Q&A: What physicians should know about the COVID-19 summer surge and updated vaccines

Key takeaways:

• Updated vaccinations may help curb this summer’s major surge in COVID-19 cases.
• Late September and October are the best times to get vaccinated and prevent illness again this winter.

Considering the current surge of COVID-19 cases, primary care providers should counsel patients to prepare for this winter’s inevitable spike, according to an expert.

In August, the CDC released wastewater data that showed the United States in the midst of a massive summer wave of COVID-19. The FDA also recently approved several updated COVID-19 vaccines for rollout.

Healio spoke with William Schaffner, MD, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center and Healio | Infectious Disease News Editorial Board Member, to learn more about the summer surge, how the upcoming vaccines will affect the situation and more.

Healio: Can you put this surge into context? How does this a spike compare with previous years?

Schaffner: There isn't any doubt that we have had a summer spike in COVID-19. We've had that every year for the last 2 or 3 years, so it was expected, but this year's summer increase was more extensive than people thought, and there hasn't really been a clear downturn yet. This spike has persisted for a somewhat longer period of time. But we anticipate, based on previous summers, that the uptick in cases will soon start to abate, followed by another increase this winter.

Unlike influenza, which creates a big outbreak every winter and then essentially disappears for the rest of the year ... COVID-19 never completely disappears. Its pattern resembles a two-hump camel. It has two increases, with one occurring in summer and followed by a much larger one in the winter. The current strains are very, very contagious. There's a lot of relatively “mild” infection out there, but with all this contagion, the virus finds people who are not up to date with their vaccines, who are older and frail, and who are immunocompromised, and those are the folks who are now being hospitalized with this illness. It's causing, at the moment, somewhere between 200 to 300 deaths a week in the U.S.

Healio: When will this surge peak? Will the updated vaccines in September have an impact?

Schaffner: A downturn is expected any time now, based on previous behavior of this virus. But we can't schedule what this virus will do, so we'll just have to wait and see. I had anticipated that the summer surge would have had a downturn by now, but it hasn't.

Vanderbilt is part of a consortium sponsored by the CDC. There are 14 locations across the country, and we track hospitalizations due to laboratory-confirmed COVID-19. These are very rigorous data; they're the more severe cases. As of last week, we haven't seen a downturn, so I'm anticipating what the data will show this week. I really don't know whether new cases will remain steady or already show a downturn.

We anticipate based on good, solid laboratory evidence that the updated vaccine ... will cover these currently circulating strains and continue to provide protection against severe disease. We have to recognize that's what the vaccines do. They are not nearly as good at preventing milder infections, but they do provide pretty good protection against severe disease [and may] keep you out of the hospital.

Healio: What should PCPs be telling their patients about COVID-19 right now?

Schaffner: People who are in high-risk groups — anybody aged 65 years and older; anyone who's frail; anyone who has a chronic, underlying medical condition; and immunocompromised people — should, at the moment, be very careful. If they go indoors to public gatherings, they should be wearing their masks, and they should think about social distancing. Maybe it's a good time to stream a movie rather than going to the movie simply because they are at high risk.

These vaccines are just starting to be distributed across the country into the hands of the immunizers, to the providers. Once they become available, everybody should make a commitment to get the vaccine because the recommendations are simple: ages 6 months and older should receive the [COVID-19] vaccine, along with their influenza vaccine. The recommendations for both are identical.

The ideal time to get vaccinated would be late September and during the month of October. That will provide the best protection throughout the winter season. But there will be some people who want get the updated vaccine as quickly as possible for any number of reasons, from travel to weddings and other commitments that will bring them indoors, in contact with a lot of people.

Healio: With this spike in mind, what can we expect this winter?

Schaffner: Expect an influenza outbreak and another increase in COVID-19 cases, one that's larger than the one we have now. There'll be continuing transmission and mild infection and even more hospitalizations. To stunt this increase and keep hospitalizations as low as possible, we are urging people to follow the recommendations of the CDC, the American Academy of Pediatrics, and the American College of Physicians. Every professional organization is speaking in harmony: “please get vaccinated and vaccinate your children if they are 6 months of age and older.”

Healio: What is the take-home message for PCPs from this discussion?

Schaffner: They should purchase the vaccine, have it available and be ready to administer it and to provide real comfort and assurance to their patients that it's a good thing.

We can, of course, answer patients’ concerns, skepticism, and hesitancy by giving them a certain amount of information. Facts that go to the brain. But what the behavioral psychologists have told us time and again is that although this information is fundamental, it's rarely sufficient to change or motivate behavior. Physicians need to understand how people feel about things, what the psychologists call your “attitude.” That's why I use the words “comfort” and “reassurance,” which go to your heart, not to your brain. Let patients know that vaccination is the responsible thing to do. It's a good thing for themselves, for their families and for their communities.

Healio: Is there anything else you would like to add?

Schaffner: The vaccines are safe. Yes, they have very rare adverse events associated with them, but they are safe. They've now been used by millions around the world. They are no longer “new” or “experimental.” For those people who are still shy of getting an mRNA vaccine, we have now a vaccine — also created by Novavax — that has been created in the more-conventional fashion. The hope is that those people who have mRNA vaccine hesitancy will avail themselves of the other vaccine options. Although we're focused on COVID-19, let's not forget influenza. And indeed, for some people who are aged 60 years and older, they ought to talk to their providers about whether they're eligible for respiratory syncytial virus vaccine. As the CDC is saying, the fall is the time to protect ourselves against these respiratory viruses that are nasty and are more active in the winter: influenza, COVID-19 and RSV.

References:

• COVID-19 current wastewater viral activity levels map. Available at: https://www.cdc.gov/nwss/rv/COVID19-currentlevels.html. Accessed Sept. 3, 2024.
• Is this the biggest Covid summer wave ever? Available at: https://www.nbcnews.com/health/health-news/covid-us-largest-summer-wave-cdc-high-transmission-rcna165765. Published Aug. 9, 2024. Accessed Sept. 3, 2024.