Covid cases up slightly as health care providers prep for respiratory illness season

As students return to school and residents of Western Pennsylvania head inside for the fall, covid-19 cases are on the rise, local health care providers say.

The increase in cases is modest compared with the past three years of larger pandemic waves, but it’s still representative of a seasonal uptick in illness, said Dr. LuAnn Brink, chief epidemiologist at the Allegheny County Health Department.

“Every fall, we expect a surge of respiratory viruses, whether that’s RSV or the flu. And now, since we’ve been living with covid for the last three years, we expect it’s going to surge in the fall,” she said. “We know our kids have been returning to band camp and preseason sports in the past few weeks, and that has led to an increase in cases.

“As they move indoors for in-person learning, we would expect that that is going to influence the number of cases as well.”

Cases aren’t limited to youth, but the back-to-school rush contributes to the spread, she noted. Over the past several months, in Allegheny County, reported cases from PCR tests have gone from a low of about 70 in June to 361 for the week of Aug. 13.

A new variant of the virus — known as BA.2.86 — has recently started to rise in prevalence.

Brink clarified the new mutation is not a cause for panic.

“They are all subvariants of Omicron, so any of the vaccines that we received are still effective in preventing the most severe illnesses,” she said. “It does not appear to be more severe.”

Rise in cases

The current covid surge actually started before students returned to school and may ramp up further as classes start, noted Dr. Michael Green, medical director of Infection Prevention and Antimicrobial Stewardship and co-director of Transplant Infectious Diseases within the Division of Pediatric Infectious Diseases at UPMC Children’s Hospital of Pittsburgh.

“Certainly we are concerned with kids going back to school, (spending) more time inside, more time in close contact, and in (a) setting unlike a year or maybe two years ago, when they got even mild symptoms and they were encouraged to get tested in order to go to school,” Green said, noting that some students showing covid symptoms now will attend school without testing themselves for covid.

“I think the return to school is going to be associated with increasing or maybe amplifying the exposures and the number of cases,” he said.

Dr. Carol Fox, chief medical officer at Independence Health System in Westmoreland, Butler and Clarion counties, said the system has seen more covid in recent weeks.

“We are certainly doing a little bit more testing than we were doing prior, testing for symptoms, and we are seeing more positive results, but we haven’t seen the severity of illness, of course, that we had seen in the past,” Fox said. “We do have people for sure who are hospitalized with covid, but they’re not nearly as ill as they were, and I wouldn’t characterize or categorize this as one of our most busy times. But certainly it’s a little more prevalent than it was four months ago.”

At Allegheny Health Network, the situation is similar, said Dr. Amy Crawford-Faucher, AHN Family Medicine family physician and vice chair of the Primary Care Institute.

“Anecdotally, I am certainly hearing about more cases,” she said. “We’re hearing anecdotally that a smattering of people are testing positive again and feeling symptoms compared to two months ago, but they’re not coming into the office. The illnesses tend to be mild, but they’re definitely happening a little bit more. That mirrors what we’re seeing in the epidemiological evidence.”

Booster shots coming

A new, updated booster vaccine that provides additional protection from the more recent covid-19 subvariants of Omicron, including the XBB.1.5 variant, is expected to be ready by late September or early October, health officials said.

Hospitals don’t yet have access to the Pfizer or Moderna version of the booster, but if and when they are approved, the shots most likely will become available through primary care physicians or at drugstores.

Crawford-Faucher says she’s planning to tell patients to consider getting their covid booster an annual task to keep updated, like getting their flu shot.

“Getting what is now looking like it will be an annual covid booster is important because, just like the flu virus, the covid virus continues to evolve,” Crawford-Faucher said. “Having updated vaccine formulations makes it best effective in tamping down a covid infection.

“What I tell folks is, unless you had a serious reaction to a covid booster — which is uncommon — there’s no downside to getting a covid booster. Even if you feel a little draggy for a day, that’s a heck of a lot better than feeling draggy for a week when you get covid.”

Brink also compared the booster to the annual flu shot, which is already available in many drugstores.

“Just like the flu shot, we get that every year: You get a new boost to your immunity, as well as a slightly better match to recently circulating subvariants,” Brink said.

‘Tripledemic’ returning?

Last year, a confluence of the flu, covid and respiratory syncytial virus, or RSV, hit hard in the late fall and early winter, putting pressure on children’s hospitals and emergency rooms.

This year, Green says, UPMC is keeping a close eye on all three respiratory diseases but can’t yet predict how the fall respiratory virus season will go.

“I think most people who used to feel comfortable making predictions about what we were going to see in the fall have been humbled by the unexpected and unpredicted changes in the patterns of RSV, influenza and (covid),” he said. “Personally, everybody is watching these things very carefully.”

He noted that the health system does not yet see a signal that RSV’s peak season will arrive early. Usually, RSV gets more severe and impactful in October or November. Last year, RSV cases started increasing in the middle of July.

“There’s already a little bit of difference in that RSV is not sort of having a rising case rate that is substantial yet, and we did last year,” he said. “So I’m encouraged by that, but that’s only today, and next week, life could change. You follow the data. … I think it’s very hard to predict how these viruses are going to be in terms of their interactions and their relative numbers. We all have to be prepared and planning for every respiratory virus season, but we won’t know for certain until we sort of see what is happening.”

Heading into the autumn, Brink said, the Allegheny County Health Department regularly talks with schools and universities to get a sense of what their situation is when it comes to covid infections. They’re keeping watch on the pandemic’s intensity levels as the weeks go by.

“We are going to survey those numbers, watch for hospitalizations and emergency department visits — which we update on a weekly basis — and continue communications and encourage universities to report outbreaks so we can talk about what those mitigation options might be,” she said.

“Flu season starts Oct. 1, but we’ve definitely seen surges happening at different times,” Brink noted. “Sometimes we have an early surge on that, and most often, we have it right after the winter holidays. It’s people mixing that really leads to the surge. It’s important to, just as before that started, to get those vaccines.”

The pattern that respiratory illness follows at this time of year is in some ways no surprise, Fox said.

“For as long as I’ve been involved in medicine, that’s one thing I can say has been a constant: As the weather gets colder and people are more inside and in closed spaces, we tend to see more respiratory illnesses,” she said. “We would encourage people to get the (covid) booster when it becomes available.”