Summer COVID surge hits at least 84 countries and continues to climb

A summer COVID-19 wave – and the accompanying fevers, coughs and general misery – continues to wash over the Americas and parts of Asia and Europe, including the Paris Olympics, offering the latest evidence that the coronavirus moves in ways distinct from other respiratory ailments.

The World Health Organization said this week that the virus is increasing in at least 84 countries despite perceptions that the pathogen is a remnant of the past. Disease trackers sounded alarms that diminished testing and low vaccination rates could provide fertile terrain for more dangerous viral variants to take hold.

“COVID-19 is still very much with us,” Maria Van Kerkhove, a WHO epidemiologist, said at a news briefing Tuesday.

At least 40 athletes have tested positive for the coronavirus and other respiratory illnesses, suggesting that the virus may not exhibit the same seasonal patterns as the common cold, flu and respiratory syncytial virus – widely known as RSV – which tend to strike during cold-weather months.

The uptick has sparked concerns about efforts to prevent the spread of the disease at the Olympics. Testing and reporting vary by team, and the lack of streamlined efforts to minimize the spread highlights stark difference between the Paris Games and the Tokyo Olympics held in 2021.

At the Tokyo Games, spectators were barred and people were required to take two coronavirus tests on two separate days within 96 hours of their flight to Japan. Upon arrival in Japan, further testing was conducted at the airport. This is a sharp contrast from the Paris Games, where people who tested positive are competing, there are no testing requirements, and spectators are back in attendance.

The rise in global cases comes during pandemic fatigue and a decline in testing for the virus and reporting of cases.

As a result, health agencies confront significant challenges in monitoring and understanding the virus’ impact.

“I am concerned,” Van Kerkhove said. “With such low [vaccine] coverage and with such large circulation, if we were to have a variant that would be more severe, then the susceptibility of the at-risk populations to develop severe disease is huge.”

Wastewater analysis offers one of the main methods for gaining insight into infection levels. Van Kerkhove said circulation rates are estimated to be two to 20 times higher than baseline levels established for comparison purposes at each testing station.

At the peak of the omicron variant in January 2022, the concentration of the coronavirus in wastewater samples peaked at 23 times higher than earlier levels, according to the Centers for Disease Control and Prevention. Levels were just barely above baseline at most stations nationally in April and May, but they have risen in the past two months to seven times the baseline concentration – a considerable increase but far below the rate of the nation’s largest outbreaks.

With the increase, public health experts worry that more severe variants of the coronavirus could emerge heading into fall and winter, and with waning vaccination rates, people with a higher risk of severe infection could face more dangerous outcomes.

Elevated infection rates during summers months in the Northern Hemisphere deviate from the typical pattern of respiratory viruses, which usually thrive during the fall and winter. While current hospitalization rates are lower than peak levels during the pandemic, WHO is calling on governments to bolster vaccination initiatives for high-risk groups.

“The virus continues to confound me in terms of what it’s doing and how it’s bucking the trends of seasonal patterns of respiratory illness,” said Scott Roberts, an infectious-disease physician at Yale School of Medicine.

Roberts suggests that a vaccine twice a year to address the surges might be an important step in minimizing summer spread.

“I certainly haven’t seen anyone doing mitigation strategies, such as masking and whatnot, in the summer months,” Roberts said. “So, maybe we need to rethink the timing of this virus and stop treating it like a once-every-year virus the way we do with flu.”

As of July 21, Russia had the highest number of cases worldwide, but the United States had the most reported number of deaths, according to WHO data.

“The number of cases is up, but the quality in terms of deadliness is not,” Otto Yang, an associate chief of infectious diseases at UCLA’s David Geffen School of Medicine, said. “Still, a lot of people are still dying, and it is still having a big impact on society, so we should still be taking this seriously.”

Otto said another concern is that the virus could become more deadly because it’s continuing to mutate, and data shows an increased risk of complications with each subsequent coronavirus infection someone endures. He cautioned that a mutating virus could also pose a threat to treatments.

As a virus spreads, it can mutate to make itself stronger. And as it mutates, it can figure out how to evade disease-fighting antibodies to better infect people and to survive longer in aerosol and droplet form, according to Andrew Pekosz, a professor of microbiology at Johns Hopkins University who studies how respiratory viruses, such as the coronavirus, replicate.

“The more opportunities we give the virus to mutate, the more likely that some of these mutations will emerge,” Pekosz said.

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COVID in the U.S.

As of July 27, the highest rate of COVID in U.S. emergency rooms was found among children 11 and younger, narrowly surpassing the incidence in adults 75 and older.

Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, said some hospitals in California have reported seeing COVID admissions higher than expected, with patients staying in the hospital longer than during recent waves. But the bigger concern for hospitals lies in the months ahead as the United States enters respiratory viral season, she said.

“That’s the worry I hear most from hospitals is [that if] we don’t get this in hand, if people don’t take their vaccination either for flu or RSV or COVID, then we could see large influxes of patients again, and that’s certainly something we’d like to avoid,” Foster said.

Despite the surge in cases this summer, some regions have instituted anti-mask policies. North Carolina passed an anti-masking bill in June, and a county on Long Island followed suit Monday. Those bans include exceptions for medical mask-wearing, but critics worry people trying to avoid COVID could still be harassed.

Pekosz said the United States is seeing a “swarm of variants” that have picked up similar mutations, which could indicate that the virus has a limited number of ways to evolve.

“We don’t have any data that suggests that the variants that are circulating now cause more severe disease,” Pekosz said.

Monitoring coronavirus cases that result in hospitalization and death is straightforward, but accurately tracking the overall number of cases poses a greater challenge because many people opt out of testing and medical care after contracting the virus.

The absence of comprehensive data on total coronavirus cases hinders the assessment of variant severity, because researchers cannot determine the proportion of cases that lead to hospitalizations or deaths.

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Fenit Nirappil contributed to this report.

Graphic: https://washingtonpost.com/documents/60d5b705-116c-4d3c-a00d-b3f04a6b51eb.pdf