COVID cases are on the rise again — just as the back-to-school season is starting. According to the Centers for Disease Control and Prevention (CDC), hospitalizations have increased by 12.5% this week (the CDC is no longer tracking case numbers, so we can’t measure the rise in them directly). It’s unlikely transmission will drop again on a dime. So how worried should parents be about their kids getting COVID, or getting it themselves — and of getting seriously ill from it? What steps should they be taking to prepare for a potential surge? And when will we be able to get a booster shot?
To answer all these questions and more, Fatherly spoke to Dr. Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine and Co-Director of the Texas Children’s Hospital Center for Vaccine Development, and Dr. Ziyad Al-Aly, Chief of Research and Development at VA St. Louis Healthcare System and Clinical Epidemiologist at Washington University in St. Louis. Here’s what they had to say.
What is the state of COVID right now in the U.S.? And what are we anticipating in the coming weeks?
Hotez: We're a little bit shooting blind because we're not counting cases like we used to. We're not getting state by state reporting to the CDC like we had in the past. We have to rely often on other metrics that we haven't used in the past. We are seeing, for instance, wastewater numbers go up, and that's been a pretty reliable indicator.
The numbers are going up, including hospitalizations, although the hospitalizations are starting at a nadir, meaning we reached one of our lowest points in a long, long time. The bottom line is, a lot of the indications are that the numbers are going up, including hospitalizations. Not so much death, but it is starting from a low level.
I can't say we’re going to see a true surge like we saw with Delta or the BA.1 Omicron wave. The numbers are going to continue to go up. Whether they'll start to go back down soon to cause more of a bump, or whether they'll continue to rise, is still a bit unknown. We don't have a lot of precedent to go on.
I'm not panicked about it, but I think it would be unwise if we don't heed that warning and learn from the past.
Al-Aly: Unfortunately, it's on the rise again. The honest and candid answer [to what’s going to happen in the coming weeks] is that we don't really know. But the wise approach is for us to be prepared. For us to take notes and be humbled by our experiences. The virus surprised us and outpaced us and outsmarted us in every single turn in this pandemic. Reflect upon that and be ready. Hope for the best, that come fall and come winter, we won't have a big surge. Hope for that, but it would be unwise to not prepare for the worst.
How is this going to interact with the back to school season throughout August and early September?
Hotez: It depends on what happens with the numbers overall. If they continue to go up, then they may climb even higher once the school season starts. And I would say probably the single most impactful thing you can do, since you do worry about the potential for long COVID in kids, is to get them boosted with this new XBB booster, assuming it's made eligible for children.
The virus surprised us and outpaced us and outsmarted us in every single turn in this pandemic.
Al-Aly: It is really enhancing the chance of transmission, especially now there is little to no masking, there is no social distancing, and most of our schools don't have good ventilation systems. That's the reality. That's a very fertile environment, so to speak, for higher transmission. Superimposed on a virus that's more prevalent in the population, that could fuel even further transmission and further growth in the number of cases. That's why I worry that the timing is not the best.
The other component is that most people who got vaccinated, got vaccinated like a year ago now. And we know vaccine immunity wanes with time. So hopefully the booster will be available soon, but we were told by this new CDC director the other day that there may be some delays. So all of those factors lead me to think that we need to be prepared for the worst. But again, I'm hoping for the best.
When can we expect to be able to get the booster this year?
Hotez: The last booster in the fall of 2022 that became available September was a bivalent booster. It had two components to the vaccine: the original lineage and one encoding the BA.4/BA.5 variant that was circulating at the time.
This is going to switch over not to a combined vaccine, but to what's called a monovalent, a single one. It's going to be specific for the currently circulating XBB variants, and that's what's going to come out any week now. We're hearing different stories, end of August. Some people say until October. I'm hoping September.
The vaccine is pretty close to the EG.5 Variant, nicknamed Eris, because that's derived from XBB. So it should cross-protect pretty well.
You still definitely want to go ahead and get that booster. That's the single most impactful thing you can do to protect yourself and your family.
Al-Aly: The CDC director said on NPR probably an early October timeframe. Vaccines are not the panacea, but they do to some extent reduce transmission. The best effect that they have is reducing hospitalization and death.
With all of this in mind, how worried should parents be right now for themselves, for their kids, and for the grandparents?
