A year after omicron began its assault on humanity, the ever-changing coronavirus mutant has increased the COVID-19 case count in many places, just as Americans flocked to Thanksgiving. It was a prelude to a wave that experts expect will soon sweep across the US.
Phoenix-area emergency physician Dr. Nicholas Vasquez, said his hospital has admitted an increasing number of chronically ill people and nursing home residents with severe COVID-19 this month.
“It’s been quite a while since we needed COVID wards,” he said. “It’s clearly coming back.”
Nationally, new COVID cases averaged about 39,300 a day on Tuesday — much lower than last winter, but a large undercount due to reduced testing and reporting. About 28,000 people with COVID were hospitalized daily and about 340 died.
Cases and deaths are up from two weeks earlier. However, one-fifth of the US population has not been vaccinated, most Americans have not received the latest boosters, and many have stopped wearing masks.
Meanwhile, the virus continues to find ways to avoid defeat.
The omicron variant arrived in the US shortly after Thanksgiving last year and caused the biggest wave of cases in the pandemic. It has since spawned a large extended family of subvariants, such as the most common in the US now: BQ.1, BQ.1.1, and BA.5. They outperformed competitors by getting better at evading immunity from previous vaccines and illnesses — and sickening millions.
Carey Johnson’s family has been hit twice. She contracted COVID-19 in January during the first omicron wave, suffering flu-like symptoms and excruciating pain that kept her depressed for a week. Her son Fabian Swain, 16, suffered much milder symptoms in September when the BA.5 variant was dominant.
Fabian quickly recovered, but Johnson had a headache for weeks. Other problems lasted longer.
“I was like, ‘I can’t pull myself together.’ I couldn’t organize my thoughts. I couldn’t muster my energy,” said Johnson, 42, of Germantown, Maryland. “And it went on for months like that.”
HOT SPOTS ARISE
Some communities are being particularly hard hit right now. Mayo Clinic tracking shows cases on the rise in states including Florida, Arizona, Colorado and New Mexico.
In Navajo County, Arizona, the average daily case rate is more than twice the state average. The Doctor. James McAuley said 25 to 50 people a day are testing positive for the coronavirus at the Indian Health Service facility where he works. Before, they attended only a few cases daily.
McAuley, clinical director at Whiteriver Indian Hospital, which serves the White Mountain Apache tribe, said they are “essentially back where we were with 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.
The Doctor. Vincent Hsu, who oversees infection control for AdventHealth, said the system’s pediatric hospital in Orlando is almost full of children infected with these viruses. The Doctor. Greg Martin, former president of the Society of Critical Care Medicine, sees a similar trend elsewhere.
Pediatric hospital emergency departments 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 seeds of a widespread wave in the United States. They point to what is happening internationally – a BA.5 rise in Japan, a combination of variants increasing cases in South Korea, the beginning of a new wave in Norway.
Some experts said a 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 it could peak at about 150,000 new cases a day, about what the country saw in July.
A new wave would be difficult, said Dr. Mark Griffiths, medical director of the emergency department of Children’s Health Care at Atlanta-Spalding Hospital. “So many systems are about to be fully overwhelmed that if we have another COVID outbreak on top of that, some systems will break.”
A bright spot? Deaths are likely to be much lower than they were at the start of the pandemic. About 1 in 2,000 infections lead to death now, compared with about 1 in 200 in the first half of 2020, Bedford said.
OMICRON’S ONE YEAR REIGN
The same widespread immunity that reduced deaths also caused the coronavirus to mutate. By the end of last year, many people had been infected, vaccinated, or both. This “created the initial niche for the omicron to spread,” Bedford said, as the virus has evolved significantly in its ability to evade existing immunity.
Omicron prospered. Mara Aspinall, who teaches biomedical diagnostics at Arizona State University, noted that the first omicron strain accounted for 7.5% of circulating variants in mid-December and 80% just two weeks later. US cases at one point skyrocketed to a million a day. Omicron generally caused less severe illness than earlier variants, but hospitalizations and deaths soared due to the large number of people infected.
The giant wave subsided in mid-April. The virus rapidly mutated into a series of subvariants capable of evading immunity. A recent study in the journal Science Immunology says that this ability to evade antibodies is due to more than 30 changes in the spike protein that covers the surface of the virus.
Omicron has evolved so much in one year, Bedford said, that it is 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, head of infectious diseases at Helix, a company that provides viral sequencing information to the US Centers for Disease Control and Prevention.
Doctors said that the best protection against bubbling stew of subvariants remains vaccination. And officials said Americans who received the new combination booster targeting both the omicron and the original coronavirus are currently better protected than others from symptomatic infections.
Peter Hotez, co-director of the Vaccine Development Center at Children’s Hospital of Texas, said getting the booster, if you’re eligible, is “the most impactful thing you can do.”
Doctors are also urging people to continue testing, maintain preventive measures such as masking up in crowds, and stay home when sick.
“COVID is still a very significant threat, especially for the most vulnerable,” said Dr. Laolu Fayanju of Oak Street Health in Cleveland, who specializes in caring for the elderly. “People have to keep thinking about each other. We are not completely out of the woods yet.”
Associated Press writer Heather Hollingsworth contributed from Mission, Kansas.
The Associated Press Department of Health and Science is supported by the Department of Science Education at the Howard Hughes Medical Institute. AP is solely responsible for all content.