US’s Summer Surge Begins Its Decline, but Risks Remain High: Update for September 20, 2024

According to the CDC wastewater dashboard, the summer surge of COVID is beginning to decline. Nationally, risks remain high and likely won’t return to moderate levels for a month or longer. Most states are still at High or Very High levels of viral activity, although nine states are currently at Low or Moderate levels. New COVID variants are rising, but we don’t yet have enough data to accurately predict COVID risks for this fall and winter.

This week’s update:

The Summer Surge Begins to Decline

The summer 2024 surge of COVID began in May and peaked six weeks ago. Since early August, it’s remained at a plateau between High and Very High viral activity levels, as defined by the CDC’s National Wastewater Surveillance System. This week, the end of the summer wave became evident, with three US regions seeing a notable decline.

Nationally, the wastewater viral activity level for COVID-19 remains High, and it will stay in the High range for quite some time. It’s important to remember that the end of a surge just means we’re declining from the high point of infections, not that infection risks have disappeared. Nine states are at Low or Moderate levels, while 40 states remain at High or Very High Viral activity.

COVID-19 Current Wastewater Viral Activity Levels Map

In the US, viral activity levels are near the second-highest level in 20 months. This equates to approximately 1 million new infections every day. But, we can expect a month or two of diminishing risks, based on the decrease in the positive rate of testing reported by Walgreens and the CDC. Data modelers like Michael Hoerger at the Pandemic Mitigation Collaborative estimate a modest decrease in infection activity in the month ahead.

What’s Next Is a Bit Uncertain, But a Winter Surge is To Be Expected

There is no doubt we’ll see a holiday surge, as we have every year of the pandemic. But, variant trackers aren’t sure which variant will cause the next significant rise in infections, or how bad that surge will be. Many new variants are growing globally, but there isn’t yet enough data to determine which one is destined to drive our next wave.

Despite a few headlines (such as the LA Times’ “An even more contagious COVID strain is ‘just getting started’ amid California wave”), the XEC variant may not be sufficiently different from the current predominant COVID strain to cause a significant surge. Ryan Hisner, who has been lauded for his careful analysis of COVID variants, says he is “doubtful that XEC will have any noticeable impact.” It’s too early to tell if other emerging variants (such as LF.7, KP.2.3 or XDV.1) may become this winter’s next predominant variant.

The combination of new COVID evolution, minimal mitigation behaviors, and low uptake of vaccinations could prevent a significant lull in fall and result in a considerable surge in winter. But, at this point, we have insufficient data to predict COVID’s future with any confidence.

Surveys Reveal Disappointing Attitudes and Knowledge About COVID Risks

Several new surveys reveal that many people are misinformed about the ongoing threat of COVID and deluding themselves on their willingness to safeguard themselves and others. For example, one recent study found that half of Americans (49%) believe they’ll never get COVID again. This is a jaw-dropping level of denial or ignorance. Most Americans get infected with COVID once or twice annually. In fact, a recent study found that reinfections are occurring a median of every 192 days.

The CDC published a study that found that 74.6% of US adults strongly or somewhat support wastewater monitoring, with nearly all (95.3%) stating they would take steps to protect themselves if wastewater monitoring data indicated disease transmission in their area. Excuse me? The US has been at high or very high COVID viral activity since Independence Day, and do you see many (or any) taking steps to protect themselves? Instead, Americans have preferred to pretend COVID is gone. The easiest and most effective thing you can do to protect you and those you love is to get the recommended COVID vaccine, yet barely 4 in ten Americans plan to do so this year.

Many like to think they’d all go to exceptional lengths to protect their family, but most are doing absolutely nothing to decrease the risk of repeat infections and Long COVID. One new study found that most parents think they would “give up social media, vacations for life and even their best friend — all for their child’s well-being.” So, how many parents are masking to decrease their child’s risk of an infection? How many have asked school administrators or teachers about safe air policies in their kids’ schools? The truth is that many are convinced they’d be heroes to protect their kids, but they are entirely unwilling to take the meager sacrifice of wearing a mask out of fear they’d be considered “odd” for doing so. Give up vacations for life? Give me a break — most aren’t even willing to wear a mask on a plane as they take those vacations!

While most are merrily pretending risks have returned to the same level as 2019, researchers and economists are sounding alarms about COVID’s ongoing threat. Insurer Swiss Re has published a report that forecasts “If the ongoing impact of the disease is not curtailed, excess mortality rates in the general population may remain up to 3% higher than pre-pandemic levels in the US.” That means the US will see an additional 90,000 or more deaths every year for a decade due to repeated COVID infections. If so, COVID will remain a top 10 cause of death, on par with the mortality impact of diabetes.

People make it seem as if there are no options between lockdowns and “normal.” In fact, there are many things we can do, if we cared to do so, that would involve very little sacrifice. For example, we could have safe events if we required a recent negative test (as was common a few years ago.) The rich and famous still do this, even if the rest of us don’t. Last week’s Emmys ceremony required that attendees and staff “show proof of vaccination AND a negative COVID test, taken 48 hours prior to their first day on site.” When is the last time you attended a concert, conference, or event that required the same? Why are the lives of celebrities worth protecting with simple, inexpensive precautions while yours is not?

COVID is reinfecting people once or twice a year, and although the risk of death and hospitalization during the acute phase has diminished, the longer-term dangers of COVID remain. The high level of repeated infections has left one of every 22 adult Americans with limits on their activity due to Long COVID.

Although few people notice, studies are accumulating on the risks of recurrent infections and Long COVID. My spreadsheet of the longer-term risks of COVID infections has reached 900 studies and continues to grow. Recent studies have found that:

• The risk of Long COVID is 85% higher in people with multiple infections compared to those with only one
• Chest CT showed alterations in 76% of Long COVID patients and pulmonary function alterations were observed in 44.7% of patients
• More than half of Long COVID patients had deficits in the executive (59%) and attentional (55%) domains, while 40% had impairments in the memory domain
• Peripheral arterial stiffness was higher in adults with Long COVID than in controls who were never infected with SARS-CoV-2

COVID remains a serious viral illness with the potential to alter your health and wellbeing for months, years, or permanently. Ignoring these hazards will not protect you from the risks, and too many of our friends, peers and family will find this out the hard way.

Do small things that keep your family safe during periods of high viral activity (like now):

• Opt for outdoor dining, drinking and socializing when possible.
• Meet friends at home versus gathering in a crowded bar or restaurant.
• Avoid large indoor crowds, when possible.
• If you cannot avoid crowds, wear a mask. Protect yourself at conferences, concerts, religious services, while commuting, and in airports and planes.
• Get all of your recommended vaccinations this year.
• And if you won’t or can’t do any of the above, then consider how your decisions can harm those around you. If you participate in a higher-risk situation on one day, give yourself several days of isolation before gathering with friends, family, and others. Make sure you are healthy and free of illness before exposing others.

Stay safe, friends.