Though COVID-19 didn’t push Colorado hospitals to the brink this fall and winter, the virus still hospitalized more than twice as many people as the flu, and it’s not clear whether that’s going to be the new normal.

Since Oct. 1, the Colorado Department of Public Health and Environment reported 3,040 flu hospitalizations and 7,877 COVID-19 hospitalizations. And while flu hospital admissions haven’t exceeded 20 in a week since early February, those linked to COVID-19 have been much slower to come down, with 226 admissions recorded in the week of April 16.

The state doesn’t specifically track flu deaths, making exact comparisons impossible. The Centers for Disease Control and Prevention estimated 450 to 700 people die of influenza or pneumonia each flu season in Colorado, while 1,032 deaths have been attributed to COVID-19 since the start of October.

Epidemiologists disagree about whether humans and the virus that causes COVID-19 have reached a kind of detente, where it can no longer create massive disruption, though it remains a threat to vulnerable people. Colorado saw small waves in summer and fall 2022 as new variants emerged and people’s behavioral patterns changed, but they didn’t approach levels that threatened health care capacity, as in 2020 and 2021.

However, COVID-19 deaths in Colorado are slightly higher now than they were a year ago, averaging four per day in early April compared to less than two per day at the same time in 2022.

It’s not entirely clear why, though it’s possible that more people have waning immunity now, since most haven’t received a booster recently, said Talia Quandelacy, an assistant professor of epidemiology at the Colorado School of Public Health. Only about 49% of those over 65, who are most susceptible to severe illness, have received one of the omicron-specific boosters in Colorado.

Earlier this month, the U.S. Food and Drug Administration said it would allow people who are at least 65 or have compromised immune systems to get a second updated booster shot, though it’s not clear how many will take it. The federal government still has a stockpile of the boosters, which will be available for free as long as supplies last.

There’s no clear sign when any virus moves from pandemic to endemic, and this virus continues to churn out variants at a rapid rate, Quandelacy said. For the past year, all of the dominant variants have been descendants of omicron, though it’s not impossible the virus could take a new direction.

“It’s hard to know how COVID is going to behave in the future,” she said.

Dr. Amesh Adalja, a senior scholar at Johns Hopkins University’s Center for Health Security, is more confident that COVID-19 has become a manageable threat, though he said more needs to be done to develop new treatments and get them to people who need them. It was never feasible to eliminate a respiratory virus that also circulates in animals, so the question is whether the worst consequences of the virus are controlled as well as they can be, he said.

“It’s become less disruptive because of vaccines and boosters and monoclonal antibodies,” he said.

None of the existing antibody drugs are effective against current variants, though others are being studied. The antiviral drugs continue to work, but patients face barriers to getting them, including lack of awareness that they need to start taking them before symptoms become severe and Paxlovid’s interactions with other drugs.

At this point, it’s not clear when the virus might settle into a predictable seasonal pattern, Adalja said. Right now, new variants are still driving transmission, though they haven’t caused the level of disruption seen in previous years, he said.

When the virus first arrived, no one had immunity, and before omicron emerged, it was relatively easy to divide a population into those who were still susceptible and those who were immune because of vaccination or prior infection. Now, it’s more of a spectrum of waning immunity, and it’s not clear how many people are susceptible again at any given time, Quandelacy said.

While that means the virus isn’t likely to be able to infect enough people to create monster waves — unless it produces a dramatically different variant — it also means the country never reaches herd immunity, when enough people are protected to stop it from spreading.

In general, reinfections are less likely to be severe than original infections, though some studies have found that people who were infected twice had higher rates of long COVID than those who only had the virus once. And it remains to be seen to what extent partial immunity will protect people as they age and develop chronic conditions.

At this point, though, almost everyone has some immunity, which makes a severe illness unlikely, Adalja said.

“All of us get reinfected all the time with the other four (corona)viruses” which cause common colds, he said. “The goal is for this to be like the other respiratory viruses.”

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