December is here and with it comes the third winter of the pandemic. With holiday travel and indoor family gatherings, the season has brought tragic spikes in COVID cases the past two years. Are we in for more of the same, or will this winter be different?
The Atlantic deputy editor Paul Bisceglio talks with the staff writer Katherine Wu about what to expect. Will a new variant accelerate infections as Omicron did a year ago? What does a wave of other viruses mean for the season? And after years of vaccines, masking, and testing, how can we help those who are most at risk this year?
Listen to their conversation here:
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The following is a transcript of the episode:
Paul Bisceglio: Hello, this is Radio Atlantic. My name’s Paul Bisceglio. I’m a deputy editor at The Atlantic, where I oversee our health, science, and technology coverage. With me today is one of our staff writers who reports on health and science, Katie Wu. Katie, hello.
Katie Wu: Hello, Paul. How are you?
Bisceglio: It’s good. It’s good. The last time I saw you was in person for the very first time.
Wu: Which is appalling because we have worked together for almost two years now. And, you know, you neglected me for most of those two years.
Bisceglio: (Laughs) How dare you. Not true. So I had to nudge you. But no, I mean, we’ve been in this for a while. This is in part because of what we’re here to talk about today, which is the pandemic. You know, the holidays are coming up. People want to be prepared and safe. And there’s a big question here: How worried should we be that things are going to get worse again?
Wu: Oh gosh. I mean, it depends what you mean by worse. I would say things are already pretty bad right now, depending on where your threshold is. A lot remains really unclear. And I certainly don’t want to get into the business of predicting the future. You know, first, some perspective. I think there’s a lot to be thankful for this year if we sort of compare this to past winters. You know, we have vaccines, we have treatments. And a lot of people are gearing up for a holiday season that could feel a lot like the ones that we had before the pandemic started. I mean, I’m certainly looking forward to that. At the same time, though, there are still people dying from COVID, and there are a lot of other respiratory viruses really hitting the country hard right now. And it’s kind of unclear how quickly that’s going to abate. I think that is really going to cast a bit of a shadow over the holidays this year.
Bisceglio: Why don’t we sort of step back and kind of take stock of where we’re at in the pandemic and what we might be able to say about where all this is headed? Let’s talk about variants. I think anybody listening should be forgiven if they’ve sort of lost track of variants at this point. Do you think you could give us a quick sort of encapsulation of the trajectory of variants? You know, we’ve gone through a couple in the past and we’ve been sort of stuck in the year of Omicron.
Wu: Yeah. So it’s actually helpful, I think, if we sort of break the pandemic down into three very, very, very rough phases. If we remember all the way back to 2020, we were, for the most part, just dealing with one version of the virus. You know, there were a couple of mutations here and there that made the virus more transmissible. But, you know, we can sort of call that the OG virus, and that really carried us through much of 2020. That was the one causing all that early chaos in that sort of pre-vaccine phase. Then right around the time we got our first mRNA vaccines, that’s also around the time when the Alpha variant first appeared. This was way more transmissible. It basically took the world by storm, especially, you know, in parts of Europe. And, you know, we saw it a bit here in the U.S., and a lot of 2021, we had these sort of single-Greek-letter variants taking over one by one by one, you know, depending on where you were looking in the world. You had Alpha, Beta, gamma—Delta really hit us here last summer. And then, of course, a little over a year ago, we got Omicron. But then things started to sort of change again in 2022. For this entire year, we have stuck with that single Greek letter, Omicron. And that’s marked a sort of phase three in all of this. We’re no longer swapping through this alphabet soup. We’re getting, you know, little riffs on Omicron: BA1, BA2, BA4, BA5. And now the sort of big bads that are taking over from BA5 are BQ1 and BQ1.1. Honestly, if I am starting to sound like, you know, a Twitter bot trying to spew out handles at this point, I don’t blame you. Honestly, it’s not—I don’t know if it’s the most worthwhile trying to keep track of individual variants right now. The sort of main takeaway here is that we’re in this Omicron era that’s lasted for more than a year at this point, but the virus is continuing to sort of riff on this motif.
Bisceglio: Like you said, we’re hitting the year anniversary of the beginning of the Omicron spike, when we hit by far the highest caseloads that we’ve experienced in the pandemic, a major spike in deaths, huge overcrowding in hospitals, and just really one of the worst moments, if not the worst moment, we experienced in the pandemic, a couple of years after everybody was hoping it would already be done. One big question of where that leaves us, especially given that we just hit that year anniversary: Should we be worried about getting Omicron’d again?
