Another Covid surge may come. Are we ready for this?

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Another Covid surge may come. Are we ready for this?

Two months after the Omicron variant’s coronavirus case numbers in the United States soared to frightening heights, scientists and health officials are set for another swell in the pandemic and, with it, the first major part of the country’s strategy to live with the virus. is test. limiting its effect.

At the local, state and federal levels, the nation is easing restrictions and trying to restore normalcy. Encouraging Americans to return to pre-pandemic routines, officials are lifting mask and vaccine mandates and showing no inclination to close offices, restaurants or theaters.

But scientists are warning that the United States is not doing enough to stop vulnerable Americans from endangering and potentially endangering lives again.

The new pills may treat the infection, but federal efforts to buy more of them are in limbo. An aid package is stalled in Congress, even as agencies have no money for tests and therapeutics. Although less than a third of people have the booster shots needed for a high level of protection, daily vaccination rates have dropped.

While some Americans may not be persuaded to roll up their sleeves, experts said there is a lot health officials can do, for example, to get booster shots at the doorsteps of older people who are willing to take the initial dose. have been proved.

“You use the quiet period to work hard,” said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University. “You don’t use calm to forget.”

The most obvious warnings that the brief period may be coming to an end, as they often have in the past two years, come from Western Europe. In several countries, including Britain, France and Germany, case numbers are climbing as the even more infectious subtype of omicron, known as BA.2, takes hold.

In interviews, 10 epidemiologists and infectious disease experts said many of the ingredients were in place for this to happen in the United States, although it was not clear when the wave might hit or how severe it might be.

Case numbers are still falling nationally, but BA.2 accounts for a growing proportion of those infections, rising to nearly one-quarter of new cases last week. The subvariant Omicron is estimated to be 30 to 50 percent more infectious than the previous version of ba.1.

In New York City, the average daily number of cases increased by about 40 percent over the past two weeks, though they are much lower than in recent months. In Connecticut, scientists estimate the frequency of BA.2 infections is doubling every seven or eight days—half the rate of growth for Omicron this winter, but compared to the 11-day doubling time of the Delta version earlier. Quite fast.

“I expect we’ll see a wave in the US soon,” said Kristian Andersen, a virologist at the Scripps Research Institute in La Jolla, Calif. Later in spring or early summer.

And noting that some cases inevitably become more serious, Dr. Anderson said, “Yes, with such a wave there will be hospitalizations and deaths.”

However, some experts cautioned that BA.2 did not increase case numbers in every country where it emerged. In a best-case scenario, he said, even as the number of US cases begins to rise, immunity left over from the first omicron wave this winter could help protect against a huge surge in hospitalizations. And a shift towards external socialization can control the increase in the number of cases.

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For now, there are fewer COVID patients in intensive care units than at almost any other point in the pandemic. According to British data, the vaccines also protect against BA.2, as they did against the previous version of Omicron, and BA.2 does not appear to cause any more or less severe disease.

In an attempt to forecast what’s to come next, US health officials and scientists have debated what kind of mix of factors drove case numbers in Europe and how severe the wave could be.

The BA.2 subvariant began its march across Europe around the time some countries were lifting restrictions and mask mandates, potentially giving additional kindling to its spread. Some scientists in the UK have attributed that country’s increase to the fact that immunity weakens over time after vaccination or earlier infections.

In some parts of Europe, such as Denmark and the Netherlands, the peak of the BA.2 wave has already passed. In other countries, where the number of cases has increased since early March, hospital admissions have remained flat or increased only slightly.

But the UK has emerged as a more shocking example of the potential for BA.2 cases to start filling hospital beds. Health officials said people aged 70 and older in England had been infected at a record high, with estimates that one out of every 30 people in that age group had Covid in the week prior to March 12.

As a result, the number of hospitalized Covid patients has increased by about 35 per cent in recent weeks, although almost half of them had incidentally tested positive after admission. To increase safety, the UK plans to start giving older people a fourth dose later this month.

