The third winter of COVID-19 is approaching. This year, along with cold weather, heightened transmission and a host of other respiratory infections are on their way.
For the most part, we know the drill: Mask up in crowded, indoor spaces. Test regularly. Ventilate spaces. Isolate if sick. Get vaccinated.
But with lagging booster rates and Washington’s COVID state of emergency set to expire Monday, state Secretary of Health Dr. Umair A. Shah said that “now is the time to take action.”
“Two-plus years in, we’re still talking about COVID,” Shah said on Thursday. “… And now is the time to get your flu shot, COVID vaccine or booster. We have to do everything we can to get ready for the upcoming respiratory season.”
It’s still too early to say how bad this winter’s surge will be, but projections indicate one is certainly on its way, said Dr. Larry Corey, former president and director of the Fred Hutchinson Cancer Center who has led groundbreaking research on herpes, HIV and COVID treatment.
Corey was also recently awarded the Infectious Diseases Society of America’s Alexander Fleming Award for Lifetime Achievement. During last week’s ceremony in Washington, D.C., Corey’s longtime friend and colleague Dr. Anthony Fauci, chief medical adviser to President Joe Biden, presented the award and acknowledged his decades of work developing antivirals, organizing clinical trials and researching vaccines.
Among his greatest accomplishments is testing the drug acyclovir, the first antiviral medication used to treat herpes; building out the global AIDS Clinical Trials Group; and coordinating massive trials of several COVID vaccine candidates in 2020.
This week, Corey and state Department of Health leaders sat down to help answer some of the most pressing questions about what to expect from COVID in the coming months.
What’s going on with COVID in Washington right now?
With the exception of a slight bump in cases in early September, the state’s COVID cases have been gradually decreasing since midsummer.
As of mid-October, the state reported a seven-day rate of about 57.5 infections per 100,000 people and 3.4 hospitalizations per 100,000. The death count, which lags cases and hospitalizations, is about 0.5 deaths per 100,000, or about six deaths per day.
In comparison, the state saw over 1,800 infections per 100,000 over seven days at the peak of the omicron surge in January.
Is another COVID spike on its way?
While Corey said another winter surge is very likely, there’s a good chance it’ll be shorter than past ones. While last year’s summer spike of the delta variant lasted four to five months and omicron’s winter wave lasted about three months, Corey predicted seeing numbers rise for about two months or so this year.
“But we’re still going to see the virus infect more people, especially high-risk people, and you’re going to see vaccine breakthroughs,” he said. “For people who are not boosted — there’s hasn’t been a lot of enthusiasm for boosting — you’re going to see a lot of sickness.”
What are some factors that might determine how long a wave lasts?
Population immunity and the outcome of competing variants and subvariants are two main factors that help experts predict the length of the next surge, Dr. Tao Sheng Kwan-Gett, the state’s chief science officer, said during a news briefing this week.
While the evolution of variants is largely unpredictable, we do have control over increasing population immunity through vaccination, he said.
Because so many people were infected by the omicron variant or one of its subvariants last winter and spring, they’ve likely built up some immunity against severe infections, Corey added.
How might this year be different or similar to past pandemic winters?
One of the most noticeable differences this year is that Washington no longer requires face masks in most indoor settings, with the exception of health care and correctional facilities. In the Seattle area, grocery stores, schools, sports games, restaurants and bars are increasingly filled with unmasked people — which has contributed to higher-than-normal respiratory infections this fall, Corey said.
“We knew it worked against influenza and other respiratory diseases,” Corey said. “And it still works. There’s stigmatization and confusion, but there should be no confusion over whether masking works.”
Subvariants on the horizon are also presenting a new challenge. This year, instead of a single variant to watch out for, multiple variants have emerged in what some experts are calling a “variant soup” — each with a fairly strong ability to evade immunity.
What variants are starting to surge in other countries? What about here?
In Washington, omicron’s subvariant BA.5 has been the dominant variant for months, making up about 78% of all circulating variants. A few others, including BF.7, BA.4.6 and BA.2.75, are also in the state, but Kwan-Gett said none is showing signs yet of emerging as the next dominant subvariant.
About a month ago, BA.2.75 took off in South Asia while BA.4.6 and BA.7 have been picking up steam, according to The Washington Post. Another omicron subvariant, BQ.1.1, started picking up a few weeks ago and could be a contender to take over in Europe and North America. Scientists are also on the lookout for another lineage called XBB, the Post reported.
Generally, how are we doing?
Things are OK, but not great, Corey said. While people have learned to test for COVID, isolate, distance, wear masks and seek medical attention when necessary, action on the federal and international levels has slowed, he said.
“We could create better vaccines,” Corey said. “But that requires funds and pushing, and we’re not seeing that. So you’re starting to see the infrastructure we built for COVID start to go away.”
Clinical trials are smaller. Work on developing new monoclonal antibodies is lagging. Federal funding has run out.
“Get boosted,” he said. “… I see it causing no harm. It can only help. I think the cards here are that the virus is continuing to evolve and it’s still creating a significant amount of disease, so all the tools we have are needed.”