The long-awaited summer lull in coronavirus cases does not appear to be happening as Covid-19 infections continue to rise across much of the United States.
An earlier increase in cases this year was due to the BA.2 Omicron subvariant. Now, the US Centers for Disease Control and Prevention reports that two other subvariants, BA.4 and BA.5, make up more than 70% of new infections in the country. These subvariants may partially escape immunity produced by the vaccine and by prior infection, although vaccination still likely protects against severe disease.
These developments come as more and more people resume travel and other pre-pandemic activities. How should people be thinking about their risk from Covid-19 right now? If vaccinated and boosted, are they safe? What about those who recently had Covid-19? What kind of precautions should people take if they still want to avoid Covid-19? And if someone tests positive for coronavirus, do they still have to self-isolate?
To answer these questions, I spoke to Dr. Leana Wen, CNN medical analyst, emergency physician and professor of health policy and management at George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health”.
CNN: Do current Covid-19 trends indicate that there is a new wave of cases in the United States?
Dr. Leana Wen: I’m not sure it would be called another surge because the numbers haven’t really come down from the previous surge. In winter, from around December 2021 to February 2022, we saw a huge increase in cases of the original Omicron sub-variant, BA.1. There was a little lull; then BA.2 came with this increase in cases. Now, BA.4 and BA.5 replace older Omicron subvariants and cause most infections in the United States. Many places are seeing an increase in infections from a high number of cases.
We should also keep in mind that the number of reported cases is much lower than the actual number of cases. I think we could have five to ten times more cases than reported, given the number of cases diagnosed by home antigen testing and not reported to public health authorities.
The good news is that these recent surges have not been accompanied by overwhelmed hospitals, illustrating the powerful effect of vaccines in primarily decoupling infection from severe disease.
CNN: With those kinds of numbers, how should people think about their risk from Covid-19? Does that mean people should cancel travel and bring back the restrictions?
Magnifying glass: I don’t think most people should have to change their daily activities, but I do think people should be aware of their risk of contracting Covid-19 if they don’t take extra precautions.
The good news is that vaccines and boosters continue to provide excellent protection against serious diseases. However, we also know that immunity wanes over time, and there seems to be some immunity (evasion) with BA.4 and BA.5 in particular. This means that vaccinated and boosted people are unlikely to become seriously ill if they contract Covid-19, but they could still be infected.
The question people should ask themselves is: how much do they want to continue to avoid infection? There are so many viruses around us and the variants are so contagious. This means avoiding infection requires extra care. Many people may no longer want to plan their lives around Covid-19 precautions, especially if they are generally healthy and well protected from serious illness.
On the other hand, many people may still prioritize not getting Covid-19 due to the risk of long-term symptoms. They may also have underlying medical conditions that predispose them themselves to more serious outcomes, or they may live with others who are more vulnerable and want to reduce their risk to those around them.
CNN: For people who want to be on the safe side, what do you recommend?
Magnifying glass: For people who want to prioritize reducing their risk of Covid-19 infection, I would advise them to first follow CDC guidelines and keep up to date with their recalls. Anyone aged 5 and over can receive a first booster. People 50 and older can get a second booster for a total of four injections.
Some people (moderately or severely immunocompromised) may receive five injections. (These people also need to know if they are eligible for Evusheld, the preventative antibody that can still help reduce progression to serious disease.)
I would also ask them to wear a high quality N95 mask or equivalent in indoor and crowded environments. Lifting mask mandates doesn’t mean people shouldn’t wear masks. Many people don’t find masks awkward. If so, I would continue to wear masks in all indoor public places. For those who find masks uncomfortable, I would encourage mask-wearing in high-risk environments – for example, mask-wearing during a crowded airport security line and during boarding and disembarking.
Of course, remember that outdoor gatherings continue to pose a much lower risk than indoors. People who want to be extra cautious should try to go to outdoor gatherings if possible, then only go to indoor gatherings if others all test negative that day.
CNN: A lot of people are tired of hearing about these precautions. What if they just want to live their life but don’t want to infect vulnerable people?
Magnifying glass: I certainly understand that feeling. It is very difficult for society to impose restrictions on individuals and ask people to suspend gatherings like weddings and birthdays forever or give up activities they love like restaurants and indoor gyms. My best advice here is to recognize that if you go inside you could contract Covid-19. Be aware of your risk and take precautions accordingly.
For example, maybe you can live your life the way you want, but before you visit Grandma in a nursing home, take a quick test that day. If you’re going to a crowded indoor wedding, get tested a few days later to make sure you haven’t contracted the coronavirus. And if you have symptoms at any time, test immediately and don’t expose others around you.
CNN: Are you safe if you recently had Covid-19?
Magnifying glass: A recent infection produces some protection that probably lasts about three months. However, reinfection can certainly occur, and some studies suggest that obtaining the original Omicron BA.1 does not protect against newer variants. Vaccination in addition to a recent recovery provides better protection, so make sure you are up to date with your vaccinations and boosters, even if you have had Covid-19.
CNN: What if you test positive — should you still self-isolate?
Magnifying glass: Yes, because you don’t want to spread Covid-19 to others. The CDC’s advice is that you self-isolate for five days, then wear a mask around others for an additional five days after that if symptoms improve. I think a testing policy is even better than that because people stay infected for different lengths of time. I encourage people to take home tests every day from day four and end isolation once their rapid home antigen test is negative. Now is the time to make sure you have plenty of home tests!
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