Another surge of COVID-19 is likely, experts say, but they expect an increasingly dominant omicron subvariant to cause less disruption than past coronavirus variants and to cause few problems for those who have been vaccinated.
Statewide and locally, COVID-19 hospitalizations are at the lowest levels they have been since the early days of the pandemic. Decatur Morgan Hospital had four COVID patients Tuesday, Athens-Limestone Hospital had two, and neither hospital had any COVID patients in intensive care or on ventilators. Decatur Morgan had more than 70 COVID patients at times in January, and at the peak of the pandemic had about 100 COVID patients.
Statewide, 156 people were hospitalized with COVID as of Sunday, the lowest since March 2020 when the virus first began spreading in the state. In late January, almost 3,000 people with COVID were hospitalized in the state.
While the low hospitalization and infection rates are good news, Alabama Department of Public Health district director Dr. Wes Stubblefield said COVID-19 surges overseas are likely to make an appearance here. A subvariant of omicron called BA.2 is most concerning, he said.
“The bad thing is that what happens in England generally follows in the U.S., and we are seeing an increase in cases there,” Stubblefield said. “It remains to be seen whether or not in the U.S. we’ll have a spike in illness and hospitalization related to that variant. There are just too many unknowns at this point.”
In the United Kingdom, the new-case average has surged 700% since late February and hospitalizations are up about 50%, fueled largely by the BA.2 subvariant. In China, new cases have surged about 1,000% in the same time frame.
According to Centers for Disease Control and Prevention data, the BA.2 subvariant of omicron was first detected in the United States in January. By the week ending March 12 it accounted for 22.3% of U.S. cases and as of the week ending Saturday 34.9% of those with COVID were infected with the BA.2 subvariant.
In the Southeast, 21.5% of cases in the week ending Saturday were from the BA.2 subvariant, up from 13% the week before, according to CDC data.
Dr. Suzanne Judd, an epidemiologist and professor at UAB School of Medicine, said BA.2 presents few new challenges to the health care system, and that people who were infected with the previous omicron variant will have some protection against the new one.
“Protection is not a 100% guarantee. It just means that you’re a little less likely to get sick,” she said. “Coronaviruses unfortunately just constantly reinfect us. It’s very normal to get a coronavirus infection and then have another one."
Judd said U.S. data suggests transmissibility of BA.2 is about the same as the previous omicron variant.
“We have to keep watching BA.2 to see what happens. It is likely we’ll have another surge. I just don’t know that it will be very driven. It may be driven as the immunity in the population wanes,” she said.
Best defense against virus
While previous infections provide some protection from BA.2, Judd said the best protection continues to be the vaccines.
“The vaccine’s pretty effective against omicron, whether it’s BA.1 or BA.2, especially at keeping people out of the hospital,” she said. "Having a low vaccination rate is definitely a concern, especially in folks that are at a high risk of being hospitalized.”
In Morgan County, 44.82% have completed their initial vaccine series, according to ADPH data, although many of those may not have received booster doses. In Limestone County, 48.28% have completed the initial vaccine series, with 39.88% of Lawrence County residents completing the initial series.
According to the Mayo Clinic vaccine tracker, 50.8% of Alabamians have completed the initial vaccine series. That's the lowest percentage of any state in the nation.
Unfortunately, Stubblefield said, fewer and fewer people are getting vaccinated, making them more vulnerable to the next COVID surge.
“Vaccine supply is great,” he said. “We’ve really not seen a problem with vaccine supply. It’s really demand that has gone dramatically down, especially recently.”
Judd said people at high risk should continue to use masks regularly.
CDC mask guidelines vary based on a county’s risk status, which it determines through metrics including hospital beds being used, hospital admissions and the total number of new COVID-19 cases. Under the CDC methodology, seven Alabama counties were at medium risk Tuesday and the rest were at low risk. Morgan and Lawrence counties are considered low risk, with no masking recommendations for those without symptoms. Limestone is medium risk.
In medium risk counties like Limestone, the CDC recommends that people who are vulnerable to COVID complications — including those who are over 65, immunocompromised or with underlying medical conditions — speak with a doctor about wearing a mask in public and immediately test for the coronavirus if symptoms appear so they can receive timely antiviral medicines.
For the CDC’s county-level COVID recommendations, go to www.cdc.gov/coronavirus/2019-ncov/your-health.
Potential variant from China
The immunocompromised and elderly, Judd said, “will want to wear the mask regularly anytime they’re out in public with people that are outside of their regular social bubble,” regardless of their county’s risk level.
Judd said the spike in COVID cases in China is worrisome because epidemiologists fear it will lead to more variants.
“We know that China has a very large population and they haven’t had a lot of COVID to date. Now that they’re picking up more in terms of the number of cases they’re having, it’s possible that the coronavirus could mutate in a way that could be a concern. But we haven’t seen it yet,” she said.
The best way to guard against the next surge, Judd said, is obvious.
“Vaccination and booster is key. That will keep you out of the hospital. It may not keep you from getting the (coronavirus) infection, but it will keep you out of the hospital and hopefully keep you from dying,” she said.
She also encouraged people to pay close attention to infection rates in their community.
“Listen to the health department and local health authorities. When they say, ‘We’re approaching another surge; it’s time to start masking again,’ it will be a good time to pull that mask back out, dust it off, and wear it again.”