Recounting the Top IPC Stories of 2022

Infection Control Today, Volume 26, Issue 10

A summary of the top stories of 2022, and what to look for in the new year.

As we head to the end of 2022, which I’m convinced has been the longest of years, there are so many topics and issues we’ve faced and some to which we may not have given enough attention. To bring this year to a close and look at all we’ve managed to do to prevent the spread of infectious diseases, here’s a breakdown of the top infection prevention and control (IPC) stories of 2022.

Rise of RSV

Respiratory syncytial virus (RSV) is a respiratory virus we tend to see in children. It is a mostly seasonal bug that can be devastating to a child’s body. With public health interventions such as masking, distancing, hand hygiene, and staying home in place because of COVID-19, we’ve seen a significant drop in cases since 2020. In fact, I think many forgot about RSV. Unfortunately, the United States is now seeing a surge of RSV infections and hospitalizations, which is deeply worrisome. Starting in September, we saw a rapid rise in cases that’s beginning to strain health care facilities.1 Many reasons are being cited: the immune debt we would often see addressed through childhood socialization and exposure related to school and social interactions, a lack of respiratory precautions in place, etc. With this significant surge, many are calling for a renewed interest in RSV vaccines, which have been long discussed but have not come to fruition. The surge in RSV cases across the United States is a recent reminder that we’ve been shielded from the more seasonal respiratory infections since the pandemic began. But we must continue to be vigilant; COVID-19 isn’t the only infectious disease we face.

Omicron, Bivalent Boosters, and Paxlovid, Oh My!

It’s hard not to include COVID-19 in an annual review of IPC stories, but it’s also challenging to know where to start. A year in the COVID-19 pandemic feels like 5 years on Earth. Because of the Omicron variant, the year started with the most significant wave of COVID-19 infections we’ve faced. Per the Centers for Disease Control and Prevention (CDC), we saw a peak on January 19, 2022, with 5.58 million cases of COVID-19 that week in the United States.2 Omicron spread far, wide, and efficiently. Its capabilities also changed, and we saw this new variant spreading with ease. COVID-19 reinfections increasingly posed a challenge; gone was the robust immune protection we had from previous variant infections, and we encountered immune-evasive variants. Omicron revealed that immunity acquired from previous infections was a lot less effective at protecting us against the new variant. Although Omicron didn’t yield the same level of hospitalizations and deaths, its rapid spread and shorter period of immune protection against reinfection challenged us in many ways. Now we have 2 subvariants of Omicron, BA.4 and BA.5, which may be challenging for response because of the concern that previous infection may yet again offer less protection. There’s good news, however. “Recent research shows that previous infection with an older variant (such as Alpha, Beta, or Delta) offers some protection against reinfection with BA.4 or BA.5 and that a prior Omicron infection is substantially more effective. That was the conclusion of a study that evaluated all of Qatar’s COVID-19 cases since the wave of BA.4 and BA.5 infections began” as noted in an article in Nature.3

In 2022, we also had new interventions and tools in our arsenal against this pandemic: bivalent boosters and Paxlovid. The bivalent boosters were rolled out in September of this year to intervene against Omicron subvariants BA.4 and BA.5. Uptake has been slow, in some ways mirroring the level of interest and attention that individuals give COVID-19 in the third year of the pandemic. Ultimately, this underscores the need for faster development and response to variants as they are identified, so we can intervene during surges instead of well after them. Paxlovid has been a newer tool for us against COVID-19, changing the game by preventing the need for hospitalization. The antiviral therapy is widely prescribed to help reduce symptoms and risk for severe disease, which has been great. It did, however, alert us to rebound, which is when symptoms flare up a few days after recovery. At first, this rebound was experienced by those taking the antiviral. But now we’ve found individuals can experience rebound without having taken the medication, which is an interesting aspect to acute infection but a bigger issue for infection prevention.4 Those who experience rebound can still spread the virus, and they need to isolate. This poses a risk to those around the person, but it also muddies the waters; will they think it’s the same infection and not isolate as a result? Is there less incentive to report rebound if you know it’ll lead to isolation? In either case, rebound has underscored a new aspect of acute SARS-CoV-2 infections that require our attention.

