What to expect for our third winter living with COVID-19

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Autumn has arrived in Oregon, with leaves beginning to change color to reds, oranges and yellows. This signals the coming of our third winter living with COVID-19. We are optimistic that this winter will not be like the last, when Omicron rapidly spread around the world, or the first COVID-19 winter, before vaccines were available and gatherings were discouraged. However, health experts predict COVID-19 cases will begin increasing next month, and the flu will return after a two-year lull.

While many of us have returned to life as normal, COVID-19 has continued to kill about 400 people per day over the past few months in the United States. It remains the third leading cause of death in the country behind heart disease and cancer.

The best thing you can do to prevent severe COVID-19 illness is to remain up to date on COVID-19 vaccinations and take steps to protect yourself. Pay attention to community transmission, and consider wearing a mask in indoor public settings, or avoiding large indoor gatherings, especially when transmission is high.

“Most of us have some immunity against severe disease, which is good,” said Dr. Paul Cieslak, medical director for Communicable Diseases and Immunizations at Oregon Health Authority. “But viral transmission remains brisk in Oregon. Wherever a lot of people are gathered indoors, the virus will be there, too.”

If you are at risk of severe COVID-19 illness, including being immunocompromised or over 65, you should make a plan now on how you will access treatments if you are infected with COVID-19.

Oregon is well-positioned this year
  • Updated bivalent booster doses are designed to induce antibodies for Omicron BA.4 and BA.5 as well as the original COVID-19 strain.
  • Effective treatments are widely available, especially for those 65 and older.  
  • Prior infection and vaccinations provide some level of immunity and protection from COVID-19.
  • Flu shots are available and are safe to receive at the same time as a COVID-19 vaccination.
  • We anticipate the updated booster dose will be authorized for emergency use for children ages 5-11 soon.

What to expect this winter

Infectious diseases spread more easily when people spend more time indoors. Cases of COVID-19 and the flu are both expected to increase starting in November. The virus that causes COVID-19 mutates rapidly, so we can’t know with confidence what variants or subvariants will be spreading this winter.

Predicting future strains of COVID-19 is an imperfect science. Delta represented almost 90% of cases in October last year. Omicron was not identified until late November in southern Africa. It then raced around the world, maybe faster than any virus in human history. Subvariants of Omicron have dominated since and now comprise more than 98% of cases globally.

The World Health Organization (WHO) is monitoring dozens of subvariants. Omicron BA.2.75.2, a descendant of BA.2 is “spreading quickly in India, Singapore and parts of Europe” and may be the most concerning. It also appears to be highly effective at evading immunity and may also evade some monoclonal antibody treatments, including Evusheld, according to a study in Sweden that has not yet been peer-reviewed. This study indicated bebtelovimab may remain effective, but more research is needed. Another Omicron strain that is effective at evading immunity is BQ.1.1, a descendant of BA.5.  Although these strains are incredibly contagious, they are not thought to cause more severe illness than other Omicron subvariants.

“Despite the emergence of BA.2.75.2 and BQ.1.1, we’re still seeing BA.5 overwhelmingly, and at this point no one knows whether those other strains will ever amount to much,” Cieslak said.

It remains to be seen if one of the strains WHO is monitoring will take over and dominate or if multiple strains will compete around the globe. It’s possible a new strain not yet identified will emerge this fall, as Omicron did last year.

While it’s nearly impossible to predict how the virus will behave this winter, our tools to limit the impact of COVID-19 remain the same.

“The updated vaccine induces antibodies against a broader array of COVID-19 variants. It should provide better protection against whatever variant hits us next,” Cieslak said.