It’s the holiday season, and although the American people are weary of Covid as we head into the pandemic’s fifth year, the unfortunate reality is that another Covid wave could soon be upon us. It’s important that people respond to the rising numbers with appropriate caution.
The unfortunate reality is that another Covid wave could soon be upon us.
There are several indications of a difficult winter ahead. The Centers for Disease Control and Prevention reports that Covid hospitalizations in the U.S. are climbing once again. Such hospitalizations are also increasing in England, and during this pandemic, what’s happening in England has often presaged what happens here. Another concern is the acceleration of a new and highly transmissible Covid variant in both the United States and England, known as JN.1. It’s highly contagious and may have the ability to partially escape the virus-neutralizing antibodies and other forms of immunity from the first Covid immunizations in 2021-22.
The good news is that the new annual immunization that became available to most Americans in September, which targets a variant known as XBB, is likely to protect against the Covid variants circulating this winter. The bad news is only about 18% of eligible Americans (as of Dec. 9) have so far taken this new XBB vaccine, leaving much of the population susceptible to symptomatic or even serious illness.
The single most impactful thing you can do to protect yourself and your family is to get vaccinated with this newly available XBB vaccine. That’s true even if you have had a previous infection with one of the omicron variants. There are studies to indicate that natural infection does not provide durable or long-lasting immunity.
However, conversations I’ve had with friends, family and colleagues this holiday season let me know that many Americans are unaware that this new vaccine is available and unaware of why it’s different from previous Covid immunizations. They don’t understand why it’s imperative to get this new annual immunization. The answer is that it’s not only to avoid hospitalization but also to reduce your risk of other long-term consequences of the infection such as long Covid or even Covid-induced heart attacks and strokes.
There are other important considerations we should all be making this holiday season. They include wearing N95 or KN95 masks in crowded public areas, including on airplanes and trains and in airports and train stations. Those planning to visit family and friends who are vulnerable to Covid because of their age or underlying conditions should be ready to self-test for Covid infection before they visit. They should also have a plan to access the antiviral treatment Paxlovid if they become sick and test positive
The number of Covid hospitalizations in the U.S. reached a nadir of around 6,500 admissions on July 1, 2023, but there were more than 23,000 Covid hospital admissions as of the last reporting date on Dec. 9. While that number is about half of the hospital admissions in our last significant Covid wave, which occurred about this time in 2022, the current trajectory and rise is concerning. As measured on Dec. 8, Covid hospitalizations in England had increased 27% over the previous seven days. The case positivity rate is also increasing In England.
On Dec. 9, the JN.1 variant accounted for 21% of the Covid cases in the United States, up from just 8% two weeks before. Some experts expect that JN.1 could become the dominant variant in the United States or possibly globally as we head into the new year.
It’s important to remember that in addition to Covid, there are other circulating respiratory viruses in the U.S. including RSV and influenza. But, thankfully, according to a recent study reported in a MedrXiv preprint from the Netherlands, the new vaccine was just over 70% protective against hospitalizations and ICU admissions among seniors at or over the age of 60. The study was done at a time before JN.1 emerged, but at least it shows that it does work against its originally intended XBB target. While this new XBB vaccine may not protect against JN.1 as efficiently, the two variants are related, and one study from Columbia University finds that the vaccine can cross-neutralize this new variant in the laboratory. This is not a guarantee of protection, but at least it is a promising sign. It’s important to remember that in addition to Covid, there are other circulating respiratory viruses in the U.S. including RSV and influenza. All Americans over the age of 6 months, including pregnant women, should get their flu immunization. There is a new RSV vaccine now available for seniors and pregnant women that people in those categories should be sure to talk to their doctors about. What happens after the winter of 2023 in terms of Covid remains uncertain. We don’t know if Covid eventually becomes a seasonal respiratory virus infection like influenza or RSV, or if the virus continues to evolve with additional waves or surges next spring or summer. In the meantime, the Food and Drug Administration and the CDC will have discussions about next year’s annual immunizations or whether a second XBB immunization will be recommended. The likelihood of Covid becoming once again as deadly as it was to Americans during the delta or BA.1 waves of 2021 and 2022, respectively, is probably low. However, on the individual health level, people who haven’t gotten this new annual immunization are potentially vulnerable to hospitalization or the downstream effects of long Covid or heart illness. Getting vaccinated and being mindful of the risks is the best gift people can give themselves this holiday season.
Dr. Peter J. Hotez
Dr. Peter Hotez of Peter Hotez MD PhD is Professor of Pediatrics and Molecular Virology at Baylor College of Medicine where he is also Dean of the National School of Tropical Medicine and Co-Director of the Texas Children’s Hospital Center for Vaccine Development. He co-led efforts to develop a low cost Covid vaccine technology that reached 100 million people in India and Indonesia. His most recent book is "The Deadly Rise of Anti-science: A Scientist’s Warning" published by Johns Hopkins University Press. 
