An "extremely infectious" omicron sub-variant, BA.2, has the potential to unleash another deadly wave of COVID-19 infections in the United States. While the astonishingly infectious progeny of omicron has been making headlines as it spreads around the world, it just passed a grim milestone in the United States as it surpassed its parent variant to become the dominant variant stateside.
Previously limited in circulation, BA.2 circulated for months before overtaking other omicron variants in a matter of weeks. Yet BA.2 — or "stealth" omicron as it has been called — made up an estimated 54.9% of all new COVID-19 infections this past week, according to the US Centers for Disease Control and Prevention.
"The virus is evolving and adapting to us and if we adapt as it adapts, then we can control it instead of it controlling us," former CDC Director Dr. Tom Frieden, CEO of Resolve to Save Lives, told Salon.
The milestone for BA.2 is particularly bleak given that the omicron variant was already thought to be the most contagious virus to have ever existed among humans on Earth.
Emphasizing that there is no way to exactly predict future scenarios, Frieden believes another surge in the United States is likely.
"We certainly, will be seeing increase in cases," Dr. Anthony Fauci, the nation's top infectious disease expert, said on BBC's "Sunday Morning," this week.
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No evidence, however, indicates higher virulence — potential to cause disease — in BA.2. Just like the original omicron strain, the sub-variant is relatively mild, though it remains difficult to attribute that to the virus or natural immunity of a large majority of the population at this point.
"Our Achilles heel is the 15 million+ people over the age of 65 who are not up to date with vaccinations," Frieden explained. "They either haven't gotten a first or a second or a booster dose."
According to the CDC, there is a significant fall-off in vaccine efficacy without a booster dose. Protection against omicron and delta variant infection wears off quickly, perhaps within months, without a booster shot. In other words, boosters are crucial for people who are older or immunocompromised.
"The most important thing is to get the most vulnerable people vaccinated, because that's what's going to result in severe disruption and death hospitalizations," Frieden added. "If people are immunosuppressed or live with someone who's immunosuppressed or elderly or live with someone who's elderly, using an N95 mask when you're around others is something that should be considered. I don't think we will see lockdowns unless there is a new variant that's deadly and highly infectious, which could happen."
Without boosting vaccinations, a similarly high rate of infections in hospitals is likely to follow a large surge as has been observed in the United Kingdom, Denmark, and other countries around the world.
"Omicron is sweeping the globe," World Health Organization technical director Dr. Maria Van Kerkhove reported last week. "Whether or not we will see BA.2 sweep the world — we're seeing that happen right now. This is not a theoretical. Omicron is a highly transmissible variant of concern. BA.2 is more transmissible than BA.1, and what we are starting to see in some regions of the world, and in some countries, [is] an uptick in cases again."
The FDA's approval for a fourth vaccine among adults and a fifth in immunocompromised individuals four months after your last — a reasonable call according to Frieden — was followed by recommendations from the CDC and President Biden. That approval, in conjunction with President Biden's commitment to vaccinate older adults, could not come sooner.
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"I think what people recognize is there's really a lot we don't know still because how long it will take for immunity to wane requires time passing. And so we know some things from Israel and some things from the UK and elsewhere, but it will take time to learn more about this," Frieden said.
"CDC's FY 2023 President's Budget request is designed to address some of the most profound public health challenges we face today, while continuing the Administration's goal of revitalizing our fragile public health system to protect the health of all Americans and alleviate the substantial human and economic costs we've endured during this pandemic," said CDC Director Rochelle P. Walensky, MD, MPH.
The Northeast continues to have the highest incidence rate, with 70% of all cases, while the South and Rocky Mountain regions are seeing the fewest cases in the US.
"Really, we don't know what the future will hold, and that's why we need to be ready to adapt," continued Frieden. "That means strengthening public health, so we have better surveillance. That means strengthening our linkages with communities so that we can — for all communities: urban and rural, city and suburbs, right and left — we need to identify who are trusted messengers and what are trusted messages that are going to make a difference."
"We need to be prepared for the possibility that would have another variant that would come along," Fauci noted in his BBC interview. "If things change, and we do get a variant that does give us an uptick in cases of hospitalization, we should be prepared and flexible enough to pivot towards going back at least temporarily to a more rigid type of restrictions such as requiring masks indoors.
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