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Another COVID-19 winter?

The U.S. appears to be on the brink of a winter surge in COVID-19 cases, but Johns Hopkins experts offer hope that this winter will be better than the last

COVID-19 cases are on the rise again in the United States after dipping just three weeks ago. Vaccine effectiveness is waning and without widespread boosters, shots given six months ago remain at least 80-85% effective against serious illness but will only prevent two out of three possible infections for those vaccinated early in the pandemic—all signs pointing to the very real possibility of a winter surge here in the U.S.

Yet David Dowdy, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health and a physician with Baltimore Medical Services, says there is reason for hope that this winter will be better overall than last winter, even if cases continue to rise, thanks to vaccines and new oral antiviral medications that will reduce cases of severe COVID, preventing hospitalization and death.

"It's worth remembering where we were at this time last year: Many schools were not in-person, many businesses were operating at partial capacity, and many gatherings had strict size limits, yet COVID-19 cases were rising more than twice as fast as they are today," Dowdy says. "Now we have extremely safe vaccines with long-lasting effectiveness against serious disease, oral antivirals that could soon make COVID-19 a highly treatable disease, and we're living our lives much more like in pre-pandemic times. The COVID death rate in the U.S. is still falling and is now only half of what it was two months ago."

So how do we make sure Dowdy's optimism gains traction? Dowdy and Rupali Limaye, a social and behavioral scientist and health communication scholar at the School of Public Health who studies vaccine behavior and decision-making, offer the roadmap below, with a caveat that "no one can fully predict the future of this pandemic," Dowdy says.

Vaccinating everyone—including children—is the way forward

If this winter is better than the last, it will be thanks in large part to vaccines. The new antivirals are great, but they aren't a preventative measure like the safe, effective vaccines, Dowdy says.

"While we still are susceptible to getting cases of COVID-19, I think that the amount of serious illness and death is going to be much less, especially because of all the efforts that people have put into to getting vaccinated and getting their families and communities vaccinated as well," he says. "So even if cases go up this winter, we're very unlikely to see a return to the overcrowded ICUs and makeshift morgues of a year ago."

The continued push to vaccinate against COVID-19 includes ensuring newly eligible children get vaccinated as soon as possible, with research indicating that vaccinating 5- to 11-year-olds may prevent 600,000 infections over the next four months alone, Limaye says. "The COVID-19 vaccine is recommended for children even if they've had COVID-19 infection. And that's simply because the vaccine can better provide longer-lasting protection than natural infection." Kids can even get a COVID-19 vaccine dose near or at the same time as other childhood vaccines, like HPV or a flu shot.

The benefits of vaccination in children outweigh the risks, especially when we don't yet know how the long-term effects of COVID-19 infections will affect brain development, Limaye says. And the benefits of the COVID-19 vaccine extend beyond any individual child: "Vaccinating our children, specifically in that age range, can have immense benefits to reduce infection of others who may be at more risk," Limaye says. "This includes grandparents that you may see at Thanksgiving, for example, teachers, and other family members as well."

Building trust among people with reservations about getting vaccinated

With so much riding on COVID-19 vaccines, convincing people in our lives to get a shot is of paramount importance when we still have a little over 40% of the eligible population—excluding 5- to 11- year-olds—who have not yet gotten the vaccine, Limaye says.

"I think what we are starting to see now is that if you have not gotten the vaccine, there's essentially two reasons why you will get the vaccine. One is that you will see either a close friend or a family member who ends up getting severe COVID and ends up in the hospital or passing. That has been a nudge that has forced people to think about the vaccine decision," Limaye says. "The second is [vaccine] mandates. That is one thing that we know will change vaccine behavior. As we're starting to see different employers think about mandates, that is changing vaccine coverage in specific populations."

Unvaccinated people account for the majority of new COVID-19 infections, for severe cases, and for spikes in states like Alabama, Louisiana, Mississippi, and Texas. "With regards to specific socio-demographics where we're seeing hesitancy, it tends to be individuals that tend to be white and that might live in more rural areas," Limaye says, adding that vaccine disparities have narrowed in the last year among the Hispanic and African American communities.

"I think the goal here is going to be to continue to be empathetic, to be compassionate, and to continue to have one-on-one conversations with these individuals because it's important to not be dismissive of people's concerns," Limaye says. "That's the only way that we're going to be able to nudge those individuals into vaccine acceptance."

Accept that COVID-19 is never going away

It's human nature to want to know exactly when the COVID-19 pandemic will be over, but Limaye and Dowdy say it's not that simple. In reality, it's time to shift our thinking from the endgame toward how we'll live our lives alongside COVID-19 going forward.

"Everyone wants there to be a day that we declare, 'This pandemic is over,'" Dowdy says. "But nobody asks, 'When is the end of the flu?' for example. This is a disease that's going to be with us for the foreseeable future. It's going to come and go." That could mean we get COVID-19 booster shots annually or in tandem with occasional spikes in community transmission, Limaye says.

Limaye agrees that we should think about COVID-19 as we do with any other pathogen like a cold or a flu. "COVID is here to stay," Limaye says. "What we really need to be messaging around is that people can still get COVID, there can still be breakthrough infections, but the great news is if you have been vaccinated, you are very much less likely to be hospitalized or have severe COVID compared to those that are unvaccinated."

"The question is, when can we get this to a point where it's tolerable to us as a society," Dowdy says. "And I think that we may be closer to that point than we imagine. If we already look at how we're living our lives today as opposed to how we were living our lives a year ago, we've made great strides. So, we're not at the pandemic end date and we never will be, but we are making real progress. And I think there's a lot of reason for optimism going forward."