The Middletown Press (Middletown, CT)
‘It’s not going to be over’
Experts: COVID expected to stay high this summer
When the Northeast emerged from the COVID-19 wave that killed thousands of residents this winter, experts voiced guarded optimism about the months to come.
Connecticut, they predicted, would likely experience relatively low transmission through the calendar’s warmer months, before perhaps experiencing another wave next fall. For a time, at least, residents would enjoy a period of relatively low transmission, a chance to put away their masks and test kits and move through their lives without concern about getting sick or infecting others.
There was only one disclaimer: A new variant or two could change the situation at any moment.
“My one caveat was always, unless there was the presence of variants,” Dr. Ulysses Wu, chief epidemiologist at Hartford HealthCare, said this week. “And that unless unfortunately came true.”
Sure enough, the BA.2 subvariant arrived to cause a new spike, leading to thousands of COVID-19 cases, hundreds of hospitalizations and dozens of deaths. Now, with other subvariants on the way, experts warn of an alarming possibility: COVID-19 might linger at relatively high levels all summer long, raising new questions about what it means to truly live with the disease.
Suddenly, the promise of a low-COVID summer feels distant.
“The expectation by many was that the omicron wave was the dying cough of COVID and that was going to be it,” said Nathan Grubaugh, a Yale School of Public Health professor who tracks the emergence of COVID-19 variants in Connecticut. “Seeing this rebound in cases now and increases in hospitalizations and deaths, it should be pretty clear that it’s not going to be over.”
In other words, Grubaugh said, “This game, I
hope we've all come to appreciate, isn't showing signs of ending.”
‘We’re always just going to have to transmission’
Currently, Connecticut finds itself amid a COVID-19 wave that isn't as severe as the one that slammed the state last winter but has nonetheless caused plenty of illness.
Over the past week, Connecticut has averaged 1,404 daily coronavirus cases — a figure that doesn't include at-home tests whose results never get reported to the state — up more than fourfold from mid-March. Hospitalizations have risen as well, reaching their highest level since February.
Despite vaccines and boosters and highly effective antiviral pills, not to mention warm spring weather, the state still has plenty of COVID-19.
“Certainly we're in a high-transmission period here,” said Dr. David Banach, hospital epidemiologist at UConn Health. “We're looking at very contagious variants that are circulating right now, and I think that, coupled with the removal of mitigation strategies, is leading to where we are.”
The good news is that Connecticut's current outbreak might be nearing its peak. Pedro Mendes, a computational biologist at UConn Health who has modeled the pandemic, predicts that hospitalizations in the state will rise slightly further, then peak in late-May and begin to decline.
The bad news is no one can say with confidence what will come next. Banach said he's still hopeful that the numbers will be lower this summer, as more activities move outdoors, but that he's learned not to be too sure when forecasting COVID-19.
“It's difficult to make firm predictions about the summer,” he said. “Generally based on our prior knowledge of coronaviruses, circulation in warmer months, particularly here in the
Northeast, is less, but I can be open to the idea that previous knowledge could evolve.”
Dr. Richard Martinello, medical director for infection prevention at Yale New Haven Hospital, said that from a “wishful thinking” perspective it's possible Connecticut is getting its viral transmission out of the way now, clearing the way for a low-COVID summer.
From a more sober perspective, though, he's less optimistic.
“We have learned that we don't understand the seasonality of the virus yet,” Martinello said. “The data that we have had, the experience that we've had over the last two years really hasn't provided us with enough information to know what that seasonality will look like.”
Wu said he expects COVID-19 cases should decrease from their current level, hopefully soon, back to a more manageable level. He doubts, however, that transmission will return to the levels of last spring, when the state was recording only a few dozen cases a day.
“I wouldn't even make that comparison,” Wu said. “It's not just variants, it's also that people are not vaccinated and are not masking.”
Vaccination rates are a key part of the problem, Wu said. Whereas a year ago most adults had received two initial vaccine doses, giving them significant protection against COVID-19, today that immunity has largely faded, and not enough people have gotten booster shots to properly compensate.
Combine that with variants that are more infectious than ever and a public that largely treats COVID-19 as yesterday's news, and spread becomes inevitable.
“The reality is, I think we're never going to get down to a basal level where we want it to be, which is closer to zero,” Wu said. “I think we're always just going to have to transmission.”
‘We’re going to continue to see variants’
Experts always said the emergence of additional COVID-19 variants was inevitable. They just hoped the new strains wouldn't come quite so fast.
