Distinguishing viruses responsible for influenza-like illness

'Prom Fever!' Generations Of Knoxville Teens Have Dressed Up And Hit The Dance Floor

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New 'FLiRT' Variants Spark Summer COVID Surge Warning

April 30, 2024 – In recent weeks, COVID-19 forecasters have reported on a new set of variants picked up in wastewater surveillance. Nicknamed FLiRT, they're threatening to cause a new wave of COVID infections, which recently bottomed out after spiking in December. 

Models released last week from Jay Weiland, a data scientist who has accurately predicted COVID waves since the beginning of the pandemic, warns that a surge is on the horizon. "He's someone who many experts like myself follow because he's been pretty accurate so far," said Megan L. Ranney, MD, dean of the Yale School of Public Health.

Ripe for Reinfection

What's more, said Ranney, FLiRT also has some concerning features, like changes in the spike protein, which play a role in helping SARS-CoV-2, the virus that causes COVID-19, take hold, colonize the body, and make people sick.

Host vulnerability is another troubling factor, given that only 22% of American adults have gotten the latest COVID vaccine. And since many people may not have had the virus in a while, they're ripe for reinfection. 

"We've got a population of people with waning immunity, which increases our susceptibility to a wave," said Thomas A. Russo MD, chief of infectious disease at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo.

There's also some concerning data that shows that even those who have gotten the newest COVID booster may not be well-protected against a potential surge. A preprint study released this week from researchers at Harvard University shows compelling evidence that the newest booster isn't holding up well against JN.1, the most recent dominant variant, and its FLiRT offshoots. The study has not yet been peer-reviewed. 

JN.1 spread globally over the winter and still makes up 95% of COVID cases in the U.S. Its lineage is the Omicron variant, which has been circulating in some form since 2021. Still, new variants can quickly take hold. JN.1 made up almost none of the cases in mid-November but quickly jumped to 21% in December and 85% by the third week of January.

In recent years, COVID waves have also fallen into a predictable rhythm, with a large winter wave and a smaller mid- to late-summer peak, largely due to people spending so much time in air-conditioned indoor settings with poor ventilation as the weather outdoors heats up, said Russo.

"All these factors considered, if I were to look in my crystal ball, I would say that we're going to have another wave or increase in cases and hospitalizations sometime this summer," he said.

Protecting Yourself Against a Summer Surge

Even though there is some question about how the new booster will hold up against the latest variants, staying up to date on vaccinations is still the best way to protect yourself. For those who haven't gotten the latest booster, time is of the essence. And for those who are over age 65 or immunocompromised, the CDC recommends getting a second updated COVID booster 4 months from their last booster. 

"Assuming that the virus continues to evolve and our immunity wanes, the general population is likely to continue to need an annual booster for protection," said Ranney. 

We've got a population of people with waning immunity which increases our susceptibility to a wave.

Thomas A. Russo, MD, chief of infectious disease, University of Buffalo

And many experts said we need to take the virus more seriously. In general, if you're sick, don't go to work, go out, or travel, and give yourself time to recover so that you don't get everyone around you sick. The CDC recommends that people stay home and isolate until at least 24 hours after any fever is gone and overall symptoms have improved. And if you're in a crowded area with poor ventilation, a mask is still a simple and effective tool for protection. 

New treatments like the monoclonal antibody Pemgarda, which the FDA granted emergency use authorization in March, may also help protect those who are particularly vulnerable to a spring or summer surge, said Shirin Mazumder, MD, an infectious disease doctor at Methodist Le Bonheur Healthcare in Memphis. The drug is to be taken as a preventive measure for anyone who is moderately to severely immunocompromised. The medication is given through an IVbefore a patient's potential exposure to COVID. It's designed for those who are unlikely to build up enough immunity and may need more protection from the virus. 

"It's another tool that can help people in addition to getting vaccinated and taking other precautions," said Mazumder.

The Increasing Risk of Long COVID

Vaccination is also important for protection against long COVID, according to a March 2024 study published in The Lancet Respiratory Medicine. And for Grace McComsey, MD, who leads the long COVID RECOVER study at University Hospitals Health System in Cleveland, it's not the risk of acute illness that's most alarming. 

She said long COVID is becoming the bigger issue for those who might not have been as fearful of acute COVID. Research released from The Lancet Infectious Diseases recently showed that many of those who end up with long COVID – a chronic illness marked by fatigue, brain fog, and heart and lung problems – didn't necessarily have a severe bout with the infection.

Numbers of long COVID cases are also on the rise, with 6.8% of Americans reporting long COVID symptoms, up from 5.3% in 2022. In all, 17.6% said that they've had it at some point, according to a survey from the CDC. "Long COVID is what I'd be most concerned about right now, given that its numbers are rising and it can make you chronically ill, even if an acute infection did not," said McComsey. 