Wu: Yeah, it’s a great question. And I think a lot of experts have sort of been waiting for the other Greek-letter shoe to drop for a while. I mean, it’s bizarre to have stuck on Omicron for the past year. Like, when is Pi showing up? Why have we stuck here so long? I don’t think there’s anything to say that we won’t eventually get Pi. In fact, I think if you sort of ask researchers to bet, they think Pi will eventually show up. But we don’t know if that’s going to be tomorrow, a month from now, even potentially a year from now. But, you know, in short, to get, quote-unquote, Omicron’d again, I think we would have to see a much larger jump in terms of the virus producing something that looks immensely different. The sort of irony of Omicron sticking around for so long, you know, this entire past year is that it’s also just really difficult for another version of the virus, you know, some would-be Pi, to outcompete Omicron. Like Omicron is only getting better at being itself. And so for another version of the virus to completely steal Omicron’s thunder, that’s a huge ask.
Bisceglio: Yeah, and is that good news? I mean, is the takeaway there that because we are likely to keep existing with Omicron for some time, we just don’t need to be as worried about another winter spike?
Wu: Oh, that is complicated. I don’t think we’re out of the woods in terms of this really causing us some serious issues. In one sense, you know, we do have a sense of what Omicron is all about, but it’s not like all these subvariants are the same thing, right? Even if we’re still calling them the same Greek letter and that may seem familiar, even comforting to a degree, knowing that there’s a lot of ways to riff on the Omicron template means that reinfections are still happening. People are still getting sick. And even if you look at some of the models that are forecasting what’s ahead for this winter and even a little bit beyond, we don’t actually need the arrival of a Pi for a big surge in cases and hospitalizations, even deaths, to unfold this winter, because we also know that our defenses against infection especially are kind of fragile. And so if big waves of disease are sort of the product of the virus’s offense, as well as our defense, the virus doesn’t necessarily need to up its offense for there to be kind of a mismatch.
Bisceglio: With defenses, similar to everything else about the pandemic, there’s good news and there’s bad news. We’re in a time when vaccines are widely available. We have boosters tailored to Omicron. We have masks, we have tests, we have antivirals. We have greater scientific advances in understanding them than we had this time last year. So that’s a lot of good news. At the same time, there’s bad news as well. The state of boosting in America is not great. Roughly 11 percent of Americans who are eligible right now have gotten the latest boosters available.
Wu: Yeah, so this is an unfortunate thing. I think with every additional shot that Americans have been asked to get, there has been a pretty disappointing drop-off in interest, which, you know, to some extent is understandable. People are tired of it, especially when the recommendations keep changing. But this is a little scary to see. I mean, we know that because immunity is not permanent and because the virus keeps changing, there is a need to sort of refresh our defenses. The way that I sort of think about it is: It’s like we’re about to take a huge exam, and a lot of people are using an old version of a textbook that they haven’t read for almost a year. And if, you know, a big winter surge is that exam that’s coming up, we’re just going in incredibly unprepared. This is also a tricky time for that to be happening because, you know, we’re heading deep into December. People are going to be gathering; people are going to be wanting to see each other. Generations, all the way from grandparents and great-grandparents down to little infants, may be in the same room. And winter is already a time when we expect a lot of respiratory viruses to spread pretty easily.
Bisceglio: So I have received four COVID shots now. Does my immune system—do I just get stronger and stronger every time I get more shots? How is this working?
Wu: So it actually helps to think about your immune system like a gas tank or a battery. The general thinking right now is that if you, I guess, take your COVID-fighting part of the immune system fresh out of the box, you might need three or so charges to bring you up to full charge. So your primary series of the mRNA vaccines and then maybe one booster after that, and then after that, you know, you sort of go along and as time goes on, the battery starts to drain a little bit. And so every once in a while, you’re going to have to plug your immune system into a socket, you know, get another vaccine. And annual would seem to be enough. You know, this understanding is, I think, still a working definition. But what’s really helpful about that is we can maybe start to think about not, like, how many shots you’ve gotten so far. I know you’re still keeping track because you just said four; that’s also where I’m at. But honestly, I’m kind of relieved that there may be a future in which I don’t have to be like, Hey, I just got my 15th COVID shot, and instead just say, Hey, I’m up-to-date because I got my annual COVID shot, just like I got my annual flu shot.
