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As the BA.5 variant spreads, the risk of covid reinfection increases

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America has decided the pandemic is over. The coronavirus has other ideas.

The latest ommicron offshoot, BA.5, has quickly become dominant in the United States, and thanks to its elusiveness in encountering the human immune system, it is causing a surge in cases across the country.

The size of that wave is unclear because most people test at home or don’t test at all. The Centers for Disease Control and Prevention reported an average of just over 100,000 new cases per day for the past week. But infectious disease experts know that the true number, which could be as many as a million, is vastly underestimated, said Eric Topol, a professor at Scripps Research who closely monitors pandemic trends.

Antibodies from vaccines and previous covid infections offer limited protection against BA.5, leading Topol calling it “the worst version of the virus we’ve seen.”

Other experts point out that, despite being hit by multiple rounds of increasingly contagious omicron subvariants, the country has not yet seen a dramatic spike in hospitalizations. About 38,000 people nationwide have been hospitalized with covid since Friday, according to data from The Washington Post. That figure has been rising steadily since early March, but remains well below the record of 162,000 patients hospitalized with covid in mid-January. The average daily death toll on Friday stood at 329 and has not changed significantly in the past two months.

Tracking US covid-19 cases, deaths and other statistics by state

There is broad agreement among infectious disease experts that this remains a dangerous virus, causing illnesses of unpredictable severity – and they say the country is not doing enough to limit its transmission.

Restrictions and mandates are long gone. Air traffic is almost back to pre-pandemic levels. Political leaders don’t talk about the virus – it’s pretty much a non-issue on the campaign trail. Most people are done with masking, social distancing and the pandemic in general. They take their chance 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 at all. We’re in a very peculiar place, where the risk is alive and it’s out there, but we’ve let our guard down and we’ve consciously chosen to expose ourselves and make ourselves more vulnerable.”

Angela Rasmussen, a virologist at the University of Saskatchewan, would like to see more funding for testing and vaccine development, as well as stronger messages from the Biden administration and top health officials. She was recently stunned on a trip to Southern California, where she saw few people wearing masks at the airport. “This is what happens when you don’t have politicians and leaders who take a strong stance on this,” she said.

The CDC said it has urged people to monitor community transmission, “keep up to date with vaccines and take appropriate precautions to protect themselves and others.”

Covid deaths no longer overwhelming among the unvaccinated as the toll on the elderly grows

Nearly one-third of the U.S. population lives in counties rated as “high” transmission levels by the CDC. Cases are on the rise, especially in the south and west.

Many people now see the pandemic as part of modern life rather than an urgent health emergency. Part of that is simply a widespread reassessment of risk. This is no longer spring 2020. Few people remain immunologically naive to the virus. They can still get infected, but the immune system — primed by vaccines or previous attacks 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 the flu or other infectious diseases. Officials have warned of a potential fall or winter wave — perhaps as many as 100 million infections in the United States — that could flood hospitals with Covid patients. In addition to the immediate suffering of such a massive outbreak, there could be economic disruptions if tens of millions of people become too ill to work.

“It feels 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. She wears a quality mask on airplanes, but does not wear a mask at the gym. She’s worried she’ll get covid again – she caught it during the ommicron wave last winter. But she doesn’t think a ‘zero covid’ strategy is plausible.

“I feel like there’s a very limited amount I can do individually, other than putting my life down,” Carnethon said. “It’s risky. I get covid at an inopportune time. I can hope it’s milder than the first time I caught it.”

A lot experts concerned about ongoing transmission also have: pushed back online terrifying and apocalyptic warnings about the virus; people don’t routinely get infected every two or three weeks, Rasmussen said.

Population-level immunity is one of the reasons the virus remains in overdrive. The risk of reinfections is increased because newly emerging subvariants are better able to evade the frontline defenses of the immune system, and there is essentially no community-level effort to limit transmission.

They got covid. Then they got it again.

Al-Aly, who is also head of research and development at Veterans Affairs St. Louis Health Care System, has searched the VA’s massive database to see what happened to the nearly 39,000 patients infected with the coronavirus for the second or third time. What he found was sobering. In a paper posted 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 the later illnesses are worse than, or even as bad as, earlier cases. But every coronavirus infection carries risks, and the risk of a really bad outcome — a heart attack, for example — builds up cumulatively, like a plaque, as infections multiply.

“Reinfection adds risk,” he said. “You’re rolling the dice again. You play 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 blew through the largely vaccinated population with astonishing ease last winter, and since then the subvariants have arrived in rapid succession, starting with BA.2 and BA.2.12.1 in the spring, and now BA.5 and its nearly identical relative BA.4.

Vaccines are based on the original strain of the virus that emerged in Wuhan, China at the end of 2019. The Food and Drug Administration has asked vaccine makers to come up with new formulas that target BA.5 and BA.4. Those boosters could be ready this fall.

But there’s no guarantee that these newest sub-variants will still be dominant four or five months from now. The virus isn’t just evolving, it’s evolving at a remarkable speed. The virus can constantly outperform vaccines.

“I worry that by the time we have a vaccine for BA.5, we’ll have a BA.6 or a BA.7. This virus continues to outsmart us,” Al-Aly said.

The lucky ones who never get the coronavirus can teach us more about it

“We are in a very difficult position regarding the vaccine choice for the fall as we are dealing with a notoriously moving target,” Anthony S. Fauci, President Biden’s top adviser on the pandemic, told in June. to The Post, a few days before he too announced he was sick with the virus.

There is already another ommicron subvariant that has caught the attention of virologists: BA.2.75. First spotted in India last month, it has been identified in a few other countries, including the United States. But it’s too early to know if it will overtake BA.5 as the dominant variant.

There is no evidence that the new forms of the virus lead to other symptoms or severity of the disease. Omicron and its many offshoots — including BA.5 — tend to replicate higher in the respiratory tract than earlier forms of the virus. That’s one theory why ommicron seems less likely to cause serious illness.

It’s also unclear whether these new variants will change a person’s risk of developing the long-lasting symptoms commonly known as “long covid.” The percentage of people with severely debilitating symptoms is probably between 1 and 5 percent — representing 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 not sufficiently vigilant about the disease. She is often the only person masking herself in a crowd, she said.

“I understand the pandemic fatigue, but the virus is not done with us yet,” she said. “I fear that current human behavior is leading to more people becoming infected and getting covid for a long time. I fear that this situation could lead to a large number of people with disabilities and chronic health problems in the future.”

The precocious nature of the virus has made infectious disease experts wary of predicting the next phase of the pandemic. Topol warns that a new batch of variants could be out of the blue, in the same way that omicron unexpectedly showed up last November with a stunning collection of mutations already packed together. The exact origin of Omicron is unknown, but a leading theory is that it evolved in an immunocompromised patient with an ongoing infection.

“It was inevitable that we might see a new Greek font family like omicron,” Topol said. “There is still room for this virus to evolve. It has been evolving at an accelerated pace for months now. So we have to count on that.”

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