COVID-19 case, hospitalization trends

According to CDC, reported levels of COVID-19 in wastewater data are higher than they have been since the first omicron wave in January 2022. Currently, CDC's National Wastewater Surveillance System (NWSS) categorizes every state with data available as having either "high" or "very high" viral activity.

"We are seeing rates are going up across the country," said Amy Kirby, NWSS' program lead. Although the rise in cases may have already reached its peak, high levels of transmission are expected to continue for at least a month.

"If you have vulnerable people in your community or family, you want to be particularly aware when cases are going up, and take more precautions," said Michael Mina, an epidemiologist and chief science officer for eMed. "And when cases are going down or at a lull, relax those precautions."

Currently, COVID-19 hospitalizations remain elevated but are beginning to trend downward. For the week ending Jan. 13, there were 32,861 new COVID-19 hospitalizations, a 9.6% decrease from the week before.

Overall, only three states, Alaska, Connecticut, and Wyoming, and the District of Columbia reported moderate increases in COVID-19 hospitalizations. The remaining states had either stable, moderate decreases, or substantial decreases in hospitalizations. 

Although COVID-19 hospitalizations and deaths are currently much lower than previous years, Maria Van Kerkhove, the technical lead for COVID-19 at the World Health Organization, noted that it is still a pressing health problem. "While the crisis of Covid is over, the threat is not," she said.

Flu trends

For the week ending Jan. 13, seven U.S. states reported very high levels of influenza-like illness (ILI) activity, and 16 states and the District of Columbia reported high ILI activity. An additional 13 states reported moderate ILI activity.

According to CDC data, there were 14,874 new flu hospitalizations for the week ending Jan. 13, a decrease from 18,775 hospitalizations the week before.

During this time, the percentage of outpatient provider ILI visits was 4.7%, which was above the national baseline of 2.9% but lower than it was the week before. 

So far, CDC estimates that there have been at least 16 million flu cases, 180,000 hospitalizations, and 11,000 deaths this flu season. There have also been 47 pediatric flu deaths, with seven new deaths reported the week ending Jan. 13.

Vaccine hesitancy remains an issue

According to health experts, although people who regularly get vaccinated against the flu would be expected to also get vaccinated against COVID-19, that hasn't been the case.

Currently, less than half of U.S. adults and children have been vaccinated against the flu this year. In comparison, only 21.5% of adults and 11% of children have received the latest COVID-19 vaccine as of Jan. 6. The gap is even wider among adults ages 65 and older, with 73% receiving a flu vaccine and only 41% receiving a COVID-19 vaccine.

One potential factor driving people's hesitance is the perceived political associations with the COVID-19 vaccine. "Getting a Covid vaccine has come to symbolize identity politics in a way that no other vaccine really has," said Sara Gorman, executive director of Those Nerdy Girls, a collective of women scientists and clinicians that was initially formed to address concerns and misinformation about COVID-19.

"It is true that people on the left tend to get more vaccines in general. But even if you are sort of somewhere in the middle, and you still want your flu shot, but getting a Covid shot would mean associating yourself with a certain political identity that's really not palatable to you, then you're not going to do it," Gorman said.

There are also questions about the safety and effectiveness of COVID-19 vaccinations, which are not occurring with the flu vaccine. Some clinicians may also not feel that their patients need additional COVID-19 vaccines and are not advocating for them as strongly.

"I think in some cases, clinicians are not recommending them as strongly as they might for people who've already got … five, six, seven vaccines already," said Malia Jones, an assistant professor of spatial dimensions of community health at the University of Wisconsin-Madison.

To encourage more people to get vaccinated against COVID-19, Heidi Larson, director of the Vaccine Confidence Project, said that health authorities should emphasize the similarities between flu vaccination and COVID-19. For example, both vaccines have to be updated regularly because the viruses that cause them can evolve. Immunity from both vaccines also wanes over time, which means revaccination is necessary to ensure protection.

CDC may also eventually issue a standing recommendation for everyone to get a COVID-19 shot every year, much like they do with the flu vaccine. "That would help signal to some of these folks who get an annual flu vaccine that this is on a schedule," Jones said. "It has to be updated every so often in order to keep our immunity fresh."

In general, it will take time to overcome people's vaccine hesitancy, especially toward COVID-19, and even then, there will likely still be people who won't want to get vaccinated.

"I don't think there's any magic fix for these things. But I do think sometimes those kinds of nudges help a bit," Larson said. "But it's only going to be for the people that are maybe leaning to yes but are not convinced enough." (Paris, New York Times, 1/10; Branswell, STAT, 1/22; CDC COVID Data Tracker, accessed 1/22; CDC Weekly U.S. Influenza Surveillance Report, accessed 1/22)

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