A fast-spreading COVID-19 strain JN.1 has begun dominating U.S. infections ahead of the holidays, with wastewater surveillance in Texas showing a spike in COVID-19 activity.
The rise in the new omicron subvariant comes amid a lukewarm uptake of the updated COVID-19 vaccine. Daniel Acosta, the director of Immunize El Paso, says the nonprofit health clinic has seen a slower uptake of both the COVID-19 and flu shots compared to last year.
At the time of writing there is no evidence the JN.1 strain causes as severe an illness as early pandemic strains. People can expect flu-like symptoms: Cough, sore throat, congestion, fatigue, headache, fever and muscle aches.
During the holidays, medical experts warn of a potential “tripledemic” – the combination of influenza, COVID-19 and respiratory syncytial virus, known as RSV, that slammed health clinics last fall and winter with sick patients.
A weekly report from the Centers for Disease Control and Prevention shows positive tests, outpatient visits and hospitalizations for flu are trending up nationwide.
Keeping sick children at home, as well as staying up to date on annual flu and COVID-19 vaccines can reduce the severity of flu-like illnesses, said El Paso County public health authority Dr. Hector Ocaranza.
The U.S. Food and Drug Administration and CDC approved the most recent version of the COVID-19 vaccine in mid-September. It is safe to get both the COVID-19 and flu vaccines at the same time, according to the CDC.
The new RSV vaccine for pregnant people and seniors can also help prevent hospitalizations, Ocaranza added. The pediatrician gave an update on El Paso’s respiratory illnesses at a county commissioners meeting on Monday.
Ocaranza cautioned that while El Paso has not reached the “tripledemic” height of last fall and winter, the upward trend of COVID-19 and RSV cases mirrors last season’s patterns. Children make up the biggest group of visitors to outpatient facilities in El Paso, which includes urgent care clinics and physician’s offices, he said.
What COVID-19 data shows – and doesn’t show
El Paso stopped publishing its weekly COVID-19 report in August, but still maintains the online dashboard. There were 67 people hospitalized with COVID-19 on the morning of Dec. 21, according to the dashboard. The city also recorded an average of 76 new cases per 100,000 people.
The case count does not represent the total number of cases in El Paso. Many people test for COVID-19 at home and are not required to report their results to the city of El Paso Health Department. Ocaranza told El Paso Matters in August that reports from hospitals and health care providers make up the vast majority of the case count, and few come from self-disclosures.
In 2022, El Paso Water began working with the CDC’s National Wastewater Surveillance System to detect COVID-19 spread in wastewater samples.
But the CDC’s website shows no recent data from El Paso’s four wastewater treatment plants. Public data from all four sites comes to a halt in mid-September – just weeks before the start of the respiratory disease season.
People infected with coronavirus, even if they are pre-symptomatic or asymptomatic, shed the virus in their stool. Wastewater sampling can measure how much virus is circulating within the community and predict trends.
A jump in virus levels over the summer prompted the federal government to restart its program mailing free COVID-19 home tests.
El Paso Water did not renew its agreement with the company that collects data for the CDC after their agreement expired, said El Paso Water spokesperson Denise Parra. The utility company partners with the Texas Epidemic Public Health Institute to monitor wastewater and the city health department has access to that data, Parra said.
El Paso’s COVID-19 data website still links to the CDC’s tracker, however.
City spokespersons Soraya Ayub and Laura Cruz-Acosta did not respond to El Paso Matters’ request for comment.
Gap persists between COVID-19 and flu shots
Scientists update the flu and COVID-19 vaccines periodically based on how the viruses have mutated and which strains are circulating. Both vaccines lower the risk of severe illness, as well as viral load for the infected person – meaning infected people are less contagious because they have less virus to transmit.
El Paso resident Carlos Aparicio, 24, said he got both the flu and COVID-19 shots to protect his pregnant wife, at the recommendation of their obstetrician. His wife, who works with children as a teacher, also got vaccinated to give immunity to their baby, he said.
Pregnant people are more likely to get “very sick” from COVID-19 than people who are not pregnant, according to the CDC. COVID-19 can also increase the risk of pregnancy complications and affect the developing baby.
Aparicio received the previous COVID-19 shots, but the 24-year-old hadn’t taken the flu shot on an annual basis since he was a child.
“But her doctor’s approval definitely sealed the deal with us,” Aparicio said.
Texas does not have comprehensive data for the number of people who have received the flu and COVID-19 vaccines this year, said Chris Van Deusen, a spokesperson for the Texas Department of State Health Services.
Since the end of the pandemic disaster declaration, the state does not require health care providers to report COVID-19 vaccine distribution, Van Deusen said. The state consolidates vaccine records in the Texas Immunization Registry, but residents have to fill out a form to opt into the registry.
The CDC relies on the weekly National Immunization Survey to estimate the percentage of the U.S. population who have received the COVID-19 and flu vaccines.
As of Dec. 15, about 43% of children and 42% of adults reported receiving the flu vaccine, according to the CDC.
While flu coverage has gotten closer but not yet returned to pre-pandemic levels, COVID-19 coverage lags even further behind. Only 8% of children and 18% of adults have received the latest COVID-19 vaccine.
Several El Paso residents shared reasons why they got the flu vaccine this year but not COVID-19 one. For some, their provider did not have the new COVID-19 shot at the time they got their flu shot – and they’ve either forgotten or haven’t made plans yet to go back.
Rosa Ramirez, 33, and her husband made online appointments for the COVID-19 and flu shots for early October. But this year, after waiting for an hour in the Walgreens in Downtown El Paso, their vaccine administrator told them the pharmacy only had flu shots and ran out of COVID-10 shots. Ramirez hasn’t returned.
“One day led to the next, led to the next,” Ramirez said. “We probably might just wait until next year. A part of me wants to get it, but if I’m being realistic, we probably won’t.”
She and her husband aren’t traveling or planning to see many friends and family for Christmas this year, otherwise they might be more motivated to try again, Ramirez said.
Ramirez said the pharmacy’s website indicated the COVID-19 vaccine was available when they made the appointment. It feels inconvenient now because of the couple’s schedules and the possibility of another hour-long wait.
Immunize El Paso director Daniel Acosta suggested the flu vaccine may feel more habitual for some people because it’s been around longer, though the nonprofit health clinic has also seen a dip in flu vaccine distribution compared to last year.
For people getting one shot but not the other, they may be feeling vaccine fatigue. He’s heard from people who wonder why there’s a new COVID-19 vaccine every year.
The misconception in the vaccines may lie in the naming.
“The flu shot is not described as an ‘updated flu shot,’” Acosta said. “Maybe a lot of people don’t even know it gets updated. … It would probably help if [the COVID-19 vaccine[ was marketed similarly to [the flu vaccine] as something to get every year. Right now people are saying they’ll wait for the next version.”
But like the flu, COVID-19 is here to stay – whether people want it to or not, Acosta said.
