What’s Next with COVID-19?

COVID infections are rising, and many people - from President Biden to Olympic sprinter Noah Lyles - have experienced this uptick. Many in our communities too have either tested positive themselves or know someone else who has. In fact, U.S. health officials now consider COVID-19 an endemic disease which essentially means that COVID is here to stay.

“COVID-19 is one of those viruses that behaves differently than other respiratory viruses. COVID infections are driven more by human behavior and immunity than weather patterns or seasons,” said Andrew Jameson, MD, an infectious disease specialist with Trinity Health Medical Group in Grand Rapids.

“In that way, it's frustrating for the community and for us as physicians because COVID-19 doesn’t behave like some of the more predictable viruses, such as influenza,” said Anurag Malani, MD, medical director of hospital epidemiology, antimicrobial stewardship, and special pathogens at Trinity Health in Southeast Michigan. “But the treatments and therapies available now are so much better than they were in 2020, so our ability to intervene and help prevent a COVID infection from becoming severe has improved significantly.”

According to Dr. Jameson, one reason why COVID-19 cases are starting to rise is that the virus has evolved to be a very good spreader, allowing it to infect people even if they have several layers of protection from past infection, vaccines, or boosters. In fact, people become susceptible to an infection again not all that long after their most recent infection or booster vaccine.

“Despite a person's immunity due to previous infection waning, the majority of the recent cases that result in hospitalization are in people who did not get the most up to date vaccine booster,” said Dr. Jameson. “We do find, however, that protection with the vaccine against severe illness continues to hold up for most people.”

Are there new COVID-19 variants this year?

Since the original Omicron variants emerged back in 2021, the virus has continued to evolve and mutate – which is what viruses do.  Currently, the CDC is monitoring a trio of variants — called KP.3, KP.2, and LB.1 — that are on the upswing. According to Dr. Malani, when the recently approved updated booster vaccine becomes available in the coming weeks, it will better target the strains that are currently circulating.

What are the symptoms now, and have they changed?

Many COVID-19 symptoms have stayed the same since 2020: fever, sore throat, coughing. "Many patients feel like they have a bad cold, or a case of flu," said Dr. Jameson.

Other symptoms have shifted: it used to be common for people to lose their sense of taste and smell when they got sick, but that now seems to happen less frequently.

If you’ve been infected before, it’s also important to understand that symptoms can vary from one infection to the next. It may actually feel like an entirely different illness. Or, you may experience the same symptoms, but in a different order.

COVID-19 symptoms can include:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Sore throat
• Congestion or runny nose
• New loss of taste or smell
• Fatigue
• Muscle or body aches
• Headache
• Nausea or vomiting
• Diarrhea

“No two COVID infections behave exactly the same,” said Dr. Jameson. “In general, the more immunity a person builds up – from infections or vaccinations – the symptoms of another infection tend to be milder. But there’s no guarantee.”

How long do test kits last?

If you’re not feeling well and have trouble finding new at-home tests to purchase at your local pharmacy, you may wonder if you can use older test kits you may have. The FDA says that tests should not be used beyond their expiration date.

I may have COVID. What should I do?

“I think the most prudent thing for people to do is to treat COVID-19 just like other respiratory viruses such as flu and RSV,” says Dr. Malani. In keeping with CDC guidance, Dr. Malani and Dr. Jameson encourage people to take the following actions if they suspect they have COVID:

• Stay home and away from others (including people you live with who are not sick) if you have symptoms that aren't better explained by another cause.
• CDC guidelines say people should isolate for five days from their first symptoms, after which they can be around other people if they’ve been fever-free for 24 hours and wear masks inside.
• Seek health care promptly for testing and/or treatment if you have risk factors for severe illness. 

For people whose immunity is impaired by disease, medication, or transplantation, there is a new preventative treatment available: a monoclonal antibody given by infusion called pemivibart (sold as Pemgarda) which provides additional protection for those at greatest risk for severe outcomes.

"If you're not feeling well, be considerate and wear a mask to protect those around you," said Jameson.

When should I get a COVID-19 booster shot?

Dr. Jameson confirms that vaccine boosters continue to be the go-to protection against severe illness from the virus.

“For those who are at high risk for severe illness – the very elderly, the elderly with comorbidities, and those who are immunocompromised – go ahead and get the recently approved updated booster vaccine as soon as it becomes available. These vaccines will be more active against some of the circulating variants,” he said. "For those whose risks are a bit lower, you can consider waiting and get the COVID-19 and influenza vaccines together, which is safe to do.”

VACCINE UPDATE:

On August 22, The Food and Drug Administration approved updated Covid-19 vaccines. The Centers for Disease Control and Prevention has said it will recommend that adults and children six months and older get updated vaccines. People who are at highest risk for severe disease, including those who are 65 and older, people who are immunocompromised and those with underlying medical conditions, should get the updated vaccines as soon as they are available.

The F.D.A. approved one vaccine from Pfizer and one from Moderna. Both vaccines target KP.2, a strain of the coronavirus that started to spread widely this spring. The variants that are most prevalent in the United States right now are very similar to KP.2, and so the vaccines should protect against them. The vaccine that rolled out last fall, by contrast, was geared at an older variant.

If you received a dose of the older vaccine this summer, you may not be able to get an updated vaccine immediately — the shots need to be spread out. People who are at high risk of developing severe disease should talk with a health care provider about the ideal interval between vaccines.

If you’re one of the many Americans who was infected during the summer, you may want to wait a few months to get a new shot. Rushing out to get one right after you were ill won’t give you much of an added benefit, because you already have strong protection. The C.D.C. has previously said that people can wait three months after a Covid infection to get a vaccine.

It takes around a week or two after getting vaccinated for antibodies to rev up and defend against the virus. Antibodies peak about a month after vaccination. vaccines will provide protection against the worst outcomes from Covid — developing severe disease, getting hospitalized and dying — for months.

If you have any questions about COVID-19 as it relates to your health, or when it’s best for you to get a booster vaccine, talk to your doctor.