As Americans have shed their protective masks and resumed the pre-pandemic level of summer travel, COVID-19 continues to tell us that it is not done. Since May, the seven-day average of US hospitalizations has doubled. The reported daily case number has increased to greater than 130,000. This number represents an undercount considering the significant number of positive unreported home tests being performed. Cases are rising in more than 40 states. The reported 14-day in cases are up 16%. Over this time interval hospitalizations are up 19% and COVID-19-related ICU usage is up 23%. COVID-19 deaths which had remained steady, or even decreasing for a number of weeks, have increased 11% over the last 14 days.
These cautionary statistics are being driven by the Omicron BA.5 subvariant, which now comprises 65% of the sequenced SARS-Cov-2 viruses causing disease in the USA. Another subvariant, BA.4, causes another 15% of our COVID-19 infections. The BA.5 is the most transmissible version of the virus that the world has experienced. Its arrival and now dominance on our shores follows a trend that what happens in Europe is coming to the United States. Cases in Europe have risen 70 percent over the last 14- day period ending July 4th. Researchers on both sides of the Atlantic are reporting a phenomenon called “immune escape.” This means that vaccinations and previous infection do not fully protect against this variant. Fortunately, the clinical severity of the disease caused by this subvariant mutation is generally less. The BA.5 was first identified in Portugal and South Africa before popping up in South America, Asia Pacific, and then Europe. Several European countries are taking precautions. Cyprus has reinstated mask mandates. This small Mediterranean island joins Austria, Great Britain, Germany, Greece, Italy, and Switzerland as world-designated COVID-19 hotspots. On the American home front, the cities of New York and Los Angeles recommend that masks be worn indoors.
Recall that viruses can only mutate when they replicate. We in the US have vaccines available but are not using them. We rank 67th in the world when it comes to being boosted. Only a third of eligible Americans have received their booster shots. Even our mature adults and elderly are lagging behind their eligibility. In the age group 65+, the fully vaccinated rate is a wise 92%, although 1st booster rate is 64% and 2nd booster rate is a paltry 22%. For the 50–64-year age group, the fully vaccinated rate is 82%, with the 1st booster rate being 45% and the 2nd booster rate is only 9%. Allow me to reemphasize that even the current boosters provide significant protection against severe disease and death. I encourage everyone to follow the CDC vaccination recommendations available at https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html#recommendations. In summary, you should be fully vaccinated if you are over 6 months of age, get one boost if you are over 5 and under 50 years old, and get a second booster if you are 50 years or over (or between 12 and 50 years old and moderately or severely immunocompromised).
Again, we are faced with a summer surge and the promise of an unpredictable fall and winter. Vaccine manufacturers are making plans for even more variant-specific vaccines. FDA and CDC approval for 2nd booster doses for everyone under the age of 50 is in the works. The availability of boosters and vaccinations only helps if we are willing to roll up our sleeves and get jabbed.
As this new BA.5 subvariant continues its march we can still be proactive and protect ourselves by utilizing the readily available home testing. The test kits are free at your pharmacy if you are on Medicare and with other insurance companies as well. Test early if you are symptomatic so that you can get started on Paxlovid (anti-viral pill) available by doctor’s prescription now, and possibly soon directly by a pharmacist.
Do your part to protect our health. Pandemic fatigue must not become the ruler over science. Get vaccinated, boosted, know your community’s COVID-19 level, and mask when appropriate. Sooner or later, we may face a variant that has the lethality of last year’s Delta and the transmissibility of Omicron, or just maybe something worse?
Clyde E. Henderson, MD
Cincinnati Medical Association