Among people who are still paying attention to Covid-19, there’s been a recent surge — not just in viral activity but in the concern once again being paid to Covid.
Headlines announce that transmission is surging and hospitalizations for Covid are rising by alarming percentages. There’s debate in some places about whether or not to resume wearing masks. People are worrying about whether the latest subvariant, BA.2.86, spells bad news for our fall and winter, and whether soon-to-be-released booster shots will be a match for it or whatever variant follows.
While the angst is understandable, there’s something we need to grasp at this point in our coexistence with SARS-CoV-2: This is our life now.
“I see so many people say: ‘Remember, Covid’s not over,’” Jennifer Nuzzo, an epidemiologist and director of Brown University’s Pandemic Center, told STAT.
“Covid’s never going to be over. You need to set expectations accordingly. It is never going to be over.”
Covid is now like influenza, RSV, rhinoviruses, and a large number of other pathogens that will at some point or points in a year increase in transmission activity and then decline, ceding the stage to something else that can make people cough, sneeze, run a fever, feel lousy, and sometimes require medical care and can on occasion lead to death. To be sure, Covid currently is the worst member of that gang, still killing more people a year than influenza, which previously wore the worst actor badge.
But when we’re looking at Covid, it’s important to remember that we are in a markedly different phase in our experience with SARS-2 than we were even a year ago, experts insist. Yes, the number of new hospital admissions is rising, and the number of deaths may follow. But they are far below the figures of previous years. In the last week of August 2021, there were nearly 86,000 new hospital admissions. Last year at the same time, the number was 37,000. This year it was 17,400.
But that important context is often missing from headlines or social media posts warning of a doubling of this metric or a percentage spike in that metric.
“There’s no context to that,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “Are we doubling 650 deaths a week? Or are we doubling 15,000 deaths? We just have to help ourselves understand that we’re in a different place. We’re going to see Covid activity indefinitely into the future.”
None of this is to say that Covid isn’t a serious threat for some. Although the infection feels like a cold or the flu for many people, this is not the common cold. It can put an infected person into hospital. It can kill. It can trigger long Covid, in which symptoms linger for months or longer.
Epidemiologist Bill Hanage noted that already this year, there have been roughly 100,000 Covid deaths in the United States — and there are 3.5 months left in the year. If half that number of people were to die during a flu season, it would be deemed a disastrous flu year.
“And yet, by comparison with what’s happened in the past, [Covid] is so much better,” said Hanage, who is associate director of the Center for Communicable Disease Dynamics at Harvard’s T. H. Chan School of Public Health. “And I think we need to hold in our heads the fact that those things are both true.’’
The current reaction to news that Covid hospitalizations are going up is reflective of the trauma the pandemic inflicted on society, Osterholm said. But we are not still in the pandemic’s acute phase, and we need to start thinking how we’re going to cope with Covid over the long term, he said — for example what, if any, mitigation measures we’re willing to reinstate.
“I think the challenge we have right now is that we have been so focused on the last three years and what the blunt force of the main pandemic was like, that we really lost our ability to imagine what the future was going to look like,” said Osterholm said, who suggested we need to be thinking more about the now and the future, not just the past.
“Before we were basically trying to completely avoid the virus,” he said. “Now we know it’s here. And now we know that we’re not going to shut down everything or even think about that. … So the point is: How do we live with it? And I think that’s the transition we’re in right now.”
For instance, Osterholm suggested it would be worthwhile having a discussion about whether schools in a particular area should temporarily close if absenteeism hits high numbers. The idea, he said, would be to treat a local burst of illness like snow days — not closing in-person schooling for protracted periods, as was done during the pandemic.
“But you can’t have that discussion right now. It’s like a third rail,” he said. But if influenza was emptying schools in the years before the Covid pandemic, “we would have done it in a heartbeat.”
“Covid’s never going to be over. You need to set expectations accordingly. It is never going to be over.”
Jennifer Nuzzo, epidemiologist and director of Brown University’s Pandemic Center
Part of the problem is the language being used, several experts told STAT, and the tenor of some of the news coverage. Hanage, for instance, bristles at the use of the word “surge,” calling it “really unhelpful.” He associates surge with a swell of cases big enough to threaten the capacity of hospitals to cope. We are not in that position right now.
Caitlin Rivers, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, acknowledged that finding the right words can be a challenge. In her Substack column, “Force of Infection,” which updates readers on a variety of infectious diseases, her goal is to contextualize discussion of what is going on, so that people can understand what they are really seeing when conditions change.
“It is a struggle to figure out how to communicate what’s going on with Covid activity accurately, to give people a sense of scale,” she said. “We are about two months into this recent increase … but it’s not as severe as this time last year … both, I think, in terms of activity in general … and in terms of hospitalizations and deaths.”
Justin Lessler, an epidemiologist at the University of North Carolina’s Gillings School of Global Public Health, can see Hanage’s point, but he also has concerns that in normalizing Covid’s role in our lives, we might be tempted to minimize it.
“I think there’s this idea that … ‘here to stay’ or ‘endemic’ somehow means ‘no big deal,’” he said. “And that’s not true.”
Lessler, also a modeler who contributes to Covid-19 Scenario Modeling Hub, a consortium that issues short-term forecasts of Covid activity, said that at this point, upticks in cases are to be expected at this time of year. “Maybe the message should be less, ‘It’s a surge,’ and more, ‘Well, the yearly epidemic is starting, and in some places it’s starting earlier than we thought,’” he said.
Another part of the messaging problem relates to the relative lack of data, as compared to a year or two ago, Nuzzo said, since the U.S. and countries around the world have cut back on their collection efforts. “We just have fewer data points to triangulate our way to understand what’s going on with this recent increase.”
And some of the data that exist aren’t as illuminating as they might seem. The pharmacy chain Walgreens announced that 48% of people it was testing in California were positive for Covid. But a figure like that is misleading, said Nuzzo, because only people who are “really darn sick” would show up at Walgreens to be tested for Covid.
With less data available — no one is trying to collect figures on how many people are contracting Covid at this point — even more attention is now being paid to the new subvariants. With each that emerges comes the supposition that things are about to get worse. But that’s not always the case. A subvariant earlier this year that was dubbed “the Kraken” on social media based on attempts to gauge its threat by studying its genetic changes turned out to bear no resemblance to the legendary, multi-tentacled sea monster.
“I think a lot of fervor gets spun up around these variant data,” Nuzzo said. “I think we often ascribe blame to variants for things that are really the product of our behaviors.”
Osterholm also thinks we shouldn’t assume new subvariants will change the state of play of transmission and severity — unless we start to have evidence things are actually getting worse.
Coming to grips with what life is going to be like with Covid as a part of the respiratory diseases mix could help us make better, more sustainable decisions about what we are and are not willing to do to try to mitigate its damage, the experts said. And toning down reactions to blips or upticks in cases could help avoid further Covid burnout that could prove counterproductive down the road, they suggested.
“My worry is if every time we see a new variant or an uptick in cases, making it overblown and freaking out about it, then nothing happens, then when the real thing comes and it is time to really bring back that pandemic playbook … people will not hear the warning bells,” Lessler said.
Hanage agreed. “It may be the case that at some point we might want to dust off that [pandemic control] advice. But saying it at the moment is just going to devalue that currency,” he said.