Experts are hoping for a milder COVID winter in Massachusetts than a year ago

Hospitalizations for COVID-19 are below last year’s count but rising.

Last January, people stood in line outside the Whittier Street Health Center waiting to get a COVID-19 test during a snowstorm.Erin Clark/Globe Staff

If you look at a graph showing the number of people hospitalized with COVID-19 in Massachusetts over the years, you’ll see a striking bump in cases every winter, with last January’s hill especially steep.

And then if you look at the pattern for this year, you see a subtle increase, not as big as the past two autumns, but still tilting upward.

Of course, the winter season is just beginning. What does the lingering pandemic hold in store for us?

Asked to dust off their crystal balls, experts pointed to several factors that give hope for a milder season. Chief among them: Nearly all COVID-19 cases are caused by variants of Omicron. Last year at this time, Omicron had just been identified and was starting to rage across the globe. People had little immunity to it.

“Last year, Omicron was a brand new variant and it took us a little bit by storm,” said Dr. Kalpana Gupta, chief of infectious diseases at the VA Boston Healthcare System. “What we’re seeing in the community in terms of variants, these are all mostly variants of Omicron.”

That means the virus variants are at least somewhat familiar to the immune system. With most people either vaccinated or previously infected, immunity is stronger than last year.

“The overall population is in a much better position than it was even last year,” said Paul Beninger, associate professor of public health and community medicine at Tufts University School of Medicine. “We will definitely see a relatively muted wave of infection.”

Additionally, new antiviral drugs can lower the risk of severe complications.

“What we have now that we didn’t have a year ago, is outpatient therapies that are really quite effective in keeping people out of the hospital,” Gupta said.

A key indicator of what’s happening with COVID-19 is the amount of virus found in waste water. The latest data show infections rising at somewhat higher rates than previous winters, with a slight dip downward in recent days. But so far, at least, hospitalization rates have not been following waste water trends, another indication that most people who get infected are not getting severely ill.

Last year, the number of people with COVID-19 in Massachusetts hospitals began to surge in early November and peaked at 3,203 in mid-January. This year, the November numbers declined slightly until the end of the month, when they rose to 581 on Nov. 29. That’s much lower than the 808 COVID-19 patients on Nov. 29 of last year.

The fastest growing Omicron subvariant in the region is BQ1.1, which accounts for 40 percent of infections, said Bronwyn MacInnis, director of pathogen genomic surveillance at the Broad Institute of MIT and Harvard. The difference this year, she said, is that “we’re not looking at one or two major players. There are literally hundreds of Omicron subvariants that are circulating.” Each makes up a tiny fraction of total cases.

This likely reflects the variety of immune responses the virus is encountering – some people vaccinated, some previously infected, some both, some with waning immunity, and others recently boosted. “The virus is just encountering a much more diverse set of roadblocks to get around,” MacInnis said. “That is causing it to shapeshift in different ways… The virus has to diversify.”

A new variant that isn’t Omicron, called XBB, has caused surges in Asia, but hasn’t spread widely in the United States, she said. “It’s still one of those minor players,” MacInnis said. “It’s definitely one we’re keeping our eye on. It certainly is highly transmissible, as Omicron was. It might lead to a surge through the winter.”

A bigger worry this year is not what COVID-19 might do, but how the system will handle the influx of people sick with other infections – especially respiratory syncytial virus or RSV, which is sickening many children, or influenza, which arrived early this year and seems to be more severe.

Influenza-like illnesses accounted for 1.22 percent of hospitalizations and 4.17 percent of hospital visits in Massachusetts during the week of Nov. 20 – much higher than seen in the same week during the previous three seasons, according to the state’s latest weekly flu report.

“It’s not just COVID any more,” Gupta said. “It’s RSV and flu combined.”

Gupta worries that with multiple viruses to worry about, people might opt for fewer vaccines than they need, or none at all.

In Boston, only 11 percent of residents have received Omicron-specific bivalent boosters, according to the Boston Public Health Commission.

The percentages are even lower for Black and Hispanic residents. Only 7 percent of Hispanic residents and 9 percent of Black residents have received the bivalent booster.

Vaccine hesitancy stems from several different factors, including mistrust of the “government as the steward of public health, mistrust in the vaccines,” and a lack of visibility of people of color who worked to help develop the vaccines, according to Dr. Bisola Ojikutu, Boston’s public health commissioner.

The BPHC operates free vaccination and testing sites across the city, focusing on neighborhoods such as Roxbury and Dorchester that had high COVID rates in the past. She said placing resources closer to people is an important step in building trust because “you see other people using them, people who look like you.”

Gupta notes that there are also racial and socioeconomic disparities in access to antiviral medications, such as Paxlovid and remdesivir.

“That does make a difference in terms of who gets sick and what the proportion is of people who end up in the hospital,” she said.

For Dr. Paul Sax, clinical director of the Infectious Disease Clinic at Brigham and Women’s Hospital, the big difference this year is how few people are taking precautions. “Restaurants are full, people are going to concerts and movies and plays, and very few people are wearing masks now,” he said. “That was actually quite different a year ago and definitely two years ago.”

But Beninger, the Tufts professor, is optimistic that people will up their game when necessary. “People have experience with that now — they’re going to pick up their masks sooner,” he said. “They’re going to practice social distancing sooner. They’re going to decrease their social calendars more quickly. So I think whatever ends up showing up, there will be a more rapid and fuller response than in the past. We will meet whatever the challenges.”