The long-awaited summer hiatus in coronavirus cases doesn’t appear to be happening as Covid-19 infections continue to rise across much of the United States.
An earlier increase in the number of cases this year was caused by the BA.2 Omicron subvariant. Now, the US Centers for Disease Control and Prevention report that two other subvariants, BA.4 and BA.5, account for more than 70% of new infections in the country. These subvariants may partially escape the immunity produced by the vaccine and from previous infection, although vaccination probably still protects against serious disease.
These developments are happening as more people travel and resume other pre-pandemic activities. How should people think about their risk of Covid-19 now? If they have been vaccinated and boosted, are they safe? What about those who have recently had Covid-19? What precautions should people take if they want to avoid Covid-19 anyway? And if someone tests positive for the coronavirus, does this person still have to isolate?
To answer these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”
CNN: Do current Covid-19 trends indicate another wave of cases in the United States?
dr. AS Leana Wen: I’m not sure if this would be called another rise as the numbers didn’t actually fall from the previous rise. Over the winter, from December 2021 to about February 2022, we saw a massive increase in cases of the native Omicron subvariant, BA.1. There was a little silence; then BA.2 came with that increase in the number of cases. Now BA.4 and BA.5 displace previous Omicron subvariants and cause most infections in the US. Many places are seeing an increase in infections from a high baseline of cases.
We should also take into account that the number of reported cases is much lower than the actual number of cases. I think we could have anywhere from five to 10 times as many cases as have been reported, considering how many cases are diagnosed by home antigen testing and not reported to the public health authorities.
The good news is that these recent increases have not been accompanied by congested hospitals, illustrating the powerful effect of the vaccines in mostly dissociating infection from serious illnesses.
CNN: How should people with numbers like this think about their Covid-19 risk? Does this mean people should cancel trips and bring restrictions back?
female: I don’t think most people should change their daily activities, but I do think people should be aware of their risk of contracting Covid-19 if they don’t take extra precautions.
The good news is that the vaccines and boosters continue to provide excellent protection against serious diseases. However, we also know that immunity declines over time, and BA.4 and BA.5 in particular seem to have some immune (evasion) there. That means it’s unlikely that people who have been vaccinated and boosted will become seriously ill if they get Covid-19, but they could still get infected.
The question people should be asking is: to what extent do they want to continue to prevent infection? There is so much virus around us, and the variants are so contagious. That means 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 a serious illness.
On the other hand, many people may still prioritize not getting Covid-19 because of the risk of long-term symptoms. They may also have underlying medical conditions that are themselves more susceptible to more serious consequences, or they may live with others who are more vulnerable and want to reduce their risk to those around them.
CNN: What do you recommend for people who want to be careful?
female: For individuals who want to prioritize reducing their risk of Covid-19 infection, I would first advise that they follow CDC guidelines and stay on top of their boosters. Anyone 5 years and older can get a first booster. Those 50 and older can get a second booster for a total of four shots.
Certain individuals (who are moderately or severely immunocompromised) may receive five injections. (These individuals should also find out if they qualify for Evusheld, the preventive antibody that can further help reduce progression to serious disease.)
I would also insist that they wear a high quality N95 mask or equivalent in busy indoor environments. The lifting of mask mandates does not mean that people are not allowed to wear masks. Many people do not find masks inconvenient. If so, I would continue to wear masks in all indoor public settings. For those who find masks uncomfortable, I recommend wearing a mask in the highest risk situations, for example a mask in a busy airport security line and during boarding and alighting.
Remember, of course, that outdoor gatherings pose a much lower risk than indoors. People who want to be very careful should try to go to outdoor meetings if possible and then only go to indoor meetings if others all have negative tests that day.
CNN: A lot of people are tired of hearing about these precautions. What if they just want to live their lives, but don’t want to infect vulnerable people?
female: I certainly understand this feeling. It is very difficult for society to impose restrictions on individuals and ask people to postpone gatherings like weddings and birthday parties forever or forgo activities they love like indoor restaurants and gyms. My best advice here is to recognize that if you go into indoor settings, you can contract Covid-19. Be aware of your risk and take precautions accordingly.
For example, you can start living your life the way you want, but before you go to see grandma in a nursing home, do a quick test that day. If you’re going to a crowded indoor wedding, take a test a few days afterward to make sure you haven’t contracted the coronavirus. And if you have symptoms at any time, test immediately and don’t expose others around you.
CNN: Are you safe if you recently had Covid-19?
female: Recent infection provides some protection that will likely last about three months. Reinfection can certainly happen, however, and some research suggests that getting the original Omicron BA.1 does not protect against the newer variants. Vaccination alongside recent recovery offers better protection, so make sure you’re up to date on your vaccines and boosters, even if you’ve had Covid-19.
CNN: And what if you test positive — do you still need to isolate?
female: Yes, because you don’t want to spread Covid-19 to others. The CDC guideline is that you isolate for five days and then wear a mask around others for another five days if symptoms improve. I think a testing policy is even better than this because people stay infected for different periods of time. I would encourage people to do daily home tests from day four and end isolation as soon as their rapid home antigen test is negative. Now is the time to make sure you have enough home testing!