Will virus spike after spring break?

College-age revelers raise familiar concerns

Images of college students partying on beaches has sparked now-familiar worries about a possible new surge in COVID-19 cases.

The virus that causes COVID-19 is consistently unpredictable, but spring break behavior in Arizona that mirrors pre-pandemic times so far does not appear to have caused any spike in infections.

Concerns have been swirling about a potential increase in cases following a more “normal” spring break, and as reports from parts of Europe show climbing cases because of an omicron subvariant called BA.2, which seems to be more transmissible than the previous original omicron strain.

Will Arizona see another case surge in the next few weeks here due to spring break activities?

“The short answer is no,” said Dr. Joe Gerald, a University of Arizona public health researcher.

“I think as time progresses and we march towards summer, the risk of a resurgence is going to steadily increase. But right now, it appears like we have really developed this strong momentum towards improving conditions,” he said. “We’ve seen (multiple) weeks of rapid, marked improvement and I don’t see any slowing of that in the data.”

Gerald does not predict a postspring break surge because the BA.2 variant isn’t growing fast in Arizona and many people are either vaccinated or have short-term immunity from getting infected in the winter.

Summer or fall could be a different story.

“I don’t see any dark clouds on the short- to medium term-horizon,” he said, adding that things could change. “You gotta keep watching the weather.”

Arizona cases are not showing an increase, although the data is reported

at a lag. State health officials on Wednesday reported 5,153 new COVID-19 cases over the weeklong period ending March 12. That’s lower than reports from the two weeks prior, which were 6,549 and 9,647 cases.

“COVID does have its time of peaks or surges, or slight increases in cases, so it kind of depends on the time of year. At this point, it has not leveled off to a predictable cadence yet,” said Jessica Rigler, assistant director for the division of public health preparedness at the Arizona Department of Health Services.

“It’s certainly possible that because people are out of school and congregating, we may see an increase in cases, but I wouldn’t anticipate it to be a surge if we did.”

A good tool for Arizonans to use whether they are traveling in the state or to somewhere else in the country is new community guidance on prevention measures from the Centers for Disease Control and Prevention, Rigler said.

All but three Arizona counties were at the “medium” community level as of March 10, which is the last time the guidance was updated.

Masks are not recommended in public indoor places at the medium level except for certain individuals, including those who are immunocompromised, at high risk for severe disease, or if they have a household or social contact with someone at high risk for severe disease. The CDC also recommends “enhanced prevention measures in high-risk congregate settings” in communities designated at the medium level.

Three Arizona counties remain at the “high” community level: Yuma, La Paz and Apache, where the CDC recommends people, including schoolchildren, wear masks indoors.

Most areas of the country as of March 10 were designated “low” or “medium,” but there are still pockets at the “high” level.

Rigler noted that Arizona and the rest of the country have been experiencing a general downward trend in infections.

“For people who were out and about in the community over spring break or even traveling to other states, it’s unlikely that they were encountering a widespread COVID-19 outbreak,” she said. “Though it’s possible we will see a slight uptick in cases due to spring break.”

COVID-19 infections in Maricopa County, Arizona’s most populated county, are continuing to trend downward, Dr. Sarah Scott, medical epidemiologist for the Maricopa County Department of Public Health, wrote in an emailed statement.

County health officials anticipate that downward trend will level off at some point, though they don’t know when that will happen, Scott wrote.

“We do know more person-to-person contact in areas with more COVID-19 transmission, such as during travel to certain areas, may put people at increased risk for infection,” Scott wrote. “For the best protection, individuals should make sure they are up-to-date on COVID-19 vaccinations ahead of travel and gatherings.”

In Pima County, which includes Tucson, health officials are not seeing “anything of concern regarding the trend of COVID-19 cases,” Pima County Health Department spokesman Anthony Gimino wrote in an email.

“The Health Department remains vigilant and concerned about a potential increase in cases,” he wrote.

‘Outlook is very favorable and positive’

Gerald said a key reason why Arizona is seeing steady improvement is a combination of “moderate success” in vaccination plus high levels of COVID-19 infection this winter.

“We just went through a three-month period of just astronomical levels of transmission, and many people who weren’t vaccinated were infected, and that carries with it some degree of acquired immunity that will protect them at least over the short term from rapid reinfection,” he said.

