Less than 10 percent of those eligible to recieve the bivalent COVID vaccine have gotten it. IU's director of public and environmental health says that does not bode well for this winter.
(Justin Hicks / IPB News)
Public health officials are enjoying a momentary lull in the COVID-19 pandemic, according to Graham McKeen. He’s the Director of Public and Environmental Health at Indiana University.
McKeen says university system’s seven-day case average is the lowest it has been in about 200 days. The state, though, is still experiencing COVID hospitalizations and deaths.
“We still have 40,000 reported cases a day. We know that's grossly underreported because of at home testing,” he said. “We still have 30,000 hospitalizations, and we're still at nearly 400 deaths per day. But we should enjoy this moment that we have and be gearing up for the winter.”
McKeen predicts Indiana and the rest of the U.S. will have a “disruptive” winter. There are many COVID variants circulating at once. He said BA5 is the dominant variant in the U.S. making up about 62% of all cases. He anticipates BA5’s descendants – BQ.1 and BQ.1.1 – will have their first wave this winter. They currently account for about 11 percent of all U.S. COVID cases.
He said there isn’t a lot of data yet on the new XBB strain, but it has shown it can evade the human immune system.
“The viral evolution has been quite staggering,” McKeen said, and emphasized the need to keep the amount of transmission low. Public health officials’ biggest fear is that a vaccine resistant variant will arise.
Without a more vaccinated public, COVID-19 will spawn more variants and subvariants as the virus looks for ways to survive.
A Bedford COVID testing site in 2020.
The potential for co-infections is high this winter. Not only have we moved into flu season, but RSV cases are rising. This highly contagious respiratory virus generally peaks in January, but McKeen said cases of RSV have doubled just over the last month.
Shandy Dearth, the director of the Center for Public Health Practice at IUPUI, said RSV in younger children is a big concern for health care professionals because those cases can be more severe.
“Common sense says if you've got two of those bad respiratory viruses at the same time, that could really harm someone,” she said. “It's so important for parents to get these younger children vaccinated and boosted, when eligible, against COVID because you definitely don't want your poor kiddo to battle both of these at the same time.”
Dearth and McKeen both acknowledge the need for better messaging about COVID. For example, McKeen would like to see more on the importance of indoor air quality and good ventilation in the fight against viral spread.
“I think that it’s not political. I think everybody can support clean air,” he said. “I think it's kind of the next frontier in public health, just like clean water was many decades ago. And there's a lot of utility -- not just for COVID, but for CO2 levels, molds, or other viruses or allergens -- to have cleaner air. And so I think that's really the next frontier. I think that's an area that everybody could get behind. But here we are three years later and I feel like we have not sufficiently addressed indoor air quality at all.”
Despite a “severe trifecta of viruses” brewing, messaging still must contend with public complacency.
“I think a lot of people, you know, they think they've gone this long and if they haven't died from COVID they're gonna get through it,” Dearth said. “But again, we're still seeing too many deaths each day here in the U.S.”
Dearth and McKeen acknowledge it can be difficult for the public to keep up with ever-changing COVID information. And personal experiences with COVID can vary.
“Some people are asymptomatic, some people have a near imperceptible cold or allergy-like symptoms,” McKeen said. “Other people, you know, have doubled bilateral pneumonia or die. So there's that range. And I think that makes it challenging when we’re trying to get people to take it seriously.”
Dearth said we have the tools we need to limit viruses from circulating, and limit COVID’s ability to create new variants:
Using a high filtration mask, especially in crowded places where you don’t know everyone’s vaccination status and may be susceptible to catching respiratory infections. Dearth says N95s are best. She points to schools as an example of masking’s ability to limit viral spread. “Even implementing it for five days, seven days, I can tell you it has really helped those schools stay open. They’re able to squish that surge a little bit and so that way they can keep operating,” she said. “And back in the spring, the Indiana legislators passed a rule that said schools can only be virtual for three days out of the school year now going forward. And so that's even more of an incentive for the schools to really squash COVID as soon as they start to see those cases arise.”
Social distancing, and not just in public gatherings. McKeen said he would like to see staying home when your sick normalized.
Vaccination. One of the biggest concerns for public health officials is COVID spawning a variant against which the vaccine isn't effective. Getting more people vaccinated reduces viral load and viral evolution, serving to limit or slow this possibility.
But McKeen notes “uptake for the bi-valent boosters has been abysmal” – it’s still in the single digits.
“And that does not bode well if we want to have a less disruptive winter,” he said.
McKeen and Dearth both point to pandemic fatigue as an issue, but Dearth offers a subtle shift in perspective. She suggests the public think about COVID vaccines like the annual flu vaccine – or, even daily seatbelt use.
“The seatbelt keeps you alive. COVID Booster is going to help keep you healthy and alive as well,” she said. “So I just encourage people to take the time-- it's super easy. It's still free across the US. Go into your local pharmacy or Health Department – there’s plenty of supply and very little wait.”
Dearth notes you can get a flu vaccine and a COVID vaccine at the same time. She recommends getting them both by Halloween for protection during holiday gatherings.
“That's one very predictable time when we start to see more cases -- when people come back from Fall Break, when they start to get together for holidays. That's when we're really gonna see numbers go up,” she said. “So go ahead and get protected now.”
McKeen has one last thought for those he refers to as “flying without precautions”: the current bivalent booster may be the last free COVID vaccine we get.