One last important piece to add about COVID-19 in 2022 is related to the CDC guidance. In late December 2021, the CDC recommended shortened isolation and quarantine periods. The shift in August of this year to continue relaxing public interventions and lessen the necessity for contact tracing encourages spread of the disease in high-risk areas like health care and congregating settings.5 The national relaxation of masking requirements for public transportation, such as on trains, also had a huge impact, signaling for many that the pandemic was over. CDC guidance has been a challenging aspect of COVID-19 infection prevention. On one hand, we understand the impact such restrictions have on the public. But on the other hand, the shifting nature of these restrictions and questionable decisions have affected trust in the federal agency. The recommendation for shortened isolation periods of 5 days has had a large impact, whereas many studies underscore that individuals can still be infectious after 5 days.6 Developing guidance during a pandemic was never going to be easy (and many cite progress, not perfection), but we need to work harder to achieve a middle ground and better science communication.

Rise of RSV

Respiratory syncytial virus (RSV) is a respiratory virus we tend to see in children. It is a mostly seasonal bug that can be devastating to a child’s body. With public health interventions such as masking, distancing, hand hygiene, and staying home in place because of COVID-19, we’ve seen a significant drop in cases since 2020. In fact, I think many forgot about RSV. Unfortunately, the United States is now seeing a surge of RSV infections and hospitalizations, which is deeply worrisome. Starting in September, we saw a rapid rise in cases that’s beginning to strain health care facilities.1 Many reasons are being cited: the immune debt we would often see addressed through childhood socialization and exposure related to school and social interactions, a lack of respiratory precautions in place, etc. With this significant surge, many are calling for a renewed interest in RSV vaccines, which have been long discussed but have not come to fruition. The surge in RSV cases across the United States is a recent reminder that we’ve been shielded from the more seasonal respiratory infections since the pandemic began. But we must continue to be vigilant; COVID-19 isn’t the only infectious disease we face.

Omicron, Bivalent Boosters, and Paxlovid, Oh My!

It’s hard not to include COVID-19 in an annual review of IPC stories, but it’s also challenging to know where to start. A year in the COVID-19 pandemic feels like 5 years on Earth. Because of the Omicron variant, the year started with the most significant wave of COVID-19 infections we’ve faced. Per the Centers for Disease Control and Prevention (CDC), we saw a peak on January 19, 2022, with 5.58 million cases of COVID-19 that week in the United States.2 Omicron spread far, wide, and efficiently. Its capabilities also changed, and we saw this new variant spreading with ease. COVID-19 reinfections increasingly posed a challenge; gone was the robust immune protection we had from previous variant infections, and we encountered immune-evasive variants. Omicron revealed that immunity acquired from previous infections was a lot less effective at protecting us against the new variant. Although Omicron didn’t yield the same level of hospitalizations and deaths, its rapid spread and shorter period of immune protection against reinfection challenged us in many ways. Now we have 2 subvariants of Omicron, BA.4 and BA.5, which may be challenging for response because of the concern that previous infection may yet again offer less protection. There’s good news, however. “Recent research shows that previous infection with an older variant (such as Alpha, Beta, or Delta) offers some protection against reinfection with BA.4 or BA.5 and that a prior Omicron infection is substantially more effective. That was the conclusion of a study that evaluated all of Qatar’s COVID-19 cases since the wave of BA.4 and BA.5 infections began” as noted in an article in Nature.3

