The U.S. now stands at just over 30 new COVID-19 cases per 100K population per day, up 33% in the past seven days.
Data source for this and other graphs of new case counts: Calculated from The New York Times. (2021). Coronavirus (Covid-19) Data in the United States. Retrieved 5/18/2022, from https://github.com/nytimes/covid-19-data.” The NY Times U.S. tracking page may be found at https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
As you can see above, the BA.2.12.2 wave — call it the Omicron II wave — is now completely well-organized. The jumble that occurred at the bottom of the curve — some lines going up, some going down — is now a set of parallel, up-sloping lines. The current level of infections — the height of the line — seems due almost entirely to the start date of the wave within each region. The sooner a region started up on this growth curve, the higher is the current rate of new cases per 100K per day.
This is much like prior waves, where there was an eerie uniformity across regions and states. To say they proceeded like clockwork would be an exaggeration. But it is no exaggeration to say that each COVID-19 wave had its own characteristic speed and duration, with each state and regional separately adhering to roughly the same template. This, to the point where you could predict the peak of the wave for the U.S. as a whole, based on the peak in the earliest states.
No near-term end in sight for the BA.2.12.1 (Omicron-II) wave.
I have a practical point: There’s no end in sight for this wave. The Northeast region is our bellwether. It was weeks ahead of the rest of the country, likely due to earlier spread of BA.2.12.1. There’s no hint of a slowdown there yet. So we can reasonably expect this wave to continue for at least weeks yet. Time for the Northeast to peak, and then for the rest of the country to follow.
And yet, we remain at the point of fewer than 300 deaths per day, and we only recently passed the threshold of 3000 hospitalizations per day. So while there are a lot of cases, average severity per case remains low. For example, only about 3% of those formally diagnosed with COVID-19 now end up in the hospital. That’s down from over 8 percent in the Delta wave. (And most of those who are hospitalized are unvaccinated, so the hospitalization risk for the vaccinated population is significantly less than that 3-per-100 rate.)
In any case, I’m back to the point of getting any personal-care services that I may need done sooner rather than later. Doctor visit, eye exam, and so on. Not because pandemic conditions are ideal, but because they are clearly going to be significantly worse than they are today, for the next month or two.
I am beginning to doubt a long-term end, a.k.a., endemic COVID-19
I guess it’s fair game to start this section with a string of broken promises. This is just to remind all that, with 20-20 hindsight, much of what our trusted experts said abut COVID-19 has turned out to be wrong.
Remember when people actually talked about these things as if they were real?
- COVID was spread by symptomatic individuals, via droplets from coughs or sneezes.
- You had no need to wear a mask as long as you maintained 6′ social distancing.
- All we needed to do was achieve herd immunity and we could put this epidemic behind us.
- If we can just “bend the curve” and not exceed the capacity of our hospital system, we’ll get through this one-year epidemic without undue excess deaths.
And now, going on three years into this, I’m starting to question this one:
- Eventually COVID will just become another low-level background infection, always in circulation, like flu or the common cold. We won’t have these huge spikes in cases, and most people will not get a severe case.
I admit that I have never quite been able to get my mind around what “endemic COVID-19” would look like. Not like flu, that seems clear. Where seasonal flu has an R-nought of about 1.5, BA.2.12.1 has an R-nought arguably over 20. Where seasonal flu largely spreads one-case-at-a-time, COVID-19 has famously spread via outbreaks and clusters — large groups of individuals who are infected at a single mass event.
I can grasp how you get a nice, steady background rate of disease circulation for something like seasonal flu. It’s not all that infectious, and it seems to spread one-case-at-a-time. Plausibly, in any given population, you end up with a few “long-and-thin” chains of infection that keep seasonal flu alive from one winter to the next.
But COVID-19 seems designed for explosive outbreaks of infections, not for some low-level background rate. Only a handful of people spread it, but those who do tend to spread a lot of it. And once the current strains are loose in a population with no or low immunity, they spread like wildfire owing to the high R-nought.
This always leads me back to the question, when is COVID finally going to run out of bodies? And the answer now appears to be “never”. The reason for that is the reinfection rate.
The data for reinfections are so spotty that its hard to say whether or not there is a trend. A few months back, in the one state where I could find data (Missouri), reinfections accounted for about 8 percent of infections, for for Omicron (BA.2). Missouri no longer appears to report that information. Now, the most recent data from New York State (this page) allows me to calculate that 11 percent of the most recent week’s infections were reinfections. But as far as a national estimate — or even an estimate for most states — there’s nothing.
As with many of the characteristics of viral infections that only became widely known with COVID, viral reinfections are not new. With common flu, for example, reinfections (with the exact same strain of flu) have been studied for decades. Those reinfections aren’t even particularly uncommon. And, as with COVID-19, rapid re-infection can occur. (That is, reinfection soon after recovery from an initial infection.) (A few random references here, here, and here, just so you can see I’m not making any of that up).
At any rate, it seems to me that once we get to the point where reinfections are common, then all bets are off. We have a virus that seems primed for large outbreaks, in a population where nothing — not vaccination, not prior infection — provides a high and lasting immunity against any new infection.
And so, I think I’m slowly coming around to the viewpoint that maybe the promise of “endemic COVID” belongs on that first list — the list of things that experts were dead wrong about.
We won’t know for sure until the virus mutates up to its full ability to spread and to avoid the immune system. So the current wave — attributable to the differences between BA.2 and BA.2.12.1 — does not serve as evidence that we’ll never reach endemic COVID-19. But, three years into this, and no end in sight, I think it’s not unreasonable to question whether or not that will ever occur. Whether this extremely-infectious virus, with a penchant for super-spreader events, for reinfection, and for “immune escape”, is ever going to settle down and become just another nuisance like flu.