Even in the United States, scientists are concerned that so many people have gone more than six months since the last dose of the vaccine, leading to reduced levels of immunity. However, it is less clear whether the easing of COVID regulations in the United States will help fuel transmission to the same extent that it might in some European countries. Some parts of the United States have not been in effect for months.

“There are a lot of moving parts,” said David Downey, an epidemiologist at Johns Hopkins University. “It’s really difficult who is driving any of these waves.”

Less than half of Americans who have received a dose of the primary vaccine have had booster shots, putting the United States in a more precarious position. Even though the case numbers are so low, on average, about 1,200 Americans are dying from Covid every day – a rate far higher than in Western Europe, where older people have received a greater number of vaccines and boosters.

Over time, two doses become less effective in preventing Omicron-related hospitalizations, British estimates suggest, while a booster dose restores protection to a significantly higher level.

Adding to the alarm in the United States, several wastewater testing sites this week showed a massive increase in viral levels on a Centers for Disease Control and Prevention map.

But scientists said the changes were difficult to measure when viral levels were so low and the true picture was more confounded: Some wastewater sites in states such as Massachusetts, Connecticut and Ohio saw increased viral levels, while many others. Had not.

Whatever happens next, scientists said the time has come to get more people vaccinated, while the size of the coming wave still dominates the country.

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“We should read about how the federal government is using its resources to get booster numbers from nursing homes to nursing homes and from church to church,” said Sam Scarpino, managing director of pathogen surveillance at the Rockefeller Foundation.

But the federal government is warning that funding for the pandemic is drying up. Senate Republicans have said they will not approve $15 billion in new coronavirus aid without offsetting it by cutting spending elsewhere. House Democrats have held off on a proposal to rebalance the money state governments want to spend on their pandemic responses.

With the aid package for now, federal officials said they would need to begin cutting shipments of monoclonal antibody treatments to states by more than 30 percent next week. The government has secured 20 million antiviral pills, but orders for more are on hold. And by June, officials said, the federal government’s efforts to make sure companies continue to produce enough tests later this year will run out of money, risking capacity.

Federal officials said there just isn’t enough money to guarantee adequate purchases of variant-specific booster shots if needed. And while those shortages will affect all Americans, the uninsured will face particular risks because a federal program to reimburse providers for testing, treatment and vaccinations for those without insurance could end in early April.

Anne Rimoine, an epidemiologist at UCLA, said, “There are so many things we can do, yet the United States has chosen time and time again to be reactive rather than proactive, and that has cost us dearly.” ” Wearing rose colored glasses instead of correcting our vision. ,

A key question is how much protection people who got sick from a previous version of Omicron can count on — and for how long. A laboratory study published this week found that people infected with Omicron had higher levels of antibodies that would likely protect against BA.2. If this protection remains in place, it could mitigate the effects of any wave, given the country’s high levels of infections this winter.

A virologist at Beth Israel Deaconess Medical Center in Boston and study co-author Dr. Dan Barouch said, “I think it’s reassuring.”

But some scientists said they are concerned that people’s immune defenses would be reduced during the first omicron boom, making them more vulnerable to BA.

“The timing of the emergence of BA.2, and the potential reduction in immunity from the BA.1 wave, is not great with the arrival of masks,” said Nathan Grubaugh, an epidemiologist at the Yale School of Public Health.

Even as health experts said they had become accustomed to the boom-bust cycle of pandemic funding, they said they were surprised that money was drying up so quickly as the country began adjusting to a new normal. plan was drawn up.

That money, he said, was needed to avoid full-scale shutdowns, and instead find enough growth that health officials can recommend masks or increased testing in particular areas and help prepare hospitals. can do.

“People naturally, understandably want to get back into their lives,” said Jeffrey Shaman, an epidemiologist at Columbia University. “The question is, how quickly will we be able to respond?”

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