If it seems like everyone you know got COVID this holiday season, you might be right.
Palo Alto’s wastewater data this past week showed a higher concentration of the virus than ever before, and levels are high throughout the Bay Area and across the country.
“Certainly there’s a lot of COVID circulating,” said Dr. Monika Roy, Assistant Health Officer of the Santa Clara Public Health Department. “It’s not unexpected in the winter season, particularly after the holidays,” she said. “Reassuringly, we are not seeing a similar dramatic rise in hospitalizations.”
What’s the culprit? Fewer of us are wearing masks, or getting the new vaccines, and the new JN.1 variant is growing rapidly, triggering the second biggest wave of infections after omicron since the pandemic began. About 1,500 Americans are dying of COVID every week, up from about 1,200 in September.
The variant is linked to about 60% of new cases, according to CDC data. A member of the omicron family, JN.1 is descended from the BA.2.86 variant. Its most notable new mutation changes the spike protein that latches onto cells, enhancing its ability to evade our immunity. But even if JN.1 is more skilled at dodging antibodies from previous infections and vaccinations, it is not entirely resistant to them.
A recent study of disease spread found that length of exposure was the biggest factor in transmission. A team led by University of Oxford researchers found that 82% of cases were acquired from exposures that lasted longer than one hour.
Despite COVID’s omnipresence, the chance of hospitalization and death is unmistakably lower than in previous years. The number of people in California hospitals with COVID grew to about 2,000 by the end of December, half of last winter’s peak, and just a tenth of the record high.
But the nebulous threat of developing what is known as long COVID remains, and millions across the United States have already experienced it.
About 15% of people with COVID continue to struggle with persistent fatigue, brain fog, shortness of breath, body aches, digestive and heart problems, though estimates vary and have changed over time.
Vaccinations and widespread immunity, in tandem with the evolving nature of the virus, appear to have reduced a person’s risk of developing long COVID, just as the threat of hospitalization and deaths has also decreased.
A recent meta-analysis of 24 studies found that people who had three doses of the vaccine were nearly 70% less likely to develop long COVID than those who were unvaccinated. The more shots you get, the less likely you are to develop long COVID.
But therapeutics like Paxlovid, the preeminent treatment, which have been shown to lower hospitalization and death rates, have shown mixed results in studies when it comes to long COVID.
Paxlovid, made by Pfizer, is a two-medication treatment designed to reduce viral spread within the body. It was approved for people who are at high risk for severe COVID due to lack of vaccination, immune suppression, age 65 or older, or who have diabetes, obesity, asthma and other health problems.
Its success in treatment led to debate about its potential to prevent long COVID. Two previous studies, one conducted by Washington University in St. Louis and the second by the U.S. Department of Veterans Affairs, suggested that it helped reduce illness and death six months after an initial diagnosis.
But a new UC San Francisco study found that the anti-viral Paxlovid does not lower the risk of developing long COVID.
“We were hopeful that Paxlovid might be a successful strategy,” said study author Dr. Matthew Durstenfeld, UCSF assistant professor of medicine. “But our study suggests that taking it really doesn’t reduce or prevent people from getting long COVID.”
The UCSF-based study of 100,000 U.S. participants, with a median age of 55 years, compared people who took the medicine during the acute phase of their infection with those who did not. Then researchers tracked down the participants six months later and inquired about their health.
Its findings, published in the Jan. 4 issue of the Journal of Medical Virology, showed that the two groups had similar outcomes: About 16% of those treated with Paxlovid developed long COVID symptoms, compared to 14% of those who were not treated with the medication. Those who took Paxlovid reported just as many long COVID symptoms as those who were not treated.
The question is why. The answer is unknown because the cause of long COVID remains a mystery.
There’s a theory that long COVID is caused by virus lingering in the body. Another leading theory is “the immune system getting super angry and being dysfunctional,” said Dr. Peter Chin-Hong, a UCSF professor of medicine who specializes in infectious diseases who was not involved in the study.
“I think it’s kind of an interesting study to add to the landscape of understanding what Paxlovid does, which is that it’s probably not one-size-fits-all,” Chin-Hong said, emphasizing that the elderly and severely immunocompromised still benefit greatly from the treatment, regardless of its ability to prevent long COVID.
Whatever the explanation he likes to think about it this way: “Things that allow the virus to enter the body less efficiently will also make you less prone to get long COVID.”
There is some good news. Early in the pandemic, researchers estimated higher rates of long COVID. So far, as vaccinations are updated and the virus evolves, your chance of developing those long-term symptoms has shrunk, said Dr. Chin-Hong.
While avoiding the virus may seem impossible right now, “it’s not too late this season to get vaccinated,” Roy said.