COVID persists, still mutating 4 years after shutdowns

Mar. 16—Four years after the World Health Organization declared COVID-19 a global pandemic, it persists and continues to mutate, infect and hospitalize.

Some semblance of normalcy has returned since the deadly early years of the disease, which was first called a pandemic by WHO on March 11, 2020. Although infections and hospitalizations are less severe, vulnerable communities need to remain vigilant, said infectious disease specialists at Geisinger Medical Center and Evangelical Community Hospital.

There were 2,699 hospitalizations of COVID-19 patients in 2023 at Geisinger hospitals. At Evangelical, 853 patients presented at the hospital tested positive for COVID-19. Of that number, 216 were admitted for their illness. At Evangelical, December had the most patients diagnosed with COVID-19, 42.

"You can argue about semantics, but many people would say that COVID has become endemic, meaning it is here and now part of our micro-biological ecosystem," said Dr. Stanley Martin, Geisinger infectious disease specialist. "It continues to persist in the population although it waxes and wanes, in part because of the rate of mutation of the virus."

Dr. John Devine, vice president of medical affairs at Evangelical Community Hospital, echoed those thoughts.

"The virus we have today is not the same virus that we had four years ago. But it hasn't left," Devine said. "COVID-19 is in our communities now and probably will be here into our future."

WHO officials consider COVID-19 an established and ongoing health issue that no longer constitutes a public health emergency of international concern. However, COVID-19 still represents a global health threat.

"COVID-19 claimed a life every three minutes (last week, worldwide) — and that's just the deaths that we know about," said Dr. Tedros Adhanom Ghebreyesus, WHO director general. "As we speak, thousands of people around the world are fighting for their lives in intensive care units, and millions more continue to live with the debilitating effects of post-COVID-19 condition.

"This virus is here to stay. It is still killing. And it is still changing."

According to Martin and Devine, the changes seem to be beneficial.

"Yes, it is mutating, but it doesn't seem to be doing so in a worse way," Devine said. "It seems to be becoming less of a concerning strain, and less virulent. In the beginning, when Delta hit us hard, we saw many older and younger people die."

Devine said hospitals are now seeing a couple of cases where patients require a stay in the hospital for a day or two. Many don't seem to be requiring admission into intensive care.

At the height of the pandemic, the contagiousness of COVID-19 led to shutdowns worldwide to keep medical facilities from being overwhelmed.

Today, almost everyone has been infected with the virus, Martin said.

"It's hard to find somebody who has not had COVID-19 at this point," Martin said. "But that doesn't mean that infections are not still ongoing. And it doesn't mean it's still not a challenge because it still kills more people than flu, although it has become a lot more manageable than what it was four years ago."

Last week, the Centers for Disease Control and Prevention (CDC) lifted its recommendation that COVID-19-infected patients quarantine at home for 10 days.

The new guidelines are just like those of other respiratory illnesses.

"If you've gone at least a day without a fever then it is OK to come out of isolation, just like you should with any respiratory virus," Martin said. "COVID-19 is very different from the flu. It is a virus that continues to wax and wane and although we had a surge this winter, just as we had with flu, it is not expected to drop down to the point where it goes away in the summertime. With flu, we expect it to go away and it has a very predictable mutation pattern, so we can anticipate what it is going to be like, and when it will come back."

The common cold, flu and COVID all present with similar symptoms — sore throat, cough, congestion, headaches, some muscle aches, fevers, and maybe some shortness of breath.

That complicates matters, especially when COVID and flu are more deadly.

"At first blush, you might not be able to distinguish it from something like influenza or RSV," Martin said. "All of these respiratory illnesses can be similar in the way they present. But there are differences, perhaps with altered taste and smell with COVID-19. Plus there is still the phenomenon of long-term COVID which can lead to prolonged symptoms we may not see with other respiratory viruses."

Older populations, along with those people who have immune disorders and respiratory disorders, remain the most vulnerable. They are more likely to have complications and be hospitalized with COVID, Devine said.

The CDC recommends an updated vaccine this spring for people ages 65 years old and older.

Devine said he believes vaccinations will continue to become streamlined.

"I think we will see more and more of a recommendation for continued immunizations and perhaps even narrowing the groups of people who get immunized," Devine said.

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