Is the COVID-19 Situation Getting Worse in United States?

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Is the Situation Getting Worse in United States with the Free Distribution of 600 Million Dollar Worth of COVID-19 Test Kits?

Against the backdrop of the EG.5 variant of the virus spreading, many countries are experiencing an upward trend in infection rates this summer, prompting concerns about the risk of co-infections with COVID-19 and influenza in the upcoming winter.

Starting from September 25th, the United States has initiated the free distribution of COVID-19 test kits to the public.

Individuals can apply for these kits through specific websites, with a limit of four kits per household.

This distribution is expected to continue until the end of 2023, with a total cost of $600 million.

Is the Situation Getting Worse in United States with the Free Distribution of 600 Million Dollar Worth of COVID-19 Test Kits?

This marks the fifth round of COVID-19 test kit distribution in the United States. The Department of Health and Human Services of the country has stated that the current dominant variants are EG.5, FL.1.5.1, and XBB.1.5, all of which belong to the Omicron lineage and possess the F456L mutation, making them more transmissible.

The test kits being distributed in this round can detect these major variants. Home testing is a crucial method for early detection and slowing the spread of the virus.

Simultaneously, the United States has approved two updated versions of the COVID-19 vaccine for use. These vaccines are designed to target the XBB.1.5 variant and are suitable for individuals aged six months and older to prevent severe illness and death. The Centers for Disease Control and Prevention (CDC) in the United States recommends that individuals receive at least one dose of the updated vaccine this fall, regardless of their previous vaccination history.

According to media reports, many countries are witnessing an increase in infection rates this summer, given the prevalence of the EG.5 variant. In early July, the Ministry of Health, Labor, and Welfare in Japan announced the arrival of the ninth wave of the pandemic in the country.

Several hospitals in Shanghai and Guangzhou have reported an increase in the number of patients at fever clinics.

Data from the Chinese Center for Disease Control and Prevention (CDC) shows that the COVID-19 positivity rate among influenza-like illness cases increased from 14.4% during July 31st to August 6th to 19.6% during August 21st to August 27th. During the same period, the positivity rate for influenza also saw a slight increase.

Why Advocate for Widespread Self-Testing Despite Milder COVID-19 Cases?

The current wave of COVID-19 in the United States has persisted for some time. According to the Congressional Record, the number of daily COVID-19 infections and hospitalizations in the country has been consistently rising since July. In the seven days leading up to September 9th, over 20,000 people were hospitalized due to COVID-19 in the United States, an 8% increase compared to the previous week. While some regions are starting to see a decline in infection rates, others continue to experience increases.

Erick Eiting, the Deputy Chief of Emergency Surgery at Mount Sinai Hospital in New York City, cited by NBC News, noted that COVID-19 infections are becoming more “stealthy,” with fewer specific symptoms such as coughing and loss of taste or smell. In particular, the rate of loss of taste and smell has decreased significantly, dropping from 60%-70% during the early days of the pandemic to 10%-20% currently.

Instead, initial symptoms are becoming more similar. After infection, most individuals will experience varying degrees of symptoms like sore throat and nasal congestion, with occasional sneezing. Some patients have reported that, compared to previous infections, the duration of fever is noticeably shorter, but they may experience new symptoms such as headaches and elevated blood pressure.

This change in symptoms may be related to the structure of the COVID-19 virus and how it infects the human body. Various organs and tissues in the body, including the lungs, heart, kidneys, intestines, and brain, contain ACE2 proteins. COVID-19 primarily infects humans by binding spike proteins to ACE2 receptors. This suggests that COVID-19 may manifest in multiple parts of the body.

Erick Eiting told the media, “The majority of cases are very mild. COVID-19 testing is essential for a diagnosis.” This increased variability in symptoms can make clinical diagnosis more challenging and hinder efforts to prevent transmission.

Public health expert Chang Rongshan emphasized that the timing of distributing test kits in the United States is very appropriate. “COVID-19 is still in a localized epidemic stage and has not yet established a seasonal transmission pattern. In the United States, the transmission curves and intensity vary in different regions. However, a simple pattern can be discerned, which is that immunity resulting from each large-scale infection lasts for approximately six months. Based on this, many regions experience two transmission peaks in a year.”

On March 22, 2022, Japan announced that it would “coexist with the virus.” In July and August of the same year, Japan experienced nearly 300,000 daily new infections, and by the end of the year, another wave of high infections hit the country. In California, USA, there have been seasonal peaks in positive test rates around July and December every year since March 2020. The Department of Health and Human Services in the United States stated that, based on past experience, the country may experience a peak in COVID-19 infections in the coming fall and winter.

Currently, some counties and cities in California have reinstated mask mandates, requiring people to wear masks in public places such as hospitals, prisons, government offices, and public transportation.

“We still need to be vigilant about COVID-19. It poses a greater threat to public health than the flu,” emphasized Chang Rongshan.

Is the Situation Getting Worse in United States with the Free Distribution of 600 Million Dollar Worth of COVID-19 Test Kits?

In April of this year, a study published in JAMA analyzed data from U.S. veterans for the 2022-2023 fall and winter season. The results showed that in high-risk individuals aged 73 and older, hospitalization and death rates after COVID-19 infection were significantly higher than those for seasonal influenza. COVID-19 had a mortality rate of 5.98%, while the flu had a mortality rate of 3.16%.