We don't know for sure what this variant will do, but we do know that COVID has thus far been excellent at spreading disease and evading immunity. Whether or not this is the next variant to take hold is hard to know for sure, but if not this one, another variant certainly will, McComsey said.

"We need to respect this virus and take it seriously, because whether we like it or not, it's here and it's still making people really sick," she said. 

My Father Survived Starvation As A Child. He Never Forgot What It Meant To Be Hungry

My father knew hunger intimately. In one of my earliest memories of him, we sat on opposite ends of a big brown leather couch in our Sudbury home, and I watched him ingest a fish. He tore into the fermented herring, cold from the Sudbury Farms grocery deli counter, with bare hands. He stuck his face into the belly, ripping it apart. He chewed to its core, spitting bones to the side of a plate on the coffee table in front of him. He wasted nothing.

Seven-year-old me watched, horrified. How had he come to eat like this? My friends' fathers used utensils, put napkins in their laps. They didn't hunch over their food and come back up only when it was gone. My dad turned to me and smiled an exaggerated smile, masticating with an open mouth like a bear, oil glistening on his gray mustache.

In my early 20s, I conducted 50 hours of interviews with my father about his experience of World War II. He was 10 when the Nazis invaded Belarus in 1941. His mother, a high-ranking member of the Communist Party and an atheist, was murdered on the second day of the invasion. My father was orphaned.

Suddenly food—how to get it, how to function without it—became the through line in his survival story.

I remember my father's precarious relationship to food as international conflicts rage, knowing civilians will suffer. The fighting that began a year ago in Sudan's capital Khartoum has led to millions enduring acute hunger. Former Sudanese prime minister Abdalla Hamdok said that 25 million people, more than half the country's population, are at threat of starvation. People in parts of Mali, Somalia, Burkina Faso and Haiti face similar scenarios.

News of food scarcity from Gaza is unrelenting. According to a report from the Integrated Food Security Phase Classification (IPC), an initiative for improving food security and nutrition analysis, famine is imminent in northern Gaza by May, and the remainder of Gaza by June. The IPC defines famine as "an extreme deprivation of food" where "starvation, death, destitution, and extremely critical levels of acute malnutrition are or will likely be evident." As of April 17, at least 28 children in northern Gaza have died from malnutrition and dehydration.

Palestinian children wait next to a fire as people prepare food for iftar (break fasting meal) during the holy month of Ramadan amid dramatic hunger on April 03, 2024. (Ashraf Amra/Anadolu via Getty Images)

During World War II, my father became what he needed to be to eat: first a beggar, then a thief. At the start of the Nazi occupation, he went door-to-door to the homes still standing, but as the population's food supply dwindled, he stole from the field kitchens the Nazis established on the ground.

"Sometimes I got away with it," he told me. "In the beginning I could move quickly and avoid [punishment], but when I no longer had the energy to move out of the way, I got a boot from a soldier."

Alex de Waal in the Guardian warns that:

As the body starves, its immune system begins to fail. The malnourished fall prey to waterborne infections and causes diarrhea, which causes devastating dehydration. Other communal diseases also ravage communities. The most common cause of death in a famine is disease, not starvation as such.

The author accompanies his father as he talks about his experiences during WWII with an elementary school class in Northborough, Mass. In 2001. (Courtesy Jason Prokowiew)

Perhaps my father, who ended up living in the burned-out buildings of Minsk and collaborating with other orphans to find food didn't understand this aspect of starvation when he told me: "Some kids gave up. They just sat there and died."

He recounted a three-month stint in the winter of 1942 when he, 11 at the time, slipped in and out of consciousness. He only survived because a neighbor established a sick house in an abandoned store and brought him there, to die or for his body to work it out. In research I conducted after his death in 2002, I found he had likely suffered from typhus fever, the disease thought to have killed Anne Frank in the Bergen-Belsen concentration camp. Typhus, spread through contact with infected body lice, which ran rampant Minsk's ghettos, can cause meningoencephalitis, coma and delirium.

My father survived typhus and the war, but the food scarcity he fought as a child informed the rest of his life. He named keeping his 11 children "fed" as his highest priority as a father.

In Gaza, the threat of famine is man-made. Aid officials have documented and described restricted shipments of food, slow and arbitrary inspections of trucks and a lack of access to limited resources. The nongovernmental organization Oxfam reports that hundreds of thousands of people in northern Gaza are trying to survive on an average of 245 calories a day.

I used to wonder why, before meals, my father prayed aloud, "We thank you Lord for the food we receive, and we thank you for all other things." Food was foremost, everything else came after. During our interviews, when I questioned my father about his parenting, he countered as though I had no clue what difficult was: "Did you ever go hungry?"

"You can't do anything without food," he said.

The IPC warns that if Israel invades the southern city of Rafah, the expanded conflict could "drive over 1 million people—half of Gaza's population—into catastrophic hunger."

You can't do anything without food. It's not something humans ought to know. May roads open, may food come in. May the weapon of starvation die. Not the people.

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