What started as a small blip is now the dominant variant: BA.2 is now responsible for more than 70% of COVID-19 cases in the U.S., according to the latest estimates from the Centers for Disease Control. But while BA.2, a subvariant of omicron, seems to spread more easily than previous versions of the virus, the full impact it might have on the country — including another potential surge — isn't clear yet.
“It certainly appears to be more transmissible,” Dr. Albert Ko, professor of public health, epidemiology and medicine at the Yale School of Public Health, told TODAY. Right now, BA.2 appears to be about 30% more transmissible than the initial omicron strain, he said. (And, remember, omicron was already a more highly transmissible variant than delta or alpha.)
Here's what to expect in the coming weeks and how to prepare for another COVID-19 wave.
Will BA.2 cause another surge in cases?
BA.2 is definitely an extremely transmissible variant. But it’s going to be “a little tough to suss out is how big of a deal that’s going to be for the United States,” Dr. Megan Ranney, emergency medicine physician and associate dean for strategy and innovation at the Brown School of Public Health, told TODAY.
“The reason why is because we’ve seen really different patterns of BA.2 infection in different countries across the globe,” she said. In some parts of the world, like the U.K., hospitalizations and deaths due to BA.2 increased alongside cases. But other countries have “seen a little bump in cases that was short-lived and didn’t really impact hospitalizations a lot,” Ranney said.
So far, in the northeast U.S., there has been a small rise in cases. But while, in New York at least, cases "have been going up for the last three to four weeks, hospitalizations have not gone up," Dr. Bernard Camins, medical director for infection prevention at the Mount Sinai Health System, told TODAY. "Our trajectory has increased," he said, "but it wasn't as fast as BA.1."
Ultimately, the experts that TODAY spoke to predict there will be a rise in COVID-19 cases in the country thanks to the emergence of BA.2. But they said that different parts of the U.S. may see local outbreaks at varying levels of severity. Areas with lower vaccination rates and higher population density as well as places where people spend more time inside will be more likely to have a rise in cases and, potentially, hospitalizations and deaths.
"I think the virus is going to continue to circulate," Dr. Otto Yang, professor of medicine in the division of infectious diseases, and of microbiology, immunology and molecular genetics at the David Geffen School of Medicine at UCLA, told TODAY. "And areas that have lower population density or high vaccination rates are going to have less illness," he said.
The fact that so many people were infected with omicron could provide some protection against BA.2 and soften the variant's impact, Camins said.
And warmer weather could be a factor, too: "Right now is the best possible weather for minimizing COVID spread across the country," Ranney said. That's because people are less likely to crowd indoors when outdoor conditions are nicer. "But it's going to start to get hot in the South and Southwest," she added, which could lead to an increase in those areas where it gets too warm to be comfortable outside.
Do the COVID-19 vaccines and treatments still work against BA.2?
The COVID-19 vaccines' ability to prevent infection has gone down considerably, Yang said. But they're still "doing great" at preventing severe disease, hospitalization and death, he said.
That divergence is due to the different immune responses that protect us from these potential outcomes. When it comes to preventing infection, your body largely relies on antibodies. In order to protect you, antibodies have to attach to a tiny part of the virus called the receptor-binding domain — and it's this part of the coronavirus spike protein that has changed significantly with the BA.2 variant, Yang explained.
But, in preventing more severe outcomes from the virus, the immune system calls on other processes that are mediated by T cells. These cells can recognize viral cells from anywhere on the spike, not just the receptor-binding domain, Yang said. "T cells still have lots of opportunities to bind to areas that are not changed by these mutations."
Unfortunately, with omicron and now BA.2, our monoclonal antibody treatment options are dwindling. Just this week the Food and Drug Administration withdrew its emergency use authorization of sotrovimab "due to increases in the proportion of COVID-19 cases caused by the omicron BA.2 subvariant." The FDA noted that "the authorized dose of sotrovimab is unlikely to be effective against the BA.2 subvariant."
But there are still other treatment options, such as the newly authorized bebtelovimab as well as intravenous remdesivir (an antiviral medication) that can be effective in the hospital.
And we now have Paxlovid and molnupiravir, which are oral COVID-19 treatments that can be taken at home. But they need to be taken within a few days of a positive test to be most effective, meaning that access to rapid testing and medical personnel who can prescribe the medications are both crucial.
