The third winter of COVID-19 is quick approaching, heralded by unnerving headlines about so-called “nightmare” variants, waning hospital capability, and a possible “tridemic” of respiratory sickness and flu.

But as chilly climate hits New England and gatherings shift indoors, the recommendation from medical doctors and well being officers has remained comparatively constant.

“You’re in all probability going to suppose I’m a damaged document,” Boston Medical Middle’s Dr. Sabrina Assoumou mentioned earlier than rattling off the standard reminders: Vaccination, masking, testing, and air flow. 

With two earlier pandemic winters underneath its belt and an arsenal of public well being instruments on the prepared, ought to Larger Boston be involved about one other COVID surge this winter?

That’s a trickier query, in line with Assoumou.

“What I do count on is that as a result of the climate is colder [and] we spend extra time indoors, there’s in all probability going to be extra transmission occurring and there’ll in all probability be an uptick in instances,” she mentioned. “Now, by way of would it not be a bump versus a surge, it’s laborious to know.”

The place are we now? 

In Massachusetts, new instances have trended downward up to now few weeks, coinciding with a drop within the focus of COVID-19 present in Larger Boston wastewater. 

Nevertheless, that decline might not final, in line with Dr. Paul Biddinger, chief preparedness and continuity officer at Mass Normal Brigham. 

“Sadly, we now have considerations that there might be an increase in COVID instances as we get later into the autumn or the winter, as we’ve seen within the final couple of years,” he mentioned. 

Throughout the Mass Normal Brigham system, the variety of hospitalized sufferers with COVID has been fairly regular — hovering between 110 and 130 since June, and near 100 proper now, in line with Biddinger. Practically three-quarters of these sufferers are hospitalized for one more cause and occurred to check constructive, he defined. 

Between relaxed prevention measures and an uptick in influenza, this winter is “going to be somewhat completely different” than the previous two, in line with Dr. Ana Bento, a science director with The Rockefeller Basis and an infectious illness epidemiology professor at Indiana College. 

A mathematical modeler by coaching, Bento is worried a couple of potential rise in instances. Nonetheless, if many of the inhabitants is vaccinated, a leap in instances may not lead to an uptick in hospitalizations for extreme sickness, she defined. 

“What I’m hoping for is that with these campaigns of booster and flu vaccination, that individuals will really do it,” Bento mentioned. 

Will instances surge?

It’s laborious to foretell whether or not there might be one other COVID-19 surge this winter, Biddinger mentioned. 

“Clearly, we’ve had substantial surges of COVID in every of the final two winters and the earlier winter particularly, as a result of omicron was so transmissible and contaminated so many individuals,” he mentioned. 

Tufts Medical Middle’s Dr. Shira Doron echoed Biddinger’s uncertainty, noting: “It’s merely unimaginable to foretell what’s going to come subsequent with this virus.”

The infectious illness doctor and hospital epidemiologist cited vaccinations, variants, timing, and inhabitants well being and age as components. 

“I don’t suppose we’re more likely to see one other omicron-like occasion with a large surge of instances, and with practically each American now having had COVID-19, we’re not more likely to see large surges of hospitalizations,” Doron mentioned in an e-mail interview. 

Nevertheless, “hospitals are already full even with only a few hospitalized COVID sufferers, and there isn’t a lot room for even a small surge,” she added.

Ought to we be involved about new variants? 

The BA.5 subvariant, prevalent through the summer time COVID surge, remains to be answerable for slightly below 40% of instances within the U.S., per Facilities for Illness Management and Prevention information. 

Nevertheless, two different subvariants — BQ.1 and BQ.1.1 — are on the rise, and Dr. Anthony Fauci, the White Home’s prime medical advisor, just lately sounded the alarm on the latter’s obvious skill to evade antibody therapies, in line with Fortune.

“Usually, the inhabitants must be vigilant [about new variants],” Bento mentioned, including that scientists are nonetheless monitoring new variants to get a greater understanding of how they could evade immunity.

“New variants are what viruses do,” Doron mentioned. “We will by no means cease the SARS CoV2 virus from mutating. And whereas it’s all the time potential for the virus to mutate to be extra lethal and/or extra immune evasive, some consultants suppose it’s unlikely we’ll see one other occasion like we had final January.”

What does this imply for hospitals?

Even when newer variants don’t trigger extra extreme sickness, there are widespread implications for the well being care system when too many individuals fall in poor health without delay.

“That may trigger extra of our employees to be out of labor, which strains an already strained workforce,” Biddinger mentioned. 

Complicating issues is an uptick in respiratory sickness and flu that’s already stretching hospital assets skinny. 

“In some unspecified time in the future, the area and our staffing assets are finite, and we don’t have any extra flexibility,” Biddinger mentioned. 

Mass Normal Brigham kicked off a system-wide planning effort in mid-September to anticipate an increase in COVID-19 and probably flu, updating surge plans for fall and winter, he mentioned. 

Nonetheless, hospitals had been already full and combating staffing forward of respiratory virus season, Doron mentioned. She mentioned she has heard of at the very least one hospital suspending elective surgical procedures to make room for extra sufferers. 

“There usually are not numerous reserves to see a surge of sufferers proper now,” she mentioned. “And positively not a surge of a couple of virus.”

One of many causes hospitals are so full proper now could be that some well being care was deferred on account of the pandemic, Doron mentioned. 

“Suspending surgical procedure simply worsens that drawback,” she mentioned. “I don’t have an answer to the hospital capability dilemma, however I do know it’s going to take some very modern pondering and coverage making.”

Biddinger urged vaccinations and boosters as a technique to assist overburdened hospitals. 

“A very powerful factor for folks to do is deal with their very own well being in order that they keep wholesome, but it surely completely helps make capability accessible for others who’re critically in poor health,” he mentioned.

What are you able to do?

“The large vital message right here, I feel, is knowing on the particular person stage that no matter we do to guard ourselves has a profit to the neighborhood,” Bento mentioned. 

The first step is staying updated on vaccination, in line with Doron. From there, it’s vital for folks to know whether or not they’re at excessive threat of extreme sickness, she mentioned. 

“If you’re not excessive threat, you possibly can take pleasure in a standard vacation season,” Doron mentioned. “If you’re excessive threat, know that winter is all the time going to be a better threat time for respiratory viruses, and know that you’ve instruments: you possibly can select to put on a top quality masks, ask guests to take an antigen take a look at, open home windows for air flow, and keep away from indoor crowded areas.” 

It could be laborious to inform whether or not there might be a surge this winter, Assoumou mentioned, however “it’s really as much as us.”

“We’re not helpless,” she mentioned. “Now we have instruments, however the way in which to stop a surge is to make use of all these completely different instruments so we are able to hold ourselves and the neighborhood protected.”