“The BA 4 and BA 5 variants have the potential to cause another major surge, especially with the general decline in the use of public health protective measures.”
By: Jeoffry B. Gordon, MD, MPH and Michael J. Passarini
The United States has been in a deceptive period of SARS-CoV-2 disease control since mid-March. There is a general sense that the pandemic is petering out. Current governmental policy has been shaped less by pandemic preparedness, building public health capacity and transparent education of the public, than by cutting new COVID funding, pandemic fatigue, commercial business imperatives, and occasionally loud public hostility to wise public health measures. Responsible officials have not prepared us for the possible risks and dangers which lie ahead.
The aggressiveness of the Omicron variants has been impressive. For instance, nearly half of the 10 million COVID cases in California have been officially reported since Dec.1, 2021 when the ultra-transmissible Omicron made its presence known. Vaccinations are still crucially important. According to the latest state data, unvaccinated Californians are 500 percent more likely to get COVID-19 than their vaccinated and boosted counterparts. They also are 800 percent more likely to be hospitalized with COVID-19, as well as to die from the disease. According to the CDC it only took 6 months since the new BA 4 and BA 5 Omicron variants first detected in Africa for them to cause the majority of new COVID infections in the USA. They could easily be 100 percent of new infections in July. The rapid increase of BA.4 and BA.5 infections seems to stem from their proven enhanced transmissibility and immune escape. This variant’s genetic changes make infection easier even after prior vaccinations, boosters and infections with Omicron and other variants. Ominously, BA.5 has a faster growth rate (doubling time) and replaces prior variants quicker than any earlier variant. Each Omicron COVID patient is likely to infect 10 people (Ro = 10), BA.5 is said to be 50% more infectious. According to French data BA 4 and BA 5 infection causes more acute symptoms which last longer than earlier variants, but does not produce as much severe illness and deaths. While the new variant’s impact appears less impressive to us because we are coming off a massive surge of the early Omicron variants, the BA 4 and BA 5 variants have the potential to cause another major surge, especially with the general decline in the use of public health protective measures. They have caused serious epidemics in South Africa, Australia, United Kingdom and Portugal. In the United States total COVID cases have increased 400 percent and hospitalizations have doubled since April 1st due to BA 2.12.1. Fortunately deaths have been steady at about 350 per day (still about 125,000 a year). Newly reported COVID cases and hospitalizations have been surging lately in Puerto Rico, Alaska, Colorado, Hawaii and several other states. The pandemic is not over.
BA 5 arrives against the background of a US with relatively low rates of vaccination over all, even lower rates of booster uptake and low residual immunity from previous infections. Some authorities predict this may allow up to 30 percent of the population to become infected or reinfected with BA.5. With the early SARS-CoV-2 variants mRNA vaccine was extraordinarily effective, preventing new infections and markedly decreasing hospitalizations and deaths. (There has not been enough time to develop reliable data on variant type or vaccine effect on long COVID.) However, given the enhanced capacity of the newer Omicron variants and the documented decline in vaccine effectiveness over time, the general vulnerability of everyone in the US is substantial. mRNA vaccinations based on earlier variants, even after 2 boosters, are less effective at preventing Omicron COVID infection, but do markedly reduce serious illness and deaths. Many people who escaped infection for over 2 years have become ill with Omicron. Recently, some have had 2 or 3 separate COVID infections. The Food and Drug Administration announced that it expects the fall boosters would include a component from BA.4 and BA.5. The effectiveness of future spike specific vaccines is limited, as by the time they are created and tested the virus has had the time and capacity to evolve a new escaping variant. Recently Pfizer and BioNTech have announced they are developing a universal coronavirus vaccine.
It seems reasonable to predict a new, and perhaps deadlier, surge is on the way. The People’s CDC decries the complacent posture of most state and federal authorities, and the oppositional priorities of several courts in opposing, neglecting, and failing to build out a modern, national public health infrastructure to protect us all. Meanwhile, we encourage you to continue to use layers of protection to reduce risk as the future course of the pandemic is both uncertain and drought with possible danger.