Repost from: The Morning Newsletter - The New York Times
The Covid virus has a Darwinian quality. As variants emerge, they compete with one another to become dominant. The most contagious variants tend to win the competition because they can spread more quickly. It’s survival of the fittest.
That is why the virus has become more contagious over time. Today, the most contagious form of Covid yet — the BA.5 subvariant — is spreading around the globe. “It looks as if we are unable to control it,” Dr. Charles Chiu of the University of California, San Francisco, told The Times.
In the U.S., cases have surged recently, as has the number of hospitalized patients with Covid (although some of them were admitted for other reasons and happened to test positive for the virus while in the hospital):
At the same time, I know that many readers aren’t sure how much attention to pay to Covid anymore. Most Americans are vaccinated, and the vaccines provide excellent protection against serious illness in a vast majority of cases. In a recent Times poll, fewer than 1 percent of Americans described Covid as the country’s most important problem.
“I’m actually pleased to see the pandemic is not top of mind,” Dr. Ashish Jha, President Biden’s Covid coordinator, told me. “It means we’re making progress. The last thing I want as the Covid response coordinator is for us to get back to the point where Covid dominates our lives in scary ways.”
Today’s newsletter offers a guide to thinking about BA.5, including what steps the U.S. can take to minimize its toll.
Powerful tools …
Throughout the pandemic, people have often conflated two different concepts: contagiousness and severity. The first involves how easily the virus spreads. The second involves how sick an average person tends to get once infected.
Both matter. A more contagious variant infects more people, increasing the number who get very sick even if the percentage of infected people who get very sick remains the same. A more severe variant, on the other hand, increases the percentage of cases that lead to bad outcomes.
But the two concepts are different. If the prospect of getting Covid hasn’t been dominating your life in recent months — because you’re boosted and not in a major risk group — a new variant doesn’t need to cause big changes to your behavior unless it’s more severe.
So far, evidence suggests that BA.5 does not cause more severe disease than other Omicron variants, as Chiu and other experts have said. Instead, the percentage of Covid cases leading to bad outcomes is declining.
Consider these comparisons: Covid cases have risen faster than hospitalizations (which, again, include many people with mild Covid who are hospitalized for other reasons). Hospitalizations, in turn, have risen faster than the number of Covid patients in the I.C.U. And deaths from Covid have barely risen.
One reason is the steady buildup of natural immunity, as more and more people have had the virus. Another factor is the availability of drugs like Evusheld (to help protect immunocompromised people before infection) and Paxlovid (to reduce severity in infected people). “We have the ability to protect ourselves,” Dr. Joseph Kanter, Louisiana’s medical director, said.
Paxlovid isn’t perfect. Many people find that it leaves a nasty taste, and rebound cases — in which people get sick again after taking the drug — are fairly common. But those rebound cases tend to be mild. As Jha said: “When you have people getting Paxlovid, they’re not ending up in the hospital. We know that it’s working.”
What about long Covid? It remains something of a mystery, and many experts hope that scientific research can eventually clarify what it is and how many people have it. Vaccines do seem to reduce the chances of having long-term symptoms, Jha said, and those symptoms seem to clear up within a few months in an extremely high percentage of cases.
Still, if even 2 percent of infections led to long-term problems, that would represent millions of people around the world, which is why more research is important. Until then, long Covid will resemble many other daily risks: Some people will largely ignore it, while others will try to reduce the risk (by wearing a mask indoors, for instance). Both approaches seem reasonable.
… not always used
The U.S., like many other countries, already has most of the tools it needs to defang BA.5. Unfortunately, many people are not using those tools.
Only about half of American adults have received a booster shot. Even fewer have received a second booster. (Anyone 50 and older is now eligible for one, and the Biden administration seems likely to expand eligibility soon.) Jha offers this rule of thumb: If you have not yet gotten a vaccine shot — of any kind — in 2022, consider getting one.
Many doctors, for their part, remain unaware of the evidence showing that Paxlovid and Evusheld make a difference. This slow adoption is typical for new drugs, but it’s costly in the case of Covid.
The hardest decisions are probably for people who are up-to-date on their vaccine shots and ready to take Paxlovid if they get sick, but still at risk because they have an underlying vulnerability, such as old age, cardiac problems or ongoing cancer treatment. In these instances, the BA.5 surge may call for more mask-wearing, skipping some indoor events or postponing travel. Longer term, it’s a reminder that medical research to find more effective vaccines and treatments continues to have the potential to save many lives.
The BA.5 surge is unlikely to lead to major new Covid rules, like mask mandates, even in most liberal cities that have previously been the fastest to adopt them. “You can’t just kind of cry wolf all the time,” Dr. Allison Arwady, Chicago’s health commissioner, told The Times. Most Americans are understandably tired of such mandates. It’s not even clear how well mandates have worked.
But Covid is still killing an alarmingly high number of Americans. The onset of BA.5 can offer a reminder that there is a middle ground between allowing Covid to dominate daily life and pretending that the pandemic is over. “We should not let it disrupt our lives,” Dr. Anthony Fauci, the top federal infectious disease official, said. “But we cannot deny that it is a reality that we need to deal with.”