There is a growing narrative – subtle but pervasive – that COVID-19 is no longer something to worry about. Case counts are lower than in previous years, emergency declarations have ended, and daily life has largely resumed. But this narrative is not only incomplete; it is dangerous. COVID-19 has not disappeared but instead has evolved and settled into endemic circulation. Although it gets less coverage, it continues to exact a measurable toll, particularly among people with comorbidities and those living in urban environments where both infectious and non-communicable diseases intersect.
First, the data are unequivocal: SARS-CoV-2 continues to cause substantial morbidity and mortality worldwide. While global reported case counts may appear modest with roughly 38,000 cases reported across 80 countries in a recent 28-day period, these figures mask significant underreporting due to significantly reduced testing and surveillance. Indeed, experts have long cautioned that official COVID-19 death counts underestimate the true burden because of limited testing, inconsistent reporting, and misclassification of deaths.
More importantly, COVID-19 is no longer a uniform threat; it is a stratified risk, disproportionately affecting those with underlying health conditions. Individuals with cardiovascular disease, diabetes, chronic respiratory illness, cancer, and immunocompromising conditions – including people living with HIV – continue to face elevated risks of severe outcomes, hospitalization, and death. The interplay between SARS-CoV-2 infection and these comorbidities is not incidental; it is synergistic. COVID-19 exacerbates existing conditions while those same conditions impair the body’s ability to respond effectively to infection.
This is particularly concerning in urban settings. Cities are epicenters not only of economic and social activity but also of disease concentration. HIV prevalence, alongside non-communicable diseases such as hypertension, obesity, and diabetes, is often higher in urban populations due to a combination of structural inequities, environmental exposures, and access disparities. These same populations, already navigating layered health vulnerabilities, are at heightened risk when COVID-19 circulates and thus priority candidates for vaccination.
And circulate it does. One of the clearest indicators comes from wastewater surveillance. The U.S. Centers for Disease Control and Prevention (CDC) continues to track SARS-CoV-2 levels in wastewater across the country, updating data weekly as part of its National Wastewater Surveillance System. Wastewater analysis provides a community-level signal of viral activity independent of individual testing behaviors. Importantly, studies consistently show a strong correlation between wastewater viral levels and subsequent hospitalizations, often with a lead time of one to two weeks.
In other words, the virus is still spreading even when we are not testing for it.
Dr. José M. Zuniga