'I feel it in my bones.' What may be next with COVID as case numbers almost flatline

After hitting a pandemic-high peak in January, COVID cases in the Charleston Tri-county area have slid into a welcome spring slump. “Numbers are really low. It's at least as low as it was a year ago in the summer when everybody thought the virus was gone,” said Michael Sweat, Ph.D., leader of the Medical University of South Carolina’s COVID-19 Epidemiology Intelligence Project.

 

His team’s latest update shows there were an average of just 3.9 cases per day per 100,000 people in Berkeley, Charleston and Dorchester counties combined for the week of March 27 through April 2. Compare that with 416 cases per day per 100,000 in mid-January.

“It’s continuing to decline week to week. So that’s just stellar,” Sweat said.

So where do we go from here? Sweat, a professor in MUSC’s College of Medicine, adjunct professor at the Johns Hopkins Bloomberg School of Public Health and former research scientist with the Centers for Disease Control and Prevention, has a hunch. “I think there is going to be an increase. I feel it in my bones. But I have a feeling that it may not be that bad.”

He pointed to several factors behind that assessment: what’s happening in Europe, seasonal patterns in the Charleston area, vaccination and booster rates, the level of immunity from Omicron and the threat of new variants.

What’s happening in Europe

While we enjoy low case numbers, other places aren’t as lucky. Sweat pointed to parts of Europe. “France is at 205 cases a day per 100,000 people and growing. When you see that combination of a pretty healthy growth rate and a large number, it's especially bad.”

And the U.K. recently hit its highest numbers of the pandemic.

We have sometimes echoed trends in Europe. Will that happen again? It’s possible, Sweat said. “We tend to lag Europe, frequently by weeks.”

Seasonal patterns

Sweat’s team, which has been tracking COVID since the early days of the pandemic, has noted four clear surges so far: the first in the summer of 2020, the second the following winter, the third in the summer of 2021 and the fourth the next winter. Will this summer break the pattern?

“We may see a surge with lower numbers – but not the kind of hospital hit we’ve had from COVID in the past. That’s my gut.”

Vaccination and booster rates

Something that could help prevent that hospital hit: increasing the rate of vaccinations and booster shots. In South Carolina, the numbers aren’t great on that front. “About 59% of the total population has received two doses of vaccine. That’s below the national average. It’s almost frozen in amber. I mean, it's hardly going up at all,” Sweat said. 

“And just 23% of people have had three doses or more. It's crucially valuable to get boosted. That continues to have strong effects, including against BA.1 and BA.2, Omicron and its subvariant.”

Is it worth getting a second booster shot? Sweat gets asked that a lot. “I've had every family member call me to ask me, ‘What should I do?’ I often tell 'em, ‘Look, you know, it could protect you against this BA.2 if it's coming along. If you're a little older and have some health issues — diabetes, for example, there's not much downside. But the data needs to be looked at more. We need more time to know about the durability of the fourth shot.”

Omicron immunity

We do know that a lot of people were recently infected with Omicron. “There's been a hodgepodge of reactions to COVID. Some people jumped on the vaccine right away and got boosted. A lot of people didn't, and a lot of people got infected. I read 43% of the U.S. population likely got BA.1.”

That could help slow the virus’ spread here, Sweat said.

Threat of new variants

A new variant called OmicronXE has shown up in several hundred patients in the U.K. It’s a mix of the original Omicron strain, BA.1, and its subvariant, BA.2. It’s unclear what effect that emerging variant will have on the pandemic. 

Meanwhile, Sweat noted a huge spike in cases in one part of Africa. “Botswana went from almost nothing to 258 cases per day, per 100,000 people in a single week. Is that another variant? That's what I would want know. And variants seem to come out of that region a lot.”

For now, he’s glad to see the low case numbers locally. His team classifies COVID’s impact on the Charleston area as “minimal” right now, down another 9% in a week. But the MUSC scientists will keep tracking the virus — whatever direction it takes. “I think there’s high uncertainty. it could also stay low for a long time, but at some point we're going get another wave."