Covid in 2024

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By Mary Carpenter

“MURKY” is how the Washington Post described current Covid infection statistics, while noting: “There’s no question a winter coronavirus wave is washing over the United States.” Last week the CDC reported “high levels of covid-19 activity,” along with a wastewater site examination showing “coronavirus levels in wastewater exceeding last winter’s peak.” But myriad factors could be complicating the numbers, such as how much virus people are shedding—related to levels of immunity and variants; and variations in treatment-plant reporting.

Murky also describes how worried people should be about Covid this winter—just as it has over almost four years to date, as risks of contagion change with the seasons, with different Covid variants and with additional research. While the CDC previously considered 15 minutes to be the exposure threshold for “a meaningful chance of getting sick,” for example, a new British study reported in last week’s Time magazine found “most exposures that result in transmission last at least an hour, if not much longer.” The British research relied on data from 7 million people using a Covid tracking app between April 2021 and February 2022.

And while weekly Covid-related deaths now range around 1,000, the total to date is less than half of that one year ago. Also, symptoms are usually mild for most people who are vaccinated or were previously infected, although they can be more severe or longer lasting–which puts them at higher risk for developing Long Covid, as well as for neurological issues that have arisen and endured following several viral infections.

“The numbers [increased amounts of coronavirus in wastewater] are bigger, but is it meaningfully larger?” CDC Wastewater Surveillance Director Amy Kirby noted in the Washington Post. With Covid infection tracking now limited to lab-confirmed cases, hospitals reported nearly 36,000 new patient admissions for Covid during the week of January 6 —compared to last winter’s weekly peak of 44,000 hospitalized cases that occurred around this time.

“Increased hospitalizations for influenza, COVID-19 and RSV,” however, point to winter surges in all these respiratory infections, according to US News. And the CDC reports seasonal flu activity also “remains elevated” in most parts of the U.S.

Red, swollen eyes, similar in appearance to conjunctivitis or pink eye, are among new symptoms of the current Covid variant, as are skin rashes— in previously reported “covid toes”—most often occurring in younger people, according to New York Presbyterian.While flu and Covid infections share early symptoms of cough and shortness of breath, Covid tends to last longer and often includes loss of taste and smell—up to 55% of patients report loss of taste and around 40% loss of smell—which often appear starting two days after contracting the virus.

Covid remains more serious than flu—affecting multiple organs while flu is mostly a respiratory illness—but a 2022 study of people with various respiratory diseases found “about one half [who were] sick with something other than Covid reported ongoing issues three months later.” St. Louis Veteran Affairs Research and Development Chief Ziyad Al-Aly told Time that “we need to start thinking of viruses differently.”

“Infections deserve respect,” said Al-Aly. “Before the pandemic, I trivialized infections. You get sick for a day or two or three and then you bounce back and it’s all over…that’s not always the case.” Even mild infections have led to long-lasting health problems, as in the 2022 study where “most [patients reporting ongoing symptoms following infections] were not hospitalized.” Common viruses, including flu and Epstein-Barr, have “been thought to trigger myalgic encephalomyelitis/chronic fatigue syndrome…that shares many symptoms with Long Covid.”

The prevalence of Long Covid in U.S. adults is decreasing —in CDC reports, between June 2022 and June 23, from 7.5% to 6%, according to UC Davis Health News. UC Davis Critical Care Director Christian Sandrock notes that new variants and prior infections may play a role but said, “I believe vaccination and better treatments are having the biggest impact.”

By better treatment, most health professions refer to Paxlovid, still under prescribed in the U.S.—which Washington Post contributing columnist Leana Wen calls the “biggest policy failure.” In a new NIH study of more than one million patients, Wen reports, Paxlovid reduced mortality from covid-19 by 73%—but between December 2021 and February, 2023, “the medication was prescribed to less than 10 percent of eligible high-risk individuals.”

And risk of post-Covid symptoms, according to one VA study, decreased by 26 percent for those who took Paxlovid. Yet physicians remain reluctant to prescribe the drug because of reported “rebound symptoms”—despite reviews by the CDC and FDA that found “rebound appears to occur with and without Paxlovid at comparable rates.” Wen and others encourage not just better physician education but explicit instructions from the FDA that doctors issue “just in case” prescriptions to high-risk patients who plan to travel.

Finally, Covid has joined other viruses, including those causing flu, intestinal infections and shingles, in connection to neurodegenerative diseases—documented in a study of 500,000 medical records—that include Alzheimer’s disease, Parkinson’s disease and ALS (amyotrophic lateral sclerosis). An earlier study “of more than 10 million people linked Epstein-Barr virus to a 32-fold increased risk of multiple sclerosis,” according to Science Alert. “The impact of viral infections on the brain persisted for up to 15 years in some cases.”

For me, I try to get each new Covid vaccine as soon as possible but have also updated my masking efforts—based on the newly reported length of exposure most likely to allow Covid transmission. Now any maskless grocery shopping trips resemble Supermarket Sweepstakes, as I rush through the store to complete my list in time. For theaters, airplanes, trips to the Apple store and anything that might last longer than an hour, I have a mask at the ready and backups just in case.

—Mary Carpenter, who regularly reports on topical subjects in health and medicine, has been tracking Covid since early 2020.