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New pandemic danger?  Pretending it’s over as the number of cases increases

May 18, 2022 — Just because a lot of people seem more than ready to put the COVID-19 pandemic behind us doesn’t mean it’s really over. In fact, the number of cases is rising again — with new infections reported in about 95,000 Americans every day — and hospitalizations are also up 20%.

It’s another reminder of the dangers that remain from a virus that has now killed more than a million Americans.

“There needs to be clear communication with the public so people understand that the virus is still a threat,” former CDC director Tom Frieden, MD, said in an email interview. “We are currently in a wave of infections.”

“How many people will die depends largely on us and our ability to stay up to date on vaccinations, mask up in a high-risk area, get people who need it diagnosed and treated quickly, and put implementing public health and social measures when needed,” he said.

The Department of Health and Human Services, meanwhile, is responding to the new picture of COVID-19 by extending its emergency order beyond its July 15 expiration date. The order gives Americans access to medicines, vaccines and more without running out of stock. pocket costs part of an emergency use authorization.

The daily average for hospitalizations has reached 3,000, a 19% increase from last week, and daily deaths hover at 275.

CDC Director Rochelle Walensky, MD, acknowledged that while these numbers are far lower than those seen during Omicron’s first peak, “Nearly 300 deaths per day is still far too many,” said she said during a press briefing at the White House on Wednesday.

Concern in Europe

It’s not just the United States on high alert. The European Center for Disease Prevention and Control recently designated the Omicron BA.4 and BA.5 subvariants “variants of concern”.

In Portugal – a country that has seen the number of COVID-19 cases soar in recent weeks – BA.5 accounted for around 37% of positive cases as of May 8, according to the Portuguese National Institute of Health.

First identified in South Africa earlier this year, BA.4 and BA.5 are now the dominant variants in the country.

Since the daily growth advantage of BA.4 and BA.5 over the Omicron BA.2 strain in Portugal (13%) is similar to what was previously reported in South Africa (around 12%) , European officials predict that BA.5 will be Portugal’s dominant variant. in the coming days.

The organization says the high growth rate is due to the “ability of the variants to evade immune protection induced by previous infection and/or vaccination, particularly if this has waned over time.”

While the presence of BA.4 and BA.5 in most parts of Europe remains low, the European CDC predicts that the variants could cause an increase in the number of COVID-19 cases and could eventually become the dominant variants in Europe in the coming months.

But early research does not suggest that BA.4 and BA.5 are any more dangerous than other Omicron strains.

It remains to be seen whether BA.4/BA.5 can outperform BA.2.12.1, which is nearly dominant in the United States, says Eric Topol, MD, practicing cardiologist at Scripps in La Jolla, CA, and publisher of Medscape. – chief. (Medscape is part of the WebMD network.)

Either way, these variants can pose an additional challenge to our immune system, which may not fully recognize them, given the minimal cross-immunity provided by BA.1, Omicron’s original strain, he says. .

“This is particularly remarkable since 40% to 50% of Americans have been infected with BA.1 [or BA.1.1]and without additional protection against vaccination, they will be vulnerable to infection BA.2.12.1.

The Case of the Missing Numbers

The United States is now in a new wave driven by the Omicron BA.2 and BA.2.12.2 variants, Topol says.

The 95,000 daily new cases reported by the CDC do not reflect “the true toll of the current wave, as most people with symptoms are testing at home or not testing at all.”

Additionally, there is virtually no testing among people who do not have symptoms, Topol says.

The true number of cases is likely at least 500,000 a day, he says, “much more than any previous wave in the United States except Omicron.”

Frieden agrees that Omicron and his sublines remain a threat. For example, BA.2.12.1, which is almost predominant in the United States, and BA.4 and BA.5, which are predominant in South Africa, “are highly transmissible, even to people who have already been infected, and to a lesser degree”. extent, those previously infected and vaccinated.”

“This can contribute to rapid and dramatic increases in infections,” says Frieden, president and CEO of Resolve to Save Lives, an organization that aims to prevent 100 million heart disease deaths worldwide and make the safer world against epidemics.

“As hard as it is to cope mentally, we have to plan something worse than Omicron in the coming months,” says Topol.

Seven things add to this “very unfavorable picture” of the near future, he says:

  • The evolution of the coronavirus is accelerating.
  • Variants are more capable of evading immunity.
  • Transmissibility and infectivity are higher.
  • Vaccines and boosters offer less protection against transmission.
  • There was some reduction in vaccine or booster protection against hospitalization or death.
  • Immunized people who have not been vaccinated are very vulnerable.
  • More dangerous variants are likely to emerge.

Paxlovid and other reasons for hope

Frieden also offered several reasons for optimism. For many in the United States, summer brings the opportunity to congregate outdoors rather than indoors, and extra ventilation reduces the risk of transmission, he says.

Additionally, “the more people stay up to date on their vaccines, the fewer deaths there will be.”

Another positive to consider is the antiviral agent Paxlovid, Frieden says, which “provides additional protection against serious illness or death if taken soon after infection.”

Topol also spoke about Paxlovid, although he was more cautious.

“Our support for infections in people at increased risk has turned to Paxlovid,” but unfortunately there is evidence that some people get sick again after taking the drug for 5 days, he says.

“Not only does this unforeseen problem need to be addressed urgently, but we may face growing resistance to Paxlovid in the months to come as it continues to be used on a large scale,” Topol says.

“We absolutely need an aggressive stance to get ahead of the virus – for the first time since the start of the pandemic – instead of surrender,” he says. “That means setting priorities, funding and realizing, unfortunately, that the pandemic is far from over.”

On funding, White House coronavirus response coordinator Ashish Jha, MD, said Wednesday that Congress’ lack of action on more money for the pandemic has put the country on edge. to encounter more problems.

Without more money, “we will end up in a fall or winter with infected people and no treatment available for them because we will have run out of them”.

Asked about a return to masking, Frieden cited the big picture. “The discourse around masking and public health tools more broadly needs to be reframed. Masking is an inexpensive and life-saving tool that can help control the spread of other infectious diseases, not just COVID.

“Wearing a mask shouldn’t just be a pandemic practice,” he says. “We can use many of the healthy practices we learned, developed and standardized during the pandemic to control the spread of ongoing diseases and keep the world healthier.”

Journalist Lindsay Kalter contributed to this report.

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