A person has a nasal swab applied for the coronavirus disease (COVID-19) test taken at a mobile testing site in Times Square in New York City, August 16, 2021.
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COVID-19 levels are rising across the United States, with more than half of the states, including North Carolina, reporting “very high” levels of SARS-CoV-2 viral activity in wastewater. According to the latest update from the Centers for Disease Control and Prevention (CDC), at least 27 states are experiencing “very high” levels of the virus that causes COVID-19 in their wastewater, while an additional 17 states are reporting “high” levels.
This increase in COVID-19 cases is raising concerns among public health officials, particularly because wastewater data is a critical indicator of the virus’s spread in the community. Wastewater surveillance allows for the early detection of rising infection rates, even before symptoms become widespread or testing data reflects the increase. This method has proven invaluable, especially as fewer people are being tested in clinical settings, and many mild cases go unreported.
Wastewater: The Canary in the Coal Mine
The readily availability home tests could be masking the actual number of COVID-19 cases in the state, health officials say. Photo by Bryan P. Sears.
Dr. David Wohl, a professor of medicine in the Division of Infectious Diseases at the University of North Carolina School of Medicine, describes wastewater levels as “the proverbial canary in the coal mine.” He explains that monitoring these levels provides a clear picture of the amount of COVID-19 circulating in the community.
This approach to monitoring is particularly important because it captures data from individuals who may be mildly ill and not seek medical attention, or those who are asymptomatic but still capable of spreading the virus. By analyzing wastewater, health officials can estimate the true prevalence of COVID-19 in a population, helping to guide public health responses and inform the public about current risks.
Dr. David Weber, medical director of the Department of Hospital Epidemiology at UNC Health, also emphasizes the importance of this data. He notes that wastewater surveillance is especially useful in detecting COVID-19 among people who might not appear in traditional testing data, either because they do not experience severe symptoms or choose not to get tested.
Summer Surge: Why COVID-19 Is Increasing
While many viruses tend to “survive better at low temperatures and low humidity,” COVID-19 levels are rising during the summer, a period typically associated with lower transmission rates for respiratory viruses. The CDC National Wastewater Surveillance System dashboard indicates that COVID-19 levels in wastewater are rapidly approaching those seen during the winter months.
Weber attributes this unexpected summer surge to three primary factors:
1. Emergence of New Variants
One key reason for the increase is the emergence of new COVID-19 variants that are more transmissible, even if they do not necessarily cause more severe illness. When a new variant appears in the summer, it “hasn’t fallen into the typical winter cycles yet that we see with other viral diseases,” Weber explains. This means that these variants can spread more easily, even during warmer months, leading to higher levels of viral activity.
The new variants circulating this summer have demonstrated a higher transmission rate, making them more efficient at spreading within communities. This has led to increased cases, as evidenced by the rising levels detected in wastewater. However, Weber notes that people infected with these new strains of COVID-19 are “not sicker than in previous waves,” which suggests that while the virus is spreading more rapidly, it is not necessarily resulting in more severe cases.
2. Waning Immunity
Another significant factor contributing to the rise in COVID-19 cases is waning immunity among the population. Many individuals have not received recent booster doses of the COVID-19 vaccine, which leaves them more susceptible to infection. “Vaccines prevent infections for about three months and serious disease for about six months,” Weber explains.
As immunity diminishes over time, people become more vulnerable to contracting COVID-19, particularly when new variants are circulating. This underscores the importance of staying up to date with vaccinations. Weber expects new vaccines targeting the latest variants to be available by the end of the month, and he advises that people should get vaccinated as soon as these become available.
Dr. Wohl agrees with this assessment, emphasizing that “getting vaccinated with the new vaccine any time after they become available makes sense given the high rates of COVID-19 we are seeing now.” He also suggests that individuals with higher risk, such as those planning travel or attending large gatherings, consider getting the current vaccine now and the new one later in the year for continued protection.
3. Reduced Mask Usage
Protestors gather in Buffalo, New York, in response to requirements that truck drivers be vaccinated for COVID-19 before entering Canada from the U.S., on Feb. 12, 2022. (Dustin Franz/AFP via Getty Images)
The third factor driving the rise in COVID-19 cases is the decreased use of masks. Throughout the pandemic, masks have been a crucial tool in reducing the spread of the virus, particularly in indoor settings or crowded areas. However, as mask mandates have been lifted and public vigilance has waned, the protection they offer has diminished.
“The mask can be protective in how many particles you expel,” Weber explains, highlighting that wearing a mask can still reduce the risk of transmission, especially in high-risk settings or for individuals who are more vulnerable to severe illness. He advises that anyone who feels at risk should consider wearing a mask, particularly in situations where social distancing is not possible.
For high-risk individuals who test positive for COVID-19, early intervention with oral therapies like Remdesivir is critical. “These can substantially reduce their risks for severe disease, hospitalizations, and death,” Weber says, but emphasizes that these treatments must be started shortly after symptoms begin to be effective.
Upcoming Vaccines and Preventative Measures
Insert Photo Here: Image of COVID-19 vaccines or a person getting vaccinated
As new vaccines become available, Weber advises the public to get vaccinated to maintain protection against the latest variants. “Because most people at least have some previous immunity, the vaccine should rapidly provide some protection,” he notes.
Vaccination remains one of the most effective strategies for controlling the spread of COVID-19 and preventing severe outcomes. While the current vaccines have been effective in reducing severe disease, hospitalization, and death, the new vaccines are expected to offer enhanced protection against the latest variants.
Dr. Wohl also supports vaccination with the new vaccine as soon as it’s available, particularly in light of the rising COVID-19 rates. He suggests that individuals who are at higher risk or planning significant activities, such as travel, consider getting the current vaccine now and the new one later in the year to ensure continued protection.
Masks Can Still Offer Protection
New Yorkers wearing masks, Photo credit BBC.
Despite the widespread relaxation of mask mandates, masks remain an effective tool in reducing the spread of COVID-19, particularly in high-risk environments or among vulnerable populations. Weber reiterates that masks can still play a crucial role in protecting individuals and communities from the virus.
For those who are at higher risk, such as older adults or individuals with underlying health conditions, wearing a mask in public spaces can help minimize exposure to the virus. Additionally, early treatment with antiviral medications, like Remdesivir, can significantly reduce the risk of severe outcomes for those who contract COVID-19. These treatments are most effective when started early, within the first few days of symptom onset.
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