Covid is surging in the United States, with virus levels on track to surpass last summer’s surge nationwide and approaching the peak of last winter’s surge in the West, according to wastewater data from the U.S. Centers for Disease Control and Prevention (CDC).
Yet vaccination and antiviral drug uptake, marred by inequitable access, remain low, and other precautions such as mask-wearing are meeting growing resistance.
“Right now, there are a lot of people with COVID all over the country,” said Dr. Peter Chin-Hong, a professor of medicine and infectious disease specialist at the University of California, San Francisco. “There are still hospitalizations and a few hundred deaths every week in the United States — and that’s a tragedy.”
The surge is driven by a trio of variants, called Flirt because of shared mutations, that appear to be more immune-evasive and more transmissible. Much of the United States has been caught in heat waves, and many Americans have stayed home to avoid the heat, which can help the virus spread.
Nationally, emergency room visits for Covid increased 15.7% last week. The rising hospitalization rates are now higher than they were at this time last summer, though it can be difficult to make comparisons now that far fewer hospitals are required to report Covid rates than in previous years.
The death toll is also rising after hitting the nadir of the pandemic. Nearly 400 people died in the week ending June 12, the last week for which complete data were available. Covid remains the fourth leading cause of death in the United States.
“Any hospitalization or death could be completely prevented with the tools we have,” Chin-Hong said.
Still, compared to other waves, “it feels like this is a very different time,” said David Grabowski, a professor of health policy at Harvard Medical School. “It’s pretty rare to walk into a building and see people wearing masks,” even in hospitals and nursing homes.
The summer surge comes as some federal and state policies have moved away from efforts that can stop the spread of the virus, experts say.
North Carolina recently passed a law restricting mask-wearing in public, and officials in New York and Los Angeles have considered the same.
In May, the CDC relaxed its guidelines for COVID isolation, recommending that patients stay home until they have been fever-free for 24 hours and symptoms resolve — even if they still test positive for the virus, during which time they are likely contagious.
While the U.S. government once covered the cost of COVID vaccinations, those costs were shifted to the private market in 2023. A bridge program offering vaccines to the uninsured ends next month, weeks before the updated booster becomes available — likely to exacerbate gaps in access to the lifesaving shots.
Only 22.5% of adults and 14.4% of children are up to date with their Covid vaccines – and the rate is even lower (13.3%) among pregnant women, despite the risks of severe illness, complications and long Covid due to Covid infection during pregnancy.
The contrasts are also stark among Americans of color, where inequities in access to health care continue to affect vaccination rates. While a quarter of white adults are vaccinated, only 15.6% of Native Americans and 16.2% of Hispanic adults have received the latest booster dose.
The disparities are “pretty stark,” Chin-Hong said, and they’re particularly concerning among older people of color, who have been at higher risk throughout the pandemic. “There’s not as much focus on ensuring that all older populations are vaccinated or understanding the power of vaccinations to keep people safe.”
Vaccination rates are higher among older adults, who have the highest hospitalization and death rates — but “those numbers are way too low,” Grabowski said. Less than a third of nursing home residents are up to date on their COVID vaccines.
“These numbers really worry me. It’s not clear that these residents will have the same protection as they did at the beginning of the pandemic,” he said.
“I think nursing homes are very weary of this issue, and I say that among staff and residents alike,” said Grabowski, who recently wrote about the changes needed to make nursing homes safer after the pandemic. “I don’t think the vigilance we had at the beginning of the pandemic is still there today.”
Antivirals like Paxlovid have had a similarly uneven rollout. People of color are significantly less likely to be prescribed Paxlovid than white patients — about 20 to 36 percent less, according to one study, and 30 to 36 percent less, according to another.
According to a preliminary study, only 15% of patients at high risk of serious illness take Paxlovid, despite evidence showing it helps reduce the most serious outcomes, including death, in vulnerable people.
“It seems like we’re not really allocating resources to the most vulnerable among us, and that’s really discouraging,” Grabowski said. “It’s a real wake-up call.”
The CDC recently explained that Covid can occur at any time of year, including summer, unlike viruses like influenza and RSV which tend to peak in the winter.
The agency recommended that everyone over six months of age get updated boosters in the fall, and that everyone over 65 get an additional booster at least four months later.
Chin-Hong hopes vaccination rates will increase again this fall, when new boosters become available. He also hopes that public opinion will change and treat COVID vaccines as routine vaccines, like flu vaccines. “Hopefully, by 2025, we’ll have a combined flu and COVID vaccine,” he said. “That might make it more acceptable to people.”
As the virus continues to circulate, measures beyond vaccines and treatments will also help control the spread, especially in high-risk settings like nursing homes, Grabowski said.
“We need to take other measures, whether it’s testing, personal protective equipment or better air quality,” he said. Still, change has been slow and some progress made during the pandemic now appears to be reversing, Grabowski said.
“To the extent that we had some planning in place at the beginning of the pandemic, I think today all of that is absent.”