Hotez: By now most adults have either gotten COVID, have been vaccinated, have been vaccinated and had breakthrough COVID, or had COVID and then got vaccinated. So except for the ones that had no vaccine and no infection, there should be some degree of resistance, meaning that it'll likely, hopefully help you not become severely ill. But if you're older and you have underlying co-factors, you still may have some risk. So you still definitely want to go ahead and get that booster. That's the single most impactful thing you can do to protect yourself and your family. And get your kids boosted if they fall in the eligibility category.
I am of the opinion that COVID is a significant illness in kids because we do see pediatric hospitalizations; it is a significant cause of even pediatric deaths. But equally important is the specter of long COVID, and we don't fully understand why as many as one in seven kids can get long COVID, based on some older numbers out of London. It may have something to do with severe illness or repeated infections. By the time we fully understand how and when kids are at risk for long COVID, it could be a couple of more years. So at this point we have to make our best assessment, and my recommendation would be if the kids are eligible, to get the XBB booster.
If COVID continues to go up and we're in big crowded indoor situations, especially with poor ventilation, I'm still recommending masking.
Al-Aly: We've now lived with the virus for a while. We are generally sick and tired of being worried. And the virus is not going to go away anytime soon. Having said that, we need to deal with reality. And the reality is that the virus is still around. It'll likely, unfortunately, kill 30, 40, 50, 60,000 people this winter depending on how the magnitude of the surge goes. High-risk people should be certainly taking precautions to minimize the risk of exposure and getting the vaccine whenever it becomes available.
The risk for younger kids is lower. It's not zero. Do we know younger kids who got COVID and got in the hospital? Yes. Do we know younger kids have long COVID after COVID? Of course, yes. But kids have to go to school. Whatever is amenable or can be done to reduce that risk of exposure and protect those kids, I think it's effort well spent. And again, vaccination is going to be the tool that will reduce that risk of exposure, and most importantly reduce the risk of severe disease.
Other than getting boosted, is there anything else parents should be doing right now to prepare for increasing cases?
Hotez: Just be mindful of your community situation if you hear hospitalizations are starting to go up, and pay attention to the local news. But it shouldn't interfere with kids going back to school. Also, don't forget that kids are going to be eligible for the flu immunization as well. So you'll want to get them immunized to both.
If you have risk factors, either because of your age or your immune status or because of comorbidities, you want to maximize your protection, making certain that you're up-to-date on your boosters. If COVID continues to go up and we're in big crowded indoor situations, especially with poor ventilation, I'm still recommending masking. N95s or KN95s if possible.
Al-Aly: They should be vigilant. I'm not going to advocate for mandates for masking or anything like that. But be strategic and smart about it. Obviously, we're not asking people to mask all the time or to social distance or lockdown or anything like that. Absolutely not. But I think being strategic about your choices and your daily routine to minimize exposure is wise. If you're going out to dinner, for example, sitting outside is the better choice that reduces your chance of exposure to the virus. Those rational choices that you could make on a day-to-day basis are going to minimize your risk. If you’re boarding a plane, maybe wear a mask. Nothing is going to bring the risk down to zero, but minimizing that risk is, I think, the smart thing to do.
High-risk groups need to be very, very careful watching for the virus and trying to reduce that exposure.
And high-risk groups need to be very, very careful watching for the virus and trying to reduce that exposure as much as they can.
It sounds like you're not freaking out about this.
Hotez: Definitely not freaking out, but be mindful the numbers are going up, so there is risk, and you should take steps to maximize your protection through the new booster and masking in indoor crowded areas.
Al-Aly: Call me jaded. I mean, all of us are like that. This is not our first rodeo. And we've seen surges in Delta and Omicron. So I wouldn't say I'm panicked, but I've also used the word humbled many times, and the idea that the virus outpaced us and outsmarted us multiple times. It's wise to prepare for the worst.
I don't think panicking helps anyone. But we've seen what the virus can do. If you had called me two summers ago in the middle of August, we would be talking about Delta. We didn't even have Omicron on our brains. Come November, Omicron was in Africa, and then soon enough, two weeks later was in the U.S., rampant in the U.S. And had this remarkable surge.
I've seen how things could turn on a dime. Literally within a week or two, a big surge could happen that could fill the hospitals and ICUs. I've seen it happen multiple times. So I'm not panicked about it, but I think it would be unwise if we don't heed that warning and learn from the past.