Covid cases are on the rise again in the US, fueled by a new variant known as JN.1. Since many people now test at home, health officials are using wastewater to get measures of its prevalence.

The variant is linked to about 60% of new cases, according to CDC data. A member of the omicron family, JN.1 is descended from the BA.2.86 variant. Its most notable new mutation changes the spike protein that latches onto cells, enhancing its ability to evade our immunity. But even if JN.1 is more skilled at dodging antibodies from previous infections and vaccinations, it is not entirely resistant to them.

A recent study of disease spread found that length of exposure was the biggest factor in transmission. A team led by University of Oxford researchers found that 82% of cases were acquired from exposures that lasted longer than one hour.

Despite COVID’s omnipresence, the chance of hospitalization and death is unmistakably lower than in previous years. The number of people in California hospitals with COVID grew to about 2,000 by the end of December, half of last winter’s peak, and just a tenth of the record high.

But the nebulous threat of developing what is known as long COVID remains, and millions across the United States have already experienced it.

For a while it seemed as if the Covid pandemic had subsided to a level where it was not a major concern. People stopped wearing masks in public and relatively few (only about 19%) have taken the new round of boosters. But that dropping of our guard may be one source of why the virus is making a comeback, now reaching the second biggest wave of infections after the omicron surge in January 2022. The good news is that fewer people are dying, though not to trivial values. The death rate from Covid, although much less than the peak rate of 25,000 per week in January 2021, is still five times higher than for the flu. Kevin Drum provides charts that show that variation of test positivity and death rates over time.

Eric J. Topol, professor of molecular medicine at Scripps Research, writes that there is a dangerous level of complacency about the threat posed by the three respiratory viruses of Covid, RSV, and flu.

With all three respiratory viruses circulating at full force, you would think we’d be seeing people wearing masks everywhere in public. That couldn’t be further from the truth. The state of denialism and general refusal to take simple steps to reduce the risk of infection can be seen everywhere.
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Now in its fifth year, SARS-CoV-2 has once again proved to be highly resilient, capable of reinventing itself to infect us. Yet we continue to make-believe that the pandemic is over, that infections have been transformed to common cold status by prior exposure(s), and that life has returned to normal. Sadly, none of this is true.

The massive number of infections in the current wave will undoubtedly lead to more people suffering from long COVID. For a high proportion of people, especially those of advanced age, immunocompromised or with coexisting conditions, getting COVID is nothing close to a straightforward respiratory infection.

What is the exit strategy that could get us to “return to normal”? It certainly can’t happen with the current complacency and false belief that the virus will burn out and go away. Inevitably, there will be another strain in the future that we are not at all prepared for and will lead to yet another very big wave across the planet.

The risk of long Covid is not something one should take lightly.

About 15% of people with COVID continue to struggle with persistent fatigue, brain fog, shortness of breath, body aches, digestive and heart problems, though estimates vary and have changed over time.

Vaccinations and widespread immunity, in tandem with the evolving nature of the virus, appear to have reduced a person’s risk of developing long COVID, just as the threat of hospitalization and deaths has also decreased.

A recent meta-analysis of 24 studies found that people who had three doses of the vaccine were nearly 70% less likely to develop long COVID than those who were unvaccinated. The more shots you get, the less likely you are to develop long COVID.

Around October of last year, I started hearing disturbing reports of an uptick in Covid cases and several people in my own circle of acquaintances got it. I got the Covid and flu vaccines and, for good measure, the RSV vaccine as well. I also started wearing masks again in indoor settings, especially when there are large crowds. I wore them during the week-long big bridge tournament last week but noticed that only about 10% of people were doing so, even though the crowd skewed to an older demographic and there were people who had come from far away, which means that they had traveled through airports and other crowded areas. So far, I have not been infected, but I would not be surprised to read about increases in cases among the attendees.

Wearing masks seems like such an easy precaution to take. Yes, it is a little uncomfortable, especially the higher-quality N95 and N94 masks, but one quickly gets used to it. But given the irrational and sometimes violent resistance to the wearing of masks by the MAGA and QAnon nutcases, their fear mongering about vaccines, and their trivialization of the dangers of Covid, we should not be surprised at the low rates of usage.