The Brink: We’re in the midst of a COVID surge, but how bad is it compared to previous years?

Hamer: We are seeing more COVID cases nationwide, but it’s complicated. Part of the problem is the quality of the data that feeds into this. It used to be when everybody was doing active testing and using PCR tests, all that data fed into the public health systems. But now lots of people are doing home tests, and those don’t end up being captured, so the data aren’t as good as they were two years ago at the heart of the pandemic.

But, that said, there’s definitely a substantial increase of reported cases in Massachusetts, and the wastewater data had been creeping up, as well, so a lot of signs that there’s more transmission. This has been the biggest spike we’ve had since Omicron. And compounding that, there’s more flu being transmitted also. I think we’re looking at sort of a syndemic of multiple diseases. What to me is really interesting is that we haven’t had a big surge in COVID for a while—is it now starting to settle into more of a respiratory season pattern?

The Brink: Many hospitals are requiring face masks again in patient-facing areas, but I don’t see too many people wearing them otherwise. Should more of us be putting them back on?

Hamer: Yes, is the short answer. Many hospitals in the Northeast, including Boston Medical Center [BU’s primary teaching hospital], have gone back to masks. I have a clinic today—I had not been using a mask consistently, but I think it’s advisable [now], because there’s a higher risk.

And then public transportation, less than 5 percent of people wear masks in my experience, but I started masking more about a month ago because I was watching the numbers, thinking I don’t want to get COVID—or other respiratory viruses, for that matter. In crowded places where there’s likely to be inadequate ventilation, right now is a good time to think about having a mask.

The Brink: And vaccine rates are particularly low too.

Hamer: The level of boosting is really pretty woeful relative to what it should be. The JN.1 variant has been on the rise—the CDC estimated that almost two-thirds of COVID cases in the US now are due to this subvariant. The bivalent vaccine, the modified vaccine that we have available, was designed for other Omicron subvariants, but it cross-protects against this. People really should be thinking about having a booster if they haven’t had it.

The Brink: You mentioned flu rates are rising, too, but how can someone tell if they have the flu or COVID, or just a plain old cold, or even allergies?

Hamer: It’s really hard to tell. Between more immunity among individuals due to COVID vaccines or having had natural COVID infections, possibly the evolution of the virus toward a milder [disease], causing more upper respiratory symptoms, there’s so much overlap between the common cold, COVID, RSV, and—somewhat—influenza. Usually, you have a fever with influenza, but not always now with COVID. A lot of patients I’ve seen will only have a stuffy or runny nose, a little bit of a cough. They may not necessarily have a fever, severe fatigue, and other symptoms that would be more suggestive of COVID, or loss of sense of smell, which we’re not seeing as commonly anymore.

Any respiratory symptoms should trigger testing, because SARS-CoV-2 is so easily transmissible. You don’t want your coworkers, your family members, to become sick, so it’s important to know.

The Brink: What are your recommendations for people who do test positive?

Hamer: They should spend five days in relative isolation—at home, if they can—before they resurface. And then when they start going back out in public, or if they go back to work, they should ideally wear a mask with all external contacts for the next five days. This goes back to studies we did here at BU among students—but also in studies that colleagues of ours did at Mass General with an older population. On average, young healthy BU students would shed virus and, by day five, many of them had gotten down to levels where they had undetectable or very low levels of viral load. But some were still shedding virus out to day seven, eight, nine, or even ten. Usually, it was around seven or eight that they finished up. So, people are still infected for at least five to seven or eight days after an episode. And that’s in young, healthy students; in an older population, the duration of viral shedding is more prolonged.

The Brink: How worried should we be about long COVID? Is that still a major concern?

Hamer: There are still people who have long COVID. There’s a lot of evidence that suggests vaccination and treatments like Paxlovid may help reduce the likelihood of long COVID developing. The flip side of that is there’s a lot of evidence that people aren’t accessing the treatments, they’re not using them. They’re not for everybody, but for those who are older, have underlying diseases or certain risk factors, they should be used.

The Brink: Most people, whether COVID is over or not, are acting like it’s already history.

Hamer: Yeah, unfortunately, it’s not over. A lot of people I knew that were very, very careful for three years, when it seemed like everything was good, they started going back to their usual lives—having more social interactions, not wearing masks in public places—and many people that had never become infected had their first infection. And I’m one of them.

The Brink: Do you have a final message for people reading this?

Hamer: There’s still a fair amount of COVID circulating. There’s also a rising risk of influenza, as well as other regular respiratory viruses, and people should be thinking about doing things that help reduce their risk. So, vaccination. If they become infected, testing; if they test positive, isolating. Also, if they’re at higher risk, speaking with their physician about having oral treatment. The public health service message is if you have cold symptoms, you should, if at all possible, try not to come to work or go to school.