Bisceglio: I mean, I think a lot of folks right now are in a place where many people are boosted. Millions of Americans have been infected at this point. So are we just collectively at less risk right now than we were a year ago?
Wu: I think it’s difficult to say collectively and it’s difficult to say we. I think if you sort of look at the range of outcomes that are happening with the virus, the sort of extreme ends of the scale are important to look at. The people who are in the best position to do well with the virus are in a better position than ever. I think they have treatments available to them. They’re up-to-date on their vaccines. They’re young. They’re healthy. Most of them probably don’t have much to worry about if they get infected with this. (Huge, huge, huge asterisk of us not fully understanding the risks of long COVID, though vaccination does seem to at least reduce that risk to some degree.) For other people, though, it’s still really, really difficult to be living in a COVID world. I think it’s especially tough for people who are immunocompromised, because one thing that I have been worried about a lot lately is that we’re already looking at a group of people for whom vaccines may not work as well. And some of the only things that we had to protect immunocompromised people, these monoclonal antibody treatments that can sort of serve as, like, surrogate immunity for them, giving them antibodies before they get exposed so they might have defenses to fight off the virus should it infect them—those monoclonal antibodies are getting rendered obsolete by some of the new variants that are showing up. Some doctors have already pulled some of those monoclonal antibodies off the shelf because they can’t be used as treatments. And there’s this big worry that Evusheld, which is a hugely important therapy for immunocompromised people, may be completely obsolete by the middle of winter.
Bisceglio: Yeah, you know, for me, I think that’s been one of the hardest elements of the pandemic to wrap my mind around at this stage in our third pandemic winter, which is that there is a real and large spectrum of risk that people are facing right now. And it's both true that there is an enormous part of the population that is young, not dealing with any health conditions, vaccinated, and can very justifiably, in my view, feel quite at ease right now, do not have reason to believe they on an individual level are at significant, serious risk. At the same time, existing right alongside everybody is another diverse and large group of folks who are still at risk and who are affected by the decisions of everybody around them. So let’s try to get more practical and direct on this, right? Like, given that reality, that there is the spectrum of risk, what should people be doing? You know, a lot of folks are going to be traveling throughout the winter, spending time indoors. How should we start thinking about risk and protecting each other when it’s both true that so many of us actually don’t have that much to be concerned about at this point, and so many others of us do?
Wu: I think the key is flexibility here. As we head into the holidays, if anyone is feeling sick, even if it’s not COVID, that is a sign that, you know, you should maybe be rethinking your plans. We don’t want anybody to be getting anything right now. And there’s a lot of stuff circulating at this time. If people haven’t gotten their flu shots or their bivalent COVID shots, now is a great time to do that. There’s still a couple of weeks before a lot of holiday celebrations get going in earnest. Testing has come down, but tests are still available to people who can afford them. It's a good time to stock up on some of those tests. And, you know, if you’re feeling worried in the days before you travel or before people are coming to you, it’s not a bad idea to take some tests, get a sense of whether you might be asymptomatically infected. Those tests might be able to pick up on that. And if you are traveling, not a bad time to at least to wear a mask so that, you know, you can be a little bit more confident that if you’re gathering with your family, you can take that mask off and feel a bit better about lowering your risk of infecting someone else or vice versa.
Bisceglio: Yeah, I’ve kept my line of questioning pretty focused on COVID, but to the point that you just raised: It’s not all about COVID right now this season, and in fact, the COVID conversation has become inextricable from the conversation involving many other viruses that are coming back rather strong this season. The term triple-demic has been tossed around by the media a lot to describe the state we’re in. How concerned should we be about non-COVID viruses this season?
Wu: Yeah, you know, it’s kind of interesting because a lot of the people that I talk to right now, their biggest concern is not COVID when it comes to infectious disease, it’s flu, it’s RSV. And the big vulnerable group this winter is kids, which is a big departure from how we’ve been talking about risk these past couple of years. So flu and RSV tend to be the other two viruses that people are talking about when they talk about this triple threat or triple-demic. I do have to pause here and say that I don’t love the term triple-demic, especially if people are using it to imply triple pandemic. Of those three, we have the COVID pandemic and then we have more local epidemics of RSV and flu. Not to minimize the other two, but just to be clear, COVID is happening on a wider scale. And it's not just flu and RSV. There’s also rhinovirus, enterovirus, parainfluenza, all of these other things that people may not have been thinking a lot about for the past few years. But, you know, it is this enormous slurry of viruses that’s kind of all hitting the population in the Northern Hemisphere at the same time. And that is the big problem. I think it’s not just one thing at a time, but everything all at once. It’s overwhelming pediatric hospitals. Kids are getting sick all over the country, some of them very seriously so. And you know, even adults are getting sick. And certainly older people, especially over the age of 65, are super susceptible to these viruses, too. I would say this is by far the worst winter in terms of respiratory viruses writ large that we’ve had since before the pandemic.
