Can Americans Handle Another COVID Surge? : Consider This from NPR Public health officials are warning of a possible surge in COVID cases this winter. How bad it could get depends on how many people take the right precautions, according to Dr. Ashish Jha. We talk to the White House COVID-19 Response Coordinator about bracing for the next potential wave.

Even if a COVID surge doesn't happen, there are plenty of respiratory ailments making a comeback, especially in children. Dr. Ibukun Kalu of Duke Children's Hospital in Durham, North Carolina explains why viruses like RSV are already swamping hospitals with sick kids.

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Are We Ready for Another COVID Surge?

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All right, look. This is just about the last thing anyone wants to hear right now heading into our fourth year of the pandemic, but another surge in COVID cases might be on the way. Already, infections are rising in countries like the U.K., Germany and France. Michael Osterholm is with the University of Minnesota.

MICHAEL OSTERHOLM: In the past, what's happened in Europe often has been a harbinger of what's about to happen in the United States. So I think the bottom line message for us here in this country is we have to be prepared for what they are beginning to see in Europe.

CHANG: And infections are ticking up here in certain parts of the U.S. Dr. David Rubin runs the PolicyLab at the Children's Hospital of Philadelphia, which tracks pandemic data.

DAVID RUBIN: We're seeing the northern rim of the country beginning to show some evidence of increasing transmission - upstate New York, Vermont, Maine, Massachusetts, where hospitalizations are rising again. We're also seeing the Pacific Northwest - Washington and Oregon in particular - start to change and some of those mountain regions start to change as well, too. The sort of winter resurgence is beginning.

CHANG: But here is some hopeful news. Infections are down from their mid-summer peak and way down from last winter. And unless a completely new and super-dangerous variant pops up, a winter surge would likely be far less deadly than past surges. Jennifer Nuzzo runs the Pandemic Center at Brown University.

JENNIFER NUZZO: We have a lot more immunity than we did last winter. Not only have people gotten vaccinated, but a lot of people have now gotten this virus. In fact, some people have gotten it multiple times. And so that does build up in the population and reduce overall our risk of severe illness.


CHANG: Still, there are omicron subvariants out there that are getting better at dodging immune systems. And while there's a booster specifically for omicron, the vast majority of us have not gotten it yet. The CDC says that out of 200 million eligible adults, only about 15 million have taken the new booster.


CHANG: So CONSIDER THIS - we are heading into yet another pandemic winter, and signs are pointing to a new wave of COVID. Meanwhile, other respiratory infections that you might have forgotten about the past couple years are making an unwelcome comeback.


CHANG: From NPR, I'm Ailsa Chang. It's Friday, October 14.

It's CONSIDER THIS FROM NPR. Fortunately, the ways we stay protected from COVID are still expanding. The FDA just made it possible for kids as young as 5 years old to get the new COVID boosters that target the omicron variant. That's 28 million children who are now eligible. But their parents are going to take some convincing. Only a third of children under 12 have had their first two shots, and just 15% have had the previous booster. Jen Kates is with the Kaiser Family Foundation.

JEN KATES: I think it's going to be a tough sell. I think there's going to be a small group of parents who are ready to go. They're anxious. It's the fall. Their kids are already getting flu and, you know, other kinds of respiratory illnesses. So they're ready, but they're a minority of parents.

CHANG: And there's doubt as to how effective the new boosters are. These bivalent COVID shots are the first ones that target two forms of the virus, the original strain and the omicron variant. Paul Offit is a pediatric vaccine expert at the University of Pennsylvania who also advises the FDA.

PAUL OFFIT: We have, to date, no evidence that the bivalent vaccine is any better, so it's a little frustrating as we keep moving forward without evidence. Hopefully, we'll be able to generate that evidence to show that the bivalent vaccine is clearly of value, but to date, those data don't exist.


CHANG: And here's another part of the problem with convincing more people to get boosters - fatigue. After three years of life with this virus, people are just done with COVID; only COVID isn't done with them. That's what Dr. Ashish Jha says.

