The dominant BA.5 variant of Covid-19 signals we’re still not in the clear

The BA.5 Covid-19 subvariant is now the most dominant strain in the country; the highly infectious variant has caused an uptick in cases and hospitalizations both in hotspots like New York City and the nation overall, but public health action and messaging is less aggressive than with previous outbreaks.

BA.5 typically causes familiar symptoms like fever, headache, muscle aches, cough, and sore throat but can still cause serious illness, especially in individuals with preexisting conditions. It’s even entered the highest halls of power, with President Joe Biden’s doctor saying in a letter Saturday that Biden is likely infected with BA.5. But there’s been little focus on the national plan to keep the subvariant under control, which the Biden administration rolled out July 12.

Tracking BA.5’s rise is somewhat complicated because of an increase in at-home rapid testing to confirm infection, rather than testing in a clinical setting, which would make its way to health authorities and paint a fuller picture of the data. While the number of cases is nowhere near the level of infections due to omicron last winter, the week-on-week total of hospital admissions overall has trended up steadily over the past month, according to data from the Centers for Disease Control and Prevention.

Furthermore, it’s likely that the full magnitude of the BA.5 outbreak isn’t being captured by available data. In some places like San Diego that use wastewater monitoring, wastewater analysis showed a massive surge in copies of the virus shed into the community’s sewage — 15.5 million copies per liter of wastewater on Wednesday of last week, versus 8 million copies per liter from the same location the previous week, according to the San Diego Union-Tribune’s Paul Sisson. That trend directly contradicts data available from the San Diego County health department, which actually showed positive rates declining 8.3 percent over the same period. For comparison, Sisson reported, there were 47.6 million copies per liter in the same location on January 9, 2022, during the omicron wave.

BA.5’s and its fellow omicron subvariant BA.4’s advantage likely comes from a combination of increased transmissibility and mutations that enhance their ability to evade immunity people have from previous infection or vaccination, Natalie Dean, an associate professor of biostatistics and bioinformatics and of epidemiology at the Rollins School of Public Health of Emory University, told Reuters. “You don’t even need an increase in transmissibility to explain the advantage,” she said.

Given data showing low rates of severe illness and death in many places and fatigue with Covid-19 restrictions, many health authorities aren’t tightening previously loosened restrictions.

“I’m like everyone else: I hate wearing that mask. But more than that, I hate the idea that I might accidentally transmit to somebody else,” Barbara Ferrer, the Los Angeles County public health director, told the New York Times. “That’s my biggest fear — that we’re so anxious to be done with this virus that we’re getting complacent.”

New York City is a hot spot. Does anyone care?

Throughout the pandemic, New York City has been a hot spot; crowded living conditions and public transit make it easy for the virus to spread through the air. While the city’s BA.5 infection rate is nowhere near what it was with previous waves, it’s continuing to trend up — and may even be much higher than available data shows.

As the Times’s reporting points out, New York City’s test-and-trace program got phased out this April under Mayor Eric Adams — who contracted Covid-19 that month. Restaurants no longer require proof of vaccination to enter, and the city’s mask mandate ended in March, although masks are still required on public transit. Despite the city’s uptick, and his own health department’s recommendation that people wear masks indoors, Adams has repeatedly resisted bringing back the mask mandate.

“We are always re-evaluating our response efforts to ensure we are providing New Yorkers with the best information possible and so that they can make the decisions that are right for them,” Fabien Levy, Adams’s press secretary, told Vox in an email. However, as City & State, an outlet covering the politics of New York City and Albany, noted earlier this month, the New York City Department of Health removed a color-coded alert system that included specific guidance about how to handle different levels of Covid -19 outbreak, including public health measures to enact. As the New York Times reported earlier this month, the system — which Adams unveiled in March — recommended that the mayor require face masks at indoor settings and crowded outdoor settings, and bring back the vaccine requirement to enter restaurants and bars.

As of Sunday, the website still states that the administration is “re-evaluating the city’s COVID Alert system,” and advises users to “check back here for updates in the coming weeks.” It also recommends that New Yorkers “wear a high-quality mask in all public indoor settings and around crowds outside,” as “there are currently high transmission levels of COVID-19 throughout the city.”

Instead of bringing back such measures, Adams’s office has promoted vaccination, at-home and community testing locations, and antivirals to address Covid-19.

“New York is leading the nation in testing and treatment delivery, and, in the last six months alone, we’ve given out more than 35 million at-home tests to New Yorkers and delivered approximately 90,000 courses of Paxlovid,” Levy said in his email to Vox. “We review the numbers every day and will continue to follow the guidance of health experts to keep New Yorkers safe and healthy.”

But New Yorkers are continuing to get sick, with reported Covid-19 cases up 22 percent over the past two weeks, hospitalizations up 25 percent, and deaths up 29 percent, according to the New York Times. Again, the numbers are still small in comparison; a daily average of 12 deaths is nothing like the daily averages in spring 2020. Vaccines and antivirals undoubtedly help prevent serious illness, hospitalizations, and deaths — but they need to be supplemented with other mitigation and support measures like masking, as Ed Yong pointed out in his article for the Atlantic earlier this month.

Things aren’t so clear from the White House, either

Biden tested positive for Covid-19 on Thursday, and while he’s reportedly still working and experiencing only mild symptoms, his age — he is 79 years old — puts him at increased risk for complications from the disease. He has been boosted twice, as Vox’s Dylan Scott and Li Zhou wrote Thursday, and is being treated with paxlovid. In a short video address posted to Twitter, Biden assured the public that he was feeling fine and getting lots of work done.

Although he shared that he had been vaccinated and fully boosted, he did not give any guidance for those watching — no exhortations to get vaccinated or boosted, or to wear masks indoors. “In the meantime, keep the faith,” he said. “It’s going to be okay.”

That’s not to say that the White House has made no effort of late to address the prevalence of BA.5; on July 12, the administration rolled out new guidance to manage the latest Covid-19 subvariant.

A press release announcing the strategy acknowledged that BA.5’s apparent ability to evade at least some immunity “has the potential to cause the numbers of infections to rise in the coming weeks,” particularly where people are unvaccinated or where vaccine immunity is waning.

To address this, the White House proposal includes increasing access to antiviral treatments like the one Biden is taking, as well as continuing to encourage vaccine and booster uptake. Increasing availability of and access to free testing is also a key tenet of the strategy, as is better ventilation, increasing access to the preventive treatment Evusheld for immunocompromised people, and ensuring access to respirators and a clear indication of situations in which masking is advised.

That proposal at least presents a comprehensive — if not aggressive — approach to the new subvariant and the “new normal” of life with Covid-19. As experts have warned throughout the pandemic, relying on vaccines as a silver bullet, particularly when an omicron-specific vaccine booster is months away, won’t stop Covid-19 and won’t prevent new variants from forming. As Yong points out, we don’t know what those variants will look like, and we have no way of predicting the seriousness of the resulting illness, or the ways they’ll evade our immune responses in the future.

“Everybody’s hoping to get a degree of what they call endemicity — living with the virus at a level that does not disrupt society,” Anthony Fauci, the US’s top infectious diseases expert, told Barron’s in an interview Thursday. “That’s where I think we’re going. I don’t believe we’re going to eradicate this.”

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