In 2022, we also had new interventions and tools in our arsenal against this pandemic: bivalent boosters and Paxlovid. The bivalent boosters were rolled out in September of this year to intervene against Omicron subvariants BA.4 and BA.5. Uptake has been slow, in some ways mirroring the level of interest and attention that individuals give COVID-19 in the third year of the pandemic. Ultimately, this underscores the need for faster development and response to variants as they are identified, so we can intervene during surges instead of well after them. Paxlovid has been a newer tool for us against COVID-19, changing the game by preventing the need for hospitalization. The antiviral therapy is widely prescribed to help reduce symptoms and risk for severe disease, which has been great. It did, however, alert us to rebound, which is when symptoms flare up a few days after recovery. At first, this rebound was experienced by those taking the antiviral. But now we’ve found individuals can experience rebound without having taken the medication, which is an interesting aspect to acute infection but a bigger issue for infection prevention.4 Those who experience rebound can still spread the virus, and they need to isolate. This poses a risk to those around the person, but it also muddies the waters; will they think it’s the same infection and not isolate as a result? Is there less incentive to report rebound if you know it’ll lead to isolation? In either case, rebound has underscored a new aspect of acute SARS-CoV-2 infections that require our attention.

One last important piece to add about COVID-19 in 2022 is related to the CDC guidance. In late December 2021, the CDC recommended shortened isolation and quarantine periods. The shift in August of this year to continue relaxing public interventions and lessen the necessity for contact tracing encourages spread of the disease in high-risk areas like health care and congregating settings.5 The national relaxation of masking requirements for public transportation, such as on trains, also had a huge impact, signaling for many that the pandemic was over. CDC guidance has been a challenging aspect of COVID-19 infection prevention. On one hand, we understand the impact such restrictions have on the public. But on the other hand, the shifting nature of these restrictions and questionable decisions have affected trust in the federal agency. The recommendation for shortened isolation periods of 5 days has had a large impact, whereas many studies underscore that individuals can still be infectious after 5 days.6 Developing guidance during a pandemic was never going to be easy (and many cite progress, not perfection), but we need to work harder to achieve a middle ground and better science communication.

Monkeypox

Yes—we had a monkeypox outbreak on an international scale that was declared a public health emergency of international concern. Monkeypox, an orthopoxvirus and cousin of smallpox, is not one we typically see in the United States. In fact, most of the cases in this global event were in countries that historically had not reported the virus. Not only is this a unique event and a reminder that a disease anywhere is a threat everywhere, but this outbreak brought to light social stigma and a mishandled response we haven’t seen since HIV/AIDS. Early in the monkeypox outbreak, there were epidemiological findings that cases were initially being spread in social networks among men who have sex with men (MSM). Each outbreak yields its own findings early on, and we find trends that can help us target interventions. But sadly, US response struggled with this.7 Much time had to be spent explaining that monkeypox is not spread solely in MSM, that it is not considered a sexually transmitted infection, and that stigma only hurts response.8 From delays in testing access to vaccine distribution, the United States was woefully inadequate in its response. I mention this because it underscores the increasing and continued threat of emerging infectious diseases but also shows that managing a new global outbreak during a pandemic comes with an increased burden, requiring continued vigilance and awareness for how we operate and communicate risk.

Other Important IPC Stories You May Have Missed

  • Polio. Wastewater samples in New York City and other counties in New York state pointed to several cases. In those areas, vaccination rates were around 60%, which is low. We know that vaccine-preventable diseases have been on the rise with vaccine hesitancy, but polio always seemed like one we had a handle on. Although this clustered concern doesn’t pose a risk to the public, it does reiterate the importance of childhood vaccines and improving uptake in areas with low vaccination rates and that such diseases are only as controlled as we allow them to be.
  • Ebola. Uganda saw a new outbreak of Ebola caused by the Sudan strain (not the strain we saw in the 2014/2016 outbreak).⁹ As of October 26, 2022, there were 115 confirmed cases, 21 probable cases, and 1844 contacts under active follow-up. Although this strain of Ebola virus is not as fatal as the Zaire strain, there have 32 confirmed deaths. Now is a good time to initiate travel-related emergency department and urgent care warnings and have educational talks with providers about the ongoing outbreak.
  • Russia and bioweapons. Not what you thought I’d mention in a talk about top IPC stories, right? I share this for a few reasons. The effort to improve biosecurity is an important global topic, and even though we don’t often deal with geopolitics in IPC, they still trickle into our realm. Earlier this year, Russia accused the United States and Ukraine of violating the Biological Weapons Convention (an international treaty) as it invaded Ukraine. In an effort to distract with disinformation, it triggered a review within the United Nations despite few countries backing Russia’s claim (and even then, it was mostly a consultation process, not support for the allegations). Why is this important? Russia’s claims made use of disinformation surrounding biolabs and portrayed US military biological activities as nefarious rather than supportive of global biosecurity and health initiatives. This poses a concern for larger work in science, efforts to keep the world free of bioweapons through biodefense, and partnership on a global scale that could affect research and innovation.

