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A healthcare worker transports a patient at the Caritas Medical Center hospital in Hong Kong, on Feb. 28, 2022. (Billy H.C. Kwok/The New York Times)
A healthcare worker transports a patient at the Caritas Medical Center hospital in Hong Kong, on Feb. 28, 2022. (Billy H.C. Kwok/The New York Times)

Two months after the omicron variant drove coronaviruses case numbers to frightening heights in the United States, scientists and health officials are bracing for another swell in the pandemic and, with it, the first major test of the country's strategy of living with the virus.

The nation has been relaxing restrictions and trying to get back to normal. Encouraging Americans to return to pre-pandemic routines, officials are lifting mask and vaccine mandates and showing no inclination of closing down offices, restaurants or theaters.

Scientists warn that the U.S. isn't doing enough to prevent a new surge from endangering vulnerable Americans.

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Efforts to buy more of the new pills are in limbo. Agencies run out of money for tests and therapeutic drugs even though an aid package in Congress is stuck. Less than one-third of the population has the booster shots needed for high levels of protection, and the daily vaccination rate has fallen to a low.

Experts said that health officials could be doing a lot more to get older people to take the initial doses of the vaccine, if they were willing to do so.

The quiet periods are used to do the hard work, according to a public health researcher.

In the past two years, Western Europe has given the clearest warnings that the brief period of quiet may soon be over. In a number of countries, including Britain, France and Germany, case numbers are climbing as an even more contagious subvariant of omicron, known as BA.2, takes hold.

In interviews, 10 public health researchers and infectious disease experts said that many of the ingredients were in place for the same to happen in the U.S.

The number of cases is still dropping, but the proportion of infections with BA.2 is growing. The previous version of omicron, BA.1, was estimated to be 30% to 50% more contagious than the subvariant.

In New York City, the average daily case numbers have gone up by 40% over the past two weeks, but they are still very low compared to recent months. Scientists in Connecticut think that the rate of BA.2 infections is doubling every seven or eight days, half the rate of omicron growth this winter.

I think we will see a wave in the U.S. sooner than most people think. He said it could come as early as April or as late as the spring or early summer.

Andersen said that such a wave would be accompanied by rising hospitalizations and deaths.

Some experts warned that the case numbers in every country where BA.2 emerged had not been driven up by it. Even if the U.S. case numbers started climbing, they said, leftover immunity from the first omicron wave this winter could help protect against a heavy surge of hospital admissions. An increase in case numbers could be mitigated by a shift toward outdoor socializing.

There are fewer COVID-19 patients in intensive care units than at any other point in the Pandemic. According to British data, the vaccines seem to protect against BA.2 as they did against the previous version of omicron.

The U.S. health officials and scientists are trying to forecast what will happen in Europe and how serious the wave could get.

The BA.2 subvariant began its march across Europe around the time that certain countries were lifting restrictions and mask mandates, which could give it extra kindling for its spread. The surge in infections in that country has been attributed to the fact that immunity tends to weaken over time following vaccinations.

The peak of the BA.2 wave has already passed in some parts of Europe. In other countries where case numbers have gone up, hospital admissions have not gone up.

Britain has become a more startling example of the potential for a surge in BA.2 cases to begin filling up hospital beds. According to health officials in England, people 70 and older have been diagnosed at a higher rate than any other age group.

In the last few weeks, the number of hospitalized COVID-19 patients there has increased by over 30%, though about half of those had tested positive incidentally after admission. Britain plans to give fourth doses to older people later this month.

Scientists in the U.S. are concerned that many people have gone more than six months since their last vaccine dose, reducing their immunity. Pfizer and BioNTech have asked the U.S. regulators to approve the fourth dose for older people. Moderna is also seeking clearance for the additional shots for adults.

It's not clear if relaxing COVID-19 rules in the U.S. will help fuel transmission like it has in some European nations. Parts of the U.S. have been free of restrictions for months.

David Dowdy, a public health researcher, said there are lots of moving parts.

Less than half of Americans who have received primary vaccine doses have taken booster shots. Even though case numbers are so low, the rate of deaths from COVID-19 is much higher in the US than in Western Europe.

British estimates suggest that a booster dose restores protection to considerably higher levels as time passes.

A number of wastewater testing sites in the U.S. have shown dramatic increases in the levels of the viruses on a Centers for Disease Control and Prevention map.

Some wastewater sites in states like Massachusetts, Connecticut and Ohio had observed growing viral levels, while many others had not, as scientists said it was difficult to measure changes while viral levels were so low.

The country still had a say in the shape of any coming wave, and scientists said that now was the time to get more people vaccinations.

The managing director of pathogen surveillance at the Rockefeller Foundation said that they should be reading about how the federal government is using its resources to get booster numbers up.

Pandemic funds are drying up according to the federal government. Senate Republicans have said that they will not approve new coronaviruses aid without offsetting it. House Democrats are against a proposal to use money intended for state governments to respond to the flu.

Federal officials said that they would need to cut shipments of treatments to states by more than 30% because of the aid package's inability to be passed. The 20 million pills the government has secured are on hold. The federal government's efforts to ensure that companies keep producing enough tests will run out of money in June.

Federal officials said that there wasn't enough money to buy enough booster shots. Uninsured people would face particular risks because a federal program that reimburses providers for testing, treating and vaccinating those without insurance could end in April.

Anne Rimoin, a public health researcher at UCLA, said that the United States has time and time again chosen to be reactive, rather than proactive.

How much protection people who got sick with the previous version of omicron will get remains a question. A lab study published this past week found that people who had been exposed to omicron had high levels of immunity. The country's high levels of infections this winter could reduce the impact of a wave if that protection lasts.

The co-author of the study said it was reassuring.

Some scientists worried that the immune defenses people built up during the first omicron surge would diminish, making them more susceptible to BA.2.

The timing of the emergence of BA.2 and the potential waning of immunity from the BA.1 wave are not good.

Even health experts who said they had become accustomed to the boom-bust cycle of pandemic funding said they were shocked that the money was drying up so soon after the country had outlined plans for adjusting to a new normal.

They said that the money was essential for avoiding full-scale shutdowns, and that health officials could recommend masks or increased testing in certain areas to help hospitals prepare.

Jeffrey Shaman is a public health researcher at Columbia University.

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