"The groundwork of all happiness is health." - Leigh Hunt

How apprehensive should we be?

August 30, 2023 – COVID-19 hospitalizations have been rising for weeks as summer draws to a detailed. But how apprehensive do you have to be? SARS-CoV-2, the virus behind COVID, is continually evolving and continues to surprise us. As a result, rates of transmission, hospitalizations and deaths from COVID could be difficult to predict.

WebMD asked experts for his or her tackle the virus currently circulating, and asked them to predict whether we'll be wearing masks again anytime soon and what the situation is perhaps like in the autumn and winter, especially now that testing and vaccinations are not any longer free.

Question 1: Do you expect a big COVID wave at the tip of the summer?

Eric Topol, MD: “This wave is probably not going to be big and could be more of a 'little cloud.' I don't think doctors are too concerned,” said Topol, founder and director of the Scripps Research Translational Institute in La Jolla, California, and editor in chief of Medscape Medical News, our sister news site for healthcare professionals.

Thomas Gut, DO: ““It is always impossible to predict the severity of COVID waves. Although the virus has generally mutated in ways that favor easier transmission and milder disease, there have been a handful of surprising mutations that have been more dangerous and deadly than the previous strain,” said Gut, vice chair of medicine at Staten Island University Hospital/Northwell Health in New York City.

Robert Atmar, MD: “I would first like to point out that projections for SARS-CoV-2 are a little risky because we are still in uncharted territory with respect to some aspects of its epidemiology and evolution,” said Atmar, a professor of infectious diseases at Baylor College of Medicine in Houston. “It depends on what you mean by significant. We, at least in Houston, are already in the midst of a significant increase in the burden of infection, at least when you consider wastewater surveillance. The amount of virus in wastewater already exceeds the peak we saw last winter. However, the increased burden of infection has not led to a large increase in hospitalizations for COVID-19. Most people who are admitted to our hospital are admitted with an infection, not because of the consequences of the infection.”

Stuart Campbell Ray, MD: “It looks like the number of infections is increasing, but the proportional increase in hospitalizations due to severe cases is smaller than in the past. That suggests that people are protected by the immunity we have acquired over the past few years through vaccinations and previous infections. Of course, we should think about how that applies to each of us – how long it has been since we have had a vaccination or COVID-19, and whether we may experience more severe infections as immunity wanes,” said Ray, a professor of medicine in the division of infectious diseases at Johns Hopkins University School of Medicine in Baltimore.

Question 2: Will masks or a mask requirement be introduced again in autumn or winter?

Topol: “The mask requirement does not work very well, but we could use it again on a large scale if a descendant of [variant] BA.2.86 takes off.”

Good: “It's hard to predict if mask mandates will be reinstated at some point. Since the omicron strains emerged, COVID has been relatively mild compared to previous strains, so there probably won't be any plans to require masks in public unless a more deadly strain emerges.”

Atmar: “I do not believe that we will see a mask requirement again in the fall or winter for a number of reasons. The main reason is that I do not believe that the population will accept a mask requirement. However, I think that wearing masks can continue to be an additional measure to improve infection protection alongside a booster vaccination.”

Beam: “Some people will choose to wear masks during a surge, especially in situations such as commuting where they will not interfere with their work. They will wear masks especially when they want to avoid infection, because they are concerned about other people, because it will disrupt their work or travel plans, or because they are worried about the long-term consequences of reinfection with COVID-19.”

Question 3: What impact might the proven fact that COVID tests and vaccinations are not any longer free have on their use?

Topol: “The number was already low and this will undoubtedly further affect their uptake.”

Good: “I expect that tests will be done less frequently now that they are no longer free. I am sure that fewer cases will be detected in patients with milder or asymptomatic disease than before.”

Atmar: “If the cost of the SARS-CoV-2 vaccine is paid out of pocket or the administrative burden associated with vaccination increases, the acceptance of SARS-CoV-2 vaccines is likely to decline. It will be important to communicate the potential benefits of such vaccination to the populations to be vaccinated.”

Beam: “One challenge with COVID-19 has always been inequalities in access to health care, and without public support for prevention and testing, this will only get worse. This applies to everyone, but is particularly burdensome for those who are often marginalized in our health system and society at large. I hope we can find ways to ensure that people who need testing and vaccination have access to it, because good health is in everyone's interest.”

Question 4: Will the brand new COVID vaccines also work against the variants currently in circulation?

Topol: “The XBB.1.5 boosters will be available on September 14th. They should help against EG.5.1 and FL.1.5.1. The FL.1.5.1 variant is currently on the rise.”

Good: “We expect the newer monovalent XBB-based vaccines to be available in the next few weeks, which provide good protection against the COVID variants currently in circulation as well as the new Eris variant.”

Atmar: “The vaccines are expected to induce immune responses to the variants currently circulating, most of that are strains which have evolved from the vaccine strain. The vaccine is anticipated to be only at stopping severe disease and doubtless less effective at stopping infection and mild disease.”

Beam: “Yes, the updated vaccine design has a spike antigen (XBB.1.5) that is sort of similar to the currently dominant variant (EG.5). Even if the variants change, the boosters stimulate B cells and T cells to guard in a way that's safer than COVID-19 infection.”

Question 5: Is there anything we need to pay particular attention to with variant BA.2.86?

Topol: “The scenario could change if new functional mutations emerge.”

Colon: “BA.2.86 continues to be quite rare and there is just not loads of data to make educated guesses directly. However, typically, individuals who have been exposed to newer mutations of the COVID virus have been shown to be higher protected against newer mutations. It is cheap to assume that individuals who haven't recently been infected with COVID or haven't received a booster shot are at higher risk of becoming infected with XBB or BA.2-based strains.”

Atmar: BA.2.86 has been classified as a variant to be monitored. We want to observe whether it occurs more frequently and whether there are any unexpected features associated with infection with this variant.”

Beam: “It's still rare, but it's been seen in geographically dispersed places, so it has legs. The question is how effective it will be at evading some of the immunity we've gained. T cells will likely continue to be protective because they attack so many parts of the virus that change more slowly, but B cell antibodies to the spike protein may have more difficulty recognizing BA.2.86, whether those antibodies were raised against a vaccine or an earlier variant.”