Opinion: How Covid-19 is resurfacing after months of calm

Opinion by Kent Sepkowitz

(CNN) — Editor’s note: Kent Sepkowitz is a physician and infectious disease expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. View more opinion on CNN.

In the past month, rates of hospitalization related to Covid-19 slowly have risen throughout the United States. Not unexpectedly, more severe cases and the overall proportion of all emergency room visits ascribed to Covid-19 are being seen in less-vaccinated areas. Most ominously, weekly deaths are just now beginning to rise, though overall numbers remain low compared with the 2022 experience.

There are several plausible reasons why this latest bump is occurring now after months and months of calm. Most attention is focusing on the latest variant, labeled BA.2.86, which is quickly replacing the strain that predominated for most of 2023, XBB.1.5. With each new variant, the protection from previous infection and previous vaccination slips away a bit more, leaving the US and the world more susceptible. Right now, BA.2.86 (or XBB.1.5 before it) does not appear to cause more severe disease, and antiviral treatments such as Paxlovid remain effective.

Against this news backdrop, I too recently met the newest normal: I woke up with a scratchy throat, a symptom often associated with early SARS-CoV-2 infection. Being a doctor, I was determined to ignore it, but as the day wore on, I began to feel ill with “viral symptoms”: chills though no fever, unusual fatigue, headache, some sniffling. It was bad enough to stay home and Zoom through my workday.

To sort it out, I decided to perform an at-home rapid antigen test. And that was when I realized just how different the entire 2023 version of Covid-19 was going to be, no matter its ultimate reach or severity. The days of shrugging off, toughing out and soldiering through a cold or even the flu ended once Covid-19 first arrived. With Covid-19 (as with home pregnancy testing and little else), we have — most of us — entered the world of facts on demand and the adjustment of social behavior according to the results. We have accepted our responsibility to interrupt the chain of contagion (and we also might grab an antiviral if the illness actually is Covid-19).

Getting facts, of course, is not quite as easy as advertised. The rapid antigen test, which we all had hoped would be relegated to the dustbin of history by now, is not as reliable as the home pregnancy test. It is a pretty good test but only when taken serially over a few days.

Opening the home-test kit led to the same sinking feeling from a year ago as I tried to make sense of the instructions until — like last year — I quit reading and simply grabbed the swab. I swabbed and swirled, then set a timer and left the room wondering how long and how bad my bout of Covid-19 would be.

But my test was negative.

This though was just the start. Remember? One negative test on the first day of symptoms, especially with the rapid antigen test, is not determinative. I went through the house looking for masks (found a few) and N95s (found just one) and looked for any test kits that might be hidden away, stacked somewhere in a moment of last year’s supreme epidemiologic overconfidence. I found none.

So, to prepare for the days ahead, I headed out to the closest drugstore — where I found that tests were sold out. I walked (very) slowly to another one several blocks away. The second drugstore had only a single remaining test on offer from the now picked-over shelves, which I bought with a credit card, not wanting to give over contaminated and infectious and perhaps lethal paper currency to the unwitting cashier.

The entire “what if” scenario appeared in full, the choreography of living with a pandemic with all the tangled concerns: In addition to the mechanics of diagnosis, I had to sort through notifying but not alarming people; tiptoeing around my house to keep a distance from my wife; trying to anticipate what might need to be canceled in the days ahead, should I be positive on the next morning’s test; and feeling draggy but uncertain why. In other words, though stale and unwelcomed, I was forced to return to the deliberate, sober, adult world of complicated decisions that are their own silent reward.

When I woke up the next morning and prepared to test myself once again, I dreaded not the disease really, but rather the tiring, tiresome, maniacal “debate” about an infection that plays by its own rules quite apart from the three-ring circus we have built around it. The virus that causes Covid-19 infection is a simple scrap of RNA that cannot survive without a living cell to support it.

The virus has no objectives, no malice, no hidden agenda or political leanings. It is difficult to deal with, but it is what experts in infectious disease, public health, immunology, vaccinology and other sciences deal with for a living. This type of work is messy and littered with crumpled drafts, but the fact is that facts, once found, are quite durable. As we prepare for what’s ahead, we are not starting from scratch.

Prepared for the worst, I took a second test: It too was negative. One more test tomorrow, I thought, and then I’m in the clear.

For now.

This won’t be the last alarm, real or false, for me (and others) in the months ahead. It is clear that Covid-19 and I have resumed our stormy relationship, something that will require reflection and a new way of going about my daily routine, perhaps even a reconsideration of my role in life.

But first, I need to order some more at-home rapid antigen tests. And masks. And tell my friends to do the same.

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