Leana S. Wen, M.D. (Twitter photo)
By Dr. Leana S. Wen, for The Washington Post
A new variant of the coronavirus, even more contagious than previous strains, is now dominant in the United States. But rising cases should not prompt calls for most Americans to hunker down or policymakers to reimpose restrictions. Instead, the rapid spread of the BA.5 omicron subvariant is a window into what the future with this coronavirus looks like.
We’ve seen this pattern before. The original omicron variant was more contagious than the delta variant before it and quickly became dominant last winter. There was a brief lull, after which that strain was replaced by a more contagious subvariant, BA.2. Infections caused by BA.2 have started decreasing, just in time for subvariants BA.4 and BA.5 to take over.
BA.5 now constitutes 65 percent of all infections in the United States. This should not be surprising. New variants are cropping up all the time, with more contagious strains displacing previous ones.
Lulls followed by surges are the new normal. Instead of reacting with alarm, health officials should set the expectation that as long as hospitals are not overwhelmed and vaccines still work to prevent severe illness, policies should focus on minimizing disruption to daily life.
Virologist and pediatrician Paul Offit agrees. Offit is the director of the Vaccine Education Center at Children’s Hospital of Philadelphia and a member of the Food and Drug Administration’s influential Advisory Committee on Vaccines. He told me in an interview that this coronavirus “will be here for my lifetime, my children’s lifetimes, and their children’s lifetimes.” He added, “We can’t keep forever masking and quarantining to prevent asymptomatic infection; we have to accept mild illness as a part of life with Covid-19.”
His goal, which I share, is to prevent people from becoming severely ill. For most people, vaccines are doing that well, including against BA.5. Hospitalizations are increasing, but they are about one-fifth of the peak of the first omicron wave. Since the true number of infections could be up to 10 times higher than the reported number, this means vaccines are doing their job and decoupling infection from severe illness.
It’s unreasonable to ask Americans to forgo traveling, going to restaurants or attending weddings to prevent what for most people will likely be mild illness. As I’ve argued before, government-imposed restrictions — including mask mandates — should be reserved for dire emergencies, which we are not in now. Instead, officials should scale up interventions that have broad support, such as testing, treatment and improved ventilation.
Resources should especially be directed to help those most vulnerable to severe outcomes from covid-19. Among those 65 and older who received the original two doses, about 30 percent have not yet had their first booster. And of those who did, only 34 percent received a second booster. We are also failing to use other tools to their fullest extent, such as the preventive antibody Evusheld and antiviral treatments including Paxlovid — all of which are effective against BA.5. This must change.
In the meantime, we need urgent investment in better vaccines, specifically a pan-coronavirus vaccine that will work across all strains, and nasal vaccines that reduce virus transmission. We need an “Operation Warp Speed Part 2” to expedite development of vaccines and additional therapeutics to treat Covid and long-haul symptoms.
This is not to say that those at low risk of severe disease should forgo precautions. Even if they are vaccinated and boosted or previously had Covid-19, there is a good chance they could contract BA.5. Without precautions, the incredible transmissibility of emerging variants means people might get Covid multiple times a year going forward.
Every time people are infected with the virus, they could end up with long Covid. Some will say this is precisely why they want to keep avoiding this coronavirus. They can continue strict precautions, including asking others to test before gathering and wearing a high-quality mask in indoor spaces. Others will say they are done; they don’t want to pay the increasingly high price to avoid Covid. Many will choose something in between; they won’t limit their activities, but they will keep up-to-date with boosters, mask in crowded places and test before visiting vulnerable relatives.
Offit explains that the definition of a pandemic includes changing the way we live, work and play. “We determine when the pandemic is over,” he said. “Based on people’s behavior, it seems like most of the country has decided that’s happened already.”
I don’t think the pandemic is over. This coronavirus could have many more surprises in the years ahead. This fall, or the next, a new variant could emerge that’s much more lethal and that does not respond to existing vaccines and treatments. Health officials need to preserve their credibility to call for an emergency response when it’s truly needed. That time is not now with the BA.5 variant.
Leana Wen is a professor at George Washington University‘s Milken Institute School of Public Health, former Baltimore health commissioner, and author of Lifelines: A Doctor’s Journey in the Fight for Public Health.