COVID in May

Concerns about a potential resurgence of COVID-19 are mounting as summer 2024 approaches. 

This is driven by several indicators, including social media posts, healthcare data, and wastewater surveillance across different regions. Our study findings corroborate this trend.  While many forecasters anticipate a surge, others expect a gradual increase through the end of May, and then a decline again around early June.

Reports from social media suggest emerging clusters of COVID-19 in Texas, several Canadian provinces, the UK, and on cruises in northern regions such as a Norwegian cruise to Alaska. 

Data from Alberta's Respiratory virus dashboard  (total weekly laboratory-confirmed COVID-19 cases) and wastewater surveillance in Calgary indicate an uptick in COVID-19 cases starting April 2024. The most recent statistics from Alberta Health reveal a significant increase in hospitalizations due to COVID-19, with 114 individuals currently hospitalized—an increase of more than 20% over two weeks. Of these, six are in intensive care, underscoring the severity of some cases.

In the UK, there is a clear upward trend in COVID-19 activity. For the week of April 29 to May 5, 2024, the positivity rate for SARS-CoV-2 infections rose to 8.6% from 6.8% the previous week. Concurrently, COVID-19 hospitalizations increased from 2.50 to 3.28 per 100,000 people, indicating a broader escalation in virus transmission and impact.

In the US, particularly in the Northeast region, wastewater surveillance data reveal approximately a 4% increase in COVID-19 detection as of May 4, 2024, compared to the previous week. in There also was a notable increase in Hawaii. This early indicator, provided by platforms like NWSS of CDC,  Biobot analytics (sunsetting this May) or Verily, potentially predates clinical reports of new infections.

April 2024 saw the coexistence of multiple offshoots of SARS-CoV-2 without a clear dominant variant, creating a "genetic diversity hotspot." This pool of genetic diversity fosters the emergence of new mutations and recombinations. By early May, variant KP.2 (JN.1.11.1.2) became dominant, accounting for 28% of infections in the US and 15 % in the UK, followed by variant KP.1.1 at 7.1% in the US and JN.1.11.1, the predecessor of KPs - the FLiRT variants, at 5.4% in the UK. Other variants like JN.1.7.1 also showed significant presence (15% and 13% respectively. KP.3 variant is also circulating in several countries, including Thailand, but at much lower levels. 

Models currently used to estimate the growth advantage of emerging lineages - a logistic regression generalized linear model (GLM) and a generalized additive model (GAM)  - predict the highest weekly growth rate advantage for JN.1.11.1 (38.92%, GAM, ~70%, GLM), KP.2 (25.09%, GAM and 21% GLM) and JN.1.7.1 (24.91%, GAM, 23%, GLM). Weekly growth rate advantage (GLM) was high for XDK variants (44%)

However, as of May 1, US hospitals are no longer required to report COVID-19 hospital admissions, hospital capacity, or occupancy data to the federal government, complicating efforts to track and manage the pandemic. The diminishing global focus on data collection, combined with the potential for people to be reinfected by multiple variants in a short period and carry the virus asymptomatically, poses significant challenges. About 5% of individuals may carry the virus long-term without awareness, yet still be capable of spreading it during flare-ups.

Furthermore, clinicians should be mindful of the reduced sensitivity of antigen testing compared to RT-PCR, which may result in false-negative results. Antigen tests exhibited sensitivities of 47% (95% CI = 44%–50%), contrasting with 80% (95% CI = 76%–85%) sensitivity observed with RT-PCR and culture as references.

This complexity is illustrated by a case study involving a mysterious COVID variant WI-CL-001 traced from wastewater to a single company in Wisconsin. Despite extensive testing, uncertainties about the infected individual and the efficacy of testing methods remained, highlighting the challenges of managing and tracing COVID in a landscape of diverse and rapidly evolving variants.

Tragically, the toll of the virus continues, with notable May fatalities including Japanese politician Kazuo Aichi (86) and record-breaking US test pilot Dick Rutan (85).

The evolving nature of the virus underscores the need for ongoing vigilance and adaptation in our response efforts.


REFEREENCES

Respiratory virus dashboard | alberta.ca

https://covid-tracker.chi-csm.ca/

High-risk Albertans urged to get another vaccine dose as COVID-19 cases ticking up (msn.com)

https://www.gov.uk/government/publications/sars-cov-2-genome-sequence-prevalence-and-growth-rate/sars-cov-2-genome-sequence-prevalence-and-growth-rate-update-1-may-2024

Flu and COVID-19 surveillance report published - GOV.UK (www.gov.uk)

Pandemic Mitigation Collaborative - COVID-19 Forecasting Model (pmc19.com)

Shafer MM, Bobholz MJ, Vuyk WC, Gregory DA, Roguet A, Haddock Soto LA, Rushford C, Janssen KH, Emmen IE, Ries HJ, Pilch HE, Mullen PA, Fahney RB, Wei W, Lambert M, Wenzel J, Halfmann P, Kawaoka Y, Wilson NA, Friedrich TC, Pray IW, Westergaard R, O'Connor DH, Johnson MC. Tracing the origin of SARS-CoV-2 omicron-like spike sequences detected in an urban sewershed: a targeted, longitudinal surveillance study of a cryptic wastewater lineage. Lancet Microbe. 2024 Apr;5(4):e335-e344. doi: 10.1016/S2666-5247(23)00372-5. Epub 2024 Mar 11. PMID: 38484748.

https://www.technologyreview.com/2024/03/22/1090059/how-scientists-traced-a-mysterious-covid-case-back-to-six-toilets/

Smith-Jeffcoat SE, Mellis AM, Grijalva CG, et al. SARS-CoV-2 Viral Shedding and Rapid Antigen Test Performance — Respiratory Virus Transmission Network, November 2022–May 2023. MMWR Morb Mortal Wkly Rep 2024;73:365–371. DOI: http://dx.doi.org/10.15585/mmwr.mm7316a2

Jay Weiland | LinkedIn

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