Chairs for people who want to be vaccinated stand in the waiting room at the Mainz Vaccination Center. Currently, demand for COVID-19 booster vaccinations at vaccination centers and doctors' offices is low.
Enlarge / Chairs for people who want to be vaccinated stand in the waiting room at the Mainz Vaccination Center. Currently, demand for COVID-19 booster vaccinations at vaccination centers and doctors' offices is low.

Based on early signs, we may be in for a rough winter.

Several European countries are seeing an increase in carbon dioxide cases as people head indoors. Trends in the US tend to mirror those in Europe.

The rise in cases is being driven by the omicron subvariant BA.5 which has been the global leader for a long time. There is a thick soup of omicron subvariants cooking on the back burner. The most immune evasive subvariants seen to date are BQ. 1.1 and XBB.

The sublineages only account for a small portion of the cases we know about. Our ability to detect and surveil new subvariants is much less than it used to be.

Low surveillance

Maria Van Kerkhove, COVID-19 technical lead for the World Health Organization, said in a press briefing Wednesday that "surveillance has changed a lot in the last few months." Since the beginning of the year, the number of sequence that the world and our expert networks are evaluating has dropped. That makes it hard for us to really track each of theomicron subvariants.

Even though we can see what's being watched, it's still concerning. Several of the sublineages that experts are tracking are particularly worrying. She said it sounded like an alphabet soup with all of the different subvariants. The bottom line is that the virus is evolving. The world is currently seeing waves of infections. This is definitely true.

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The best way to protect yourself from a surge in hospitalizations and death is for people to be boosted. Booster adoption in the US has been dismal. Less than half of the US population has received a single booster of the COVID-19 vaccine. A majority of people over the age of 50 have not gotten a second booster. There are only 7.6 million Americans who have gotten their fall booster.

Weak boosting

The poor booster rate is highlighted in a modeling study. The researchers modeled a winter wave that would sweep the globe like last winter. They compared the outlook with current vaccination and booster rates to what could be avoided if those rates mirrored the coverage of the flu vaccine in the 2020- 2021 season, which was 59 percent for those aged 6 months to 17 years, and 50 percent for adults.

A potential winter surge in COVID-19 infections could result in a peak of 16,000 hospitalizations and 1,200 deaths per day by March 23, according to the researchers. It would prevent more than 745,000 hospitalizations and more than 75,000 deaths if the fall COVID-10 booster campaign matched the modest vaccine levels of 2020.

The new boosters aren't as good as the previous ones, there is no holiday-relates surge, and the guidance for isolation isn't as bad. The wave is likely to be underestimated.