On the cusp of last summer, as COVID vaccination rates were on the upswing and transmission rates were dropping, New Jersey officials talked excitedly about a return to normalcy, with offices filling with employees again and masks no longer required in schools.
Then the delta variant emerged unexpectedly in June and upended all those plans.
As summer 2022 approaches, New Jersey appears to be in a better place — so long as a new, more virulent strain does not emerge.
Key metrics including severe illness and death have remained relatively low for more than two months, even though cases are on the upswing and every county is seeing high levels of transmission.
Public health experts and front-line physicians have expressed everything from caution to optimism over the past few weeks as New Jersey enters its third pandemic summer.
Is COVID still a virus that can mutate into the mass killer that has already taken 1 million American lives? Or is it evolving into one that jumps more benignly from host to host?
“The assumption that you’re going to have milder illness is a hope but not necessarily something that will pan out,” said Dr. Stanley Weiss, an infectious disease specialist and epidemiologist at Rutgers Medical School. “The biology of this virus is changing over time. So we don’t have ironclad answers.”
Dr. Gian Varbaro, chief medical officer of Bergen New Bridge Medical Center in Paramus, said it’s unlikely that the virus will mutate into a more deadly strain.
“Every pandemic ends the same way, with the virus mutating to become more infectious but it also becomes less virulent, less deadly,” he said. “It’s not in an infectious agent’s interests to kill the people who it’s infecting, because then it can’t spread. The best thing for a virus would be for you to never know you have it.”
As New Jerseyans spent Memorial Day weekend opening community pools, hosting neighborhood barbeques and gathering in somber ceremonies to remember this country’s war dead, it may seem like the pandemic is over. But it’s not.
Forecasting the summer
The latest forecasting models by the state Department of Health show two scenarios through mid-August: a “moderate plus” model, in which cases and hospitalizations remain relatively stable, and a “high” model that shows two surges.
But long-range forecasts are difficult.
The federal Centers for Disease Control and Prevention project metrics out only two or three weeks. And as COVID continues to mutate into new variants with new characteristics, the virus has shifted its trajectory multiple times over the pandemic’s 30 months, making it difficult to predict its next turn.
“The emergence of new variants can change any well-informed prediction,” said Gemma Downham, director of infection prevention for AtlantiCare, one of the largest medical providers in South Jersey.
The daily COVID death toll has been in the single digits for almost three months, and most hospitals are reporting few serious cases of illness, with fewer than 40 patients on ventilators statewide as Memorial Day weekend ended. The vast majority of patients testing positive for COVID at hospital admission are being admitted for conditions unrelated to the virus. As of Monday night, 844 people in the state’s hospitals had tested positive for COVID.
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The Health Department’s worst-case scenario shows COVID cases surging in mid-June and again in mid-July, with the daily hospital census at almost 2,000. The high would hit on June 18 with 7,050 cases, 1,602 hospitalizations, 154 intensive care admissions and 63 people on ventilators — all about double what the numbers have been in mid-May.
The moderate forecast does not show a significant surge in the first half of the summer.
But that model appears to have already been exceeded. The model, which was completed on May 11, predicted a peak of 3,264 cases and 742 hospitalizations by May 17, compared with the actual tally of 3,842 cases and 862 hospitalizations that were reported by health officials on May 17.
Downham, an epidemiologist, said she expects the surge to subsidize before the start of summer but is concerned that the virus is still transmitting at a high level, allowing it to mutate.
People who are vaccinated and boosted seem to have either no symptoms from the subvariants or symptoms so mild that they are mistaken for allergies or a cold. As a result, people let their guard down, and transmission goes up.
Many New Jerseyans have been reinfected during the latest wave, and long-term health implications of repeated COVID infections are still unknown.
“Even if you have mild to no symptoms, you are still contagious and can spread it to others who might be more vulnerable,” Downham said.
“We are seeing individuals who were recently infected with omicron getting reinfected sooner than expected,” she said. “It appears as though immunity after an omicron infection is lasting less than 90 days.”
At Bergen New Bridge, New Jersey’s largest hospital, doctors are seeing more people come in with COVID, but their symptoms are not severe enough to warrant admission.
“What we’re seeing is a lot of outpatient COVID and an increase from what it was several weeks ago, but nothing that’s requiring hospitalization,” Varbaro said.
Threat of new variants?
Conventional wisdom holds that summer will result in less transmission in the Northeast, because people will spend less time indoors. While that held true in 2020, delta showed in 2021 that a new variant can upend that notion.
By the end of last summer, Gov. Phil Murphy had reinstated mask-wearing in all schools, many back-to-the-office plans were postponed and New Jersey’s COVID metrics ended up worse on Labor Day 2021 than they were the prior year.
Major variants detected so far this year are from the lineage of the original omicron strain that forcefully surged in December and January in New Jersey and then declined just as fast.
The region has seen the rapid emergence of the new BA.2.12.1 subvariant, which became the dominant strain in New Jersey and New York in early May. It has pushed out the BA.2 subvariant and now makes up more than 70% of strains, according to CDC date.
On the horizon are the BA.4 and BA.5 subvariants, currently circulating in South Africa and Europe. If the patterns of transmission continue, it will be only a matter of time before they reach New Jersey.
Vaccines, booster shots and early treatment with monoclonal antibodies have shown to be effective in preventing severe illness for now.
But health care professionals and policymakers have to remain nimble, because the virus could change dramatically in a short period of time, as seen with the delta and omicron variants, Weiss said. Using outdated data “is worse than useless, it’s misleading,” he said.
And scientists are constantly finding more information on how current strains behave. A study released this month suggests that COVID has the ability to linger in the body for much longer than suspected. “It shows how little we know about the virus,” Weiss said.
Varbaro is optimistic that things will gradually get better even as the virus continues to spread and reinfect more people across the globe.
“We’re going to see more blips and bump-ups like we’re seeing now with these subvariants of omicron, but less virulent,” he said. “Is it possible if it makes some quantum leap in infectiousness? Sure. But it’s unlikely.”
Scott Fallon has covered the COVID-19 pandemic since its onset in March 2020. To get unlimited access to the latest news about the pandemic’s impact on New Jersey, please subscribe or activate your digital account today.