COVID’s winter wave has blanketed the nation, along with flu. After a brief decline, hospitalizations for both COVID and flu have increased again in Texas.
“I've got a very bad cough. A very bad cough. Headaches. Shortness of breath. I haven't been able to sleep. Just miserable,” said Olivia Strange, a grandmother in San Antonio who had been sick for more than a week.
Strange lives in San Antonio with her son and four-year-old granddaughter, Alora. As often happens in multi-generational homes, Alora came home with a little cough around the time Strange started feeling bad. The grandmother didn’t know if she had COVID, influenza, RSV, or even allergies, but she knew she was at high risk for poor outcomes. Strange has kidney disease that requires dialysis and congestive heart failure.
“I've been taking over-the-counter medications and stuff, but it doesn't seem to be working,” Strange said. “So they told me, come in and get tested, get the right medications.”
At the University Health System’s Urgent Care Express Med walk-in clinic, Dr. Juanito Lomboy asked Strange a battery of questions about her health while examining her to see if he could determine what was most likely to be causing her symptoms.
“We always play detective, as your jobs are kind of like questioning, because their management depends on your primary diagnosis.”
Lomboy ordered tests for COVID, flu, and RSV. The treatment is different for each. There are antivirals for both flu and COVID, though treatment for both should be initiated within days of symptom onset, and Strange had been sick too long for antivirals to help. Lomboy also ordered a chest x-ray to assess Strange for pneumonia and prescribed a variety of medicines to ease her cough, congestion, headaches and sore throat.
“So those are the symptomatology help us clear up the confusion between what's going on, because the worst thing you could do is misdiagnosing and giving an inappropriate treatment,” Lomboy said.
More people in Texas have been infected with influenza than COVID so far this winter, according to the Texas Respiratory Illness Interactive Dashboard, but COVID is more likely to land you in the hospital.
And, according to the World Health Organization, COVID is likely far more prevalent than simple case counts would lead you to believe.
“Case based data that is reported to WHO is not a reliable indicator,” said WHO technical lead on Covid-19 Maria Van Kerkhove at a briefing in January. “It has not been a reliable indicator for a couple of years now."
“So if you look at the epi curve, it looks like the virus has gone, and it’s not,” Van Kerkhove added.
Van Kerkhove also warned that COVID levels were up to 19 times higher than were being reported, based on the amount of virus being found in wastewater samples from around the world.
The world is still in the grip of the COVID pandemic, Van Kerkhove said, as the virus continues to evolve in unpredictable ways. The current COVID wave is fueled by the virus’s evolution during the holiday season. Omicron subvariant JN.1 supplanted XBB as the dominant strain and is now implicated in more than 90% of COVID cases in the United States. COVID wastewater activity across the US remains high. In the south — specifically in Texas — activity remains very high.
According to Your Local Epidemiologist Katelyn Jetelina, the emergence of JN.1 is a big driver of this current COVID wave. She said it's one of the most fit COVID strains we've seen since the original Omicron variant.
“So that means that even though we have a lot of immunity in our population, in our communities, it's still finding a way to transmit from person to person fairly rapidly. And the fastest it's transmitted from person to person since that original Omicron tsunami,” Jetelina said.
The current COVD vaccine was formulated to protect against the previous dominant Omicron subvariant, XBB, but Jetelina said JN.1 isn't so different that the vaccine is no longer effective.
“It's not SARS-CoV-3,” Jetelina pointed out. “It's still COVID, and what we've seen in the lab is really positive news that, yeah, our vaccines still work against JN.1. Maybe not as well as if XB was circulating, but still a great amount.”
Jetelina added, “This virus is going to continue to mutate, and the best we can do is try to keep up with it.”
This, as it becomes clear that the tools that we grew to depend on in the first years of the pandemic are not as accessible or as reliable as they were during the early years of the pandemic.
In this episode of Petrie Dish, Bonnie Petrie speaks with Katelyn Jetelina about living with COVID 19 in 2024. From whether the math still adds up when considering drugstore COVID tests (maybe) to whether XBB booster shots are worth getting in a JN.1 world (yes) to how to decide whether to wear a mast (proximity and duration), Petrie and Jetelina sort through what you need to know as we embark on our fifth year of the pandemic during another winter wave.
