Covid surges in US as unequal access plagues vaccination and treatment rates

Covid is surging across the US, with levels of the virus on track to exceed last summer’s wave nationally and approaching the peak of last winter’s wave in the west, according to wastewater data from the US Centers for Disease Control and Prevention (CDC).

Yet vaccination and antiviral uptake, plagued by inequitable access, have remained low, and other precautions like mask-wearing are being met with increasing resistance.

“A lot of people right now are getting Covid all over the country,” said Dr Peter Chin-Hong, professor of medicine and infectious disease specialist at the University of California, San Francisco. “There are still hospitalizations, and there’s still a few hundred deaths every week in the US – and that’s a tragedy.”

The rise is being driven by a trio of variants, called Flirt because of shared mutations, that seem to be more immune-evasive and transmissible. And much of the US has been locked in heatwaves, with many Americans staying indoors to avoid the heat – which can lead to more spread of the virus.

Nationally, emergency room visits for Covid increased by 15.7% in the past week. Rising hospitalization rates are now higher than last summer at this time, although it can be difficult to make comparisons now that significantly fewer hospitals are required to report rates of Covid than in previous years.

Deaths are also increasing after reaching the lowest point of the pandemic. Nearly 400 people died in the week ending 12 June, the last week for which full data was available. Covid remains the fourth-leading cause of death in the United States.

“Any hospitalization or death could be completely prevented based on the tools that we have,” Chin-Hong said.

Yet compared to other surges, “it just feels like a very different time right now”, said David Grabowski, professor of healthcare policy at Harvard Medical School. “It’s pretty rare to go into a building and see people masked” – even in hospitals and nursing homes.

The summer surge comes as some federal and state policies have pulled away from efforts that can stop the spread of the virus, experts say.

North Carolina recently signed into law restrictions on wearing face masks in public, and officials in New York City and Los Angeles have considered the same.

In May, the CDC loosened its guidelines for Covid isolation, recommending patients stay home until they are fever-free for 24 hours and symptoms are resolving – even if they’re still positive for the virus, during which time they are likely contagious.

While the US government once covered the costs of Covid vaccination, those costs shifted to the private market in 2023. A bridge program offering vaccines to uninsured people is ending next month, weeks before the updated booster will be available – which will likely exacerbate gaps in access to the lifesaving vaccines.

Only 22.5% of adults and 14.4% of children are up to date on Covid vaccines – and the rate is even lower (13.3%) among pregnant people, despite the risks of severe illness, complications and long Covid because of Covid infection during pregnancy.

There are also stark contrasts among Americans of color, where inequities in health access continue to affect vaccination rates. While a quarter of white adults are vaccinated, only 15.6% of Indigenous people and 16.2% of Hispanic adults have gotten the latest booster.

The disparities are “quite striking”, Chin-Hong said – and they’re especially worrisome among older people of color, who have been more at risk throughout the pandemic. “There isn’t as much attention to making sure that all older populations get vaccinated or understand the power of vaccinations to keep people safe.”

Vaccination rates are higher among older adults, who have the highest rates of hospitalization rates and death – but “those numbers are way too low”, said Grabowski. Less than a third of nursing home residents are up to date on their Covid vaccines.

“Those numbers really worry me. It’s not clear that those residents are going to have the protection that they did earlier in the pandemic,” he said.

“With nursing homes, I think there’s a lot of fatigue around this issue, and I say that both among the staff and the residents,” said Grabowski, who wrote recently about the changes needed to make nursing homes safer after the pandemic. “I don’t think the vigilance we saw early in the pandemic is there today.”

Antivirals like Paxlovid have had a similarly unequal rollout. People of color are significantly less likely to be prescribed Paxlovid compared with white patients – about 20% to 36% less, according to one study, and 30% to 36%, according to another.

Only 15% of patients at high risk of severe illness take Paxlovid, one pre-print study suggests, despite evidence that it helps reduce the worst outcomes, including death, among vulnerable people.

“It doesn’t seem like we’re actually directing resources to the most vulnerable among us, and that’s been really disheartening,” Grabowski said. “That’s a real red flag.”

The CDC recently explained that Covid can surge at any time of the year, including summer, unlike viruses such as the flu and RSV that tend to peak in winter.

The agency recommended that everyone above the age of six months receive updated boosters in the fall, and everyone over the age of 65 receive an additional booster at least four months later.

Chin-Hong hopes vaccination rates will rise once again this fall when the new boosters are available – and he hopes public attitudes shift to view Covid vaccines as routine as flu shots. “Hopefully, in 2025 we’ll have a combo flu and Covid vaccine,” he said. “That might make it more palatable for people.”

As the virus continues circulating, measures beyond vaccines and treatments will also help control the spread – particularly in high-risk environments like nursing homes, Grabowski said.

“We need to take other steps, whether it’s testing, personal protective equipment, better air quality,” he said. Yet, change has been slow, and some gains made during the pandemic have now seemed to reverse, Grabowski said.

“To the extent that we had some planning in place earlier in the pandemic, I think today that’s all absent.”