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Is a Fifth Wave of COVID-19 on the Horizon?

Cases are climbing in many areas of the country, but this winter should be different from last

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After a brief lull, new cases of COVID-19 are starting to creep back up, both in the U.S. and in Europe, leaving many to wonder whether we’re headed toward a fifth wave, just in time for winter.

The answer, experts say, isn’t as simple as a yes or no. And that’s because we’re in a much different place in the pandemic this year, compared to last.

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“It certainly does feel like a bit of déjà vu, but it’s not the same type of déjà vu,” said Syra Madad, an infectious disease epidemiologist and senior director of the System-wide Special Pathogens Program at New York City Health + Hospitals.

Vaccines will curb infections and illness

For starters, about 60 percent of the U.S. population is fully vaccinated against COVID, meaning nearly 200 million people will be highly protected from hospitalization if they get infected with the coronavirus. Millions of newly eligible kids 5 to 11 will only add to those numbers.

“So even if cases go up this winter, we're very unlikely to see a return to the overcrowded ICUs and makeshift morgues of a year ago,” said David Dowdy, M.D., associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, at a recent media briefing.

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Unvaccinated people are over 11 times as likely to die from COVID as vaccinated individuals, recent data from the Centers for Disease Control and Prevention shows. At last winter’s peak, when the vaccines were just rolling out, an average of 3,400 people were dying of the illness each day. Now that average, while still alarming, hovers around 1,000.

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And though the vaccines are not 100 percent effective at preventing infections, having a significant share of the population vaccinated will help to keep case counts from surging out of control, experts predict. Unvaccinated individuals are roughly six times as likely to test positive for COVID as their vaccinated peers. What’s more, people who are vaccinated and do contract COVID are less likely to spread it to others, studies show.

Last November, the U.S. was seeing about 160,000 new infections each day; now, we’re counting about 80,000, “which is still very high, but you're not seeing that exponential growth that we saw last year,” Madad said.

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“Last year, everybody was at risk,” said Catherine Troisi, an infectious disease epidemiologist with the University of Texas Health School of Public Health. “This year, you can protect yourself.”

Treating COVID-19 could get easier

Another factor that could make this winter less lethal than last: advancements in the treatment of COVID-19.

Two drugmakers, Merck and Pfizer, have requested emergency use authorization from the U.S. Food and Drug Administration (FDA) for antiviral pills that they say can greatly reduce the risk of hospitalization and death in people who are infected with the virus.

If authorized, the pills will be the first at-home treatment designed to keep the disease from progressing. Currently available treatments must be administered in a health care facility.

“If you have COVID-19 — and especially if you have a weakened immune system or are otherwise at risk — these are a game-changer,” Dowdy said. However, when it comes to preventing an infection in the first place, “vaccines are far and away our best tool and will remain that way,” he added.

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It’s important to ‘continue to be vigilant’

The coronavirus will still have some advantages this winter. Cold weather pushes people indoors, where germs, including the one that causes COVID-19, spread more easily. Some states in the Northeast, even those with high vaccination rates, are already seeing a spike in COVID cases, Troisi pointed out.

Add to that the fact that virus transmission, driven mostly by the extremely contagious delta variant, is still high throughout most of the U.S., which means “there's more chances of you coming in contact with the virus and being exposed to it,” Madad said. Plus with the holidays on the horizon, more people will take to the rails, roads and skies to visit friends and family, giving the virus even more opportunities to circulate.

“If you're unvaccinated, you should worry,” Madad said, pointing to the relentless delta variant, which sent cases soaring this summer. “The data and the science are clear: You are at really high risk for getting exposed to the virus and potentially having severe outcomes.”

If you’re fully vaccinated, “the sky is not falling down; you're still well protected,” she added. However, a booster shot, if you are eligible, can add even more protection. So can wearing a mask in indoor public settings.

“The bottom line is, cases are increasing and it's a time to continue to be vigilant,” Madad said.

How many coronavirus waves will we see?

When will all these COVID crests flatten out for good? That’s a little harder to predict, the experts say, and the virus has surprised us again and again, most recently with the emergence of the omicron variant. But the pandemic as we know it will likely shift when we gain more control over the outbreak, said Anthony Fauci, M.D., the nation’s top infectious disease expert, in a recent news briefing.

“We don’t know really what that number is, but we will know it when we get there,” he said. “It certainly is far, far lower than 80,000 new infections per day, and it’s far, far lower than 1,000 deaths per day and tens of thousands of hospitalizations.”

In the meantime, seasonal waves will likely persist, Dowdy said, adding that we could see them for many years, “if not for our lifetimes.” But as we build up immunity to the virus, COVID will likely get milder over time, he said, which is why getting vaccines into the arms of as many people as possible is so important.

“The world may never look like it did before the pandemic, and we may still be in for a winter surge in cases this year. But from a COVID-19 perspective, there are many reasons to believe that things will be much better in 2022 than they have been for us these past two years,” Dowdy said.

U.S. Surgeon General Warns of an Increase in COVID-19 Cases This Winter

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