Over the past several years, COVID-19 has surged twice a year — once in the winter and once in the late summer. This pattern seems to be repeating in 2026.
The Centers for Disease Control and Prevention (CDC) reported on Aug. 26 that COVID-19 cases were growing in nearly every state as summer travel and back-to-school season created the crowded conditions that help the virus spread. And, last week, the U.S. Food and Drug Administration (FDA) approved an updated vaccine for people at high risk of developing serious illness.
The good news is that, more than six years since the novel virus disrupted the world, it is far less dangerous than it once was.
Most people have some kind of immunity, either from prior infection, vaccination, or a combination of the two, and the dominant strain currently circulating has not mutated enough to evade the body’s protection.
This is reflected in the shrinking number of deaths and hospitalizations. As of early August, there were fewer than 6,000 U.S. deaths associated with COVID-19 in 2026, down by more than 60% compared to the same time last year and 10 times fewer deaths than there were in just the month of April 2020.
“What a different world it is today than April of 2020,” says John Brooks, MD, an infectious disease physician, epidemiologist, and clinical assistant professor at Emory University School of Medicine in Atlanta. Brooks served as the chief medical officer for the CDC’s COVID-19 response from 2020-2022. “It really is a testament to the American and worldwide scientific clinical and public health community how quickly, in retrospect, we began to get control of this infection.”
However, the virus remains a threat, particularly for older adults and people with compromised immune systems. People on immunosuppressant drugs for cancer treatment are especially vulnerable. Furthermore, the U.S. Department of Health and Human Services estimates that about 18 million people in the country have long COVID, a condition that lingers months or years after an active infection and can have debilitating symptoms including fatigue, brain fog, and heart problems. While there is no clear evidence that those with long COVID are more vulnerable to reinfection, another infection can worsen symptoms. Having multiple infections also seems to increase the risk of long COVID.
“Vulnerable people remain vulnerable,” Brooks says. “And for vulnerable people, COVID-19 can be a dangerous illness.”
Greatest impact on the elderly
Since the beginning of the pandemic, the most serious illness has been seen in older adults. Despite making up only 16% of the U.S. population, people age 65 and older have accounted for 75%-80% of deaths throughout the pandemic, according to CDC data.
“It’s widely understood that during the early days of the pandemic older adults were affected the most, cost the most lives, and had the most days of life lost,” says Jeffrey Whittle, MD, MPH, an internal medicine physician at the Clement J. Zablocki VA Medical Center and a professor of medicine at the Medical College of Wisconsin who studied COVID-19 mortality among the elderly in the early years of the pandemic.
The immune system tends to mount a weaker defense with age, and older adults tend to have more chronic health conditions that can contribute to their risk of bad outcomes.
Still, many who died early in the pandemic may not have been close to death before infection. According to one data analysis of COVID-19 deaths among older adults in the United Kingdom during the first two and a half years of the pandemic, about 28% of people likely would have lived another five years had they not been infected.
The introduction of the vaccine in late 2020 and the comparatively high uptake by older adults in the United States helped turn the tide, according to a study of people living in Indiana, Illinois, and Wisconsin led by Bernard Black, JD, a law professor at Northwestern University, and on which Whittle was a coauthor.
“One of the things we did really well is we developed vaccines in record time,” Black says. “They worked, and they saved a lot of lives.”
Yet even as vaccines and widespread immunity greatly reduced the disease burden of COVID-19 after the 2021 peak, the illness continued to have an outsized impact on older adults. A CDC analysis comparing data from October 2022 with data from September 2024 found that — despite a significant drop in the number of COVID-19 infections, outpatient visits, and hospitalizations — deaths remained roughly the same at about 101,000 annually from one year to the next. Some of these deaths may have been preventable with the use of antivirals and immunization.
Another CDC report found that, from June 2023 to September 2025, fewer than 40% of adults over 60 who had an outpatient visit for COVID-19 received a prescription for an antiviral, despite recommendations to start treatment as soon as possible.
And in a national survey of adults 50 and over conducted last winter, nearly half said they hadn’t had a COVID-19 vaccine in more than a year; about 30% of those who didn’t get the vaccine said they didn’t think they needed one.
“COVID-19 still poses a risk to the health of older adults, particularly those of more advanced age and particularly if they have one or more chronic health conditions,” says Jeffrey Kullgren, MD, MS, MPH, a researcher and associate professor at the University of Michigan and an internal medicine physician at the VA Ann Arbor Health System who led the survey.
Kullgren says the survey should be eye-opening for physicians who treat older adults and should encourage them to have conversations about vaccination.
“It’s important for clinicians to remain humble, curious, and concerned in these conversations to really understand where people are coming from,” he says. “The reality is these conversations can be really challenging.”
Established and new treatments
Beyond the success of the vaccine, clinicians caring for people with COVID-19 have more treatments at their disposal now than they did a few years ago.
“We’ve been able to maximize survival of people who had very bad COVID,” Brooks says. “A variety of important drugs were introduced.”
The Infectious Diseases Society of America’s (IDSA) 2025 guidelines for treating mild to moderate COVID-19 recommend treating people at high risk with the antiviral drug nirmatrelvir, known by the brand name Paxlovid, or in some cases, with remdesivir, an antiviral that is given intravenously and slightly reduces the risk of hospitalization.
For patients with severe COVID-19 who experience an extreme immune reaction that can be harmful, biologics that modulate the immune system have reduced both mortality and the risk of needing a mechanical ventilator.
According to the IDSA paper, about 6% of people with high risk for severe COVID-19 require hospitalization, though that number increases to 20%-50% of cancer patients.
In June, the FDA approved the first antiviral drug authorized to prevent development of COVID-19 after a known exposure to the virus. Ensitrelvir, marketed as Xocova, has been in use in Japan for more than three years and a clinical trial conducted in the United States in households where at least one person became ill with COVID-19 found that taking a five-day course of the drug reduced the risk of developing COVID-19 by 67% compared with a placebo. The drug is now available in the United States with a prescription and should be started within 72 hours of first exposure.
“It’s particularly important for higher risk patients to consider this intervention,” says Frederick Hayden, MD, an emeritus professor at the University of Virginia School of Medicine and one of the investigators for the clinical trial.
Hayden adds that ensitrelvir prophylaxis could be especially useful for COVID-19 outbreaks in congregate care settings like skilled nursing homes where multiple people at high risk of severe outcomes live in close quarters and for health care workers who work with vulnerable people.
However, the drug is not recommended for people who are pregnant and does not replace guidelines for vaccination.
Last week, the FDA approved updated COVID-19 vaccine formulations for people age 65 and older as well as for anyone with a condition that puts them at high risk of severe illness, including cancer, diabetes, obesity, heart disease, and a range of other conditions. People who wish to get vaccinated but don’t qualify as high risk may be able to get a shot from their doctor or pharmacist and should not be required to show documentation that they are eligible, Brooks says. The vaccines are expected to be available in early September.
Brooks also encourages those feeling sick to stay home or wear an N-95 mask around others to avoid spreading the virus.
“Thank goodness this is not the infection that it was in 2020,” he says. “But it still is really bad for older adults and people who are immunocompromised.”
