Summary

The Covid-19 situation in America has dramatically improved, with hospitalizations and deaths dropping significantly compared to the previous year.

Abstract

As of the recent data from the CDC, the United States is experiencing a stark decline in Covid-19 hospitalizations and deaths, indicating a level of normalcy not seen since before the pandemic's initial surge in 2020. Experts attribute this positive shift to several factors: the stability of the Omicron variant, which has not been displaced by a new variant; the effectiveness of vaccines, boosters, and antivirals like Paxlovid; widespread natural immunity due to infections; and the potential mildness of the current variant. However, the risk of long Covid remains a concern, with its prevalence and long-term effects still being difficult to track. Despite this, the current situation is considered favorable, though experts caution against complacency due to the unpredictable nature of the virus.

Opinions

John Swartzberg, an infectious diseases specialist, notes the unprecedented low levels of hospitalizations and deaths and credits the longevity of the Omicron variant's dominance as a contributing factor.
Mark Cameron highlights the success of vaccine innovation and antivirals in managing severe Covid-19 illness and the strategic approach to the fall booster campaign, similar to the flu vaccine program.
Swartzberg suggests that the accumulation of immunity through infections, vaccinations, and boosters, combined with the virus's relative stability, likely contributes to the decrease in severe illness.
There is speculation that Omicron may have become milder over time, which is consistent with the general trend of pathogens becoming less virulent as they adapt to hosts.
Swartzberg expresses concern over the ongoing threat of long Covid, noting the challenges in tracking it effectively, but also points out that the risk of developing long Covid appears to be lower with Omicron and with the use of vaccines and Paxlovid.
Cameron and Swartzberg both acknowledge the potential for new variants or a resurgence but remain cautiously optimistic, emphasizing the unpredictability of the virus's behavior and the need for continued vigilance.

Where Did Covid Go?

The virus has all but disappeared from our everyday lives. Why?

At this time last year, America’s Covid-19 situation was still precarious.

Following a springtime dip in deaths and hospitalizations, both rebounded strongly during the summer. The week of July 23, 2022, nearly 45,000 Americans were newly hospitalized with Covid-19. More than 3,000 people died.

Now contrast those numbers with the CDC’s latest Covid-19 estimates: the week of July 8, the most recent for which data is available, just over 6,000 people nationwide were hospitalized with Covid-19. About 100 people died.

“We haven’t seen anything like this since the pandemic began,” says John Swartzberg, MD, an infectious diseases specialist and clinical professor emeritus at the University of California, Berkeley. “In terms of hospitalizations and deaths, we’re almost back to where we were before the initial surge of 2020.”

Everyone hoped we’d get here. But even six months ago, few public health experts would have predicted that the SARS-CoV-2 virus would beat such a full and hasty summer retreat.

Which begs the question: Where did Covid go?

Any answers to that question are going to be speculative. But Swartzberg ventures some educated guesses.

For one thing, after an initial period of rapid evolution and adaptation, the virus seems to have settled down. “Omicron has been the dominant variant since the winter of 2021-2022 — much longer than any other variant,” he says.

While new subvariants are emerging all the time, none has been able to unseat Omicron at scale. The relative stability of the virus has helped ensure that medical science’s countermeasures continue to be effective. Those include vaccines and boosters, first and foremost, but also the antiviral Paxlovid, which has helped slash rates of severe illness among at-risk groups.

“We owe a lot to the innovative Covid-19 vaccine response and to the new antivirals used to treat patients with severe Covid-19 illness,” says Mark Cameron, PhD, an associate professor in the Department of Population and Quantitative Health Sciences at Case Western Reserve University in Cleveland. “We’ve started getting ahead of the virus, and we’re tailoring our fall booster for the prevailing variant, much like how the yearly flu vaccination program works.”

Meanwhile, an ever-larger percentage of the population has contracted the virus at least once. Studies have found that infection confers a period of immunity. It stands to reason (though research hasn’t yet established this as fact) that if the virus hasn’t changed drastically — and if an ever-larger chunk of humanity has been infected, vaccinated, and boosted — then rates of severe illness will fall.

Finally, it’s possible that Omicron has grown milder as time has passed. Again, it’s too early to say if this has happened, but it’s common for novel pathogens to become less virulent as they adapt to their host.

“In general, killing your host tends not to be particularly helpful,” Swartzberg says. “The virus continues to be highly transmissible and able to reinfect people, which is great for it, and so there’s nothing driving it to make us sicker in order to survive.”

Any article about the current Covid-19 situation would be remiss if it didn’t mention the ongoing threat of long Covid. But assessing that threat remains frustratingly difficult.

“Tracking of long Covid is still poor,” Swartzberg says. “It is not a reportable disease, and so we still don’t have a good handle on it.”

Some prior global estimates have found that up to half of people infected by SARS-CoV-2 develop symptoms that last for months following the initial illness. “Most people seem to get well after 9–12 months, but somewhere between 5–10% are still symptomatic after a year,” Swartzberg says.

The good news is that the risk of developing long Covid seems to be lower now than it once was. “We know that Omicron is less likely to cause long Covid than its predecessors,” he says. “We know that if you’re up to date with your vaccines or if you take Paxlovid, long Covid is less likely.”

Anecdotally, Swartzberg says he knows many people who have contracted Covid-19 recently, but none of them have developed long Covid.

“Still,” he adds,” it’s a worrisome thing. It nags at me.”

Despite some lingering risks, the situation we’re in now is just about the best anyone could have hoped for. Will it last?

“I hope our luck doesn’t run out,” Cameron says. “It doesn’t take much digging to find news items of concern, including new variants gaining foothold and localized upticks of Covid-19.”

Swartzberg agrees that our present good fortune could change. “From the start of the pandemic, no one has been able to anticipate what this virus is going to do next,” he says. “It has continued to baffle us.” It’s possible that a new and terrible strain of the virus could emerge — though he doesn’t think that’s likely. “We’re not seeing anything that would favor it becoming more virulent,” he says.

It’s also possible that the protections afforded by vaccines, boosters, and prior infections will wane, which could lead to a resurgence of hospitalizations and deaths.

But really, there’s no reason to forecast doom and gloom.

“I think psychologically it’s still difficult for people to celebrate after being so beaten up by this thing,” Swartzberg says. “But it’s reasonable to be optimistic right now.”