An earlier spike in cases this year was driven by the BA.2 Omicron sub-variant. Now the US Centers for Disease Control and Prevention reports that two other subtypes, BA.4 and BA.5, account for more than 70% of new infections in the country. These subvariants can partially escape the immunity created by the vaccine and by a previous infection, although vaccination still likely protects against severe disease.
These developments come as more people resume travel and other pre-pandemic activities. How should people think about their risk of Covid-19 right now? If they are vaccinated and boosted, are they safe? What about those who have recently had Covid-19? What precautions should people take if they still want to avoid Covid-19? And if someone tests positive for the coronavirus, does that person still need to self-isolate?
To help with these questions, I spoke with CNN medical analyst Liana Wen, MD, an emergency physician and professor of health policy and management at the Milken Institute School of Public Health at George Washington University. She is also the author of Lifelines: A Doctor’s Journey in the Fight for Public Health.
CNN: Do current Covid-19 trends indicate a new surge in cases in the United States?
Dr. Liana Wen: I’m not sure it would be called a new spike because the numbers haven’t really gone down since the previous spike. During the winter, from December 2021 to around February 2022, we saw a huge spike in cases from the original Omicron sub-variant, BA.1. There was a little lull; then BA.2 came along with this increase in cases. BA.4 and BA.5 now displace the previous Omicron subvariants and cause most of the infections in the US. Many places have seen an increase in infections from a high baseline 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 10 times more cases than are being reported given how many cases are diagnosed through home antigen tests and not reported to public health authorities.
The good news is that these recent spikes have not been accompanied by hospital overcrowding, illustrating the powerful effect of vaccines especially in separating infection from severe disease.
CNN: With these numbers, how should people think about their risk of Covid-19? Does this mean people should cancel travel and bring back restrictions?
Wen: I don’t think most people should change their daily activities, but I think people should be aware of the 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 severe disease. But we also know that immunity wanes over time and there seems to be some immunity (escape) with BA.4 and BA.5 in particular. This means that people who are vaccinated and boosted are unlikely to get seriously ill if they contract Covid-19, but they can still get infected.
The question people need to ask is this: 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 that avoiding infection requires extra attention. 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 contracting Covid-19 because of the risk of long-lasting symptoms. They may also have underlying medical conditions that themselves predispose them to more severe outcomes, or they may live with others who are more vulnerable and want to reduce the risk to those around them.
CNN: For people who want to be cautious, what do you recommend?
Wen: For people who want to prioritize reducing their risk of contracting Covid-19, I would advise that they first follow CDC guidelines and stay current on their boosters. Anyone over the age of 5 can get a first booster. Those 50 and older can get a second booster for a total of four shots. Some individuals (who are moderately or severely immunocompromised) may receive five vaccines. (These individuals should also find out if they are eligible for Evusheld, the preventive antibody that can further help reduce progression to severe disease.)
I would also advise them to wear a high quality N95 mask or equivalent in an indoor, crowded area. Removing mask-wearing mandates does not mean that people should not wear masks. Many people do not find masks uncomfortable. If that is the case, I would continue to wear masks in all indoor public places. For those who find masks uncomfortable, I would encourage wearing masks in the most risky settings – for example, a mask while in a crowded airport security line and during boarding and disembarking.
Of course, remember that outdoor gatherings continue to be much less risky than indoors. People who want to be very careful should try to go to outdoor gatherings if possible and then only go to indoor gatherings if everyone else tests negative that day.
CNN: A lot of people are sick of hearing about these precautions. What if they just want to live their lives but don’t want to infect vulnerable people?
Wen: I certainly understand that feeling. It is very difficult for society to impose restrictions on individuals and ask people to permanently put gatherings like weddings and birthdays on hold, or to give up activities they love, like closed restaurants and gyms. My best advice here is to recognize that if you go indoors, you can contract Covid-19. Be aware of the risk and take appropriate precautions.
For example, maybe you can live your life the way you want, but before you visit Grandma in a nursing home, take a quick quiz that day. If you go to a crowded indoor wedding, get tested a few days after to make sure you haven’t contracted the coronavirus. And if you have symptoms at any point, get tested immediately and don’t expose others around you.
CNN: Are you safe if you’ve recently had Covid-19?
Wen: Recent infection creates some protection that probably lasts about three months. However, reinfection can certainly occur, and some studies have shown that receiving the original Omicron BA.1 does not protect against newer variants. Vaccination in addition to recent recovery provides better protection, so make sure you keep up with your shots and boosters even if you’ve had Covid-19.
CNN: So what if you test positive — do you still have to self-isolate?
Ven: Yes, because you don’t want to spread Covid-19 to others. CDC guidelines are to isolate for five days and then wear a mask around others for another five days after that if symptoms improve. I think the testing policy is even better than that because people stay infected for different periods of time. I would encourage people to do home tests every day from day four and end isolation once their home rapid antigen test is negative. Now is the time to make sure you have plenty of homework!
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