Time Hospitalizations for COVID-19 have been on the rise since the beginning of July. Then came the identification of the heavily mutated and possibly highly-transmissible BA.2.86 variant by the global surveillance network. Such a variant has the potential to evade our vaccine- and infection-induced antibodies and cause a surge of seasonal hospitalizations. The recommendation by the FDA’s VRBPAC in June that the Fall updated vaccine be composed of an XBB-lineage of the Omicron variant appeared to be at risk. There was mounting concern we be faced with a similar situation from last year where the virus had already mutated well beyond the BA.4/5-bivalent vaccines by the time they were rolled out.
But the landscape of the pandemic—especially the clinical disease caused by SARS-CoV-2—has significantly changed. On the front lines of the emergency department (ED), we are seeing a different virus. This is likely a combination of both high levels of population hybrid immunity and evolution of the virus itself to favor infection of the upper airway and cause less severe disease.
The CDC’s recent decision to universally recommend vaccines for everyone, while falling short of a much-needed targeted recommendation for high-risk groups, paves the way for equity of access and insurance coverage for Americans needing to top up their protection against infection. And recent preliminary studies from multiple labs on BA.2.86 has actually been reassuring.New hospital admissions had increased nationally by 9% in the first week of September and have been on an upward trajectory since the beginning of July driven by EG.5, FL.1.5.1, and the XBB subvariants. At 16,000 current hospitalizations, this is still far below the Omicron peak of 145,000 hospitalizations that overwhelmed our health care system in January 2022.