The large group of people who were infected in the past three months and since recovered have relatively high immunity now, although that will wane through the summer and fall, and they’ll again be susceptible to infection, Gerald said.

“For the next two to four weeks, the outlook is very favorable and positive, but the risk is going to increase as we move into the summer and fall and winter,” he said.

Omicron BA.2 hasn’t made a big dent in Arizona yet. Last week, BA.1 cases accounted for about 94% of sequenced omicron genomes and BA.2 just 6%, lower than the previous two weeks, according to a sequencing dashboard maintained by the Translational Genomics Research Institute.

“We do know that the BA.2 variant is becoming more prevalent in the U.S. There’s no clear evidence here in Arizona that it’s growing, certainly rapidly,” Gerald said.

“The BA.2 variant, if it’s like anything anywhere else, it’s going to continue to increase in proportion and kind of take over as the dominant variant,” he said. “And it is more transmissible, so that does up the risk that improvements could slow or reverse.”

The fact that individuals are relaxing mitigation strategies and various restrictions they placed on themselves will also mean more opportunities for the virus to spread, Gerald said.

Eyes on Europe as cases increase

Gerald said he’s not sure what to make of the virus news out of Europe given the mixed messages — some western European countries are doing fairly well and seeing improvements like Arizona, while a few such as the United Kingdom are seeing a second resurgence after their winter wave.

U.K. news provides reason for concern, but it’s not playing out like that everywhere, he said.

“COVID’s coming back. It’s really when is it coming back and what will it look like and how bad is it going to be?,” Gerald said. “COVID is going to return to the headlines at some point in the next 6 to 12 months, but for right now we’re getting a reprieve.”

Gerald expects fall may be the most likely interval for Arizona’s next resurgence, around the time of the normal respiratory season and return to school. Immunity will have waned by then, although there’s also the question of what will happen with additional booster shots, he said.

“It’s a rapidly changing landscape so it’s really hard to predict now too far in the future because there are just too many unknown variables,” he said.

“Hopefully, we’ll have some weeks to months of warning before we might see something unless of

course it’s homegrown.”

Too soon to tell for college spring breaks

Arizona’s universities have so far continued to report low case counts, but the picture post-spring break is likely not yet clear. Arizona State University and University of Arizona students were on spring break the week of March 6, and Northern Arizona University students are off this week.

UA President Robert Robbins said during a late February virtual briefing that he would be “shocked” if the university didn’t see a bump in cases after spring break.

Robbins on Monday urged students and employees to get tested, especially if they traveled over spring break. He said officials plan to monitor case rates this week and if transmission remains moderate, the university plans to make masks optional starting Monday. ASU and NAU already removed mask requirements for most places on campus.

“I believe that it’s prudent to see what level of infection is present among our university community before changing our protocol for the Tucson campus,” Robbins said during Monday’s briefing.

UA’s numbers haven’t yet shown a significant increase, with the university on Wednesday evening reporting 10 positives from 379 tests. The past 10 days have seen 31 positive tests from 2,110 tests, for a percent positivity of 1.5%. Percent positivity was around 11% in late January, by comparison.

ASU’s most recent data also shows few cases, with 27 known positives among students and seven among employees, much lower than earlier in the semester, per Monday’s update. The next update, this coming Monday, could show infections that happened over spring break.

Reported cases from NAU and Grand Canyon University have also remained low, but wouldn’t yet show any potential spring break impact.

No big hospitalization spikes expected

There’s a lot more high-risk socializing happening, but it’s difficult to predict how that will affect COVID-19 case counts, said Will Humble, a former state health director who is now executive director of the Arizona Public Health Association.

“The other thing that’s so hard about this right now is that so many people are just using the rapid tests they got mailed by the federal government … and when they’re positive, it (often) never makes it in as a case. Very, very, very few of those rapid antigen tests from the home kits, when there’s a positive, does that make it into the data.”

Humble predicts Arizona will have “periods of time” when there are increases in cases, but he doesn’t anticipate any of the extreme spikes in hospitalizations that the state experienced during its three major waves of COVID-19 illness. “Nothing like that is going to happen again, I don’t think,” he said.

Emergency department visits and hospitalizations could increase, but at a much lower slope of curve than cases, partly because there’s a lot of immunity in the community from vaccinations, previous infections and reinfections, Humble said.