Infection Preventionists Are Heroes

I’ll admit my own bias—I’m an infection preventionist and hospital epidemiologist who has focused a lot of my research and work on the roadblocks we face to building and supporting biopreparedness programs within health care. We’re often forgotten when it comes to discussing health care worker burnout and what frontline responders did during the COVID-19 pandemic. Facing the third year of the pandemic, we’ve seen increases in health care–associated infections (HAIs) and antimicrobial resistance and a deep need for sustained response to infectious diseases, and that means infection prevention. We’ve battled monkeypox, extreme burnout, and changing CDC guidance, and carried the burden of ensuring ongoing COVID-19 safety while reducing the risk for HAIs. The world is learning more about IPC efforts and the role we’ve played in this pandemic, but such change doesn’t happen overnight. While we wait for a more recognized role within health care and public health, I want to end on this note: Infection preventionists are critical resources for responding to infectious disease threats, be they HAIs or novel pathogens, and ultimately form the intersection of public health and health care.

References:

  1. Thompson D. Cases of child RSV are swamping hospitals. What are the symptoms, treatments? U.S. News & World Report. October 25, 2022. Accessed October 28, 2022. https://www.usnews.com/news/health-news/articles/2022-10-25/cases-of-child-rsv-are-swamping-hospitals-what-are-the-symptoms-treatments
  2. Trends in number of COVID-19 cases and deaths in the US reported to CDC, by state/territory. Centers for Disease Control and Prevention. Accessed October 28, 2022. https://covid.cdc.gov/covid-data-tracker/#trends_weeklycases_select_00
  3. Prillaman M. Prior Omicron infection protects against BA.4 and BA.5 variants. Nature. July 25, 2022. Accessed October 28, 2022. https://www.nature.com/articles/d41586-022-01950-2
  4. Sheikh K. Covid-19 symptoms can rebound even if you don’t take Paxlovid. New York Times. October 27, 2022. Accessed October 28, 2022. https://www.nytimes.com/2022/10/27/well/live/covid-symptoms-rebound-paxlovid.html
  5. Massetti GM, Jackson BR, Brooks JT, et al. Summary of guidance for minimizing the impact of COVID-19 on individual persons, communities, and health care systems - United States, August 2022. MMWR Morb Mortal Wkly Rep. 2022;71(33):1057-1064. doi:10.15585/mmwr.mm7133e1
  6. Marquez C, Kerkhoff AD, Schrom J, et al. COVID-19 symptoms and duration of rapid antigen test positivity at a community testing and surveillance site during pre-Delta, Delta, and Omicron BA.1 periods. JAMA Netw Open. 2022;5(10):e2235844. doi:10.1001/jamanetworkopen.2022.35844
  7. Wu KJ. What should worry most Americans about our monkeypox response. Atlantic. August 4, 2022. Accessed October 28, 2022. https://www.theatlantic.com/health/archive/2022/08/monkeypox-public-health-emergency-response/671060/
  8. Mputubwele N, Osmundson J. A viral colonial legacy: HIV, monkeypox emerged due to ongoing colonial viral neglect. Contagion Live. September 25, 2022. Accessed October 28, 2022. https://www.contagionlive.com/view/a-viral-colonial-legacy-hiv-monkeypox-emerged-due-to-ongoing-colonial-viral-neglect
  9. Ebola disease caused by Sudan virus - Uganda. World Health Organization. October 28, 2022. Accessed October 28, 2022. https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON421