It may be time to dust off the face masks and air purifiers.

The US is in the midst of a significant Covid-19 wave, and when the US Centers for Disease Control and Prevention updates its wastewater dashboard on Friday, experts expect it to confirm that viral activity levels are the highest they’ve been during a summer surge since the CDC began publicly tracking such data in January 2022.

As of August 3, the CDC’s measure of national Covid viral activity in wastewater is at 9.01 and rising - just shy of the peak at 9.28 in July 2022. Before it started rising again in May, it was at 1.36.

“Currently, the COVID-19 wastewater viral activity level is very high nationally, with the highest levels in the Western US region,” Dr. Jonathan Yoder, deputy director of the CDC’s Wastewater Surveillance Program, said in an email. “This year’s COVID-19 wave is coming earlier than last year, which occurred in late August/early September.”

Emergency room visits, hospitalizations and deaths are also ticking up, although not to the same extent as infections, according to the CDC’s Covid dashboard. As of the end of July, the CDC’s dashboard shows about 4 are being hospitalized for Covid for every 100,000 people in a given area, up from a low in May of about one Covid hospitalization for every 100,000 people – the lowest level since the pandemic began.

The CDC’s wastewater data closely aligns with what they’re seeing at the nationwide WastewaterScan network, too.

“This is a very significant surge. The levels are very high. They’re the highest we’ve ever seen during a summer wave,” said Dr. Marlene Wolfe, an assistant professor of environmental health and public health at Emory University and a program director for WastewaterScan. “We’re detecting SARS-CoV-2 in 100 percent of our samples across the country right now.”

Health officials no longer track the coronavirus as closely as they did during the public health emergency, and there are no longer reliable estimates of daily or weekly new infections in the US. Instead, the nation is largely relying on wastewater levels to follow numbers of new cases.

Wolfe says the amount of virus in wastewater doesn’t precisely correlate to numbers of infections. That’s because there are a host of things that can influence how much virus is in wastewater – including how much water is flowing through the sewage system when sampling takes place, as well as how much virus people may be shedding with a given variant. Despite these variables, she says sampling over time has shown there is a strong relationship between the number of people infected in a given area and the amount of virus in local wastewater.

“We can’t say exactly how many more cases that may be compared to previous years, because some of those changes might have happened in the virus in the areas that we’re measuring,” she said.

The rise in cases is being driven by waning immunity in the population and a trio of new variants that have drifted enough from their parent virus, JN.1, to escape the ability of our antibodies to quickly neutralize them.

Cases are also climbing just as children head back to classrooms in many parts of the US, giving the infection plenty of opportunity to spread.

It’s not clear when this surge will peak and start to taper off.

“Here in Houston, Texas, wastewater numbers are still high and not declining. They have reached a plateau at a high level for several weeks,” said Dr. Peter Hotez, an infectious disease expert who is director of the Center for Vaccine Development at Texas Children’s Hospital.

The surge of cases has also come ahead of the availability of an updated Covid-19 vaccine designed to better protect against the new variants, which could help slow the spread of the virus.

“It’s a bit disappointing that these are not available now, as Covid is surging,” Hotez said.

The US Food and Drug Administration has not yet approved the latest tweaks to the Covid-19 vaccines, but experts say they’ve heard that updated shots from Pfizer, Moderna and Novavax should be ready in the coming weeks.

In June, the FDA, following its normal process of reevaluating the need for changes to the Covid vaccines, directed manufacturers to update their shots for the fall to better match the variants that were making people sick.

“We keep hearing rumors that it will be here by the end of September, so we shouldn’t have to wait too long,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University.

The best thing people can do as far as their own personal risk is to get that vaccine when it does become available, Hotez said.

“Next, of course, is a good N95 or KN95 mask when you are in crowded indoor areas,” Hotez said, and seek out the antiviral medication Paxlovid if you test positive. For that reason, it’s also a good idea to stock up on Covid-19 tests to identify whether any coughs or runny noses are being caused by the coronavirus.