ASHISH JHA: We've seen a surge of infections each of the last two winters. We are seeing this increase in Europe. Europe tends to fall - you know, sort of precede us by about four to six weeks. And so it stands to reason that as we get into November, December, maybe January, we are going to see an increase in infections.

CHANG: Jha is the White House COVID-19 response coordinator, and he says how bad that surge will get depends on whether or not enough people take the right precautions. But again, if a new, very deadly variant emerges, that throws all projections out the window. Dr. Jha recently told my colleague Mary Louise Kelly that there are subvariants out there that do concern him.

JHA: There are at least three subvariants that we're tracking very, very closely, all of which appear to have a lot more immune escape. Now, the good news about them is, while they seem to do a better job of escaping immunity, they are derived from BA.5 or BA.2, its closely related cousin, and the new vaccines we have, which protect you against BA.5, should really continue to work really quite well against these new variants. So we don't know all the details. We're going to - obviously, we're studying that right now. One more reason for people to go out and get this new bivalent vaccine.

MARY LOUISE KELLY, BYLINE: OK. Well, I was listening. I got the message. I have scheduled mine for next week. And I'm not alone. The CDC is estimating something like 13 to 15 million people have already gotten the new updated boosters. But compare that with more than 200 million adults in this country who got the initial COVID shots. It's a small fraction. What is the issue here?

JHA: Well, you know, we expected this to ramp up. So these new vaccines became available in early September, or right around Labor Day. And - just like the annual, you know, flu shot, which people tend to get mostly in October and November - and I think the reason is that's when the weather starts getting colder. People start thinking about the holidays, and it triggers people to sort of realize, yeah, they should probably get the flu shot before they start gathering.

My sense is something similar is happening with COVID vaccines. We've seen a pickup. And my expectation is that as the rest of October goes along and as we get into November, you're going to see a lot more Americans getting this new vaccine.

KELLY: Just practical advice, is getting it now better than November, better than December? How should we time it?

JHA: Yeah. So I've been recommending to all my family and friends that they get it before Halloween. I mean, go get it now. And the reason is, if you get it before Halloween, you're going to have a really high degree of protection as you get into Thanksgiving, as you get into the holidays. You know, you can't time these things too tightly. So in general, my recommendation is go get it, go get it soon and certainly get it before Halloween.

KELLY: OK, but let me invite you to speak to all the people listening who maybe say, look; I got the original shot. Maybe I even got boosted. Maybe I've even had COVID. Maybe I've had it more than once by now. I am over it. What do you say to them?

JHA: I would say I understand the fatigue. You know, we are now at a point where COVID doesn't have to rule our lives. We don't have to take extraordinary precautions the way we did two years ago or even a year ago. And we're at a point for - where, for a majority of Americans, this is now a once-a-year shot.

You know, I've gotten a - I've gotten a flu shot - I'm sorry. I've gotten a flu shot yearly for 20-some-odd years. It's not a big deal. I go get my flu shot every fall, and it helps protect me in the fall and winter. And we're in a similar position with COVID in terms of the vaccine, where, for a majority of Americans, it's a once-a-year shot. Now, let me be very clear. For some high-risk people - I think about my elderly parents who are in their 80s.

KELLY: Yeah.

JHA: They might need a shot more than once a year. They might need one again in the spring. But for a majority of people, we're at a point where a once-a-year shot is - it's not that inconvenient, not that big a deal and it's a great way to protect yourself.

KELLY: Speaking of protecting ourselves, masks. At one time, there were mask mandates all over. Once they were lifted, there was not a lot of appetite to put them back on, even as various surges swept through and wreaked havoc. Here at NPR, the mask mandate that's been enforced in the newsroom all this time is being lifted in a couple of weeks. I know you're going to tell me we should - ideally, you would love everyone to wear a mask, but as you try to balance best public advice with what people are going to be willing to do at this point, what is your guidance going into the winter?

JHA: Yeah. So my guidance - first, if you take a step back, my guidance for how do we keep ourselves healthy and safe this winter, it is a multi-pronged approach. So obviously, it begins with vaccines - clearly No. 1.

KELLY: But on the masks...

JHA: Beyond vaccines, I think, for people...

