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With record-breaking travel expected over the Thanksgiving weekend, life seems to be returning to normal. It is really easy to assume that the Covid-19 pandemic is abating. But is this just wishful thinking? People still get infected with SARS-CoV-2. Covid-19 can still lead to hospitalizations and death. New variants, such as BA.2.86 and the recently described JN.1, are troubling. And let’s not forget about the flu virus and RSV. So should we remain concerned about holiday travel?
Let’s start by looking at the numbers.
According to the Centers for Disease Control and Prevention, there were 16,237 new hospitalizations for Covid-19 in the United States in the week ending November 11, 2023. In the same week, the CDC also reported 544 deaths from Covid-19. These numbers may seem large. And, of course, we must remember that each number represents a person. Those 544 deaths represent 544 people who will not be celebrating Thanksgiving. But are these numbers really that big?
In the comparable week of 2022, the CDC reported 23,803 hospitalizations with Covid-19 and 2,200 deaths. For the same week in 2021, the numbers were 37,474 and 7,159. Clearly, the absolute numbers are down significantly. The death-to-hospitalization ratio has also decreased significantly. In this week of 2021, the death-to-hospitalization ratio is 0.19. In other words, about 19% of people hospitalized with Covid-19 died. In 2022, this percentage drops to approximately 9%. Now the rate is below 3.5%. This comparison is certainly not perfect; countless factors affect this measurement. But this suggests that the severity of the disease has decreased in recent years.
Does this mean there is nothing to worry about?
The short answer to this question is no. We must remain vigilant. In 2021, hospitalizations and deaths began to increase in late November and peaked in mid-January 2022. The same trend was observed between November 2022 and January 2023. We should expect the same pattern this winter. Hospitalizations and deaths are likely to increase over the next two months. However, there is no immediate reason to believe that we will experience a surge comparable to that seen in the past two years.
Of course, a new variant can change the calculation entirely. We saw this happen when Omicron first came out. Currently, two existing options can be problematic. The BA.2.86 variant has caused concern since it was first identified in July, mainly because it differs significantly from its predecessor. And a fork of this variant, the JN.1, is also being closely watched.
Unfortunately, data on these variants are scarce and inconclusive. In a paper recently published in Nature, the researchers report that BA.2.86 exhibits a strong affinity for its receptor on human cells, suggesting that this virus can be transmitted efficiently. These researchers also note that BA.2.86 is not particularly resistant to existing antibodies, suggesting that so-called breakthrough infections may not be a major problem. We know that the prevalence of BA.2.86 and JN.1 remains low.
What about other respiratory diseases?
Although Covid-19 remains the most alarming respiratory infectious disease, we should not forget other respiratory infections. In its latest weekly flu report, the CDC reported that flu cases are on the rise in many parts of the U.S., as is typical this time of year. The same is true for confirmed cases of RSV. However, current rates of influenza and RSV infections are not unusually high.
So what can we conclude about holiday travel?
After Thanksgiving, we will almost certainly see an increase in Covid-19 cases. The same goes for the flu and RSV. That’s the bad news. The good news is that basic mitigation strategies continue to be effective. Early data suggest that the latest Covid-19 vaccine provides some protection against current SARS-CoV-2 variants, including BA.2.86. Similarly, the flu and RSV vaccines, while not perfect, provide protection against these viruses. Masks work. And washing your hands is always a good idea. For people visiting at-risk friends and relatives, such as the elderly, basic mitigation strategies like these can have a big impact.
In some ways, we are beginning to enter a post-pandemic era. But Covid-19 is not gone. It probably won’t go away. Instead, we should live smartly with it.
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