Hospital systems and experts say covid-19’s impact on health care and everyday lives is decreasing, while cautioning that the virus is and will remain present in the United States.
New data from the Centers for Disease Control and Prevention show that nationally, the number of people dying each week in the United States has returned to pre-pandemic levels.
According to Dr. Amesh Adalja, a senior fellow at the Johns Hopkins Center for Health Security, the lack of excess deaths reflects a stabilization of the impact of COVID on the health care system, in that it no longer has the capacity to threaten hospital capacity.
"We're back to where we were before COVID-19. Now the mortality rate is what you would have expected in the past," he said. "We're not seeing more people than would be expected to die. ... Because of the tools that science and medicine have given us, with vaccines and antivirals, it's an incalculably more manageable disease than it used to be."
Adalja emphasized, however, that covid-19 is not gone, and it's not going anywhere anytime soon.
"People will get covid as long as there are people on the planet," he said. "It's not a disease that can be eliminated."
In the future, he says, as new variants of the virus emerge, they're likely to have less impact.
"The virus will always produce new variants. They will continue to evolve; there will always be evolution of the virus," he said. "Increasingly, the new variants will not necessarily have as much impact. Those variants will be circulating in a population that is well protected (by) immunity that will protect them from severe disease, hospitalization and death."
Covid wastewater testing, in which county and state health departments check for the amount of covid-19 prevalent in wastewater, is expected to be the future of tracking the disease and others, Adalja noted.
According to the Allegheny County covid-19 online dashboard, this past week represented a record low level of prevalence in Allegheny County for covid variant XBB 1.5, with 152.18 copies per liter of wastewater on July 9 and 703.96 on July 12.
"I think it will continue and spread to other diseases," Adalja said. "It's a very simple and noninvasive way to understand what's circulating in the community."
Upcoming boosters
According to Adalja, a new booster focusing on the XBB variant of Omicron may be available this fall.
"The current boosters are tied to the BA4-BA5 variants," he said. "There will probably be versions of XBB Omicron boosters."
The most important thing with booster vaccines is for people who are at highest risk of adverse outcomes from covid to get them, Adalja noted.
"I think with the earlier booster programs, there was too much universalization of the boosters, and (it) diluted the message to the high-risk individuals," he said, arguing that prioritizing getting everyone boostered as opposed to those who need it most, such as older adults, made things more confusing. "Seventy-five percent of deaths are in people over 65."
Dr. Amy Crawford-Faucher, a family physician and vice chair of the Primary Care Institute at Allegheny Health Network, said she has been telling her patients to think of boosters for covid the same way they think of annual flu shots - as something to refresh in the fall season.
"Even though we see that you can get covid any time of year, typically when people are indoors in closed spaces, you share more respiratory viruses," she said.
Dr. Donald Yealy, chief medical officer at UPMC, said he expects the covid vaccines to be updated annually. He described them as serving as a reminder to your immune system and an introduction to any new variants.
"The goal here is not to prevent everyone from getting infected - there's nothing that can do that, really," he said. "It's to make sure you're as prepared as possible so that if you do get exposed, your infection is either trivial or doesn't cause you to need hospitalization or intensive care."
For those who haven't yet received the latest bivalent booster, though, they can still go ahead and get it before this fall, he said.
"It won't prevent you from being vaccinated in October," he explained. "It won't ruin your availability to get the newer one when it comes out in a few months."
Health System Prevalence
At Independence Health System, Chief Medical Officer Dr. Carol Fox says the system still tracks covid internally, but its prevalence in the hospitals has dropped significantly since the worst days of the pandemic.
Spokeswoman Robin Jennings said the health system has had covid patients, but "nothing significant."
"The number of patients who have been hospitalized over the past few weeks to months has been relatively small, and very few, if any, have required intensive care," Fox said, noting that this is "really good news."
Crawford-Faucher noted that as of this past Sunday, only between 15 and 20 patients were hospitalized with covid at AHN's hospitals.
UPMC has recently averaged "somewhere between 25-35 people with an active covid-19 infection, about one or two per hospital," Yealy said.
"Some require intensive care, some require respiratory support. It's nowhere near the numbers we saw 18 months ago, but it's not completely gone," he said, advising that people should still test, wear masks and avoid contact with others if they're sick.
"We don't think widespread masking and isolation is necessary right now, but if you're very susceptible to covid-19 infection or you're going to be around people who are, masking still makes sense," he added. "Get tested, stay away from others, and wear the mask if you are unsure or around vulnerable people. But you don't have to wear it the rest of the time."
Crawford-Faucher noted that the gradual phasing out of case-by-case tracking in favor of home testing and wastewater tracking sometimes makes it more difficult to determine the ubiquity of the virus in the community. But when the number of hospitalizations spikes, the system knows there is a larger problem.
"(Covid) is still out there, and it seems to be a much less scary beast than it was when it was at the forefront," Crawford-Faucher said. "I think that's good news because it's not as dangerous to the public as it used to be."
She added that deaths from covidia these days tend to be "sporadic."
"They are most likely to occur in patients who also have multiple other complicating medical conditions," she said.
Covid cases are still floating around, so taking precautions to prevent infection or spread is still important, Fox said.
"We're certainly still aware of not only people presenting for evaluation and treatment, but also individuals who work here, individuals are still getting it," Fox said. "The bottom line is, if you're sick, you need to be very vigilant about washing your hands and not being around people who are at the highest risk for serious illness, whether you have COVID or the flu or anything of that nature. We want to try to protect the vulnerable people around us.
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