Are you confused about BA.5 and the current state of the pandemic? Here’s how the experts are thinking about it.

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The rapid growth of BA.5 — the most transmissible form of SARS-CoV-2 yet — is scrambling America’s plans to elegantly move to the next stage of the pandemic with the virus under control.

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The omicron subvariant, which made up less than one-third of new cases a month ago, is now the most dominant strain in the US BA.5 is troubling for several reasons: it’s better at jumping from person to person than any other strain, and it’s more likely to break through immunity generated by vaccines or infections than omicron and its subvariant siblings. (Experts predict that BA.5 will quickly take over BA.4.)

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Dr. Eric Topol, a cardiologist and director of the Scripps Research Translational Institute, says it’s worse than delta, omicron, or any other strain of the virus we’ve seen.

“There’s a big misconception that in order to be worse you have to kill people,” he said. “If we didn’t have prior immunity from vaccines and boosters and infections and all these combinations of those, it would have been worse than omicron.”

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The official numbers say that about 100,000 people have tested positive every day for the virus for the last four or so weeks. However, that kind of data is no longer a reliable metric, now that fewer people are getting tested, and states have scaled back their COVID-19 data operations. Even home test usage has started to decline, according to Dr. John Brownstein, an epidemiologist and chief innovation officer at Boston Children’s Hospital.

“It’s an additional information stream, but we have to interpret that data with real caution,” he said.

The actual number of cases is thought to be much higher. The University of Washington’s Institute for Health Metrics and Evaluation currently predicts cases are 7.14 times higher than what’s being reported. That means Wednesday’s count of about 124,000 cases is more like 885,000 new infections,

No doubt you’ve heard from a friend, colleague, or family member who’s gotten sick over the last few weeks. Official case counts are up. More worrisome is the increasing number of hospitalizations, which are up 19% over the past two weeks.

Now we’re seeing health officials kick into action. The Biden administration reportedly is mulling a second booster for all adults. Dr. Ashish Jha, the White House’s COVID-19 response coordinator, this week twice told Americans older than 50 years to get a booster. “It’s going to save your life,” he said. And the Food and Drug Administration finally authorized Novavax’s NVAX,
COVID-19 vaccine — which could be more effective against a wider range of variants than the mRNA shots, according to remarks made by company officials last month.

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That’s a lot of news for a virus that has largely faded out of everyday conversation in place of inflation worries and much-needed vacation plans. But the flurry of activity this week also signals that BA.5 is ushering the US into the next phase of the pandemic. What Americans want are fewer restrictions and worries. Instead we’re going to spend the second half of 2022 waiting for a new generation of mRNA shots that better target BA.4 and BA.5 while people get sick for the second, third, or even fourth time.

“We’re dropping our guard at the same time the virus is upping its game,” said Dr. Rick Bright, CEO of the Pandemic Prevention Institute and former director of the Biomedical Advanced Research and Development Authority. “That’s creating this huge gap and a huge level of vulnerability, which is only going to allow the virus to stay around longer and continue to change.”

This gap makes it challenging for individuals to figure out what to do, and that’s happening after many Americans long stopped tuning in to the day-to-day nuance of the pandemic. Only 34% of people in the US have been boosted although boosters have been available for adults since the end of last year.

“People are so tired about hearing about COVID,” Bright added. “The apathy and the fatigue level is at an all-time high.”

Federal health officials have been saying the same things for months — if you’re younger than 50, get your first booster. If you’re older than 50, get your second booster. Get vaccinated if you haven’t already. But experts like Topol say there hasn’t been enough urgency behind their words, and now BA.5, with its immune-escape capabilities, further complicates the messaging. This week, Jha and Walensky also answered questions about whether an infection during last winter’s omicron surge protects you against BA.5. (it doesn’t) and if getting a booster now will preclude you from getting a next-generation booster in the winter (it won’t).

“The reason to get a booster now is to prevent infection now,” Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said Tuesday. “There’s a lot of infections now and [an] increasing number of hospitalizations now.”

A year later

It was this time last year when the powerful delta variant set off a wave of new COVID-19 cases and hospitalizations at a time when it felt like the pandemic was in the rear view mirror. This is when the first breakthrough infections occurred, the first COVID-19 vaccine mandates rolled out, the first talk of boosters came up, and the return of mask rules in some cities. It was a disappointing moment for many people who thought that doing their part in 2020 and 2021 should have earned them some well-deserved normalcy.

“In previous surges, we had much greater uptake at masking. There was a lot more vigilance on the part of the population. There was a lot more testing,” Brownstein said. “We have a population that, in many respects, has moved on from this virus so that [creates] a lot of unknowns as far as what’s going to happen in the next several weeks.”

But — surprisingly — there are things to feel optimistic about. The rising number of hospitalizations has not yet translated into more intensive-care admissions or deaths. (We should know more on this front in the coming weeks.) The vaccines, while outdated, still largely prevent severe disease and death. There are nasal vaccines in development that are thought to prevent transmission and infection by producing IgA antibodies. Paxlovid works, even though it can cause rebounds and experts like Bright and Topol predict resistance to the antiviral in the future. SARS-CoV-2 also mutates less often than the flu, and there’s a universal flu vaccine now in a Phase 1 clinical trial.

“It’s beyond discouraging, especially since I know that we can prevail. And I say that because of what we’ve learned with flu,” Topol said. The “target of this virus is so much easier. Even though it mutates, it’s nothing compared to flu. What’s encouraging is we’ve got a drug Paxlovid that makes Tamiflu look like a joke. I am very encouraged by the science that we can prevail. It’s just that we’re not doing it.”


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