Bisceglio: Is this exact scenario, this avalanche of different viral infections, something we’re going to have to deal with every winter from now on, forever?
Wu: Returning to my reluctance to predict the future, I think my main point here has to be I don’t know, but I and a lot of the people that I’ve been talking to are optimistic that this is not going to be the template for every single winter that’s to come. And the thinking is that part of the reason we’re having such a rough go of things right now is because there is kind of a backlog of kids who entered the season without a lot of the typical immunity against these viruses that you would normally expect them to have. So, you know, think back to pre-pandemic times if you can. Winter was always a rough time for kids. You know, they would go to day care; they would go to school. They would spend a lot of fall and winter sick with infection after infection. And you know, that was kind of crummy. But they also had the opportunity to build up immunity to these viruses. You know, it’s thought that by the time most kids reach toddlerhood, they have gotten RSV and flu and their bodies have banked knowledge of those viruses and have a better sense of how to fight them off the next time. But because of the pandemic, you know, all these mitigation measures we took, masking and distancing, they did an amazing job of tamping down the levels of these other viruses. And that meant a lot of kids started off the season having never seen flu or RSV before. And so just the population of susceptible kids is a lot bigger. I do want to make sure here that I am not implying here that masking was a bad thing, that distancing was a bad thing. That was necessary. And in fact, it showed us how to tamp down on levels of these respiratory illnesses. I think it’s just that because we entered fall with so many of those mitigations all of a sudden gone, these viruses found ample opportunity to spread, and they hit us all at once. But to return to your idea about, you know, whether this will be the case next year, I think the hope is that more kids will be caught up this year just because there is going to be a lot of transmission, and next year will hopefully be easier, and the year after that even easier.
Bisceglio: Long COVID is, I think, always the complicating factor in these conversations, and in some ways, the way that the conversation inevitably has to end. We can always look at the positives of the defenses we’ve built up. And then there’s always this lingering factor. This stage into the pandemic, three years in, how worried should people be about the effects of long COVID?
Wu: I will say that from my personal perspective, I remain very worried about long COVID. It’s difficult to even sort of quantify the risk for it. Scientists are still figuring out just how much immunity can protect us from long COVID, whether, you know, drugs like Paxlovid can reduce the likelihood that you develop long COVID, if you take Paxlovid early enough. And we still don’t have a good slate of treatments for long COVID. And, you know, because this is a chronic condition, it’s pretty scary. You know, you can get it from an infection of any severity and you could be dealing with it for years to come. And I think that’s why I still don’t feel comfortable saying, you know, we can declare victory over this virus. Why I still don’t feel comfortable saying that the pandemic is anywhere near over. This is an unusual virus in the sense that it can cause these long-term conditions of all sorts that can infect all kinds of body systems. And we really are still just starting to grapple with the long-term implications of that. Like, it really has only been three years. We don’t know what we might detect 10 years from now, 20 years from now. And there are even some scientists worried that long COVID or something similar to it could be affecting our experience with other respiratory viruses now in this current season. I think we have to have some humility here and acknowledge that we still don’t fully understand this. So that’s a big part of the reason why I’m still masking when I go out into public, when I’m traveling, but I’m trying to introduce other things back into my life that just make things feel more normal. I want to be able to see the people that I love. I want to be able to interact with them. But things like masking and testing make me feel more confident about doing those things.
Bisceglio: Katie, it was great talking to you. It’s always awesome catching up.
Wu: Thank you so much for having me. It was—oh gosh, can I call this fun? It was kind of a dark conversation, but I still had a good time. And I hope your holidays are the best they’ve been in at least three years and you get to enjoy some time with your cat.
Bisceglio: Right? I wish you the best holidays of the pandemic, too.
Wu: Thank you.
Bisceglio: This episode of Radio Atlantic was produced by Kevin Townsend and Theo Balcomb. It was fact-checked by Sam Fentress. Claudine Ebeid is the executive producer of Atlantic Audio. I’m Paul Bisceglio. Thanks for listening.