Questions patients may have about this “hot COVID summer”

The summer of 2023 has brought with it a new wave of challenges in the ongoing battle against COVID-19. Dubbed the "hot COVID summer," this season has seen a surge in cases of SARS-CoV-2 infection. And it sparks natural worries as we enter the respiratory virus season.

While infections remain much lower than in the past, the increase in cases has still led to hundreds of Americans dying each week. Weekly hospitalizations have also risen by 21.6% across the country, according to data from the Centers for Disease Control and Prevention (CDC). But public health experts appear confident the U.S. is well-positioned to manage the virus heading into the fall.

As people continue to enjoy the warm weather this month and into September when summer ends, they must also remain vigilant, adapting strategies and precautionary measures to ensure that this summer does not give way to complacency in the face of a still formidable adversary: COVID-19.

Here are some questions patients might have about the summer surge in COVID-19 cases, along with the answers that physicians should be ready to share.

Every summer since COVID-19 was declared a pandemic, the U.S. has seen an increase in SARS-CoV-2 infections. This may be due to the cyclical nature of the virus in which an increase in cases is followed by a quieter period only to see another rise in infections. These waves of infections may continue every year for the foreseeable future.

The rise in cases during summer may also be due to people retreating indoors together when the weather is very hot. The good news is that our current COVID-19 vaccines and boosters offer adequate protection against severe outcomes.

As a descendant of the COVID-19 Omicron variant, EG.5—unofficially nicknamed Eris—now makes up the largest proportion of new infections in the U.S. and is labeled as a “variant of interest.” Overall, 20.6% of COVID-19 cases were projected to be caused by EG.5. This is up from 7.5% through the first week of July, according to a summary of variant surveillance from the CDC.

The next most common COVID-19 subvariant after EG.5 is FL.1.5.1, with 13.3% of cases. This is followed by XBB.1.16 with 10.7% and XBB.2.3 with 10.6% of cases. The XBB.1.5 subvariant of Omicron is also still circulating, accounting for 4.7% of COVID-19 cases in the U.S.

At this point, there is no indication that the EG.5 subvariant of Omicron causes more severe COVID-19 cases, according to an article published in JAMA^®. The World Health Organization classified the level of risk for severe disease as low for EG.5. And while EG.5 may be linked to the current rise in cases and hospitalizations, that is based on its transmissibility, not severity.

People who are generally healthy and have either had COVID-19 or been vaccinated and boosted are unlikely to become severely ill if they acquire the SARS-CoV-2 virus. It is also important to speak with your physician about what to do if you test positive for SARS-CoV-2. In those instances, patients may be eligible for Paxlovid. Those who should consider taking additional precautions are older adults or people with compromised immune systems. For these people, key protective measures include getting up to date with vaccines and boosters and wearing a well-fitting, high-quality mask—such as an N95 or KN95 respirator—while in crowded indoor spaces. Beyond severe outcomes, there is still concern over long COVID symptoms such as brain fog, so taking precautions are still important as we face this summer surge.

Every summer since the start of the COVID-19 pandemic has brought a spike in cases, that typically begins in the southeastern U.S. This summer the rise in cases has been a moderate surge compared to previous years. 

For the first couple years of the pandemic, there were frequent waves of dominant variants such as Alpha, Delta and Omicron. The past year has seen Omicron and its subvariants, such as EG.5, remain the dominant strains of SARS-CoV-2, and more people have some level of immunity whether it is from previous infection or vaccination.

While many people assumed that getting infected meant higher protection from future encounters with the virus, the latest wave of COVID-19 cases shows that reinfections are becoming more common with newer variants—such as the EG.5 or XBB.1.16 subvariants of Omicron—contributing to second or even third infections.

And as SARS-CoV-2 continues to evolve and behave more like its closely related cousins that cause common colds and infect people repeatedly throughout their lives, it is important not to let your guard down. This is because each reinfection will increase your risk of developing chronic health conditions such as diabetes, kidney disease, organ failure and even mental health conditions. 

Yes, a new COVID-19 vaccine booster is expected to be available in the fall, pending authorization from the Food and Drug Administration (FDA) and recommendation from the CDC. The new booster will target the XBB 1.5 subvariant of Omicron. While not an exact match, early clinical trials show that the updated booster shot will effectively target both the EG.5 and FL 1.5.1 subvariants. But it is important to consult your physician about whether you should get the current bivalent booster now or wait for the updated one in the fall that targets XBB.

Yes, it is still important to take a test if you suspect you may have COVID-19. This is where at-home antigen-based tests can help. But remember, these tests are not as accurate as ones done in the laboratory. When taking a COVID-19 test at home, make sure to read the instructions, pay attention and take away distractions. If your results are negative and your symptoms worsen, retake the test within 48 hours.

While we are not likely to see universal masking requirements for the public, COVID-19 hospital admission levels are a tool to help communities decide what prevention steps to take based on the latest data. When hospital admission levels are high the CDC recommends wearing a high-quality mask or respirator. Wearing a high-quality mask or respirator is helpful even if others are not wearing one. This is especially important for people at high risk for severe illness such as people with compromised immune systems.

Two COVID-19 oral antivirals are available for treatment. The first one is Paxlovid, which is a combination of nirmatrelvir tablets, and a pharmacologic boosting pill called ritonavir. Paxlovid is approved by the FDA for the treatment of mild to moderate COVID-19 in adults who are at high risk for progression to severe illness, including hospitalization or death. It is also authorized for use in children 12 or older who are at risk of severe outcomes from COVID-19.

The second oral antiviral is called molnupiravir. When this antiviral enters the bloodstream, it blocks the ability of the SARS-CoV-2 virus to replicate. Molnupiravir is only authorized in adults because it can affect bone and cartilage growth, which would be detrimental to children.

The emergency use authorization of the Johnson & Johnson (J&J) COVID-19 vaccine expired in May, and the vaccine is no longer available in the U.S. Adults who got one dose of the J&J COVID-19 vaccine should get one bivalent mRNA dose from Moderna or Pfizer-BioNTech at least two months after completion of the previous dose. Learn more from the CDC about updated clinical consideration for use of COVID-19 vaccines.

The bivalent Pfizer and Moderna vaccines are available for those 6 months or older. Most individuals, depending on age, previously vaccinated with a monovalent COVID-19 vaccine who have not yet received a dose of a bivalent vaccine may receive a single dose of a bivalent vaccine. 

Those who already received a single dose of the bivalent vaccine are not currently eligible for another dose. Those 65 years or older and who are immunocompromised who have received a single dose of a bivalent vaccine may receive an additional dose of the bivalent vaccine.

Then there is the Novavax protein subunit COVID-19 vaccine, which is authorized for emergency use as a two-dose primary series for those who are 12 or older. It is also available as a first booster dose at least six months after completion of a primary series if you are unable or unwilling to receive an updated Pfizer or Moderna vaccine, are 18 years or older and have not gotten any other booster dose.