The Remarkably Fast-Evolving Virus Leaves Me Unsettled

We are sick and tired of hearing about COVID-19 and the still present possibility of getting sick from the virus, which has yet to settle into an endemic state.
   
Uncertainty can be hard to bear. As Americans rightfully celebrate the recent steep decline in COVID-19 cases, hospitalizations, and deaths, we hope for continued low viral spread. Lately, that decline has plateaued in the U.S. and locally, as we have begun to experience sustained upticks in infections. Reopening has played some part in this reversal and so has BA.2, the subvariant of Omicron BA.1 that is now dominant here.
   
We all know how contagious Omicron BA.1 was, infecting approximately 50% of Americans last winter in fewer than ten weeks. Epidemiologists had never seen a virus burn through a population so fast. With BA.2 now responsible for greater than 72% of all new COVID-19 infections in our country, it is sobering that this highly mutated Omicron subvariant is even 40% more infectious than its parent BA.1.

Thankfully, BA.2 is similar to BA.1 in that it does not cause more severe disease than its parent when people with normally functioning immune systems get infected. Unlike the original SARS-CoV-2 virus and its Alpha, Beta, and Delta variants, both Omicron variants usually affect the nose and throat of infected people rather than causing pneumonias and deadly cytokine storms in the lungs.
   
So, what can experts predict about COVID-19 in the coming months and year?
   
It is still too early to know whether the U.S. will soon experience a large surge from BA.2 as has already happened in Europe, Hong Kong, and elsewhere. We are at risk because, unlike other Western countries, only two-thirds of Americans are fully vaccinated, and of that group, just 45% have received a first booster shot.

Unfortunately, BA.2 is different enough from BA.1 that only one of the early treatment monoclonal antibodies—bebtelovimab—is still beneficial. On the plus side, we are entering the warmer months when people will congregate more outdoors, and immunity to BA.1 appears to protect against BA.2. Most Americans likely have that immunity either from a BA.1 infection or through boosting, or both.
   
By May or early June at the latest, scientists must decide on the composition of a fall booster shot by estimating which variants of the virus it needs to protect against. There’s the rub.
   
Unlike the endemic flu virus, which is more predictable (in terms of numbers of cases, timing, and likely mutation directions), permitting scientists to plan vaccines more accurately six months ahead, SARS-CoV-2 is not yet predictable. First, it changes its genetic composition about four times faster than the flu virus, and vaccine planning against a fast-moving target is difficult.

Second, while the virus causing COVID-19 can descend step-wise as it did from Omicron BA.1 to Omicron BA.2, it also remains subject to huge and unpredictable genetic jumps. Such a leap took place when Omicron BA.1 appeared, seemingly out of nowhere, and replaced Delta. Those genetic jumps may be descended from distant COVID-19 cousins that are out there spreading among the worldwide majority of humans who are unvaccinated.

This is what happened last fall and winter, resulting in high rates of sickness and death that could not have been anticipated. One reason that Omicron BA.1 cases surged to such record highs is that BA.1 was able to evade immunity from previous infections with earlier variants. Thankfully, being fully up-to-date with vaccinations protected people from getting seriously ill, needing hospitalization, or dying, though not from getting breakthrough infections. Should there be another large genetic evolutionary jump like the leap from Delta to Omicron BA.1, scientists planning an Omicron-specific booster shot for the fall might be far off base.
   
Further ahead, and understanding that the SARS-CoV-2 virus will continue to mutate fast, we can hope that it keeps spawning any new variants from Omicron rather than leaping to a totally novel and potentially more serious variant. It is good to know that virologists observe and analyze these changes continuously.
   
Without a clear-cut path forward, it is wise to follow current recommendations for vaccinations and booster shots, including the recent advice that Americans over age 50 and others aged 12 and above with compromised immune systems get a second booster shot four months or more after their first ones. We also need to reduce viral transmission here and globally so that SARS-CoV-2 cannot find more opportunities inside infected people’s bodies to mutate in possibly dangerous ways.
   
The bottom line for me is to prevent serious disease (vaccinate and boost), to protect the vulnerable (respect the mask), and when exposed to COVID-19 or feeling ill—even with common colds and sore throats—(test-to-treat). For more COVID-19 information and to find vaccines, masks, tests, and treatments, visit http://www.covid.gov

Barbara Hemmendinger, MSS, a member of the Lycoming County Health Improvement Coalition and a retired family medicine educator, belongs to Let’s end COVID!, a group of concerned people in northcentral PA working to overcome the COVID-19 pandemic through, education, outreach, and mitigation.
Published: 4/16/22

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