SAN RAFAEL, CALIFORNIA: Safeway pharmacist Shahrzad Khoobyari administers a Pfizer COVID-19 booster … [+] vaccination into the arm of Chen Knifsend at a vaccination booster shot clinic in San Rafael, California. (Photo by Justin Sullivan/Getty Images)
In September, during an interview on the television program 60 Minutes, President Biden asserted that “the [Covid-19] pandemic is over.” For all intents and purposes, pre-pandemic life has resumed across the U.S. and many other parts of the world. But just because things appear normal doesn’t mean we’re out of the woods.
Since the spring of 2020 many U.S. politicians have been asserting that the end of the pandemic is near, only to have their blissfully ignorant comments rebutted by facts on the ground. On April 24th, 2020, for example, merely 7 weeks after the first death attributed to Covid-19 was announced in the U.S., former Vice President Pence predicted that the U.S. would “have this coronavirus epidemic behind us” by Memorial Day weekend. Pence’s fanciful prediction didn’t exactly pan out.
On July 4th weekend 2021 President Biden declared “our independence from the coronavirus,” brashly proclaiming that “the virus is on the run.” Just a few weeks later the nation was in the midst of the Delta wave.
Optimism is a good thing, unless it’s a stubborn way to avoid reality. In reality, the pandemic is far from over.
While for most people the fear factor is gone, that doesn’t undo the fact that daily Covid-19 related deaths in the U.S. have remained stuck between 400 and 500 for months, or that long Covid is affecting millions to one degree or another. Vaccinations have helped to bring down disease severity and deaths considerably. But, the vaccines’ ability to curb transmission is limited at best. And so, in light of there being few if any mitigation measures set up, community transmission has stayed perilously high.
Invariably viruses mutate over time. But, the more infections there are the greater the likelihood of mutations and emerging sub-variants (as well as entirely new variants) that have immune-evasive properties, whether against vaccine- or naturally acquired immunity.
What’s in store for the U.S.
As Covid-19 cases and hospital admissions across Western Europe rise – due mainly to seasonality and waning immunity (see figure below), but also the advent of new sub-variants – we’re reminded that what happens in Europe doesn’t stay in Europe. The next U.S. Covid-19 wave is brewing. Indeed, given that the U.S. has followed European trends throughout the pandemic, a major wave in the U.S. is almost inevitable. The Northeast tends to be one of the first regions to get hit. The recent sharp uptick in coronavirus in Massachusetts wastewater suggests a wave is imminent.
Covid-19 hospital admissions rising across Western Europe
In addition to the factors seasonality and waning immunity, what will accelerate this wave is the surfacing of new sub-variants, as is happening across Europe. As was alluded to above, the SARS-CoV-2 virus is perpetually evolving. It will find new and old hosts, sometimes repeatedly, leading to genetic drift or changes in the molecular structure of SARS-CoV-2.
Currently, we have what can be characterized as a “sub-variant soup” on our hands; a veritable mix of many different Omicron sub-variants competing with one another to try and dominate the SARS-CoV-2 space. This is a global phenomenon. Given the world population’s ever-increasing mobility, both within borders of nations and beyond, such sub-variants wind up traveling between continents.
At present, subvariants of particular concern in Europe and elsewhere include BQ.1 and BQ.1.1, both off-shoots of the omicron sub-variant BA.5. They have some worrisome immune-evasive properties.
Two other sub-variants are raising red flags. One is named BA.2.75.2, the other XBB. The latter could be the most antibody-evasive coronavirus sub-variant, thus far.
The sub-variants BA.5 and BA.4.6 still hold sway in the U.S, as together they currently comprise 94% of cases. But experts are on the look out for increasing numbers of infections from new sub-variants.
As cases and hospitalizations increase across Europe, the woefully inadequate booster campaign in the U.S. is leaving some Americans particularly susceptible to a late autumn wave. Until now, less than 4% of eligible adults have received a booster. There doesn’t appear to be much urgency among the public to get vaccinated, even among those who qualify as at-risk, such as the over 65 group. Almost 40% of those 65 and older have only heard “a little” or “nothing at all” about the updated bivalent boosters, according to polling data released by the Kaiser Family Foundation. Bivalent vaccines include both a component of the original virus strain and that of the BA.4 and BA.5 lineages of the Omicron variant.
Poor public health messaging, including statements from the President – a very familiar theme throughout the pandemic – has left many Americans unsure about whether they should get the new bivalent booster. This includes vulnerable groups like the elderly and immunocompromised who stand to benefit the most from being boosted.
Also, there’s practically no effort anymore on the part of federal, state, or local officials in the U.S. to limit the transmission of the virus by way of non-pharmaceutical interventions, such as masking and improvements in ventilation. Furthermore, given the widespread distrust of public health officials, and outright antipathy in many places towards Covid-19 mitigation measures, it is very unlikely the U.S. will institute anything remotely similar to what, for instance, Germany is planning on doing.
In Germany, the federal government has agreed on a package of measures to combat the spread of the coronavirus. Most of these rules will be up to the discretion of individual states to interpret and implement. However, nationwide there will be a number of mandatory restrictions in place pertaining to public transit and visits to hospitals and care facilities for the elderly and sick. Masks will be required in all forms of public transportation, and for visitors to hospitals and nursing homes. Additionally, visitors must submit a negative Covid-19 test from the previous 24 hours.
As Yogi Berra once said, it ain’t over till it’s over. This aphorism might sound trite, but it is advice many U.S. politicians don’t heed. The virus’s path and what we do to disrupt that path will determine when the pandemic is over, not us saying so or simply normalizing what is not a normal state of affairs.
