Don't call it a comeback — because it's not, really — but Covid-19 appears to be in the midst of another summer uptick, a reminder that the virus that caused so much economic and social turmoil in the past few years has not been completely eliminated as a public health threat.
It's not a surge. The waves the US experienced with the delta variant and omicron are unlikely to be repeated again, now that so many people have either been vaccinated, infected, or both. But wastewater surveillance — which some experts regard as the best measure of Covid activity now that testing is so scattershot — indicates an increase in the virus's prevalence. The concentration of Covid-19 in US wastewater has roughly doubled in the past month, according to Biobot Analytics. It has been the first notable upswing since last winter.
Likewise, emergency department diagnoses have ticked up, according to CDC data, another indication of more Covid activity. Thus far, hospitalizations and deaths are still flat.
Because of preexisting immunity and evolutions of the virus itself, most cases should be mild. Some people may not even realize it's Covid. Even if immunity from antibodies is waning, which may lead to people feeling sick, immunity in their T cells should help most people avoid getting seriously ill.
But some rise in severe disease is expected when the virus is spreading more; it is a statistical inevitability. In Nashville and surrounding middle Tennessee, Dr. William Schaffner, formerly the medical director of the National Foundation for Infectious Diseases, said his surveillance network's number of hospitalized Covid patients had grown slightly, from the mid-teens to the low 20s, in the past few weeks.
It's the summer travel season, so people are out and about, mingling with others and sharing germs. Most people have also not received a Covid-19 vaccine shot in a while, given the low uptake of the boosters, and so their vaccine-conferred immunity is starting to wane.
"The way I like to characterize it is it's smoldering along," Schaffner told me of Covid-19 these days. "There are many opportunities now for spread to take place. Here and there, there will be little upticks."
This summer bump is not a crisis. But it is a reminder that, so soon after the US finally reached the point that there were no longer any "excess deaths" that defined the pandemic, Covid-19 is still with us. CDC director Mandy Cohen told NBC News this week the agency is preparing for another "tri-demic" this winter — with Covid, influenza, and another respiratory virus, RSV, circulating widely — that could challenge the US health care system.
"We need to make sure the American people understand all three and what they can do to protect themselves," Cohen said.
How the US can best minimize Covid's damage going forward
We do have the tools to minimize the damage these viruses can do. The challenge has been getting people to take advantage of them.
Last year, the number of people who said they planned to get a flu shot was actually down. Only one-third of Americans received a booster dose of the Covid-19 vaccine, despite the CDC's recommendation that most people should, and less than one in five received the omicron-specific booster. Experts have attributed those trends to "vaccine fatigue" and a general skepticism about public health among some patients after a contentious discourse about interventions during the pandemic.
This winter, an RSV vaccine will be available for the first time for people over 60. A new variation of the Covid-19 vaccine is expected to be ready as well. And then there will be an updated version of the flu shot. The vaccine campaign will be another test for a health care system that is still in the middle of a transition from the pandemic to a new normal.
Last year, that transition was felt primarily by the early and wide spread of RSV and influenza. After two years of being suppressed by Covid and mitigation measures, those viruses returned with vigor. Biology was dictating the terms of the public health response.
This year, Schaffner said he doesn't expect such an early, steep spike in infections. The transition is centered more on the health system itself and its ability to take advantage of these new tools to slow the viruses.
"Our challenge will be to organize ourselves to actually receive these vaccines," he said, calling it "a learning and transitional year."
The playbook for patients to help the health care system work through that transition is the same as it's always been. Even though most people are no longer wearing masks, people who may be at higher risk because of their age or health may still want to consider doing so if they are indoors around large groups of people.
And then, if people do feel sick, it's still important to take tests. A positive result allows doctors to prescribe the antiviral Paxlovid for patients who would benefit from it. The drug has been shown to significantly reduce the risk of hospitalization and death and yet, as of the beginning of this year, it was being prescribed in less than half of confirmed Covid-19 cases.
People are going to get sick with Covid-19. It's too widespread and too transmissible to stamp out entirely. But catching it early helps prevent the worst outcomes: hospitalization and death.
"It's severe disease that should be the focus, because it is essentially preventable by Paxlovid, which is underutilized in high-risk individuals," Amesh Adalja, a senior scholar at Johns Hopkins University, told me.
At-home testing is the first step toward taking better advantage of Paxlovid, Schaffner said. If you're feeling sick, take a rapid test. If it's positive, call your doctor. If it's negative, take another in the next 24 to 48 hours. Even if they remain negative, if symptoms worsen, you should still keep your doctor in the loop.
According to Schaffner, public health officials also have more work to do in educating doctors on the best practices for prescribing Paxlovid. "We are not optimally using Paxlovid," he told me.
But patients can help themselves by paying close attention to their symptoms. Masking may be worthwhile if you're older or immunocompromised.
As we prepare for another year of a "tri-demic," adjusting to this world where even in the hot summer months Covid is still with us, we all have a part to play to protect ourselves and others.
