infected have greatly weakened immunity to the current variants of the virus, but weakened immunity is better than no immunity at all.
People with healthy immune systems and who have been vaccinated or infected previously remain less likely to experience a more severe infection that leads to hospitalization or death.
“Most of us are not ignorant about COVID-19, but the people with the weakest defenses are the most frail, those who are immunocompromised, those with underlying chronic conditions,” Schaffner said.
