Our excellent YLE copy editor is out this week. So, I read and reread this about a thousand times and even downloaded an AI grammar program. I guarantee there are still mistakes. I think we will all live, but consider this your warning.

Yesterday, the New York Times suggested the pandemic is over. We are in a very different place. And, I understand the desire for a “thank goodness that’s done” mindset. And I hope COVID-19 isn’t always on top of your mind.

But COVID-19 is still around. I hope you continue to join me on the scientific discovery ride. Here is your state of affairs.

United States

After a few quiet months, COVID-19 is increasing in the Southern and Western United States. Three early indicators—wastewater, ED visits, and test positivity— are increasing uniformly, albeit from low absolute levels. Using back-of-the-napkin math, this equates to ~1 in 1,180 people infected today. If you squint really hard, hospitalizations are starting to increase, too.

This isn’t surprising; we’ve consistently seen a Southern summer wave throughout the pandemic. While the latest Omicron subvariant soup may partly drive this uptick, it’s more likely behavior; people moving inside due to ridiculous heat.

Since late January 2023, excess deaths have reached pre-pandemic levels. This has been a massive reprieve.

I am surprised; I always assumed that we would need to increase the excess death baseline given we added a new threat to our repertoire. But, for now, we don’t. Perhaps this is due to a combination of things:

• You can’t die twice. COVID-19 has killed the most medically fragile people over the last three years, and those premature deaths lead to fewer deaths today. In this case, excess deaths could rebound in coming years;
• Population-level immunity. Hybrid immunity is holding up greater than we expected, even among older Americans;
• Relative. COVID-19 deaths are so small relative to the entire burden of death that it’s immaterial. It’s a fraction of all daily deaths and within the margin of error;
• Another type of death could be decreasing, thus canceling out the impact of COVID-19. (I don’t think this is likely.)

This will be fascinating to follow given the upcoming respiratory season, COVID-19 still settling into seasonality, millions of people losing health insurance, and other things, like the heat wave. I don’t think excess deaths has settled just yet.

International surveillance

Zooming out, eyes are on two particular places around the globe:

1. Okinawa, Japan. COVID-19 hospitalizations continue to increase exponentially, surpassing their winter wave and overwhelming hospitals. This is driven by XBB, changing behavior (big holiday), and a large pool of susceptible people— it’s been about six months since their last wave. Everyone is waiting to see if this transpires outside of Okinawa.

   

2. Dominican Republic: A new Omicron variant— FL1.5.1— is showing its teeth by exponentially increasing quickly. This variant has the same spike protein as what’s currently circulating (XBB) but several non-spike mutations. It’s in its infancy, so it’s unclear if (and how) it will impact real-world metrics. It’s one to keep an eye on.

What’s next?

The COVID-19 Modeling Hub— eight academic teams across the U.S.— just released projections for the next two years: hospitalizations and deaths will likely stay within last year’s range.

Unfortunately, this means we should expect to lose 55,000 (optimistic model)- 450,000 Americans (pessimistic model) due to COVID-19.

We’re waiting on a fall vaccine eligibility decision from CDC, which will happen in mid-September.

Whispers on the street suggest that everyone will be eligible.

The ACIP meeting should be fascinating because we will see the first cost-effectiveness analyses now that vaccines are privatized—are the benefits of the COVID-19 vaccines worth the individual cost for everyone? I would also love to see the updated CDC benefit/risk analysis for young males.

Bottom line

COVID-19 is increasing; don’t be surprised to hear more people getting infected around you. I already am. This isn’t enough reason to change my personal behaviors, but that time may come this fall.

Stay healthy (and cool) out there.

Love, YLE

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH Ph.D.—an epidemiologist, wife. During the day, she is a senior scientific consultant to several organizations. At night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health world so that people will be well-equipped to make evidence-based decisions. This newsletter is free, thanks to the generous support of fellow YLE community members. To support this effort, subscribe below:

I wrote two weeks ago that mid-summer often marks the beginning of a new Covid-19 wave, and that those often start in the South.

Well, I have new news. Biobot wastewater data show an increase in the Southern, Northeastern and Western regions.

Deep dive: State level data is quite messy, and wastewater data providers don’t tell exactly the same story—WastewaterSCAN and NWSS do not show as much of an increase in activity as Biobot. Still, because this is pretty much exactly what I was expecting in terms of summer epidemiology, I think it’s likely a real signal.

For my Canadian readers, there are no noticeable changes in wastewater trends right now.

Why do summer waves start in the South? The old chestnut is that it’s especially hot in the South, so people spend more times indoors with the air conditioning on, without good ventilation and filtration. This explanation gives me pause. The average American spends 90% of their time indoors.

I haven’t found a breakdown showing how that breakdown changes by region or by season, but it’s hard to believe it varies enough to explain the dynamics of a summer wave. In short, I’m content to say it’s still a scientific mystery why summer waves start in the South. If you have data I don’t know about, please send.

What it all means: Overall, the viral concentration in wastewater is still very low — about on par with April, and far, far below what we saw over the winter. Personally, I don’t plan to make any changes (yet) based on this information, other than to keep a closer eye on things. But I know some of my readers need or want to be extra cautious, so I wanted to let you know soonest.