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COVID-19 Dominated 2021—Here’s What Experts Think About 2022

Leif Greiss, The Morning Call

12/31/2021

Marked by a pandemic, an insurrection, healthcare worker shortages, global supply chain problems, catastrophic natural disasters and anti-vaccine conspiracy theories 2021 may go down as one of the worst years of the 21st century.

As we enter another new year, there is still no clear end in sight for the COVID-19 pandemic, which has warped and changed over the course of its nearly two-year reign.

Even so, public health experts, scientists and healthcare professionals have worked tirelessly to combat COVID-19 leading to medical advancements and care that have saved countless lives. Here’s a look back at some of the highlights and lowlights of the COVID-19 pandemic in 2021 and what we might expect in 2022.

Surges and Variants

The year began in the middle of the worst surge of hospitalizations and deaths of the pandemic. Cases continued to skyrocket in January 2021 as did hospitalizations until they began to recede in mid-February. Then a new, less severe wave of COVID-19 hit in March.

Now 2021 is set to end in what may be the middle of the current surge, one that has broken new records for new cases reported. On Thursday alone, 19,436 new cases of COVID-19 were reported in Pennsylvania.

Nearly every surge in 2021 has been connected to the spread of a new variant of the virus that causes COVID-19.

Numerous variants have spread on a global scale over the course of the year. The first was the highly infectious alpha variant, which was first identified in the United Kingdom and was initially often referred to as the UK variant. The first case directly linked to alpha in Pennsylvania was identified in January of 2021 and it wasn’t too long until alpha overtook the original variant of COVID-19.

Alpha remained the dominant strain until the middle of summer when the delta variant hit the U.S. and started to spread. Besides being highly infectious, delta also appears to have some level of resistance to vaccines. Breakthrough infections among the vaccinated still are significantly less likely than in an unvaccinated person and the rate of hospitalizations and deaths remains significantly lower for the vaccinated.

As we crept toward the end of 2021, the omicron variant of COVID-19 appears to have overtaken delta as the dominant strain in the Lehigh Valley.

St. Luke’s and Lehigh Valley Health Network confirmed the first cases of omicron just over two weeks ago. Dr. Jeffrey Jahre, infectious disease expert for St. Luke’s University Health Network, said based on the health network’s current testing results, it already appears that omicron accounts for the majority of positive COVID-19 tests they are seeing.

Vaccines

The Pfizer and Moderna vaccines received emergency use authorization just weeks before the start of 2021. More than 240 million Americans have received at least one shot of a COVID-19 vaccine, according to the Centers for Disease Control and Prevention and more than 8 million Pennsylvanians, about 64%, have been fully vaccinated to this point.

COVID-19 vaccines are now plentiful and available to just about anyone who wants one, but for the first part of 2021, only select groups of people were eligible and shots and supplies were scarce. The strict rules for storing the Pfizer and Moderna vaccines also made it difficult to stock them.

Many people who were eligible and wanted to get the COVID-19 vaccine spent days or in some cases weeks trying to schedule an appointment for their first shot. For seniors, many of whom were not particularly tech-savvy or faced challenges due to physical disabilities, scheduling the first shot and getting to an appointment proved to be a particularly difficult process.

Universal eligibility opened up for the COVID-19 vaccines opened up for adults in mid-April. Emergency authorization for the Pfizer vaccine for children ages 12 to 15 occurred about a month later.

Pfizer’s vaccine has proven to be America’s COVID-19 vaccine of choice, which may be partially due to being the only vaccine available in the U.S. with federal authorization to be given to children ages 5 to 17. In total, nearly 116 million Americans have received a Pfizer COVID-19 shot, about 73 million have gotten the Moderna jab and about 16 million have gotten the Johnson & Johnson vaccine.

Johnson & Johnson’s Janssen vaccine originally pitched as a one-and-done solution received emergency authorization and started being administered several months after the other two vaccines. However, about a month after the J&J shot was authorized it was linked to a condition where a rare type of blood clot in conjunction with low levels of blood platelets developed in a handful of people. A temporary hold was put on its use and distribution, but that was resolved and the J&J vaccine distribution resumed about a week later.

The proliferation of COVID-19 vaccines led to the hope that the pandemic could be quashed, or at least contained, but the impact of COVID shots hasn’t yet dealt the virus a finishing blow.