According to CNN reports, older individuals continue to have the highest hospitalization rates during this current wave of infections in the United States. Additionally, the hospitalization rate for children under 5 years old has been increasing recently. Jonathan Reiner, a medical analyst and cardiovascular expert at CNN, stated, “We haven’t seen data like this for several months.”

Although many countries have gone through several waves of the pandemic, a certain proportion of the population still remains uninfected due to good self-protection measures and vaccination. Among them, many are elderly individuals with underlying conditions such as malignancies and immune deficiencies. “We cannot simply equate COVID-19 with the flu; it is still necessary to strengthen screening and prevention efforts. Once a COVID-19 positive case is detected, individuals should stay home and reduce social activities. This will help lower the peak of the pandemic.”

The Possibility of an “Super Influenza Season” This Winter

“This winter and next spring, China may face the risk of the simultaneous or co-occurring prevalence of respiratory infectious diseases such as COVID-19 and influenza,” according to the “Technical Guidelines for Influenza Vaccination in China (2023-

2024)” released on September 5th. The ongoing COVID-19 pandemic has had a certain impact on influenza activity.

In the spring of this year, the regular pattern of influenza activity was disrupted, with the normal winter-spring flu season delayed by 2-3 months. Professor Yu Hongjie from Fudan University’s School of Public Health attributed this to the control measures taken against COVID-19, which not only prevented COVID-19 but also had an effect on other respiratory infectious diseases like influenza. Furthermore, the policies for COVID-19 prevention and control were optimized and adjusted at the end of 2022. As a result, the competitive advantage of COVID-19 in infecting and affecting the immune systems of the population delayed the peak of influenza virus transmission compared to previous years.

“In recent years, the level of seasonal influenza activity in China has remained relatively low,” described Chang Rongshan as a “seesaw” phenomenon. When COVID-19 is prevalent, influenza is suppressed, and vice versa.

He speculated that in the past few years, fewer people received influenza vaccinations, and due to self-protection measures such as mask-wearing, the immunity resulting from natural infections was weaker. Therefore, the upcoming autumn and winter season may witness an earlier and more intense flu season.

Hong Kong, China, provides a reference in this regard. Since March 2023, influenza activity in the region has significantly increased. In late August, local health authorities announced that the level of seasonal flu activity had exceeded the baseline level, entering a “summer flu season.”

Wei Sheng, a professor at the School of Public Health and Emergency Management at the Southern University of Science and Technology, also believes that there may be a rebound in flu cases during the upcoming autumn and winter season. However, the extent and timing of this rebound are still uncertain.

Chang Rongshan cautioned against the risk of co-infections with COVID-19 and influenza. In 2021, Chinese researchers found that co-infection with influenza A virus (IAV) could promote the infectivity of the COVID-19 virus in various cell types. In mouse experiments, co-infection with the flu led to higher COVID-19 viral loads, increased transmissibility, and more severe lung damage. However, infection with other respiratory viruses did not increase the transmissibility of COVID-19. This may be due to the unique characteristics of IAV, which can upregulate the expression of ACE2 receptors.

Seizing the Opportunity to Get Vaccinated

Once multiple infectious diseases like the flu and COVID-19 overlap, the healthcare system will face significant pressure.

In the winter of 2022, a “triple epidemic” of COVID-19, the flu, and respiratory syncytial virus (RSV) hit Europe and the United States. Multiple countries experienced shortages of cold and flu medications, and emergency rooms were overwhelmed. In November of that year, the Pan American Health Organization declared that RSV was burdening the healthcare systems of Canada, Mexico, Brazil, Uruguay, and the United States.

According to reports from various media outlets, fever clinics in many parts of China have seen a recent increase in patient visits. In Shanghai, a pediatric specialty hospital detected over a hundred cases of flu in a single day, and during the peak weekend hours, the daily number of patients receiving intravenous treatment can reach 900. A doctor at a tertiary hospital in Guangzhou told “Medicine World” that to cope with the surge in fever clinic patients, the hospital has expanded its fever clinic capacity, and some children have tested positive for influenza or mycoplasma infections through nucleic acid testing.

Chang Rongshan reminded the public that, compared to COVID-19, the flu poses a significant threat to children. Studies conducted in different countries based on family and community data have shown that the incidence of flu is highest in children, decreasing with age. Research on the infection rates of seasonal flu in children and adults during the 2018-2019 flu season in northern China showed that the overall infection rate for children with seasonal flu was 31%, and the infection rate for subtype A (H3N2) was 17%, both significantly higher than the infection rates in adults (21% and 10%, respectively).

“Whether it’s COVID-19 or the flu, vaccination is an effective way to prevent severe illness and death,” said Chang Rongshan. September is an ideal time for vaccination, with a focus on the elderly and children. Typically, protective antibody levels are achieved 2-4 weeks after vaccination, and the protection can last for 6-8 months.

Is the COVID-19 Situation Getting Worse in United States?

References:

1. Sore throat, then congestion: Common Covid symptoms follow a pattern now, doctors say. NBC News

2.Risk of Death in Patients Hospitalized for COVID-19 vs Seasonal Influenza in Fall-Winter 2022-2023. JAMA. 2023;329(19):1697-1699. doi:10.1001/jama.2023.5348

3. National situation of novel coronavirus infection. ChinaCDC

4. Technical Guidelines for Influenza Vaccination in China (2023-2024)

5.Coinfection with influenza A virus enhances SARS-CoV-2 infectivity. Cell Res. 2021 Apr;31(4):395-403. doi:10.1038/s41422-021-00473-1.

(source:internet, reference only)

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