Q&A: COVID expert on worse-than-expected winter surge

COVID-19 cases could soon see a jump now that holiday shoppers and partygoers are celebrating, moving about and socializing without pandemic restrictions.

Health officials say the number of COVID-19 cases and hospitalizations are rising dramatically across the nation. Los Angeles has seen cases triple since early November, while hospitalizations in San Diego are on the rise.

Dr. Eric Topol, director and founder of the Scripps Research Translational Institute, joined KPBS Midday Edition to talk about just how deadly COVID could be this holiday season. The conversation below has been lightly edited for clarity.

A spike in COVID cases was expected after Thanksgiving, but is this spike worse than we thought?

Topol: Yes, I think we had hoped that our immunity wall that had been built by our massive number of infections throughout the country and certainly in this region, as well as the boosters and the vaccines ... would help fend off another significant wave. But right now, what we're seeing in L.A. but also throughout the country, is that the wave is — already in its early stage — looking worse than anticipated. So this really reflects immunity waning, that is the boosters and even our infections.

We need to get boosters that are more recent within the last four to six months. And also we of course, are not using masks and mitigation. So a lot of things we could do right now to impede this wave. New York State is the bellwether right now, because they have the most of this new variant BQ.1.1, and also another worrisome variant just behind that called XDB, and things are looking bad there. Their worst hospitalizations for COVID in the past ten, almost eleven months.

The numbers show that, in fact, more than 90% of Americans already had COVID. Vaccines should be giving us pretty strong immunity against the virus, shouldn't it?

Topol: I'm troubled by that "97% had COVID" because there are other recent assessments that are using actual antibody testing, not models, and those numbers are considerably less in the 70s and 80s. I still think there are a lot of people that haven't had COVID that are vulnerable. But also even with the vaccines and boosters.

The problem is that when omicron came along a year ago, that put a whole different look about the durability of vaccines and susceptibility to infection. So even though boosters really are essential for preventing hospitalizations and deaths, they're not holding up much with respect to infections for very long. That's why the masks are all we have to really rely on, and we're not doing that very well. So we have some tools here: boosters, masks, other mitigation measures. And, fortunately we're in a better climate. We don't have as much forced indoor gatherings, we don't have the cold and low humidity issues that a lot of the other parts of the country are confronting. So, we should be doing better. But it also means embracing the tools that we have.

Tell us more about the new dominant strain out there, BQ.1.1.

Topol: So, now we've lost all our monoclonal antibodies, they no longer work because this variant has so many new mutations that it basically prevents our antibody treatments from having an effect. And the way it hurts us, is it is our immunity wane from prior infections and vaccines and boosters. This is a double whammy because our immune system doesn't recognize it well. So the good thing is that the Bivalent booster has effects against this variant, and that's another reason to get it. A recent Emory study, which may be the best one of all, showed it had five to 10-fold increased antibodies, neutralizing antibodies directed against BQ.1.1, so it's a way that when the Bivalent booster was directed at BA.5, but that's already basically faded. It wasn't known until this became a reality through the testing, that we got at least a way to handle, to some extent, the new variant. Most of the time we're chasing variants, but this is one time fortuitously, we've gotten a bit ahead of it.

Why does it seem to be so hard for us to keep up with this virus?

Topol: It's really crazy how we don't do things aggressively like the nasal vaccines or the pan variant, universal coronavirus vaccines. It's because, largely, there's this misperception —the illusion — that the pandemic is over and then it just keeps coming back to haunt us. And just when we get through this wave, then we're probably going to have to deal with XBV, another variant wave in the early part of next year. That is, we may get a Phi or Sigma — a whole new family. That's why it's really essential that this country goes after nasal vaccines and variant proof vaccines with the utmost priority, and unfortunately, we have no congressional governmental support for doing these kinds of things.

You write that we collectively are not taking enough care of the vulnerable members of our communities. It's still seniors and immunocompromised people who remain at greatest risk, so how is it that we're failing at that?

Topol: What's interesting is if you look at around the world, in Europe, in Asia, like Japan, South Korea, or Australia and New Zealand, is they really look after their elders. Not only do we rank 70th in the world for boosters, but even worse for taking care of our elders. Also, we don't mask up with high-quality mass, not just for ourselves, but for the sake of our immunocompromised people, which are at least 7 million Americans, as well as people who are compromised. As we get older, our immune system doesn't work as well, even in response to infections and vaccines. So, we're helping each other, we're just not doing it as so many other countries around the world have shown us it can be done.

The media has been all over COVID News for the last two years, but this particular surge isn't really making many headlines. Why do you think that is?

Topol: Flu is the worst we've seen now in at least a decade for hospitalization and maybe even longer for a number of cases. So that's gotten a lot of attention, that's appropriate. We also have a lot of RSV for children and also people of older age. So part of it is we've got other infections to deal with, but part of it is we've just got profound fatigue with COVID understandably, but that doesn't mean it's going to go away. We can't will it away. So the problem we have is we're distracted and this wave is sneaking up pretty quickly and there's very little media attention. You know, today we're just starting to see the beginning of that, but we already started to see this taking off before Thanksgiving and now it's accelerating.

We have more than one reason than COVID to start wearing masks again this season, don't we?

Topol: It's really a triple threat. That is, you've got to have protection against all three of the prevalent respiratory viruses. The best way we can help reduce flu besides flu shots, RSV — which we don't have any vaccine for — and obviously COVID, is to wear a mask. So, if there ever was a reason to use a high-quality mask, it's right now.

Is this another year where people should think twice about going to a big family get-together?

Topol: I think the get-togethers are important, and (we're just not able to deal with them). For example, why not do the rapid tests to make sure that people are not asymptomatic carriers or pre-symptomatic — or using rapid tests, trying to get really good ventilation and air quality? So yeah, a gathering could be indoors, but we're lucky here in San Diego. Oftentimes we can have windows open or we can be outdoors, so there's lots of things we can do to reduce that risk. The hope is that we can do it, and ignoring it or being the denial isn't going to help anything.