The latest sub-variant of the new coronavirus, which has become dominant in Europe, the United States and elsewhere, is also in many ways the worst yet.
The BA.5 sub-variant of the main Omicron variant appears to be more infectious than any previous form of the virus. It’s also apparently better at evading our antibodies, which means it may be more likely to cause breakouts and re-infections.
Vaccines and boosters are still the best defense. There are even Omicron-specific booster shots in development that in the coming months could make the best vaccines more effective against BA.5 and its genetic cousins.
Still, BA.5’s continued madness halfway across the planet is a stark reminder that the COVID pandemic is far from over. “We’re not done yet, by any means,” Eric Topol, founder and director of the Scripps Research Translational Institute in California, wrote on his Substack.
High levels of at least partial immunity from vaccines and past infections continue to prevent the worst outcomes—mass hospitalization and death. But worldwide, the untreated number of cases is growing, with serious consequences for potentially millions of people who face an increasing risk of long-term illness.
Equally worrying is that the latest wave of infections is giving the coronavirus the time and space it needs to mutate into even more dangerous variants and sub-variants. “Developing options is now a freight train,” Irwin Redlener, founding director of Columbia University’s National Center for Disaster Preparedness, told The Daily Beast.
In other words, unstoppable.
BA.5 first appeared in viral samples in South Africa in February. By May, it was dominant in Europe and Israel, displacing earlier forms of the main variant of Omicron, while also causing global daily cases of COVID to rise from around 477,000 per day in early June to 820,000 per day this week .
By late June, the BA.5 had become dominant in the United States. Cases have not yet increased, with the average daily number hovering around 100,000 since May. But that could change in the coming weeks as the BA.5 continues to outpace the less portable sub-variants.
Topol offered a brief explanation for the dominance of BA.5. Where the mutations that created many earlier variants mostly affect the spike protein—the part of the virus that helps it latch onto and infect our cells—BA.5 has mutations throughout its structure. “The BA.5 is quite different and very relevant, representing a significant difference from all previous variants,” writes Topol.
Widespread mutations of BA.5 have made the subvariant less recognizable to all those antibodies we have built up from vaccines, boosters and past infections. BA.5 has managed to slip out of our immune system like a ninja, contributing to the rising rate of breakthrough cases and re-infections.
This comes as no surprise to epidemiologists, who have warned for months that persistently high disease rates — which they attribute in large part to a staunch anti-vax minority in many countries — will facilitate increasingly infectious and evasive variants and sub-variants. The more infections, the more chance of significant mutations.
A young child receives a Moderna vaccination against COVID-19 at Temple Beth Shalom in Needham, Mass., on June 21, 2022.
Joseph Prezioso/AFP/Getty
In that sense, BA5 could be a preview of the coming months and years. A year ago, we had a chance to block the main transmission vectors of SARS-CoV-2 through vaccines and social distancing.
But we didn’t. Restrictions on businesses, schools and crowds have become politically toxic around the world. Vaccination rates remain stubbornly low, even in many countries with easy access to injections. In the US, for example, the percentage of fully vaccinated people has stopped at about 67 percent.
So, COVID lingered 31 months after the first case was diagnosed in Wuhan, China. The longer the virus circulates, the more variants it produces. BA.5 is the almost inevitable result of this tragic dynamic.
The situation is not entirely hopeless. Yes, BA.5 appears to reduce the effectiveness of the best messenger RNA vaccines. Vaccine maker Moderna released data showing that the booster it is developing specifically for Omicron and its progeny works only a third as well against BA.5 as earlier subvariants.
But vaccines, boosters, and past infections still offer significant, albeit reduced, protection against BA.5. “Even an amplification of the original genome or a recent infection will do it [produce] some cross-protective antibodies to reduce the severity of a new Omicron subvariant infection,” Eric Bortz, a virologist and public health expert at the University of Alaska Anchorage, told The Daily Beast.
The more extra strokes you get on top of the base course, the better protected you are. Probably the best protection is obtained from two primary injections of the mRNA vaccines from Pfizer or Moderna plus several boosters. “Take your goddamn fourth shot!” Redlaner said.
The problem in the United States is that only people 50 or older or with certain immune disorders qualify for a second booster. And the U.S. Food and Drug Administration won’t say if or when it might approve second boosters for younger people. “I don’t have anything to share at this time,” an FDA spokesperson told The Daily Beast when asked about boosters for under-50s.
A girl receives a COVID-19 test at a testing station on July 7, 2022 in Shanghai, China.
Hugo Hu/Getty
This is an obvious bureaucratic error. Nearly one million booster doses are about to expire in the US, all because of a lack of takers. “A profound loss that should be extended to all people under the age of 50 seeking additional protection,” Topol wrote.
To be fair, Pfizer and Moderna are working on new boosters that they have tailored specifically for the Omicron sub-variants. On June 30, an FDA advisory board approved these variant-specific boosters. The FDA has announced that it may approve them for emergency use by some Americans as early as this fall.
But there is a risk that these hits will show up too late, especially if they are highly optimized for only one recent sub-variant and therefore ineffective against future sub-variants. “Chasing options is the wrong approach,” Topol writes. “By the time the BA.5 vaccine booster is potentially available, who knows what the predominant strain will be?”
Fortunately, there are backup options. Masks and voluntary social distancing, of course. Post-infection therapies, including the antiviral drug paxlovid, also help. “This is not the time to abandon non-pharmaceutical intervention,” Redlener emphasized.
But voluntary mask wearing and paxlovid are bandages on a festering global wound. The rise in BA.5 infections set the stage for the next major sub-variant—BA.6, if you will. It could be even worse.
It’s looking increasingly likely that COVID will be with us, well, forever. “COVID is becoming like the flu,” Ali Mokdad, a professor of health indicators at the University of Washington Institute of Health, told The Daily Beast.
That is, endemic. A constant threat to public health. The big difference, of course, is that COVID is much more dangerous than today’s flu. And it continues to mutate in ways that make it even worse.
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