Experts urge domestic action against winter COVID surge

Much of the U.S. is in the throes of a winter COVID-19 surge with cases poised to eclipse last year’s summer peak, driven by new variants, waning immunity and holiday gatherings.  

The country has come a long way from the worst days of the pandemic. But vaccinations have stalled out amid fatigue, and new variants have neutered almost all monoclonal antibody treatments. Antiviral drugs such as Paxlovid still work, but they’re not safe for some immunocompromised patients. 

Last week, the U.S. surpassed 100 million total cases since the start of the pandemic, according to data from the Centers for Disease Control and Prevention. The actual totals are likely much higher because of infected people who never got tested or those who tested positive at home and never reported the result.

The omicron subvariant XBB.1.5 has rapidly spread to become the dominant COVID-19 mutation in the U.S., likely fueling the increase in cases.

Hospitalizations are also rising quickly, especially amid the vulnerable population over age 60, though the average weekly admissions of 5,600 for the general population are about 74 percent lower than the worst of last winter’s omicron surge, which peaked at more than 21,000 a week.

But public health experts are expressing frustration that instead of focusing on mitigation measures including masking and improved ventilation, U.S. officials have turned their attention towards China.

Beginning Thursday, all incoming travelers from China, including Hong Kong and Macau, will need to present negative COVID-19 tests before entering the United States regardless of vaccination status. 

“If I saw any public health utility in this, I would strongly support it. I don’t see any public health utility,” said Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

“We should probably look at ourselves first. Any country ought to be testing people from the United States,” Osterholm said, noting the “atrocious” levels of booster shot uptake and the rapid rise of the XBB variant, particularly in the Northeast. 

“We’ve had no evidence XBB is in China,” Osterholm said.

The return of the testing requirement comes amid China’s rapid dismantling of its “zero COVID” strategy, which has resulted in infections running wild without an adequate health infrastructure or enough vaccinations in place. 

Biden administration officials said the enhanced testing is meant to decrease the number of infected passengers boarding airplanes and could give public health authorities time to identify and understand any potential new variants that may emerge. 

They argue China has virtually stopped reporting any outbreak data, and officials said they are concerned about potential new variants circulating without their knowledge.

But infectious disease experts said new variants are much more likely to arise domestically than to come from China. The virus mutates to escape immunity, whether from prior infection or from vaccination. The U.S. currently has much higher levels of both compared to China. 

“We’ve theoretically beefed up our surveillance system, but if they focus only on China, we will miss the [variant] that shows up in Seattle or New York City or Austin, Texas, or wherever,” said Georges Benjamin, executive director of the American Public Health Association. “We shouldn’t put all of our eggs in the basket of thinking that it’s only going to come from China. I think that’d be a terrible mistake.”

Rick Bright, an immunologist and former head of the Biomedical Advanced Research and Development Authority (BARDA), said it appears that the viruses circulating in China are similar to those that circulated in the U.S. last summer and never gained a foothold. 

“This is another missed opportunity to educate the public on effective mask wearing, testing, and the importance of getting a recent vaccine boost. And a huge missed opportunity to gain valuable knowledge from genomic surveillance,” Bright said in a direct message to The Hill.

Federal health officials are asking people to wear masks in areas of high community transmission, as are some state officials. But there is no political appetite for mask requirements, as much of the public has moved on from worrying about the virus. 

In his final White House appearance in November, top medical adviser Anthony Fauci emphasized the need for people to get the updated shot, even if they’ve previously been vaccinated. 

The country can get to a point where there’s a minimal background level of infections and very few deaths, he said, but only if people protect themselves. Despite the availability of vaccines and treatments, hundreds of people are still dying of COVID-19 every day.

“We’re gonna get there. We can get there with less suffering if we use the interventions that we have,” Fauci said. “If you want to let nature take its course, we’re ultimately going to get there, but we’re going to lose a lot more people than we need to.”

The Biden administration continues to encourage vaccination and last month restarted its program of offering free at-home COVID-19 tests through the mail. But federal funding for testing, vaccines and other pandemic measures has dried up, with Congress unwilling to appropriate more money.

“Instead of talk about stopping funding for tests, masks, vaccines and drugs, along with chatter about lifting the public health emergency, all energy should be focused on ramping up to weather the last major surges of this virus,” Bright said. “We have the ability to predict these surges now and the tools to block them.”