As the summer travel season gets underway, COVID cases and hospitalizations are rising in Los Angeles County. Some people who have recently been reinfected are saying their latest bout is the worst yet.
There are currently no signs that the latest coronavirus variants are leading to more severe illnesses, either nationwide or in California.
But some doctors say this latest COVID surge challenges a long-held myth: While new COVID infections are often mild compared with a first brush with the disease, they can still cause serious illness. Even if someone doesn’t need to go to the emergency room or be hospitalized, people sometimes describe painful symptoms.
“The dogma is that every time you get COVID, it’s milder. But I think we have to remain open to the possibility that some people have worse symptoms,” said Dr. Peter Chin-Hong, an infectious disease expert at UC San Francisco.
Every time you get COVID, he said, it’s “kind of like playing COVID roulette.”
This underlines the need to be careful during summer travel and activities, even though the overall risk remains relatively limited.
Because everyone’s experience with COVID is different and influenced by a number of factors, it’s difficult to quantify how many people are now experiencing more acute symptoms compared to previous infections. But anecdotally, including on social media, people are expressing shock at how sick they’ve become from the latest subvariants, collectively called FLiRT.
“I’ve had COVID a few times but this is the worst I’ve ever had,” one person wrote on Reddit. The person reported recurring fevers, congestion so bad he couldn’t breathe through his nose, “horrible sinus pressure and headaches… and I can’t stand for long without feeling like I’m about to pass out.”
“COVID used to feel like just a common cold, but this strain is [wreaking] chaos,” the person wrote. “I hate to complain like this but I am shocked at how much it is draining me.”
Another person wrote that their “throat feels like razor blades” and that they feel like they are “living in living misery.”
“I have so much mucus but it hurts so much to cough because my throat is literally on fire!!” the person wrote. “This is my 4th time having Covid and I swear I feel like this is the worst I’ve ever had!!”
Others who escaped COVID for more than four years became infected this summer.
One person became ill and first tested positive after hosting a Father’s Day gathering for 12 people. The person described “uncontrollable, shaking shivers, so bad I couldn’t feel most of my fingertips.”
A 42-year-old nurse, who has had COVID four times, said her last illness was “intense with fever, cough, pressure on the head and pain. It affects my throat and ability to swallow.”
Others, however, have said that it is easier to recover from each subsequent COVID illness. And one person who was infected for the first time wrote that he/she had “super mild symptoms” [that] It just feels like a seasonal allergy flare up.
Some research supports the idea that subsequent COVID infections carry additional risks. A 2022 report in the journal Nature Medicine focused on veterans found that, “Compared with uninfected [people]the cumulative risks and burdens of repeated infections increased as the number of infections increased, increasing the risk of medical problems, hospitalization, and death.
And while the prevalence of long COVID appears to be declining, doctors note that with any infection, there is a risk of developing the syndrome. A report published last summer by the U.S. Centers for Disease Control and Prevention said the prevalence of long COVID among U.S. adults was 7.5% in early June 2022, but had dropped to 6% by mid-June 2023 — still a significant portion of the population.
There are a number of possible reasons why a subsequent COVID illness might feel worse than the first. Say someone who was vaccinated in 2021 and last had a booster shot got infected in 2022 and then again in 2024. The relatively long period of time without exposure to infection or a booster shot may have “led to [their body] don’t have that much immune memory. And the variants have changed so much anyway, it’s like being exposed to something that’s relatively different from the virus that the immune system has seen before,” Chin-Hong said.
Without keeping up to date with COVID vaccinations, which “remind the immune system what the more recent variants look like,” a recent infection could cause the body to react with relative surprise to the FLiRT subvariants that are now dominant nationwide.
“It’s evolved like this, and the body thinks, ‘OMG, what is this thing I’m seeing?’” Chin-Hong said.
The logic is much the same for annual flu shots, which are formulated each year in the hope of arming the immune system against the dominant circulating versions of that virus.
For the week ending Saturday, an estimated 70.5% of COVID specimens nationwide were of the FLiRT subvariants — officially known as KP.3, KP.2 and KP.1.1 — up from 54.9% a month earlier. Another closely related subvariant, LB.1, is estimated to make up 14.9% of specimens, up from 10% a month earlier.
Previous immunity from old vaccinations can still do a decent job of protecting many people from serious illness. But without the refresher course that an updated vaccine brings, Chin-Hong said the immune system “probably won’t be able to stop the virus in its tracks, or neutralize the virus once it gets in, because it looks so different, before it kicks in memory immunity.”
“In the meantime,” he added, “this virus is happily infecting cells, while the body tries to use its current memory to make new immune cells.”
It is also notable that even for young adults who keep their COVID vaccinations up to date, it has been almost a year since their last vaccination. In addition, the effectiveness of the vaccine decreases over time.
A report published by the CDC in February found that getting the updated 2023-24 COVID vaccine provided about 54% more protection against symptomatic disease compared with not getting the shot. The vaccine’s effectiveness against symptomatic infection is higher in the first few months after getting the updated shot.
The vaccines continued to provide good protection against hospitalization and death.
In LA County, COVID cases and hospitalizations continue to rise. For the week ending June 30, an average of 229 coronavirus cases were reported per day, up from 106 a month earlier. And for the week ending June 29, an average of 197 people were hospitalized with the coronavirus per day, up from 117 a month earlier. And while COVID hospitalizations are higher now than they were at the same point last year, they remain below the relatively mild peak seen in summer 2023.
Officially reported cases are an undercount because they only include tests performed in medical facilities and do not account for home tests or people who do not test. In LA County, last summer’s COVID surge peaked at 571 cases per day in late August, and peaked at 620 people infected with the coronavirus per day in hospitals in early September.
Viral levels in LA County wastewater have been relatively stable. For the week ending June 22, the most recent available, viral levels in sewage were 17% of the winter 2022-23 peak, the same as the week before. Last summer, they peaked in early September, when viral levels in sewage were 38% of the previous winter’s peak.
The percentage of positive COVID-19 tests continues to climb across California. In the week ending July 1, 10.6% of COVID-19 tests in the state were positive, up from 4.1% a month earlier. The percentage of positive tests last summer peaked at 13.1%, near the end of August.
There has been relatively low uptake of the updated COVID vaccine, which became available in September. Since then, 36.7% of California seniors 65 and older have received at least one dose of the updated vaccine, as have 18.5% of adults 50 to 64 and 10% of the youngest adults up to age 49.
For people who haven’t had an updated vaccine in the past year, “you should consider getting it, especially if you’re older and have a weakened immune system,” Chin-Hong said. Hundreds of COVID deaths continue to be reported each week across the country, with seniors and people with weakened immune systems at greatest risk.
Even if you get the 2023-24 vaccine now, you can still get the updated COVID vaccine that is expected to be available this fall. The CDC will recommend that everyone 6 months and older get the updated version of the 2024-25 vaccine.
Chin-Hong said October is a good time to get vaccinated against COVID for 2024-2025.
Chin-Hong said even healthcare workers need to be reminded to follow proper COVID infection control protocols, such as the importance of getting tested if you feel sick and reporting your illness to your employer.
“It seems like everyone thinks COVID is just normal now,” Chin-Hong said. But taking common-sense measures — like coworkers deciding not to go to work if they’re sick, and testing themselves if they have symptoms — can make a world of difference in keeping COVID to a smaller number of people.
And now that COVID is on the rise, it’s also a reminder that it’s wise to keep a mask in your pocket to put on if you’re near a sick person, Chin-Hong said.