Ready or not— and more signs are pointing to “not”— countries around the world have launched an endemic COVID-19 strategy. In the U.S., that means the end (or at least a significant reduction in numbers) of publicly accessible COVID testing sites and the cessation of other restrictions and guidelines. Globally, the change has been even more significant: even China— which has maintained the strictest protocols in the world— recently announced a major reduction in mandatory travel requirements. Acceptance of COVID-19 as an endemic virus does not mean the virus is gone, however. What it does mean is that much like the flu, we can expect COVID-19 to stick around in some form indefinitely. Unlike the flu, which spikes in the winter, COVID-19 hasn’t yet proven more virulent in one season over another. And if the current state of things is any indication, we’re in for yet another COVID summer, COVID fall, and COVID winter.
Why are COVID cases on the rise again?
Over the past two years we’ve counted multiple surges— a significant increase in reported numbers— of COVID-19 cases both in the United States and globally. Despite early protocols that helped reduce serious infection and widespread vaccination, these surges have continued to occur for two primary reasons: large group gatherings (particularly around the holidays) and the mutation of the SARS-Cov-2 virus itself. A new surge, first identified in late June 2022, has been linked to the two main mutations— also called subvariants— of the COVID-19 Omicron variant, BA.4 and BA.5. These two mutations are particularly problematic because they evade some of our protection from both prior infections and vaccines. They’re also difficult to track, and in early July 2022, the FDA found that antigen tests may accurately identify infection with Omicron only 60-percent of the time, even in those showing symptoms. That said, as with previous variants and subvariants, if you’ve had a second booster, you’re more likely to experience milder symptoms, even if the protection isn’t perfect.
The increase in Omicron this summer, and into the fall months, doesn’t mean you have no protection. It does mean that even if you have received the vaccine, you should act a bit more like you haven’t. Even those who previously had COVID, whether Omicron or another variant, should exercise caution. That’s because, no matter how you received it, your immunity wanes over time, and eventually disappears completely. COVID-19 is much like the flu in that way. The annual flu shot bolsters your body’s defense against the flu— including the year’s newest or strongest variants— long enough to get you through flu season. But eventually that immunity you got from the flu vaccine wears off and you need a new shot the following year. Waning immunity is contributing to the overall rise in COVID-19 cases, and the less protected you are, the more likely you are to become infected. Vaccine manufacturers are also already developing an updated booster to directly target these subvariants. That doesn’t mean those who’ve yet to get a second booster should wait; getting a second booster now and a targeted booster later will offer the most protection over the summer and until the updated booster is available.
What does the rise in COVID cases mean for the summer?
When we first assumed that COVID-19 would become endemic, the general belief was that like the flu, COVID infection rates would decrease in warm months, and increase in cold months. But it’s early July 2022, and COVID cases in the U.S. are trending up. While that’s something we’ve seen in previous summers during the pandemic, this time there are more factors to consider. The loosening of international travel restrictions and a move to endemic response strategies within the United States will undoubtedly result in sharp increases in both national and international travel. In fact, we’re already seeing it: the Transportation Security Administration (TSA) screened 6.74 million people over the three days prior to the July 4th holiday. That’s just eight-percent fewer travelers than the same three-day period in 2019, the summer before the onset of the pandemic. Increased air travel will be joined by increases in travel overall, and massive crowding at both event venues and popular travel destinations. Add waning immunity into the mix and you’ve got a recipe for a potentially massive surge in COVID cases.
The precedent is already set: in 2021, the vaccination of more than half of U.S. adults led to the relaxation of masking requirements just in time for Memorial Day festivities. Within two weeks, the Delta variant had caused a marked increase in COVID cases. That may have resulted from a combination of unestablished immunity— from those who had just received a vaccine or had not completed primary vaccination regimen, waning immunity from those vaccinated earlier in the year, and a then still-significant number of unvaccinated individuals. Continued caution, whether mandated or not, is the best way to prevent COVID surges, or at least to protect yourself.
Living in a COVID world, year-round
Too many are thinking past the endemic conversation to a post-COVID world, but we’re not there yet. Rather, the way we interact with the virus is changing, and we must all be smart about that interaction. We all known to take a PCR or antigen test at home or at the doctor’s office when we’re not feeling well, before and after travel, and when we’ve been exposed to the virus. Using the results from these tests, while accepting their Omicron-specific limitations, you can make informed decisions about your interactions with others. On their own, antigen tests simply aren’t enough to eliminate or even significantly reduce future COVID surges. That’s because they only tell you whether you have the virus— and again, accurately only for certain variants— and not whether you remain protected against infection.
Antibody tests can be an important missing piece to the puzzle. Only an antibody test can tell you whether you have a detectable level of immunity against COVID-19, and therefore some level of protection against the virus and its variants, and to some lesser degree, its many emerging subvariants. The FDA has cleared two antibody tests under emergency use authorization (EUA); while these tests aren’t available for in-home use, you can access them through your doctor. The U.S. FDA EUA-approved CovAB antibody test requires a quick oral swab with results in just 15 minutes, and more specifically can detect antibodies associated with Omicron infections. The U.S. FDA EUA-approved Siemens COV2T total antibody test requires a whole blood sample and provides results within 24 hours. While knowing “if” you have the virus might help you decide whether you’re liable to infect others, an antibody test can tell you more about your immune system’s ability to lessen the severity of the virus’ impact on your body, and that knowledge pays dividends when used correctly.
As the virus continues its endemic evolution, we must all make educated decisions for our health and the health of those around us. While COVID may eventually morph into a seasonal endemic virus like the flu, it currently shows the potential to cause infections year-round for years to come. As we continue to navigate the ever-changing landscape of COVID-19, knowledge remains the key to our health. Right now, that knowledge supports the combination of vaccinations and boosters, PCR tests and antibody tests, along with continued vigilance against potential and real surges.
Dr. Jerome Adams is a former vice admiral in the U.S. Public Health Service Commissioned Corps and served as the 20th Surgeon General of the United States. He is currently a distinguished professor and director of health equity initiatives at Purdue University.
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