Covid outbreaks in elite circles in Washington, D.C., and on Broadway have received a lot of media attention in recent days, but they appear to be only one part of a broader regional rise in infections: States in the Northeast are now reporting an uptick in cases.
Last week, this newsletter covered what seemed like a mystery at the time: Covid cases were not broadly rising across the U.S. despite the emergence of the BA.2 subvariant of Omicron. But the Northeast’s continued increase has driven a new round of concerns, with nationwide cases up 10 percent over the past two weeks.
What is less clear is whether the regional rise will amount to a much larger Covid surge. “There’s definitely something coming,” William Hanage, an epidemiologist at Harvard, told me. “But depending on all the moving parts it might be a ripple relative to previous waves.”
So far, recorded cases are up slightly, standing at about 6 percent of where they were during the peak of the Omicron wave in the Northeast. (More cases are probably going undetected, as more people use at-home tests without reporting them to public health officials.)
Hospitalizations are also relatively low in most Northeastern states, and deaths are actually down. Both lag behind cases, typically by weeks. “So it could be too early to see a rise,” Jennifer Nuzzo, an epidemiologist at Brown University, told me.
But some experts believe an increase in hospitalizations should have started showing up in at least some places, based on how previous waves played out. “This is something of a head scratcher,” said Robert Wachter, chair of the medicine department at the University of California, San Francisco. “It makes me think that the prior relationship between cases and hospitalizations may not be holding, which would be very good news.”
Any wave would have to contend with recently built-up immunity, both from the vaccines and the Omicron surge that infected potentially 45 percent of Americans this winter.
Not all regional outbreaks grow into national ones. Around this time last year, the Alpha variant struck hard in Michigan and Minnesota but ultimately fizzled out. Experts still do not really know why — another example of how much we still do not understand about Covid (an issue we have covered in this newsletter).
Still, we do know that BA.2 is spreading rapidly, now making up the vast majority of U.S. Covid cases. Experts worry that could lead to a spike, as it has in other parts of the world.
Britain and other European countries, which have often been ahead of the U.S. in Covid waves, saw a recent surge in Covid cases, fueled by BA.2. But that increase is receding and did not lead to a sharp rise in deaths in Europe.
We do not know what that means for the U.S., which has sometimes seen bigger waves than parts of Europe — but not always. As has been true since the start of the pandemic, a lot of uncertainty surrounds Covid.
What we do know
For all of Covid’s unpredictability, we do know some things can help prevent or mitigate another big surge.
The first is vaccination. To the extent that built-up immunity is keeping another wave at bay, more vaccine-induced immunity can help. “The most serious consequences will, as ever, be mostly determined by how many people are vaccinated/boosted,” Hanage said in an email.
New treatments can help, too. Some are already available: The drug Evusheld can help prevent a Covid infection, particularly for immunocompromised people. And the antiviral medication Paxlovid helps treat infections. (Here’s a guide for where to get it.) More treatments are in the works, such as a drug called sabizabulin aimed at treating critically ill people.
But in much of the U.S., policymakers and the general public seem less willing than before to take such steps. As Katherine Wu wrote in The Atlantic, America may be looking at its first “so what?” wave — “a surge it cares to neither measure nor respond to.”
“I’m guessing we’ll be performing a natural experiment — seeing what happens when a significant uptick in cases doesn’t lead to a significant change in behavior or policies,” Wachter told me.
The bottom line
We do not know whether the Northeast’s uptick in cases will translate to a major Covid wave. But there are steps we can all take to help prevent an increase from becoming something bigger.
Related: The Times wants to hear about your experience with antiviral Covid pills.
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