COVID is like Michael Myers in Halloween: just when you think it’s finally out of the picture, it comes back to threaten you again. Coronavirus cases in the U.S. have been plummeting for weeks, and hospitalizations are near an all-time low. But with another Omicron variant pushing up case numbers around the world, it seems depressingly plausible that at least one more wave — the sixth, if you’re counting — could be headed America’s way.
Omicron BA.2 is similar to the variant that caused this winter’s spike, BA.1. But it has 20 different mutations, four of them on a crucial region of the spike protein. These disparities are likely part of the reason BA.2 appears to be considerably more transmissible than the original Omicron — 33 percent, according to one Danish study. BA.2 is also thought to infect vaccinated people more easily than its forebear, though, fortunately, it does not appear to be any deadlier. First detected in the Philippines in November, the variant spread widely in South Africa and India in December and has since become the dominant strain around the world.
It’s hitting parts of Asia particularly hard. China, which imposed strict, widespread lockdowns during the early days of the pandemic and has maintained a “Zero COVID” strategy since, mostly avoided the waves that hit the U.S. and Europe. Then BA.2 showed up. In the last few weeks, the number of cases in China has surged from 300 a day to more than 3000. In response, the Chinese authorities have re-imposed lockdown measures affecting more than 50 million people.
Because these countries have experienced the pandemic so differently from the U.S. until now, it’s difficult to draw conclusions about what their surges mean for America in the short term. Europe is a better comparison. Like the U.S., it has been pummeled by wave after wave. This winter’s Omicron surge hit the continent hard, but once it peaked, most experts expected infection rates to quickly fall as the population picked up natural immunity. That’s why France re-opened its nightclubs, Austria decided not to enforce its strict vaccine mandate, and Italy announced an end to its coronavirus certificate program. “The skies seem finally to be clearing,” a French government spokesperson said last month.
But they weren’t. Scarcely had the BA.1 numbers begun to fall when BA.2 cases started ramping up. As a result, instead of the clean bell-shaped rise-and-decline we experienced here, infection rates in Europe remained high, and now they’re climbing higher. New cases in the U.K. are up 82 percent over the last two weeks and hospitalizations are up 38 percent.
So what does that mean for the U.S.? Though European surges have been a reliable precursor to stateside waves throughout most of the pandemic, the tea leaves are more ambiguous this time. Cases here are still falling. But an increasing proportion of those cases are BA.2 — up from 5 percent a month ago to 25 percent this week — and viral loads detected via wastewater are rising in some places. The experts are divided as to what it all means.
The case for not worrying
One voice counseling calm is New York Times science reporter Carl Zimmer, who recently noted that epidemiologists don’t believe that BA.2 will cause a massive wave of cases. Among the cited reasons: our current COVID-19 vaccines are effective against the BA.2 variant, just like they were against BA.1. And the millions of people who were infected with the original Omicron strain have antibodies that protect against BA.2. In other words, the same factors that caused the downslope in BA.1 infections here could keep BA.2 at bay, too.
Nathanie Landau, a professor of microbiology at the NYU Grossman School of Medicine, is sympathetic to this view. The new variant is “quite similar to BA.1,” he says. “I don’t think it’s likely to result in a second wave of infection in the United States.”
Former Food and Drug Administration commissioner Dr. Scott Gottlieb thinks there will be a bump in case numbers, but not a significant wave. “A lot of people who are worried this is the beginning of another surge, but given how much infection we’ve had, given how vaccinated we are, I think that’s going to be a pretty good backstop against uncontrolled spread here,” he told CNBC on Monday.
The case for worrying
Among the opposing camp is Eric Topol, a professor of genomics at the Scripps Research Institute in San Diego. “Great to see U.S. COVID-19 hospitalizations down to 23,000 and approaching their pandemic low,” he wrote this week. “But indicators from the new wave in Europe and U.S. wastewater surveillance suggest this may be short-lived.”
Samples taken from municipal sewer systems provide a measure of how much viral material is being produced by all the sick people in a community. Because infected people produce virus particles before they consciously feel sick, wastewater samples provide an early signal of a wave that hasn’t yet shown up in regular COVID-19 testing. According to the CDC, a quarter of its wastewater testing sites have seen an increase in SARS-CoV-2 RNA levels of 100 percent or more over the last 15 days. Topol has also pointed out how each of the last five U.S. waves were preceded by ones in Europe and the U.K. — and each time the U.S. has paid for its failure to heed those warnings.
If U.S. cases follow Europe’s trend, what lies in store for us might well be worse than for them. U.S. vaccination and booster rates are significantly lower than most European countries. No more than two thirds of eligible Americans have been fully vaccinated, and about half of the Americans eligible for a booster shot still haven’t gotten one, including a third of seniors. America’s relatively low vaccination rates probably explain why the first Omicron wave hit much harder here than it did in Europe. During the peak of that wave, the U.S, suffered ten times as many COVID deaths as Germany, despite having only four times as many people.
Which is not to say that the Europeans have played their cards flawlessly; they may have worsened the onset of their BA.2 wave by prematurely lifting COVID-19 restrictions. Unfortunately, the United States is following the same path. 49 states have abandoned indoor mask mandates, with the last holdout, Hawaii, set to join the club on March 26.
It’s easy to understand why. After two years, people are sick of restrictions, and the sense that the danger has passed make the discomfort and inconvenience of COVID protocols even more unpalatable. That disgruntlement plays out in the political arena, where the Republican Party seems intent on dismantling the country’s COVID-19 defenses. When Democrats tried to pass $15 billion in coronavirus aid this week, Republicans blocked it, thereby killing, at least temporarily, funding for the tests, vaccines, and medicines that will be needed to fight future waves.
What should we do?
Regardless of how the government responds, we can still act individually to protect ourselves, like by wearing high-filtration N95 face masks in indoor public spaces. Of course, getting as fully vaccinated as you can, including a booster shot if eligible, remains the best and most important protection available.
“It’s very important to be vaccinated and boosted,” says Landau. One CDC study found that while two shots of COVID vaccine are just 57 percent effective against Omicron if received more than six months ago, a booster shot raises the effectiveness back up to 90 percent, but again, many fully vaccinated Americans still haven’t gotten a booster.
Getting boosted is especially important for the elderly and immunocompromised. Fourth shots may finally be on the way as well. Just this week, both Pfizer and Moderna announced they were seeking emergency FDA authorization for a second booster shot.
Meanwhile, if you haven’t yet gotten all the shots you’re eligible for, don’t wait to see if there is another wave — the time to get them is now.
This article originally ran in New York magazine on March 19, 2022.