KELLY: ...Wear them, don't wear them?

JHA: Yeah, yeah, yeah.

KELLY: What's your guidance? Yeah.

JHA: Well, so I think - I mean, my only point here is there are other things - treatments, testing, improving indoor air quality - those all matter as well. Masks also clearly work. They become one more layer of protection. For me, the issue is not an issue of whether masks are important or not. They should be seen in that broader context of we have many layers of protection.

KELLY: Right.

JHA: And if people want to avail themselves of all of it, then they should absolutely wear a mask. But if they choose not to wear a mask, there are other things they can do to protect themselves.


CHANG: That was Dr. Ashish Jha, the White House COVID-19 response coordinator.


CHANG: If you think COVID is the only virus of concern this season, Dr. Ibukun Kalu would like you to reconsider that.

IBUKUN KALU: We are seeing an earlier start to our typical respiratory season. We would call it winter respiratory season, and we're seeing more kids infected with viruses from late summer into early fall and now going into the winter.

CHANG: Dr. Kalu is with Duke Children's Hospital in Durham, N.C., and she says these kids aren't just coming down with COVID. They're coming down with other respiratory illnesses like RSV.

KALU: We're seeing rhinovirus, enteroviruses. And some of those can spread all through the year. I think the combination of ongoing COVID as well as kids that have symptomatic respiratory illnesses from other viruses and require hospital support is overwhelming the hospitals due to the beds we have available but also some of our staffing needs.

CHANG: Dr. Kalu explained to my co-host Mary Louise Kelly that she's not seeing the same rates of infections in adults.

KALU: The reason for more severe illnesses with some of this viruses is the smaller airways in kids. Because the viruses get in there and cause such high amount of inflammation, they are unable to get air in. And that's why we see such severe illnesses with a virus like RSV.

KELLY: Well, so what's going on? What might be driving this?

KALU: That is a question we're all trying to figure out. Our habits, ability to wear a mask, particularly early in the pandemic, and a shift in travel patterns changed how the virus spread. And a lot of kids were not in community childcare settings for a long time.

KELLY: Right.

KALU: Now that we're back to relative normalcy and seeing viruses spread again, maybe some of them were dormant. Maybe some kids did not have prior infections so don't have any built-in immunity for other viruses. Or maybe they changed just a little bit and seem to be spreading faster most our kids. So it could be any of those, where people are trying to figure out which particular reason. But ultimately, we are seeing more infections early in the season, anticipating it might be a long, protracted season and trying to encourage everyone to do what they can to reduce spread.

KELLY: For parents, for families out there trying to figure this out, what should they look for? When is it time to take a kid to the doctor, take them to the hospital?

KALU: So kids get lots of infections. They typically would have a runny nose, a cough. They might have a fever or a change in the ability to eat or drink. Usually, most parents and caregivers can manage routine symptoms at home. It is good for you to contact your provider and talk through symptoms and be aware that if you see any of those symptoms worsening, specifically if a child is having issues breathing or is constantly throwing up or unable to drink or eat - you know, kids usually are drinking some type of nutrition.

KELLY: Yeah.

KALU: It would be important to ensure they get seen to assess if they need oxygen support or if they need help with maintaining their hydration.

KELLY: It sounds like - and I don't want to oversimplify in any way, but it sounds like you have a hard winter coming up in the health care industry, another one, but that common sense should prevail. And that should go without saying, but we've all been so worried about COVID, about taking care of our families, our kids. We shouldn't panic if your kid has a running nose or a cough. Take care of them, watch the symptoms, call your pediatrician, monitor it, get help when you need it.

KALU: Exactly. We have learned a lot during the pandemic, and that shared knowledge can help us here. So we're not approaching this with lots of unknowns. We do not yet know how bad this season will be. In the southern hemisphere, they did see a worse influenza season than the prior two years. So we're anticipating that we will see more infections. However, we know how to manage some of those things, and we can collectively work in preventing spread.


CHANG: That was Dr. Ibukun Kalu of Duke Children's Hospital in Durham, N.C. In this episode, we also had reporting from NPR's health correspondent, Rob Stein.



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