A project of the AAMC and CDC
aamc.org does not support this web browser.

How To Prepare for a Potential Cold-Weather COVID-19 Surge

Ken Budd
August 26, 2022
A woman squeezing the sample liquid on a test strip while carrying out a Covid-19 rapid self test at home.

For many across the U.S., a new school year has begun, and children may bring home more than just homework.

Students could be carriers of COVID-19 — and kids’ return to classrooms, lunchrooms, and school buses may help fuel a fall-and-winter surge of 100 million COVID-19 infections, the Biden administration has warned.

Other factors may also increase case numbers. Omicron subvariant BA.5, which accounted for about 89% of U.S. COVID-19 cases as of August 25 is extremely contagious, and “it looks like BA.5 probably spreads outdoors more easily than prior strains,” says Ross McKinney, Jr., MD, chief scientific officer at the AAMC.

Booster rates are another issue: Roughly 67% of Americans are fully vaccinated, but only 48% have received their first booster, and just 32% of individuals from eligible groups have received the second, according to data from the CDC. Pandemic fatigue has led to less mask-wearing and taking fewer other precautions, and cold weather will send more people indoors.

“It’s pretty clear that in temperate parts of the world, which includes pretty much all of the United States, COVID spreads more easily in the winter months,” says Stephen Kissler, PhD, a research fellow in the Department of Immunology and Infectious Diseases at Harvard University’s T.H. Chan School of Public Health. “There may be exceptions in some of the southern states, but I think we’ll have a harder time managing cases of COVID in the winter, which is alarming because cases are already at a reasonably high level.”

The number of daily cases rose from 27,655 on April 1 to 114,121 on August 23 the CDC reports. That is likely an undercount since many people test at home and do not report their infections to public health authorities. And people who contracted COVID-19 this past spring and summer could lose their immunity as the weather turns cold, which could further fuel a surge in cases, says Luis Ostrosky, MD, chief of infectious diseases with UTHealth Houston and Memorial Hermann Hospital.

“Immunity lasts about four to six months, and we’ll have a drop-off of immunity in the December-January timeframe,” he explains. “I think we’re going to hit an immunity cliff in the winter.”

And as cases rise, so will the possibility of new variants.

“On top of a surge, we may be dealing with a rapidly evolving virus,” says Kissler. “That’s the thing that keeps me up at night.”

Surge strategies

New boosters may help counter the surge. On August 31, the U.S. Food and Drug Administration approved updated boosters from Pfizer and Moderna that include omicron BA.4 and BA.5 components, allowing them to better fight recent subvariants. The Biden administration announced an agreement in July to buy 66 million doses of Moderna’s bivalent COVID-19 boosters for the fall and winter; the federal government had already purchased 105 million doses, bringing the total to 171 million. Before the doses can be administered, the Centers for Disease Control and Prevention needs to vote Thursday, September 1, on whether to do so.

Many of the usual strategies — vaccinations, social distancing, masking in crowded spaces — will remain useful in a surge. In August, when the CDC streamlined its COVID-19 guidance, the agency said it no longer recommends “testing of asymptomatic people without known exposures … in most community settings.” But many experts still suggest that testing can play a vital role in reducing case numbers.

“You test, you identify cases, you isolate that person, you do contact tracing,” Ostrosky says. “It’s public health 101.”

Group testing before a family gathering can reduce the odds that you’ll interact with someone who’s contagious, though it can also create a false sense of security, Ostrosky warns. Antigen tests correctly identify COVID-19 infections in 73% of people who have symptoms, but only 55% of those who are asymptomatic, according to a review of studies by Cochrane, a UK-based nonprofit and health information network.

“If you’re relying on that, you have a 50% chance of being wrong,” Ostrosky says. “Last winter, people thought they were safe because they tested before going to Christmas parties or on trips, and we still saw transmissions. When some people test negative, they don’t always take other precautions.”

In addition to testing before a social gathering, it’s important to test afterward and to inform other attendees if you’re positive. (The federal government continues to offer free at-home tests at covid.gov/tests through September 2nd, 2022.)

Risk management strategies can also reduce infections. This means monitoring everything from infection rates to hospitalization rates in your community or areas you may be visiting, and determining your level of vigilance.

“When COVID rates are really high, it’s probably a good idea to mask indoors, and when COVID rates are really low, it’s probably okay to not mask indoors,” Ostrosky says. “We’re going to be living with COVID for the foreseeable future and we can’t implement a single set of measures the whole time.”

Risk assessment also applies to social interactions. If you’re attending a packed basketball game, for example, you’ll probably want to wear a mask even if you’re vaccinated, because people are yelling.

“If you go to a concert or a play where you’re sitting there quietly, and you have your mask on, that’s basically safe, because people are not generating aerosols,” the AAMC’s McKinney says.

Another issue: Less mask-wearing and social distancing could lead to a surge in other respiratory viruses.

“Vaccine mistrust has led to low uptake of flu vaccines,” Ostrosky says. “It’s converging into the perfect storm for a bad flu season this year.”

Reducing risk for children

After days together learning, lunching, and (probably) coughing in schools, children can easily bring COVID-19 home to their families.

“If we get an early fall wave, I think it’s going to come from school exposures,” says McKinney. “I’d love to see a big push to get kids vaccinated, because I suspect that kids are going to be the vectors.”

Here are some ways to protect kids, siblings, and parents.

  • Vaccinate your kids against COVID-19. CDC data from mid-August shows that only 5.7% of U.S. children age 2-4 have been vaccinated and only 3.4% of kids two and under. McKinney attributes the vaccine hesitancy to fear, misinformation, and the perception that kids don’t get that sick. “But kids can get sick, and they can even get prolonged symptoms,” he says.
  • Avoid the perfect attendance award. “When kids get sick, they should not go to school,” says McKinney. “Perfect attendance is not worth it if you’re contributing to an epidemic.” The same is true in the workplace. If you think you might have COVID-19, take a direct antigen test. And if you feel bad, stay home.
  • Check your school’s COVID-19 mitigation measures. Few schools will enact mask or vaccine mandates, Ostrosky says, but make sure that at least some social distancing measures are in place, that the school has good ventilation, and that policies exist for testing and reporting positive results for contact tracing. And don’t forget: Kids can still wear masks, even if they’re not required. “Most kids have adapted much better to masks than adults have,” says McKinney.
  • Take care of routine immunizations. “That’s the most important message I would get out: Make sure your child is up to date not just on COVID vaccinations, but on all vaccinations, going into the school year,” Kissler says. McKinney points to polio cases in New York State. In August, the New York State Department of Health announced that the virus had been detected in Orange County and Rockland County — and that polio vaccination rates were low: roughly 60% in Rockland and just under 59% in Orange. “Vaccination protects kids,” McKinney says. “Even diseases that we haven’t seen for a while can come back.”

Vaccination and boosters remain the best way to protect children and adults alike, experts say, and to prevent the spread of the virus.

“The message is simple: Basically, everybody who dies [from COVID-19] is unvaccinated or under-vaccinated,” McKinney says. “If you want to get sick, you have the option. But you also have the option to be well. And the vaccine will help keep you well.”