A summer COVID wave has washed over most of the United States, bringing yet another round of gatherings turned into superspreaders, vacations foiled by illness and reminders that pandemic life has not been fully erased. Not even President Biden was spared.

Coronavirus activity in wastewater reached levels considered “high” or “very high” in 26 states, according to the most recent data reported by the Centers for Disease Control and Prevention. Other metrics also suggest the virus is rising, including the prevalence of COVID diagnoses in emergency rooms and the rate of tests processed at labs coming back positive, but not to the degree of the winter surge.

Biden has entered isolation in his Rehoboth Beach home in Delaware after testing positive with mild symptoms Wednesday, the most high-profile example of the virus’s reach. In a July 7 campaign event in Pennsylvania, Biden contrasted himself against Donald Trump by declaring, “I ended the pandemic - he didn’t.”

His administration no longer treats COVID as a public health emergency — instead, managing it as a routine respiratory virus to be blunted with an annual vaccination campaign. This strategy reflects how SARS-CoV-2 has established itself as a common pathogen that no longer overwhelms hospitals or the health-care system — the threat that spurred drastic measures to contain transmission early in the pandemic.

“COVID is not gone. COVID is going to be around, probably forever, and we are going to typically see two to three waves a year,” said Ashish Jha, dean of the Brown University School of Public Health who stepped down last year as the White House coronavirus coordinator.

“It raises a question of how worried should we be,” Jha added. “It sounds scary, but it’s not, for most people.”

At 81, Biden falls into the age group considered at highest risk of developing severe complications from COVID.

Older adults are more likely to have milder symptoms if they are up to date on their shots and receive antiviral treatment early in their illness, experts say. Biden started a Paxlovid regimen Wednesday and received an updated coronavirus vaccine in October. White House officials did not respond to questions as to whether Biden received a second dose of the latest vaccine available to seniors.

The ongoing Republican National Convention in Milwaukee, with an estimated attendance of 50,000, has presented opportunities for COVID transmission in an arena crammed with maskless people. (Masks are also uncommon at Biden campaign events.)

Phil Griffin, a convention delegate from Winchester, Va., said he brought two masks in case organizers required them, but he has not worried about COVID, even after Biden tested positive.

“I’ve not heard anybody in Virginia or any of the delegations — Michigan, Ohio, Louisiana — around us that have had any symptoms,” Griffin said. “So we’re blessed, I guess like the president,” he added, referring to Trump’s narrow escape from a would-be assassin’s bullet. “We’re all at this point blessed to have good health - as far as we know.”

Meanwhile medically vulnerable Americans are navigating another summer fraught with the risk of COVID. Elizabeth Kidd watched with trepidation as daily emails from her mother’s assisted-living facility in Northern Virginia started arriving in late June warning of a growing outbreak, including in the memory-care unit where her mother is treated for dementia.

Kidd, 52, takes medication that suppresses her immune system to manage her Crohn’s disease, placing her at higher risk for COVID. Her mother is 79 and struggles to remember what COVID is. So Kidd did not visit for two weeks, worried the prolonged isolation would make it easier for her mother to forget who she is.

“The whole thing is pretty nerve-racking,” Kidd said. “I don’t want COVID, and I don’t want to accidentally be the one who brings COVID back to the memory unit.”

Fortunately, her mother did not get sick, and Kidd visited Tuesday after the facility no longer had active cases but still required masks. As Kidd shared updates with her mother about the grandchildren she doesn’t always remember are her grandchildren, she also reminded her that COVID is like a very contagious flu. COVID has spiked every summer since the pandemic started, which experts attribute to increased travel, large gatherings such as weddings and conferences, the rise of new variants and even the heat driving people inside where the virus spreads more easily.

“When we’re outdoors, it’s difficult for COVID to transmit, but it’s been so oppressively hot, particularly in the southwest United States, and people are just spending a lot more time indoors,” said Andrew Pekosz, professor of microbiology at the Johns Hopkins Bloomberg School of Public Health who specializes in respiratory viruses like COVID. The ongoing COVID uptick coincides with the ascendancies of KP variants dubbed FLiRT and the closely related LB. 1, which accounted for 85 percent of new cases as of early July, according to CDC estimates.

They have mutations that make it easier for the virus to spread more easily than previous variants and to more efficiently infect people who have some level of immunity. But they do not appear to cause more serious disease.

WastewaterSCAN, a private initiative that tracks municipal wastewater data, found a 54 percent increase in copies of viral RNA per gram of wastewater solids between June 30 to July 12. Viral levels were high in most regions and medium in the Midwest.

“You might have some summer travel plans that you don’t want to have ruined or affected by you being sick,” said Alexandria Boehm, an environmental engineering professor at Stanford University and principal investigator of WastewaterSCAN. “If you are immunocompromised, this might be a good time to think about masking or just to be cautious about going into crowded venues.”

While COVID does not hospitalize and kill people as often as it used to, even mild cases can still be disruptive and inflict illness that can feel nastier than the patient would expect.

Jay Brodbar, who hasn’t taken a flight since the start of the pandemic, regularly masks indoors and received his latest coronavirus vaccine in April, had hoped he’d continue avoiding the virus as he embarked on a two-week road trip through the Northeast. But the 74-year-old started experiencing fever and chills July 8 while he was in New York and tested positive the next day.

Brodbar cut his trip short by a week and drove eight hours back home to Toronto. Reeling from what he described as the worst sore throat of his life, he said he felt better after taking Paxlovid and a steroid nasal spray.

Summer COVID waves come at an awkward time for public health officials who have made fall vaccination campaigns the cornerstone of their response. The current vaccine targets the defunct XBB variants. Updated vaccines won’t hit the market for at least another month, leaving patients and their providers to discuss the trade-offs of getting an outdated shot now that still offers some protection or waiting for the new version.

While public health officials tout that Americans now have the tools to combat COVID, those tools are getting tougher to access. The federal government has stopped widespread distribution of free masks and test kits. The federal Bridge Access Program to offer free coronavirus vaccines to uninsured people ends in August.

Health officials are imploring people at higher risk for developing severe COVID to test when symptomatic and take Paxlovid early to stop viral replication, as Biden is doing.

But other Americans are having a harder time than the president getting Paxlovid. Many pharmacies do not have the medication stocked given previous low demand. And those who do manage to access the medication are sometimes hit with eye-popping bills.

Robyn DeChabert, 27, received a prescription for Paxlovid when the Virginia Beach resident went to an emergency department Sunday with difficulty breathing and a painful cough. She credited the antiviral treatment with hastening her recovery the last two times she contracted COVID, when she received the medication free because the federal government had covered the costs.

But when her sister went to pick up the prescription for her this time, the pharmacy charged $1,700, which she could not afford. Her sister left without the medication. DeChabert is uninsured until she starts her service industry job next month.

“It is still baffling to me that a medicine that two years ago was very much accessible to a lot of people is now something that’s being priced out for many Americans,” said DeChabert, who was able to get Paxlovid from a friend. “I shouldn’t have to go into medical debt just to be able to live.” Pfizer, the manufacturer of Paxlovid, offers some patient assistance programs to cover out-of-pocket costs for people who have no health insurance or who are on government insurance plans, as well as up to $1,500 in co-pay assistance for people with commercial insurance.

Kit Longley, a Pfizer spokesperson, said enrollment in both programs takes minutes to complete to access electronic vouchers. But some providers and pharmacies do not tell patients, and DeChabert said she was never informed assistance was available. Laura Vozzella contributed to this report.

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