Three years into the COVID pandemic, where is Nebraska headed?

During the first year, roughly 200,000 cases were confirmed in Nebraska. Thanks to a huge omicron spike, the second year brought even more cases — nearly 270,000, according to Centers for Disease Control and Prevention data. But last year wound down with just under 100,000 cases, although many cases were not counted due to declines in testing.

Deaths declined even more significantly, thanks to the swift arrival of vaccines that have proven highly effective in preventing the virus’s worst effects. Nebraska counted more than 2,500 deaths during the first year, just over 1,700 during the second and slightly more than 600 in the third.

But while the worst of the pandemic appears to be fading, the virus is still out there, even as most Nebraskans — indeed, most Americans — have long since returned to life as usual.

The losses are real. And while down, they continue. Nationally, an average of 350 people a day were dying from COVID-19 as of Thursday. Since the start of this year, Nebraska has reported an average of more than three deaths a day to the CDC.

The state’s COVID-related deaths over the past three years add up to nearly 5,000 Nebraskans — the official count Thursday was 4,954. That far surpasses the 114 deaths from influenza during that same period and the 24 from respiratory syncytial virus, or RSV, according to state data. COVID-19 was Nebraska’s third leading cause of death in 2022. Heart disease was No.1, followed by cancer.

That has left the state, and the nation, at an inflection point. The Biden administration plans to end the United States’ public health emergency in May. But the World Health Organization said in January that its public health emergency of international concern will continue, although officials acknowledge that the pandemic is at a transition point.

Dr. Bob Rauner, president of Partnership for a Healthy Lincoln, said COVID-19 infections will be with us forever, just as the flu virus that wreaked havoc in 1918 and 1919 continues to circulate today.

“That’s never going to go away,” he said.

But for people who are fully vaccinated, up to date on boosters and get the antiviral Paxlovid if they do catch it, he said the virus shouldn’t present a significant problem. For those who aren’t vaccinated and boosted, and for those who are particularly vulnerable, however, it still poses a risk.

Boosters, according to recent state data, continue to offer significant protection against serious illness and death.

Over the 20-week period from September through January, Nebraskans who were vaccinated but didn’t have an updated booster were two times less likely to die from COVID-19 than those who were unvaccinated.

But those who were vaccinated and had the updated booster had an even greater advantage. They were 17 times less likely to die than people who were unvaccinated. Some 17% of Nebraskans have gotten the newest shot, slightly higher than the national rate of 16.4%.

For the first time in three years, the state did not see a big winter spike in COVID cases and hospitalizations. It’s not clear, however, whether that was because the virus variants circulating during the past several months are similar to those that have been around for the past year or because many people now have some immunity through vaccination, infection or both.

Dr. James Lawler, an associate director of the University of Nebraska Medical Center’s Global Center for Health Security, said the fact that many people have been vaccinated and infected is one reason the nation has avoided a massive winter wave.

However, he noted that cases and hospitalizations remain higher now than they were during low points last spring and in summer 2021, before the delta variant wave.

“We’re still, to me, at an unacceptably high level,” he said.

More than 100 people were hospitalized with COVID-19 in the Omaha area last week. Those patients’ vaccination statuses were not available.

Rauner noted that of the 22 people hospitalized with COVID-19 at Lincoln’s Bryan Health on Thursday, four were vaccinated and up to date on boosters. The rest were not. Of the four who were vaccinated and up to date, all fell in the higher-risk 75-and-older group.

While such cases aren’t likely to overwhelm health systems in the near future, he said, they continue to weigh on hospitals facing a number of stressors, including staffing challenges.

What will the virus do next?

Rauner said there still is no evidence that the coronavirus has become a seasonal virus, like its common cold-causing cousins.

More likely, he said, it is human behavior that is seasonal, because people tend to congregate indoors in groups at certain times of the year.

Nor do scientists know what the virus will do next.

Dr. Maureen Tierney, associate dean for public health and clinical research at Creighton University’s School of Medicine, said a lot of scientists are surprised variants in the omicron-line continue to dominate.

Lawler said it’s logical to expect that another variant will arise with advantages in transmission and immune escape — and cause a significant surge.

“I think it’s unrealistic to assume that’s not going to happen,” he said. “Now, it may not happen, but my money would be on we’ll certainly see more surges.”

When will there be another booster?

Another unknown: When federal health officials will offer an additional — or a further-updated — booster shot.

Food and Drug Administration officials said in January that Americans may be offered a single dose of a COVID vaccine each fall, much as they are flu shots.

By this fall, it will be a year since those who got their updated boosters soon after they became available have gotten a shot. Protection from both the shots and infections wanes over time.

“I think that’s way too long,” Lawler said.

Advisory panels in Canada and the United Kingdom have recommended that high-risk people be offered a booster this spring.

Lawler said he has not heard any definitive plans to offer a second booster for the vulnerable in the U.S. before fall.

Currently, people who are just starting the vaccination process begin with the original vaccine and boost with the bivalent shot.

Tracking the virus

Meanwhile, it has become more difficult to track the virus. More people are either not testing or using at-home tests that aren’t reported to public health departments.

The CDC’s COVID Data Tracker has added significantly more data over time. But Johns Hopkins University earlier this month shut down its COVID tracker, which launched soon after the virus emerged.

The Nebraska Department of Health and Human Services months ago switched to a respiratory illness dashboard that tallies trends in COVID, flu and RSV. The agency also tracks variants and monitors COVID-19 concentrations in wastewater.

The Douglas County Health Department also is working to launch an updated respiratory illness dashboard that will feature all three of the illnesses that caused a “tripledemic” earlier this winter.

Masks now rare

Masks, now a rare sight in public, still are required in many health care facilities, although most continue to evaluate those policies.

Effective Monday, CHI Health will no longer require masks for staff, patients or visitors within its facilities, including hospitals, with some exceptions. Officials noted that even though the virus is still circulating, the community is in a better place because people can protect themselves with vaccines and antivirals. Patients, however, can ask providers to wear masks.

Nebraska Medicine currently requires masks in all clinical areas. Methodist Health System requires masks in hospitals but makes them optional in some clinics.

The Nebraska Infectious Disease Society recently repeated an earlier plea that health care facilities continue to require masks in order to protect patients and staff.

Rauner said he doesn’t worry about the coronavirus in his day-to-day life, because he’s healthy, in his 50s and up to date on vaccines.

Instead, he worries that the nation isn’t planning now for the next pandemic. If the next virus has a mortality rate of 20% to 30%, like the original SARS or the Middle East Respiratory Syndrome (MERS), the nation needs to be ready. COVID-19’s mortality rate was closer to 0.5%.

“We should be using the time now to be prepared for the next one,” he said.

But many aspects of the pandemic are now mired in debate, from the origins of the virus to the effectiveness of masks. Observational studies, Rauner said, show that masks work.

“The most important missing ingredient is an intelligent debate about this,” he said.

World-Herald staff writer Henry J. Cordes contributed to this report, which contains material from the Associated Press.