What should we expect from COVID-19 this fall?

Cory Franklin and Robert Weinstein, Tribune News Service

The changing leaves of fall mark the country’s fourth autumn with COVID-19. Although most reporting is anecdotal, new variants have caused case counts to rise. The number of new cases in the country was recently the highest since last winter but still far below case totals during the last three autumns. The reporting of hospitalisations and deaths is more accurate than that of case counts, and the news is optimistic. While hospitalisations have risen significantly, paralleling cases, the numbers are proportionately fewer than in previous years. Deaths are rising but not significantly, and overall mortality from COVID-19 is dropping, slowly but steadily. This is probably the result of a combination of acquired population immunity (vaccination and previous infection) and reduced severity of the current variants.

A dramatic uptick in COVID-19 cases or an emerging, more lethal variant could leave the country in the lurch, especially in light of the questionable decision by public health entities to cut back on case reporting. In light of this lack of knowledge, what can the public do? The response should be to demand better reporting by physicians, public health officials and science journalists. Here are six topics we should know more about. Current COVID-19 trends: Tracking COVID-19 cases and trends has become more difficult, in part because of home testing. Public health officials have largely abandoned anything other than wastewater virus surveillance. “We have essentially given up on other types of surveillance,” said Bill Hanage, an associate director at the Center for Communicable Disease Dynamics at Harvard University. “People are testing at home. … The only way we really have of keeping hold of what pandemic activity is going on is through stuff like wastewater. … That’s about as close as we can (get) to forecasting.”

We can still appreciate large shifts in COVID-19 trends by measuring wastewater, hospitalizations and deaths, but more sensitive surveillance methods are still necessary. There is a need for innovative ideas, perhaps a trial of QR codes on home test kits to allow “citizen surveillance” reporting and/or tracking pharmacy prescriptions for the COVID-19-specific medication Paxlovid.

Vaccines: As COVID-19 evolves with emerging variants, every new booster is unique. Boosters must be developed rapidly in preparation for new outbreaks; therefore, much of the data on effectiveness comes from testing immune responses in animals. It takes time to obtain real-world results in adults. The public needs up-to-date information on how the new generations of vaccines actually perform in patients, along with potential side effects incurred. The information should be readily accessible and easily understandable to lay readers.

Long COVID-19: Long COVID-19 — persistent, lingering symptoms from previous COVID-19 infection — is a potential problem for millions of Americans. Yet estimates of the number of patients affected vary significantly because there are no agreed-on definitions of what constitutes long COVID-19. Moreover, adequate control groups are important because many symptoms seen in people with past COVID-19 infection are also seen in patients who have not had COVID-19. How big a problem do we face, and how do we know?

COVID-19 and obesity: Obesity is a major risk factor, possibly the major risk factor, for death from COVID-19. The US obesity epidemic is one explanation as to why the U.S. has more than 1 million COVID-19 deaths, far more than any other country. New research and recent treatments have brought a revolution in the care of obesity. This raises the questions of whether vaccines and treatment work as well in obese patients and whether healthy eating campaigns and the obesity medications recently approved by the Food and Drug Administration could be targeted at patients at especially high risk for COVID-19.

COVID-19 social isolation: This year, the US surgeon general released an advisory about the public health crisis of loneliness and social isolation in the country. This was aggravated by lockdowns during the COVID-19 epidemic, and this continues to be a problem that has likely aggravated the distressing suicide rate in the country. Last year, nearly 50,000 people died by suicide, according to the Centers for Disease Control and Prevention. We should direct more effort to combating personal isolation and maintaining family and social connections.