Today, the vast majority of COVID-19 cases in Connecticut stem from the BA.2 subvariant, a relative of omicron that has been dominant in the state for several months, spurring the recent surge in cases. Though BA.2 does not cause more severe illness than the original omicron variant, it does appear to be more infectious, spreading more easily from person to person than any previous strain.
Grubaugh, whose Yale School of Public Health labs conducts careful surveillance on variants in the state, said Connecticut is already confronting a BA.2 sublineage that's more infectious than the version that first hit the state earlier this spring. That, he said, may help explain why the current wave has been more significant than many experts initially predicted.
“As we develop immunity the virus evolves to find more ways to infect people,” Grubaugh said. “So what we're dealing with is this consistent replacement by variants and sublineages within those variants that are more transmissible.”
Even still, if BA.2 were the only variant to worry about, maybe Connecticut's near-term outlook wouldn't be so worrisome. But instead, the state is already staring down BA.4 and BA.5, a pair of subvariants that have caused a surge in South Africa and appear to evade natural immunity from previous strains.
So far, Connecticut has recorded only five total cases of the two variants, according to researchers at the Yale School of Public Health, but experts say many more are likely to come.
“I'm very worried about it,” Martinello said. “Seeing what South Africa is experiencing, it's enough to make us concerned that the same will happen here.”
Grubaugh said he's not sure if BA.4 and BA.5 will replace the current BA.2 sublineage, given how infectious the latter is. Either way, he said, Connecticut will be stuck with a form of COVID-19 more transmissible than any before it.
Meanwhile, experts say there's no particular reason to think these new subvariants will be the last ones. Connecticut survived the delta variant only to encounter omicron, got past the initial omicron just to meet BA.2, BA.3 and BA.4 — and will likely face future variants whenever this crop moves along.
“As long as infections are happening and there's replication happening both in the U.S. and the rest of the world, we're going to continue to see variants,” said Dr. Marwan Haddad, who chairs Community Health Center Inc.'s COVID-19 advisory group. “We're going to have to expect there will be surges.”
‘I just want people to care a little bit’
So what does all this mean for life in Connecticut?
Some Connecticut residents have long since stopped caring about COVID-19 and resumed full pre-pandemic behaviors. Others, including many of those at highest risk from the disease, have maintained significant precautions, wearing masks in public and avoiding crowded indoor spaces.
Between those two groups are thousands of people who feel increasingly confused about the risk they do or don't face and the safety measures they should or shouldn't take in their daily lives. They may wonder, if COVID-19 is going to stick around, possibly at elevated levels, why bother anymore with masking and social distancing?
Infectious disease experts say they understand that perspective and, in fact, grapple with the same questions themselves.
“We're going to have to work to find a balance between responding to the virus, being able to mitigate the impact of the virus while resuming normalcy and regular activities,” Banach said. “As a society we're going to have to work towards trying to understand what that balance is.”
Banach said he anticipates that masking and other control measures will become even more personalized than they are currently, with individual people evaluating their personal vulnerability, their risk tolerance and the presence of COVID-19 in their communities.
Wu said he will continue wearing a mask in public indefinitely, and while he doesn't expect everyone to do the same, he does wish more people were taking even basic steps to protect against the disease.
“I don't want people to take it ultra-seriously,” Wu said. “I just want people to care a little bit.”
To Haddad, any discussion of control measures must consider people with suppressed immune systems, who are particularly vulnerable to COVID-19, as well as the risk of long-haul COVID, a condition researchers still don't fully understand.
“What is our obligation to protect our elderly and our friends, family and strangers who are immunocompromised and might not have that same [immune] defense?” Haddad said. “How do we protect those who continue to be vulnerable?”
As many people, in Connecticut and elsewhere, have itched to return fully to pre-pandemic life, some experts have begun to look at things differently. Over the past two years, measures meant to contain COVID-19 also reduced cases of influenza and other viruses, leading to the suggestion that some precautions could be worth holding onto.
While mandates and business closures appear to be a thing of the past, Martinello says more modest measures, like voluntary masking in crowded places, could become part of a new normal, for the sake of a healthier society.
“This is an opportunity to think about what our societal norms should be in the future to help protect the health of the population,” he said. “I am not suggesting we need to wear masks all the time, I'm certainly not suggesting lockdowns, but it is time for us to think about how do we re-calibrate our behaviors and what we think about as safe and normal.”