Even then, these medications won't work for everyone. "The trouble with Paxlovid, of course, is that there are some contraindications," Ranney said. "There are some medications that you just can't prescribe Paxlovid with." It can't be taken with some antipsychotic drugs and those used to treat heart arrhythmias, for instance. It may interact with many other medications (including some hormonal birth control and opioid painkillers). So it's something that people should take only after a conversation with a health care provider, she said.
Should you get a second booster to prepare for BA.2?
"We have some data that shows that there's a waning of immunity against severe disease, and it may happen within three to four months," Ko explained. But, when thinking about adding another booster to pick up the slack, there's not much data to go on, he said.
The best data we have so far, published this week in the New England Journal of Medicine, suggests that a fourth dose does provide some additional protection against severe disease in people age 60 and older for at least six weeks, Ranney said.
Right now, the current recommendation from the CDC is that people who are age 50 and older, as well as those who are immunocompromised, can get a second booster dose with the Pfizer or Moderna mRNA shots. Those who are at least 50 years will get the most benefit if they also have an underlying health condition that puts them at a higher risk for severe COVID-19, the CDC said in a statement.
"If you're in one of those risk groups, whether you're elderly or have a medical complication, I think it's good (to get a second booster) given the fact that we don't know when the next wave is coming," Ko said. If you're older, "and then particularly if you've got diabetes, if you're obese, if you have heart conditions, lung conditions — those folks may want to think about getting the fourth shot," Ranney agreed.
Weighing the potential risks and benefits might be more challenging for this dose because we have so little data about how much additional protection it might provide. "We don't really think it's dangerous (to get a fourth shot)," Camins said. "But who wants joint pain, muscle aches, or fever if the return is so small?"
Others may be more than willing to pay the price of those temporary side effects for even a marginal bump in protection — especially if they are in one of those higher-risk groups or if their previous reactions to the vaccines were mild. "If you've got something that you can do that's really no risk or no cost to you, and has even a small benefit, that's worth doing," Yang said. "I personally think it's worth getting (a second booster) if you qualify."
The CDC recommendations leave the door open for people who are eligible and their doctors to decide what's best for their specific situation and risk factors.
Those who are younger and don't have underlying health conditions don’t need a fourth shot yet, Ranney said. “We’re well protected from what we really care about.” But, she added, keep in mind that the recommendation may change and another dose might become necessary at some point in the future. Or, down the line, we might have variant-specific boosters or pan-coronavirus vaccines that can target multiple strains.
What can you do to protect yourself from the BA.2 variant?
Whether the next wave is due to BA.2 or another coronavirus variant, it pays to be prepared. Here's what to keep in mind right now:
- Get boosted. And if you're eligible, consider getting another booster. The protection from the initial series of vaccines wanes within six months. But the boosters continue to protect us against severe disease and hospitalization — even against omicron and, so far, BA.2.
- Keep an eye on your local numbers. Familiarize yourself with the CDC's new metrics to keep track of what's going on in your area, which might differ from other parts of the country. When hospitalizations get to a certain level, you should start wearing a mask more regularly and implementing other precautions, like COVID-19 screening tests, the CDC says.
- Remember the basics. At this point, you likely already know the most impactful things you can do to protect yourself from COVID-19. That includes getting up-to-date on your vaccinations, wearing a high-quality and well-fitting mask indoors, getting tested if you develop symptoms, prioritizing good ventilation and avoiding crowds. "The same basics still apply," Yang said.
- Take advantage of nicer weather. With warmer spring weather these days, it may be more possible to meet up with friends outside or to enjoy other outdoor activities now than it was during winter. Knowing that these gatherings tend to be safer because of the inherently better airflow (especially if everyone is vaccinated), opt for outdoor activities whenever you can.
- Keep rapid tests on hand. Knowing that COVID-19 numbers may start to increase — in the middle of peak allergy season, of course — it's a good idea to have a few rapid tests at home for when you develop ambiguous symptoms like congestion, sore throat or cough. If you have health insurance, your tests should be covered, Ranney said. Community health centers and other local institutions (like libraries) may also have tests to give out, especially for those who are uninsured. And, if you haven't already, go ahead and order your free rapid tests from the government.
- Know what to do if you test positive. Think through the steps you would need to take to get Paxlovid or molnupiravir, which need to be prescribed within a few days of your positive test to be most effective. Also, it helps to know ahead of time how long you'll need to isolate, wear a mask and take other precautions after testing positive.
- Look into Evusheld. People who are immunocompromised or otherwise high risk may be eligible to receive Evusheld, Ranney said. This antibody cocktail is used to help prevent — but not treat — COVID-19 infections in those who are especially vulnerable.
