When Baltimore saxophonist Gregory Thompkins started hacking and getting congested a couple of weeks ago, he never suspected the coronavirus.

“I haven’t gotten it in all these years, I thought, ‘Why would I be getting it now?’ But sure, enough, that’s what it was,” said Thompkins, who recovered relatively quickly with the help of Paxlovid.

“I guess that shows how our defenses are down,” he said.

Thompkins’ experience comes as Maryland and many other parts of the country are experiencing a slight, but significant increase in Covid-19 cases – the first since the federal government ended the public health emergency in May.

In contrast to previous summer upticks, this one, experts say, does not necessarily herald a winter surge and there is no immediate cause for alarm.

“There’s not been any signs of concern in Baltimore. This has happened the last several summers as people socialize or go indoors to get out of the heat where the virus transmits more efficiently,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

“Some of those cases are translating into hospitalizations. But it’s a very very small increase compared to what we used to see when cases went up,” Adalja told The Brew.

Hospitalization rates have increased 12% nationally, but Maryland is seeing an outsized jump.

Hospital admission rates increased 39% statewide and 44% in the city over the week of July 29, the most recent publicly available from the Centers for Disease Control and Prevention (CDC).

But Adalja notes that the increase comes from a “very low baseline” of cases, which could make the change in hospital admissions look particularly dramatic.

The most recent CDC data classifies Baltimore’s hospitalizations as “low,” with 75 new hospital admissions and 2.9 hospitalizations per 100,000 residents.  

Covid in Wastewater

Adalja also points out that the concentrations of Covid viral matter in wastewater have already begun to plateau, signaling the worst of the increase may be over.

Many sources no longer use an individual case count as the most accurate Covid surveillance metric. Instead, the agency has partnered with Biobot to detect viral concentrations of the disease in wastewater.

That data indicates that infections have increased nationally this summer.

Virus levels have more than doubled on average nationwide from the beginning of the summer until now.

The current level (353 copies/mL) may seem high, but it is less than half the levels measured this time last year (921 copies/mL).

Biobot also indicates viral concentration in the Northeast is outpacing the national average, with 400 copies/mL observed in early August.

One major contributor to the relatively low hospitalization rates is widespread immunity levels.

Whether acquired through vaccinations or prior infection, more people than ever have some kind of protection against the disease.

“There’s been a very high degree of de-linking cases to hospitalizations because of all the immunity that’s in the population,” said Adalja.

“We’re always going to have ups and downs in cases of Covid-19, but increasingly, these are going to be outpatient cases that don’t put pressure on healthcare capacity.”

Variants Behind the Uptick

The new wave of cases is largely driven by XBB subvariants of the Omicron strand, a group of variants that has continuously evolved to evade immunity.

According to the most recent wastewater data, the XBB 1.5 and XBB 1.16 strains make up a combined 46.8% of nationwide cases.

“This is kind of Omicron-making incremental evolutionary jumps to become more efficient, but nothing as concerning as when the Omicron variant first appeared,” said Adalja. 

Neither of these variants are new.

XBB 1.5 was prominent throughout the winter and XBB 1.16 has been in the U.S since April. There is no evidence either is more deadly or long-lasting than previous strains.

Current booster shots aren’t made to target this particular variant, but they may protect against severe disease, says Dr. Amesh Adalja at Johns Hopkins Center for Health Security.

But while Adalja isn’t concerned about the XBB substrains, noting that continual evolution is “what respiratory viruses do,” current booster shots aren’t made to target this particular variant.

“The strain that’s currently circulating is not well protected against by the BA4, BA5 Omicron booster that is available,” he said.

“But for high-risk populations, the current booster is something they can get, not to protect them against infection, but to protect them against severe disease.”

An additional booster shot, specifically engineered to target XBB variants, is likely to be available this fall.

Taking Precautions

In the meantime, some area residents are taking measures into their own hands.

“People don’t seem to understand that you need to get these booster shots to stay healthy and wear a mask when you’re in a crowd even now,” Baltimore County resident Pat France said.

France has so far avoided the disease, but has seen multiple friends and family members fall ill, including an unvaccinated cousin who was hospitalized for two weeks.

As a senior citizen, she’s hyper-aware of the disease, but feels many younger people are ignoring the potential threat of Covid. France started posting articles on Nextdoor to try to reach them.

“It’s not over. I don’t think it’s ever going to be over,” she told The Brew. “I think we’re going to deal with this for a long long time, just like we deal with the flu. And people just don’t seem to understand that.”

Paxlovid is one of the most important countermeasures to Covid infections, says Dr. Adalja.

Adalja urges those who have higher risk factors to be aware of their options.

He points to the antiviral drug Paxlovid, which can be taken after infection to prevent individuals from developing more serious cases of Covid-19.

“Paxlovid is one of the most important countermeasures we have because it decreases hospitalization rates by over 90% and death by 100%,” he said.

“So if you’re high risk, remember there is a drug that you should be trying to get as soon as you test positive.”