By Mark Van Sumeren
March 28, 2022 – The United States has emerged from the worst of the BA.1 Omicron subvariant by every measure. Positive test rates, new cases, hospitalizations, and deaths with Covid have fallen to levels unseen since last summer – the last time we had a consensus that the pandemic was over. Meanwhile, Covid infections rage in Europe – where vaccination rates and prior infection levels match or exceed ours – and the Asia Pacific region, where strict containment measures previously kept the virus from spreading.
So, what lies ahead for the United States? Declining Covid infections and a “normal” summer? Or a renewed wave, fueled by the BA.2 subvariant?
Let’s gather the evidence.
At the height of the Omicron wave, three in every ten PCR tests indicated a Covid infection; last week, this rate fell to nearly one in fifty. Consistent with the lowered community transmission, test volumes have plunged by one-third in the previous month and by two-thirds since the worst of the Omicron wave. Ubiquitous home tests contribute to this lowered reported test volume, masking the number of Covid infections.
Reported cases dropped last week to the lowest level since July 6-13, 2021. In just a month, these new cases fell by nearly two-thirds. At its peak in January, Covid infected thirty times as many people in the United States as it did last week. Yet, this ebbing in new cases slowed in recent weeks – hinting that we may reach the bottom soon.
Similarly, hospitalizations fell to nine-month lows last week. Covid patients occupied one of every twenty inpatient beds last week. A month ago, one of every seven beds hosted a Covid-infected patient. In January, Covid patients required half of the inpatient bed capacity in the United States.
Most encouraging, deaths with Covid have declined over the past two months. Fewer people died last week with Covid than during any time since August 1-6, 2021.
These gains led the Centers for Disease Control and Prevention (CDC) to brighten its Community Level ratings again last week. The CDC rates 91% of the country as “Low” in its measure of virus transmission and health system impact; another 7% are rated as “Medium”. When it launched this rating system just a month ago, the CDC assessed that 30% of the country was at a “High” level of transmission and healthcare impact.
Furthermore, experts predict brighter days ahead. An ensemble forecast published early last week showed both cases and deaths declining in the next three weeks. The Institute for Health Metrics and Evaluation (IHME) anticipates cases and hospitalizations will fall through at least July 1.
Sounds great, so why the concern?
Our recent infection wave stemmed from the spread of the BA.1 subvariant. Since then, a mutation of this variant, BA.2, emerged in Europe and the Asia Pacific, sparking new infection spikes. During previous infection waves, the United States followed Europe’s lead, with our surge trailing that in Europe by about three weeks. Indeed, BA.2 is now circulating in the United States and is crowding out earlier variants.
Already, we have witnessed renewed BA.2-driven surges in Austria, France, Germany, Israel, Italy, and the Netherlands, on top of earlier waves when the BA.1 subvariant circulated.
Despite the overall case decline in the United States, fourteen states reported higher new case counts last week than a week earlier. These included heavily populated Florida, Illinois, New Jersey, New York, and Texas. In New York City, cases spiked 25% in the past week.
Mercifully, Covid patient census declined in each of these states.
The further concern comes from the CDC’s wastewater monitoring efforts. During the March 9-23 period, 42% of the monitored sites across the country reported increased SARS-CoV-2 RNA levels. One-quarter of these sites cited 100% or higher increases; 10% recorded 1000% or greater increases.
We appreciate our progress against the BA.1 subvariant in recent weeks, particularly as we witness declining hospitalizations and deaths. Further, the expert forecasts encourage us to anticipate a relatively healthy situation as summer approaches. Nevertheless, BA.2’s emergence, its impact in Europe, and increased SARS-CoV-2 wastewater levels here raise the possibility of a renewed infection surge ahead.