The number of COVID-19 infections and hospitalizations is surging across the region. But not fast enough to overcome widespread COVID fatigue, a phenomenon some frustrated public health experts say feeds a deadly state of denialism.
Levels of coronavirus in Boston-area waste water recently reached their highest point since the Omicron surge two years ago. Yet pandemic-era precautions like masking and testing before parties and flights — even when you have a cold — have gone the way of toilet paper hoarding and Zoom birthday parties. And just one in five Massachusetts residents say they have received the latest booster, which protects against the new, highly contagious JN.1 variant causing the surge.
What are the potential consequences? The answers vary depending on which public health expert you ask.
With more than 95 percent of Americans now carrying antibodies against some forms of the virus, either from a vaccine or previous infections, the risk of serious illness and death is low for most of the population. The elderly, immunocompromised, and those with preexisting conditions are the most likely to pay the price. Their vulnerability constitutes the most urgent reason for the young and healthy to take precautions, most public health experts agree.
“I have too many stories of people who said, ‘I gave it to mom, dad, grandpa, and they died,’ ” said Dr. Robert Klugman, medical director of Employee Health Services at UMass Memorial Medical Center. “And people feel horrible that they’ve infected people that are immunocompromised because they approached it in a laissez-faire way. And we see that every day.”
But there’s another compelling reason for the young and the healthy to get boosted and consider following precautions: long COVID. The little-understood condition is broadly defined as a set of symptoms that are present four weeks or more after an initial infection, often consisting of brain fog and extreme fatigue. Dr. Ziyad Al-Aly, chief of research and development at the VA St. Louis Health Care System, has been studying long COVID for close to four years. He compared the casual attitude of some to playing “Russian roulette.”
“Out of a hundred times, yes, you’re going to emerge unscathed about 96 percent of the time,” said Al-Aly, who estimates the risk of getting the condition is between 3 and 4 percent. “But in some cases this leaves people — people in their 20s, 30, and 40s — significantly disabled.”
Al-Aly and his collaborators recently compared the long-term outcomes of 81,000 patients hospitalized with COVID-19 between 2020 and 2022, to that of about 11,000 hospitalized with seasonal flu between 2015 and 2019. They found that patients were at a significantly increased risk of death, hospital readmission, or health problems in both cases. But those with COVID-19 were roughly 50 percent more likely to develop the chronic condition.
“Personally, I worry,” he said. “Because we know how to treat the acute phase of COVID. We have Paxlovid. We don’t have anything to treat this. But at the end of the day, it’s a personal choice. It’s about risk tolerance.”
Dr. Peter Hotez, a vaccine expert and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, noted that new studies have found that boosters significantly reduce the risk of long COVID.
He also pointed to studies linking repeated COVID infections to a host of other problems, including a greater risk of heart attack and stroke in adults, and of Type 1 diabetes in children.
Hotez attributed people’s apathy in part to a failure of public health messaging. Since the Biden administration declared the public health emergency over last May, he noted, it has been largely silent.
“People don’t understand that there’s urgency to get this new vaccination,” Hotez said. “To me, that’s the single most important piece that’s missing right now.”
Dr. Eric Topol, executive vice president of Scripps Research in San Diego, noted a recent President Biden tweet boasting that when he took office the pandemic was “raging.”
“Guess what? It’s raging now,” Topol said. “It’s a fantasy that the pandemic is over.”
Topol called on the Biden administration to spend more money to speed the approval of new inhalable vaccines that block infections by promoting upper airway mucosal immunity, which he said is the best hope for a viable pandemic “exit strategy.”
Some suggest local officials could also do more.
“How often do you get an alert from the Department of Public Health or the Boston Public Health Commission that says you should be worried about COVID right now?” said Dr. David Hamer, an infectious disease expert at Boston University and physician at Boston Medical Center. “In the past, they at least used to send out bulletins to providers. I haven’t seen anything like that in the last month or two.”
Others downplayed the dangers and suggested the concerns were overblown.
Dr. Shira Doron, chief infection control officer for the Tufts Medicine health system and hospital epidemiologist at Tufts Medical Center said both the state Department of Public Health and, to a large extent, the Centers for Disease Control and Prevention are now “treating COVID like other respiratory viruses and respiratory pathogens”— a shift she considers entirely appropriate. While COVID should not be taken lightly, she suggested the risk of long COVID has been overstated.
“There’s nothing good about respiratory viruses, and they all have potential long-term complications, especially if you’re older, especially if your acute illness is more significant,” she said.
Doron also questioned claims that COVID is deadlier than influenza, saying most comparisons fail to account for the population of individuals infected with COVID whose symptoms are so mild their illness is never confirmed. By that measure, she said, COVID became less deadly than the flu in April 2022, according to a Financial Times analysis.
In response, Al-Aly said in an email that COVID deaths are actually undercounted. ”In far too many instances, death due to COVID is misattributed to something else (because in a lot of states, documenting death due to COVID has become a taboo). Despite all the under-documentation . . . COVID still kills more people than flu.”
Doron suggested current public health measures are sufficient.
“I don’t think we could have sustained a society with that level of restriction on people’s social interactions any longer,” said Doron, who continues to wear a mask — or stay home altogether — after a known COVID exposure and if she has lingering symptoms. “We barely held on as long as we did without utter divisiveness.”
Adam Piore can be reached at firstname.lastname@example.org.