A year after omicron began its assault on humanity, the ever-evolving mutant coronavirus was skyrocketing the number of COVID-19 cases in many places just as Americans were gathering for Thanksgiving. It was the start of a wave that experts expect will soon sweep across the United States
The emergency doctor Dr. Nicholas Vasquez, of the Phoenix area, said his hospital admitted a growing number of chronically ill people and nursing home residents with severe COVID-19 this month.
“It’s been a while since we needed COVID stations,” he said. “It’s a clear comeback.”
Across the country, there were about 39,300 new COVID cases per day on average on Tuesday — far fewer than last winter, but a significant undercount due to reduced testing and reporting. About 28,000 people with COVID were hospitalized every day and about 340 died.
Cases and deaths had risen two weeks earlier. Still, a fifth of the US population has not been vaccinated, most Americans have not received the latest booster shots and many have stopped wearing masks.
Meanwhile, the virus keeps finding ways to avoid defeat.
The Omicron variant arrived in the U.S. just after Thanksgiving last year, causing the pandemic’s biggest fall wave. Since then it has spawned a large extended family of subvariants, the most common in the US today: BQ.1, BQ.1.1, and BA.5. They edged out competitors by getting better at bypassing immunity from vaccines and past diseases — and sickening millions.
Carey Johnson’s family was hit twice. She contracted COVID-19 during the first Omicron wave in January and suffered flu-like symptoms and excruciating pain that held her down for a week. Her son Fabian Swain, 16, suffered from significantly milder symptoms in September when the BA.5 variant was dominant.
Fabian recovered quickly, but Johnson suffered from a headache for weeks. Other problems stayed longer.
“I thought, ‘I can’t get it together.’ I couldn’t organize my thoughts. I couldn’t get my energy together,” said Johnson, 42, of Germantown, Maryland. “And so it went on for months.”
HOT SPOTS ARE CREATED
Some municipalities are currently particularly badly affected. The Mayo Clinic’s tracking shows cases trending in states like Florida, Arizona, Colorado and New Mexico.
In Arizona’s Navajo County, the average daily fall rate is more than double the national average. dr James McAuley said that at the Indian Health Service facility where he works, 25 to 50 people are testing positive for the coronavirus every day. They used to see only a few cases a day.
McAuley, clinical director at Whiteriver Indian Hospital, which serves the White Mountain Apache Tribe, said they were “essentially back to where we were at our last big peak” in February.
COVID-19 is part of a triple threat that also includes the flu and the virus known as RSV.
dr Vincent Hsu, who oversees infection control for AdventHealth, said the system’s children’s hospital in Orlando is almost full of children who have contracted these viruses. dr Greg Martin, past president of the Society of Critical Care Medicine, sees a similar trend elsewhere.
Children’s hospital emergency rooms and emergency departments are busier than ever, said Martin, who practices primarily at Grady Memorial Hospital in Atlanta. “It’s a record compared to any month, week, day in the past,” he said.
Looking ahead, experts see the seeds of a widespread US wave. They point to what is happening internationally – a BA.5 surge in Japan, a combination of variants pushing cases in South Korea, the start of a new wave in Norway.
Some experts said a US wave could start during the holiday as people congregate indoors. Trevor Bedford, a biologist and genetics expert at the Fred Hutchinson Cancer Research Center, said there could be about 150,000 new cases a day, which the nation saw in July.
A new wave would be rough, said Dr. Mark Griffiths, Medical Director of the Emergency Department of Children’s Health Services at Atlanta-Spalding Hospital. “So many systems are on the verge of being completely overwhelmed that if we add another COVID surge to it, some systems will collapse.”
A glimpse of hope? The number of deaths is likely to be much lower than when the pandemic began. About 1 in 2,000 infections are now fatal, compared with about 1 in 200 in the first half of 2020, Bedford said.
OMICRONS ANNUAL GOVERNMENT
The same widespread immunity that reduced deaths also drove the coronavirus to mutate. By the end of last year, many people had become infected, vaccinated, or both. That “created the initial niche for the spread of Omicron,” Bedford said, as the virus had evolved significantly in its ability to escape established immunity.
Omicron thrived. Mara Aspinall, who teaches biomedical diagnostics at Arizona State University, found that the first Omicron strain accounted for 7.5% of circulating variants in mid-December and 80% just two weeks later. US cases rose to one million a day at one point. Omicron generally caused less severe illness than previous variants, but hospitalizations and deaths skyrocketed given the sheer number of those infected.
The giant wave subsided in mid-April. The virus quickly mutated into a number of subvariants that were able to evade immunity. A recent study in the journal Science Immunology says this ability to evade antibodies is due to more than 30 changes in the spike protein that litters the virus’s surface.
Omicron has evolved so much in a year, Bedford said, that it’s now “a meaningless term.”
This rapid mutation is likely to continue.
“There’s a lot more pressure for the virus to diversify,” said Shishi Luo, chief of infectious diseases at Helix, a company that provides virus sequencing information to the US Centers for Disease Control and Prevention.
According to doctors, the best protection against the bubbling stew of the sub-variants is vaccination. And officials said Americans who received the new combination booster for Omicron and the original coronavirus are currently better protected than others from symptomatic infections.
dr Peter Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital, said getting the booster when you’re eligible is “the most impactful thing you can do.”
Doctors are also urging people to continue testing, maintain preventative measures like masking in crowds and stay home if sick.
“COVID is still a very big threat, especially for the most vulnerable,” said Dr. Laolu Fayanju of Oak Street Health in Cleveland, which specializes in the care of older adults. “People have to keep thinking about each other. We’re not quite off the hook yet.”
Associated Press writer Heather Hollingsworth contributed from Mission, Kansas.
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