Comment Unlock This article is free to access. Why; America has decided that the pandemic is over. The coronavirus has other ideas. The latest omicron offshoot, BA.5, has quickly become mainstream in the United States, and thanks to its difficulty in dealing with the human immune system, is causing a wave of cases across the country. The magnitude of this surge is unclear because most people test at home or don’t test at all. The Centers for Disease Control and Prevention last week reported just over 100,000 new cases a day on average. But infectious disease experts know that wildly underestimates the true number, which could be as high as a million, said Eric Topol, a professor at Scripps Research who is closely tracking pandemic trends. Antibodies from vaccines and previous Covid infections offer limited protection against BA.5, leading Topol to call it “the worst version of the virus we’ve seen”. Other experts point out that despite being hit by multiple rounds of increasingly contagious micron subvariants, the country has yet to see a dramatic increase in hospitalizations. About 38,000 people have been hospitalized nationally with Covid since Friday, according to data compiled by the Washington Post. That number has been rising steadily since early March, but remains well below the a record 162,000 patients hospitalized with covid in mid-January. The average daily death toll on Friday stood at 329 and has not changed significantly over the past two months. Track US covid-19 cases, deaths and other metrics by state There is broad agreement among infectious disease experts that this remains a dangerous virus that causes disease of unpredictable severity — and they say the country is not doing enough to contain transmission. Restrictions and orders are long gone. Air travel is almost back to pre-pandemic levels. Political leaders they don’t talk about the virus — it’s essentially a non-issue on the campaign trail. Most people are done with the mask, social distancing and the pandemic in general. They take their chances with the virus. “It’s the wild west out there,” said Ziyad Al-Aly, an epidemiologist at Washington University in St. Louis. “There are no public health measures. We’re in a very strange place where the danger is alive and well out there, but we’ve let our guard down and chosen, deliberately, to expose ourselves and become more vulnerable.” Angela Rasmussen, a virologist at the University of Saskatchewan, would like to see more money for vaccine testing and development, as well as stronger messaging from the Biden administration and top health officials. She was dismayed recently on a trip to southern California where she saw few people wearing masks at the airport. “That’s what happens when you don’t have politicians and leaders taking a strong stand on this,” he said. The CDC said it urged people to monitor community transmission, “stay up to date on vaccines and take appropriate precautions to protect themselves and others.” Covid deaths are no longer overwhelming among the unvaccinated as the number of elderly people rises Nearly one-third of the US population lives in counties rated as having “high” levels of transmission by the CDC. Cases are increasing especially in the south and west. Many people now see the pandemic as part of the fabric of modern life rather than an urgent health emergency. Some of it is just a broad recalibration of risk. It is no longer the spring of 2020. Few people remain immunologically naive to the virus. They can still get infected, but the immune system—primed by vaccines or previous bouts with the virus—generally has deeper layers of defense that prevent serious illness. But the death rate from Covid-19 is still much higher than the death rate from influenza or other communicable diseases. Officials have warned of a possible fall or winter surge — perhaps as many as 100 million infections in the United States — that could flood hospitals with Covid patients. Beyond the immediate inconvenience of such a massive outbreak, there could be economic turmoil as tens of millions of people become too sick to work. “It’s like everyone has given up,” said Mercedes Carnethon, an epidemiologist at Northwestern University Feinberg School of Medicine. Carnethon said she’s also not as careful as she used to be. He wears a high-quality mask on airplanes, but he doesn’t wear a mask in the gym. He’s worried he’ll get Covid again – he caught it during the Omicron wave last winter. But he doesn’t think a “zero Covid” strategy is plausible. “I feel like there’s a very limited amount I can do individually without ending my life,” Carnethon said. “It is dangerous. I will catch Covid at an inconvenient time. I can only hope it’s milder than the first time I caught it.” Many experts concerned about continued transmission pushed back against cyber terrorism and apocalyptic warnings about the virus. People don’t usually get infected every two or three weeks, Rasmussen said. Population-level immunity is one reason why the virus remains mutated. The risk of reinfections has increased because newly emerging subvariants are better able to evade the immune system’s first-line defenses and there is virtually no effort at the community level to limit transmission. They got covid. Then they took it again. Al-Aly, who also heads research and development at Veterans Affairs St. Louis Health Care System, has scanned the vast VA database to see what happened to the nearly 39,000 patients who were infected with the coronavirus for a second or third time. What he found was disappointing. In an article published online last month but not yet peer-reviewed or published in a journal, Al-Aly and his co-authors reported that people with multiple infections have a higher cumulative risk of serious illness or death. It is not that later diseases are worse than, or even as dangerous as, earlier cases. But any coronavirus infection carries risks, and the risk of a really bad outcome — a heart attack, for example — builds cumulatively, like a plaque, as infections multiply. “Recontamination adds risk,” he said. “You roll the dice again. You’re playing Russian roulette.” Vaccination remains an important, if still underused, weapon against the virus — even if it is not as effective at stopping new infections. Omicron overcame the largely vaccinated population last winter with surprising ease, and has since Subvariants have arrived in rapid succession, starting with BA.2 and BA.2.12.1 in the spring, and now BA.5 and its near-identical relative BA.4. The vaccines are based on the original strain of the virus that emerged in Wuhan, China in late 2019. The Food and Drug Administration has asked vaccine makers to come up with new formulations that target BA.5 and BA.4. These boosters could be ready this fall. But there’s no guarantee that these latest subvariants will still be dominant four or five months from now. The virus not only evolves, but it does so with remarkable speed. The virus can continually outwit vaccines. “I’m worried that until we have a vaccine for BA.5 we will have a BA.6 or a BA.7. This virus continues to overtake us,” Al-Aly said. The lucky few who never contract the coronavirus could teach us more about it “We’re in a very difficult position in terms of vaccine selection for the fall because we’re dealing with a notoriously moving target,” Anthony S. Fauci, President Biden’s top adviser on the pandemic, told The Post in June . a few days ago, he also announced that he was sick with the virus. There is already another minor variant of omicron that has caught the attention of virologists: BA.2.75. First appearing last month in India, it has been spotted in several other countries, including the United States. But it’s too early to know if it will overtake the BA.5 as the dominant variant. There is no evidence that the new forms of the virus lead to different symptoms or severity of the disease. Omicron and its many offshoots — including BA.5 — typically replicate higher in the respiratory tract than earlier forms of the virus. This is one theory as to why the omicron seemed less likely to cause serious illness. It is also unclear whether these new variants will change a person’s risk of developing the long-term symptoms commonly known as “long-lasting covid”. The percentage of people with severe debilitating symptoms is likely to be between 1 and 5 percent — that’s millions of people in this country, according to Harlan Krumholz, a professor of medicine at Yale University. His colleague, Akiko Iwasaki, a professor of immunology and an expert on long-term Covid, said in an email that she believes the world is no longer vigilant enough about the disease. He is often the only person hiding in a crowd, he said. “I understand the pandemic fatigue, but the virus is not done with us,” he said. “I fear that current human behavior is leading to more people becoming infected and getting long-term Covid. I fear that this situation may lead to a large number of people with disabilities and chronic health problems in the future.” The early nature of the virus has made infectious disease experts cautious about predicting the next phase of the pandemic. Topol warns that a new batch of variants could come out of the blue, in the same way that omicron unexpectedly appeared last November with a surprising collection of mutations already packaged together. Omicron’s exact origins are unknown, but a leading theory is that he evolved into an immunocompromised patient with a persistent infection. “Inevitably we could see a new family of Greek letters like the omicron,” Topol said. “There is still room for this virus to evolve. It has been evolving in an accelerated fashion for months. So we have to count on that.”
