AAs the BA.2 wave peaks in the UK and begins to subside in some European countries, US health officials face an uncertain future even as US lawmakers have delayed renewing funds to cope to the pandemic.
While the Omicron subvariant now accounts for around 72% of Covid cases, the United States has not seen a nationwide increase in cases. Covid hospitalizations are now at the lowest point of the pandemic.
But scientists warned this week that the coronavirus will continue to evolve to evade immunity, causing future surges that are hard to predict.
Covid-19 has evolved faster than expected, and “we should expect a lot of evolution in the future,” Trevor Bedford, a professor of biostatistics at the Fred Hutchinson Cancer Center, told a panel of independent advisers from the FDA. “These viruses will do better and spread locally and maybe regionally and maybe globally.”
The US has generally followed outbreaks in the UK three or four weeks later, but reported cases are holding steady at an average of around 26,000 a day. Although deaths have dropped significantly since Omicron’s peak, more than 500 Americans still die every day.
“I think we’re going to see an increase in cases in some places,” said Benjamin Linas, a professor at Boston University School of Medicine. Lifting precautions will likely drive future increases, he and others wrote in a study published earlier this month.
“We’re not in the crisis we were in 2020, but we have to be realistic that we’re not completely done either,” Linas said.
Parts of the northeast, including New York and Massachusetts, are starting to see upward ticks. Philadelphia is considering a return to indoor masking next week.
In Washington DC, where confirmed cases have increased 135% over the past two weeks, several high-profile politicians have tested positive, including House Speaker Nancy Pelosi on Thursday.
It is difficult to analyze the extent to which surges elsewhere have been driven by behavioral changes, increased BA.2 transmissibility and decreased immunity, and whether factors in the United States could suppress such a surge.
As the pandemic drags on, changes in how cases are reported and counted can also cloud the picture.
Home tests are often not counted in official counts, making it increasingly difficult to understand how widespread infections are. Wastewater monitoring could be helpful in filling the gaps, but many places are still ramping up these programs.
Several states have moved to weekly or bi-weekly reporting, instead of daily case reporting, mirroring a similar shift in June 2021 during a lull before the Delta surge. Oklahoma is changing how it reports its seven-day case average.
Changes to the definitions of Covid hospitalizations and deaths may also complicate tracking the pandemic.
Some states have also narrowed their definitions of Covid hospitalization to focus only on patients receiving Covid-specific drugs, while others have changed the way they define Covid deaths.
Last Monday, US lawmakers reached a deal for $10 billion in Covid funding, some of which has already expired. But on Thursday, several senators confirmed that the vote would not take place until after the upcoming two-week spring recess.
That amount was less than the $15 billion previously cut from an omnibus spending bill or the $22.5 billion requested by the White House.
The new bill will not cover testing and treatment for people without insurance, who lost that coverage in March. More than 30 million Americans are uninsured, and the lack of affordable and accessible testing and treatment could further affect the country’s ability to track and treat serious cases and illnesses.
The new funding package would also reduce spending on global Covid campaigns, including vaccination, which could prolong the pandemic by allowing new variants to emerge and spread.
“This is a global health issue, and if we continue to cut vaccine budgets in developing countries, we will have the next Omicron,” Linas said. “Because we have these pockets where the virus is going to reproduce, it has already prolonged the epidemic for at least a year – and if this continues, we will continue indefinitely.”
It’s estimated that half of Americans were infected with Omicron over a 10-week period — a “remarkable number,” Bedford said. By comparison, the flu usually infects maybe 10-20% of the population in about 20 weeks.
But it would also mean that about half of Americans weren’t infected in the first wave of Omicron, making them potentially vulnerable to another wave now. The coronavirus, as it swept the world and infected millions, mutated two to 10 times faster than the flu usually does, Bedford said.
It is likely that future variants will still emerge from Omicron, surpassing even the immunity of previous Omicron cases, he added.
But there is also the potential for a new generic variant of a previous strain to emerge, such as Delta. Omicron appears to have evolved from a much older version of the virus in the summer of 2020 before exploding across the world in late 2021.
It is also unclear whether Covid-19 will eventually become a seasonal virus, like influenza or respiratory syncytial virus (RSV).
“It’s not clear to me if it’s actually related to the months of the year, or if it’s just confounded by the virology that’s happening,” Linas said. The flu, for example, is “highly seasonal” but “I don’t think we know about Sars-CoV-2 yet.”
A major treatment has been halted in the United States due to questions about its effectiveness. The US Department of Health and Human Services (HHS) has withdrawn its approval of sotrovimab, a monoclonal antibody, because studies show it is less likely to be effective against Omicron. Recent research also indicates that this treatment could create resistance – a major concern with other monoclonal antibodies and antivirals.
Vaccines and treatments help, but they alone are not enough to stop the pandemic, and they must be accompanied by measures such as ventilation and masking during times of high transmission, Linas said.
Power surges are also highly dependent on human behavior.
“There is no virus outbreak outside of the context of how people behave,” Linas said. “It would be a big mistake to indulge ourselves and our leaders…The actions we take or don’t take matter a lot.”