Is Europe's new COVID surge coming to America next?
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While many Americans have decided the pandemic is “over” as it pertains to their own lives — a full 37 percent, according to the latest Yahoo News/YouGov poll — those who’ve been paying close attention to the latest COVID-19 developments overseas are now asking themselves two troublesome questions.
What the heck is happening in Europe? And is it about to happen in the U.S. too?
Over the last two weeks, COVID cases have shot up more than 25% across the European Union. In several European countries, the curve is even steeper: The United Kingdom (120%), Finland (88%) Switzerland (83%), Belgium (62%), Austria (59%), Germany (53%), Italy (49%), the Netherlands (45%) and France (27%). Hospitalizations are starting to rise as well.
And it’s not just this new trajectory that’s alarming; it’s the fact that it’s coming so quickly on the heels of Europe’s previous wave of infection — an Omicron surge that was even larger, and peaked even later, than the one in the United States.
At first, both areas seemed to be descending at a similar pace, with the EU about a month behind America. The U.S. dropped to 100 new daily cases per 100,000 residents by the beginning of February; the E.U. fell to the same threshold by the beginning of March. But then, instead of continuing to plummet as the U.S. rate did, the European Union reversed course.
Today, the United States is averaging 9 new daily cases per 100,000 residents. The E.U. is averaging 125. Austria is averaging 475 — more than ever before.
So does this mean the United States is about to experience yet another huge surge at precisely the moment when our last modest safety measures — namely, indoor mask requirements in public places and schools — have been lifted?
The answer is … complicated.
It’s true that over “two years of the pandemic, the United Kingdom and Europe have provided five unmistakable warnings to America that a new surge was occurring,” as Dr. Eric Topol, founder and director of the Scripps Research Translational Institute, wrote Wednesday in the Guardian. “Within weeks, each time, the United States experienced a new wave, some not as severe (such as with the Alpha variant), some worse (Delta and Omicron variants). From this COVID track record over two years, it is palpable: What happens in the UK and Europe doesn’t stay in the UK and Europe.”
The issue, then, is probably less about whether U.S. COVID cases will rise in the coming weeks and more about how much. The BA.2 subvariant of Omicron — which is almost certainly aggravating the situation in Europe due to the fact that it’s at least 30 percent more transmissible than its sister lineage — is now gaining steam in the U.S. as well, accounting for 30% of new cases. U.S. wastewater surveillance also shows sharp increases in coronavirus RNA levels in sewage at 53 of the 419 sites where it was conducted between Feb. 24 and March 10.
That could be a leading indicator of a big new wave, but it’s not a guarantee. As Topol noted, the Alpha variant — which was 50 percent more transmissible than the original version of the virus — decimated the U.K. last winter, prompting fears of a spring surge in the United States. Yet while the proportion of U.S. Alpha cases kept going up, the total number of COVID cases kept going down. Ultimately, Michigan was the only state where Alpha really caught fire. The rest of the country was largely spared.
To anticipate whether America’s next chapter will look more like Alpha (a smaller, localized bump) or more like Omicron: The Sequel (another steep surge), it’s worth considering the three interrelated causes of Europe’s new spike — and asking whether they’re likely to affect the U.S. in the same way.
According to Topol and other experts, those three causes are: BA.2, which is now dominant in many European countries experiencing COVID surges; the recent lifting of mitigation measures across Europe, coupled with increased social mixing; and the tendency of vaccines' protective power to wane over time, especially in terms of shielding against transmission (as opposed to the much more robust protection they provide against hospitalization and death).
What’s already clear is that the current European upswing is not as simple as “scary new variant sparks massive new surge” — the same story we’ve seen so many times before. Studies show that a previous Omicron infection provides “strong protection” against reinfection with BA.2, meaning that while back-to-back infections are possible, they’re probably not the driving force here. Rather, BA.2 is likely spreading primarily via people who didn’t just catch Omicron over the winter — and most readily among those who are also unvaccinated, followed by those who are unboosted (since a recent vaccine dose still blocks some degree of infection and transmission).
This suggests that the degree to which case counts are climbing in Europe may have as much to do with back-to-normal behavior as with a mutating virus.
One underappreciated aspect of the pandemic — and of why waves rise and fall the way they do — is what scientists call “network effects.” Virologist Trevor Bedford has summed up the phenomenon nicely.
“As [viruses] kind of percolate through the community, you can imagine those transmission chains circling back on themselves and hitting someone [who] has already been exposed,” Bedford explained in December. “Rather than continue to spread outward from the initial case, in other words, the fact of natural social networks and limited niches means that chains of transmission can’t continue indefinitely. And so that would make these waves slow as they reach some per-capita size, just [as] a natural epidemiological phenomenon.”