The COVID-19 vaccine has also been a matter of contention and conspiracy theories and a minority of people remain vehemently opposed to getting the shot. Kaiser Family Foundation surveys have shown that many parents of young children have concerns about their children getting the vaccine or are in total opposition.

Vaccine mandates have also been a topic of contention, particularly during the second half of 2021. Some healthcare providers as well as some universities and colleges implemented the mandates, but there wasn’t a widespread trend of employers, the federal government, state governments and others requiring vaccines until late summer. Despite some vocal opposition, vaccine mandates have generally been effective at encouraging high rates of vaccination among those who fall under them.

Hospitalization, Death and Long COVID-19

Of the Pennsylvanians and Lehigh Valley residents who were infected with COVID-19, thousands have ended up hospitalized in 2021. Peak COVID-19 related hospitalizations were in January with more than 5,600 occupying beds in Pennsylvania and well over 600 patients on ventilators. In the Lehigh Valley, COVID-19 hospitalizations peaked at around 460 people in a given day.

There have been shifts in the demographics of who is affected by COVID-19. The elderly were hit hard at first, but were among the first eligible for vaccines. They are vaccinated at higher rates than other age groups, and now make up a smaller share of those hospitalized for COVID-19 than they once did.

Now larger proportions of those who ended up hospitalized for COVID-19 are those younger than 65 including people in their 50s, in particular those who are unvaccinated. There have been slightly more young people and children contracting and getting sick from COVID-19.

Despite the proliferation of vaccines, more than 20,000 Pennsylvanians died from COVID-19 in 2021 a roughly 23% increase in deaths from 2020. The total number of deaths is about 36,000.

Though the majority of people who are hospitalized for COVID-19 survive, something that became more apparent over the course of 2021 was how COVID-19 could still leave profound lasting effects on the bodies of those who were infected.

Research has shown that anywhere from 5% to 60% of those who contract COVID-19 experience lingering symptoms, and though these effects are more common in people who have had severe COVID-19, even those with mild symptoms or who were asymptomatic can experience long-lasting ailments.

These long-term symptoms include cardiomyopathy, which is when the heart weakens and has trouble pumping blood, as well as difficulty breathing, scarring of the lungs, memory impairment, anxiety, depression and a mild cognitive impairment that physicians and researchers are calling “brain fog.” Some patients have even temporarily lost the ability to walk following a COVID-19 infection.

Children can experience a post-COVID-19 illness unique to them referred to as multisystem inflammatory syndrome in children, which can result in tiredness or fatigue, headache, insomnia, trouble concentrating, muscle and joint pain and cough, according to the Centers for Disease Control and Prevention.

Healthcare providers including St. Luke’s and LVHN have have created internal treatment programs to help patients experiencing long COVID-19 to get their lives back.

Looking Forward

Despite the gloom of the last 21 months, there are some positive signs heading into 2022, Jahre said.

Despite how rough the pandemic has been, especially for those working in the healthcare industry, tremendous progress has been made in 2021.

One example, he pointed out, was the relatively short time vaccines in the U.S. went from being in short supply to being highly accessible. Tremendous amounts of research and new information has been discovered about COVID-19 and the virus that causes it and it’s a sure thing that we will learn more about fighting the virus in the next year, Jahre said.

It’s also possible the current surge caused in part by the omicron variant may not stick around for too long. Jahre said based on how omicron has behaved in other parts of the world that were hit earlier, the trend is that omicron enters with a bang but recedes relatively quickly.

Dr. Alex Benjamin, Lehigh Valley Health Network’s chief infection control and prevention officer, said current projections suggest that cases and hospitalizations may start to dip by the end of January, though he added no one is absolutely certain what will happen.

Some other things are still unresolved, including when and if a COVID-19 vaccine might become available to children younger than 5. Though the vaccines are under development, research has not yet yielded a shot for the youngest kids that has substantial efficacy Benjamin said.

Another hope for 2022 is that new oral prescription drug treatments for COVID-19 should be available and are expected to be highly effective, Jahre said.

He added though it may feel like the pandemic has gone on forever there is reason to believe that it will come to an end.

“Even though this has been what I would call a very formidable foe—if you look at the history of pandemics most even before the vaccine era have lasted three years or less,” Jahre said.