Jan. 12, 2024 – Sneezing, coughing, sniffling – it may seem that everyone you know is sick with some type of respiratory virus right now. At present, the United States is getting hammered with such illnesses, with visits to the doctor for respiratory viruses on an upward trend in recent weeks. Data from the CDC's wastewater surveillance system shows that we are in the second-biggest COVID surge of the pandemic, with the JN1 variant representing about 62% of the circulating strains of the COVID-19 virus at the moment.
So why does no one seem to care?
The Pandemic Is Still With Us
In the last week of December, nearly 35,000 Americans were hospitalized with COVID. That is a 20% increase in hospital admissions in the most recent week, CDC data shows. At the same time, almost 4% of all deaths in the U.S. were related to COVID, with the death rate up 12.5% in the most recent week.
This current JN1 variant surge features the highest hospitalization numbers since nearly a year ago. On Jan. 7, 2023, there were more 44,000 hospitalizations. It’s anyone’s guess when this upward trend in hospitalizations and deaths will level off or decrease, but for now, the trend is only increasing.
About 12% of people reporting their COVID results are testing positive, although the number is likely higher, given the popularity of at-home testing.
Why No Alarm Bells?
If numbers had been going up like this a year or two ago, it would be front-page news. But unlike the early years of the COVID experience, the shared, global alarm and uncertainty have been largely replaced with complacency and "pandemic fatigue."
Many of us would prefer to just move on.
For people in higher-risk groups – like older Americans and those with medical conditions – that’s not a viable option. And for those living with someone at risk, we continue to mask up, keep our distance, and wash our hands frequently.
With complacency about COVID so common, and the pandemic emergency officially over, the all-hands-on-deck response to the pandemic is also waning. This means fewer infectious disease experts, scientific researchers, and government resources directed squarely at COVID. So where does that leave us now?
“The risk is not as high, but it’s still there,” said Adjoa Smalls-Mantey, MD, DPhil, a New York City-based psychiatrist.
One reason for COVID complacency is “the risk of imminent death is gone compared to when we didn’t know much about COVID or had a vaccine yet,” Smalls-Mantey said. “People also are more complacent because we don’t see the reminders of the pandemic everywhere, limited movements around restaurants, museums, and other gathering places.” The same goes for strong reminders like lockdowns and quarantines.
A lot has changed with COVID. We aren't seeing the same number of deaths or hospitalization's related to the virus as we once were, and health care systems aren't overrun with patients, said Daniel Salmon, PhD, MPH, a vaccinologist in the Department of International Health and Department of Health, Behavior and Society at Johns Hopkins Bloomberg School of Public Health in Baltimore.
“But COVID is still out there, " he said.
Another thing that adds to complacency is most people have had COVID by now or at least been vaccinated in the original series. That can feel reassuring to some, “but the truth is that protection from COVID and protection from the vaccine diminish over time,” he continued.
Masking Is More Normalized Now
Because of our experience with COVID, more people know how respiratory viruses spread and are willing to take precautions, experts say. COVID has normalized wearing a mask in public. So it appears more people are taking precautions against other viral threats like the common cold, the flu, and respiratory syncytial virus (RSV).
“I do think people are more cautious – they are washing their hands more and [are] more aware of being in crowded spaces. So overall, the awareness of virus transmission has increased,” Smalls-Mantey said.
Individual risk tolerance also drives use of protective measures.
“In my experience, people that tend to be more anxious about things tend to be more anxious about COVID,” Smalls-Mantey said. As a result, they are more likely to moderate their behavior, avoid crowds, and adhere to social distancing. In contrast, there is the "I'm fine" group – people who see their COVID risk as lower and think they don’t have the same risk factors or need to take the same precautions.
A Mix of Optimism and Pessimism?
“It’s a glass half empty, half full situation” we find ourselves in as we approach the fourth anniversary of the COVID pandemic, said Kawsar Rasmy Talaat, MD, an infectious disease and international health specialist at Johns Hopkins University.
Our newfound agility, or ability to respond quickly, includes both the new vaccine technology and the response the FDA has shown as new COVID variants emerge.
On the other hand, collectively we are better at responding to a crisis than preparing for a future one, she said. “We’re not very good at planning for the next COVID variant or the next pandemic.”
And COVID does not circulate on its own. The flu “is going crazy right now,” Talaat said, “so it's really important to get as vaccinated as possible.” Americans can protect themselves against the JN1 COVID variant, protect themselves against the flu, and if they are older than 60 and/or have other medical conditions, get a vaccine to prevent RSV.
The Future Is Uncertain
Our track record is pretty good on responding to COVID, said Antoine Flahault, MD, PhD, director of the Institute of Global Health at the University of Geneva in Switzerland. “About 2,000 different new variants of SARS-CoV-2 [the virus that causes COVID] have already emerged in the world, and the game is not over.”
Regarding a future threat, “we do not know if among the new emerging variants, one of them will be much more dangerous, escaping from immunity and from existing vaccines and triggering a new pandemic,” said Flahault, lead author of a June 2023 commentary, “No Time for Complacency on COVID-19 in Europe,” in the journal Lancet.
Flahault described the public health response to the pandemic as largely effective. “However, we can probably do better, at least we could try performing better against SARS-CoV-2 and all respiratory viruses which cause a huge burden in our societies.” He said improved indoor air quality could go a long way.
“We have learned from the pandemic that respiratory viruses are all almost exclusively transmitted through aerosolized fine particles when we breathe, speak, sing, cough, or sneeze in poorly ventilated and crowded indoor spaces,” Flahaut said. If we want to be better prepared, it is time to act. “It is time to protect people from acquiring respiratory agents, and that means massively improving indoor air quality.”
Talaat remains a bit pessimistic about the future, believing it’s not if we’ll have another public health emergency like COVID, but when. “We need to be better prepared for the next pandemic. It's just a matter of time.”