This concept makes intuitive sense: None of us are exposed to an infinite number of different people in our daily lives; for most, the number of people we actually share indoor air space with on a regular basis — family, co-workers, friends, classmates — is relatively modest. The size of that network then determines — and ultimately limits — each little eddy of viral transmission, which together shape the trajectory of a mass outbreak.
Most of these networks were smaller during the pandemic; now they’re getting bigger again as “normal life” resumes. That gives the virus more and more room to spread once it gets going.
Even then, though, a variant can’t spread forever; eventually, it will still “circle back on itself” and hit someone who already has sufficient immunity to stop it. It’s possible that what’s happening in Europe is that after a longer period of more serious social distancing, more widespread shutdowns and more prevalent masking, this month’s “full reopening” — many countries there just celebrated Carnaval, for instance — has triggered a relatively sudden expansion in the number of people everyone is being regularly exposed to. And that, in turn, is making it even easier for the fastest variant yet to find anyone who didn’t just have Omicron (not to mention anyone with waning vaccine-induced protection against infection).
If that’s the case, the U.S. has some advantages over Europe. While a few liberal states and cities are only just lifting mask mandates now, much of the country returned to “normal” long ago. It’s unlikely, in other words, that changing behavior will make as much difference in the United States as it’s making in the EU, for the simple reason that U.S. behavior isn’t really changing all that much. Perhaps some older and more cautious Americans are starting to encounter wider circles; perhaps that will affect the U.S. curve in the coming weeks. But for the most part, America has already been letting the virus rip.
Another advantage for the U.S. is that BA.2 is starting to take hold here at a much lower level of transmission. Again, the E.U. was averaging 100 new daily cases per 100,000 residents when it started to U-turn; even the U.K. only bottomed out around 40. Part of that is because of testing; the U.S. tends to test at about one-third the U.K. rate. Still, America cleared the measurement of 100 cases per 100,000 residents around Feb. 3, and cases kept falling; it cleared the mark of 40 cases per 100,000 resident around Feb. 16, and cases continued to fall. Today the U.S. is recording 9 cases per 100,000 residents, and just 1.4% of tests are coming back positive. It’s simply harder for BA.2 to spread when there’s less of it around.
Yet harder doesn’t mean impossible — and the U.S. also has some disadvantages compared to much of Europe. If BA.2 does take off in the States, Americans remain more vulnerable to hospitalization and death. Just 64% of the U.S. population has received two shots; only 29% has received three shots. The U.S. ranks 65th and 70th (respectively) on these two crucial metrics. Among those who need protection the most — seniors — the U.S. has a booster rate of just 65%. In the U.K. and many European countries, that number is 90% or more. Studies show that without a booster, even “fully vaccinated” seniors are 10% to 20% less protected against Omicron hospitalization and death. Millions of U.S. seniors remain entirely unvaccinated as well.
At the same time, an estimated 7 million Americans are immunocompromised, while no children under 5 have been vaccinated and “long COVID” looms as a real concern.
So while no one knows how hard — or not hard — the U.S. will get hit this spring, experts say now is the time to prepare for the worst, even as we hope for the best. Mask mandates are unlikely to return so soon after they were lifted, but studies do show, as the CDC’s Greta Massetti put it last month, that people who choose to “wear high-quality masks [such as N95s, KN95s and KF94s] are well protected even if others around you are not masking.” Meanwhile, the Biden administration has asked for at least $15.6 billion to keep variants like BA.2 from upending society by expanding surveillance, updating vaccines, securing therapeutics, improving ventilation and stockpiling masks and tests. So far, both Democrats and Republicans in Congress have refused to provide that funding.
“We need this money,” a senior administration official told reporters during a press call on Tuesday, pointing to looming shortfalls in the ability to manufacture and widely distribute tests, therapeutics and vaccines. “Time is not on our side. We need this funding immediately.”
It’s entirely possible that BA.2 will turn out to be this year’s Alpha, or that America’s wall of infection- and vaccine-induced immunity is strong enough to keep hospitalizations and deaths low even as infections rise. And yet experts also warn that whatever versions of the virus come after Omicron and BA.2 won’t necessarily be “milder” — and that concerning new variants are likely to materialize someday, especially as COVID this week finally seems to have breached the defenses of China, the world’s most populous country.
“We haven’t even seen a new, major variant yet, but there are too many reasons to believe that is likely in the months ahead, owing to extensive animal reservoirs and documented cases of spillover to humans, a large number of immunocompromised people in whom the virus can undergo accelerated evolution, rare but increasingly seen co-infections, and lack of containment of the virus globally,” Topol explained in the Guardian. “That, in itself, requires preparedness. Unfortunately, we have a mindset that the pandemic is over, which couldn’t be further than the truth.”
