A year after Omicron launched its att*ck on humanity, the ever-changing mutant coronavirus caused a spike in COVID-19 cases in many places as Americans gathered for Thanksgiving. It was a prelude to a wave that experts believe will soon sweep across the United States
Phoenix-area emergency physician Dr. Nicholas Vasquez said his hospital had admitted a growing number of chronically ill people and nursing home residents with severe COVID-19 this month.
“It’s been a long time since we needed COVID wards,” he said. “It’s a clear comeback.”
Across the country, the number of new COVID cases averaged around 39,300 a day on Tuesday – significantly lower than last winter, but significantly underestimated due to limited testing and reporting. About 28,000 people with COVID were hospitalized daily, and about 340 died.
Cases and d*aths increased from two weeks earlier. Yet one-fifth of the U.S. population has not been vaccinated, most Americans have not received the latest boosters, and many have stopped wearing masks.
Meanwhile, the virus keeps finding ways to avoid failure.
The omicron variant arrived in the United States just after Thanksgiving last year and caused the largest wave of cases in the pandemic. Since then, a large extended family of sub-variants has spawned, such as those currently most popular in the United States: BQ.1, BQ.1.1 and BA.5. They outpaced their competitors by excelling at evading vaccine immunity and pre-existing diseases – and infecting millions.
Carey Johnson’s family has been hit twice. She contracted COVID-19 in January during the first wave of omicrons, suffering flu-like symptoms and excruciating pain that held her back for a week. Her son Fabian Swain, 16, suffered from much milder symptoms in September, when the BA.5 variant was dominant.
Fabian recovered quickly, but Johnson had a headache for several weeks. Other problems lasted longer.
“I was like, ‘I can’t get this together.’ I couldn’t collect my thoughts. I couldn’t get the energy together,” said Johnson, 42, of Germantown, Maryland. “And so it went on for many months.”
Some communities are particularly hard hit right now. Tracking by the Mayo Clinic shows an increase in cases in states such as Florida, Arizona, Colorado and New Mexico.
In Navajo County, Arizona, the average daily case rate is more than twice the state average. Dr James McAuley said 25 to 50 people a day test positive for coronavirus at the Indian Health Service facility where he works. Previously, they only saw a few cases a day.
McAuley, clinical director of the Whiteriver Indian Hospital, which serves the White Mountain Apache tribe, said they were “basically back to where we were with our last big peak” in February.
COVID-19 is part of a triple threat that also includes influenza and a virus known as RSV.
Dr. Vincent Hsu, who oversees infection control at AdventHealth, said the system’s pediatric hospital in Orlando is almost full of children with these viruses. Dr. Greg Martin, former president of the Critical Medicine Society, sees a similar trend elsewhere.
The emergency departments of children’s hospitals and urgent care clinics are busier than ever, said Martin, who practices primarily at Grady Memorial Hospital in Atlanta. “This is a record compared to any month, any week, any day in the past,” he said.
Looking ahead, experts see the beginnings of a widespread wave in the US. They point to what is happening internationally – BA.5 surge in Japan, combination of variants that increase cases in South Korea, start of a new wave in Norway.
Some experts say the wave in the US could start during the holidays when people gather indoors. Trevor Bedford, a biologist and genetics expert at the Fred Hutchinson Cancer Research Center, said the peak could be around 150,000 new cases a day, similar to July.
The new wave would be rough, said Dr. Mark Griffiths, medical director of the Atlanta-Spalding Hospital Pediatric Health Care Emergency Department. “So many systems are on the verge of total overload that if there is another COVID surge on top of that, it will rupture some systems.”
One bright spot? The number of d*aths is likely to be much lower than at the beginning of the pandemic. Bedford said around 1 in 2,000 infections now lead to d*ath, up from around 1 in 200 in the first half of 2020.
The same widespread immunity that has reduced the number of d*aths has also forced the coronavirus to mutate. By the end of last year, many people had become infected, vaccinated, or both. This “created an initial niche for the omicron to spread,” Bedford said, as the virus has evolved significantly in terms of its ability to escape existing immunity.
Omicron prospered. Mara Aspinall, who teaches biomedical diagnostics at Arizona State University, noted that the first strain of omicrons accounted for 7.5% of the circulating variants by mid-December and 80% just two weeks later. The number of cases in the US at one point jumped to a million a day. Omicron generally caused less severe illness than previous variants, but the number of hospitalizations and d*aths skyrocketed based on the sheer number of people infected.
The giant wave subsided by mid-April. The virus quickly mutated into a series of subvariants capable of 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 blasts the surface of the virus.
Bedford said Omicron has evolved so much over the years that it’s now a “meaningless term”.
This rapid mutation is likely to continue.
“There’s much more pressure to diversify the virus,” said Shishi Luo, chief of infectious diseases at Helix, a company that provides virus sequencing information to the U.S. Centers for Disease Control and Prevention.
Doctors have found that the best protection against the bubbling stew of minor variants remains vaccination. Officials said Americans who received a new combination reminiscent of omicron and the original coronavirus are now better protected than others from symptomatic infection.
Dr. Peter Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital, said getting a booster if you qualify is “the most impactful thing you can do.”
Doctors are also encouraging people to continue testing, maintain preventive measures such as masking in crowds, and stay home when sick.
“COVID continues to be a very serious threat, especially for the most vulnerable,” said Dr. Laolu Fayanju of Oak Street Health in Cleveland, which specializes in elderly care. “People have to keep thinking about each other. We’re not completely out of the woods on this yet. “
Associated Press Writer Heather Hollingsworth contributed from Mission, Kansas.
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