Is Covid-19 a mutation? Our experts explain how to prepare

The previous spike in the number of cases this year was driven by the Omicron variant BA.2. Now, the US Centers for Disease Control and Prevention reports that two other subvariants, BA.4 and BA.5, make up more than 70% of the country’s new infections. These subvariants may partially escape vaccine-produced immunity and prior infection, although vaccination could still potentially protect against severe disease.

These developments are occurring as more people resume travel and other activities prior to the pandemic. How should people think about their risk of contracting Covid-19 right now? If they are vaccinated and boosted, are they safe? What about those who have recently been infected with Covid-19? What kind of precautions should people take if they still want to avoid Covid-19? And if someone tests positive for the coronavirus, should that person continue to be isolated?

To help with these questions, I spoke with CNN Medical Analyst Dr. Lena Win, MD, an emergency physician and professor of health policy and management at George Washington University’s Milken Institute School of Public Health. She is also the author of Life Lines: A Doctor’s Journey in the Fight for Public Health.

CNN: Do the current trends of Covid-19 indicate another wave of cases in the US?

Dr. Lina Wen: I’m not sure this would be called another increase because the numbers haven’t really come down from the previous high. In the winter, from December 2021 to about February 2022, we saw a huge spike in cases from the original Omicron variant, BA.1. There was a slight calm. Then came BA.2 in parallel with this rise in the number of cases. Now, BA.4 and BA.5 are replacing earlier sub-variants of Omicron and causing most infections in the United States. Many places are seeing an increase in infections from a high baseline of cases.

We also have to keep in mind that the number of reported cases is much lower than the actual number of cases. I think we could have anywhere between five to 10 times the number of reported cases, considering the number of cases diagnosed by home antigen tests and not reported to public health authorities.

The good news is that these recent increases have not been accompanied by hospital overcrowding, illustrating the powerful effect of vaccines in separating infection from often severe disease.

CNN: With these kinds of numbers, how should people think about the risks of Covid-19? Does this mean that people should cancel travel and bring back restrictions?

Wen: I don’t think most people should change their daily activities, but I do think people need to be aware of the risk of contracting Covid-19 if they don’t take extra precautions.

The good news is that vaccines and boosters continue to provide excellent protection against severe disease. However, we also know that immunity diminishes over time, and there appears to be some immunity (evasion) with BA.4 and BA.5 in particular. This means that vaccinated and boosted people are less likely to become severely ill if they contract Covid-19, but they can still become infected.

Some passengers wear masks at the Times Square subway station in New York last week.

The question people should be asking is: How much do they want to continue to avoid infection? There are a lot of viruses around us, and variants are very contagious. This means that avoiding injury requires more attention. Many people may not want to plan their lives around Covid-19 precautions anymore, especially if they are generally healthy and well protected from severe illness.

On the other hand, many people may still prioritize not contracting Covid-19 due to the risk of long-term symptoms. They may also have underlying medical conditions that predispose themselves to more serious outcomes, or they may live with others who are more vulnerable and want to reduce their risk to those around them.

CNN: For people who want to be careful, what would you recommend?

Wen: For individuals who want to prioritize reducing their risk of contracting Covid-19 infection, I would first advise following CDC guidelines and staying up to date on their boosters. Anyone 5 years of age or older can get an initial booster dose. Those 50 and over can get a second batch for a total of four shots.
Should parents get the vaccine for their children under five?
Some individuals (who are moderately or severely immunocompromised) can receive five shots. (These individuals should also find out if they qualify for Evusheld, the protective antibody that can further help reduce progression to severe disease.)

I would also urge them to wear a high-quality N95 mask or equivalent in crowded, enclosed spaces. Lifting mask mandates does not mean that people should not wear masks. Many people do not find masks uncomfortable. If so, I will continue to wear masks in all indoor public spaces. For those who find masks inconvenient, I encourage wearing masks in the most dangerous places – for example, a mask while in a crowded airport safety line and during boarding and disembarking.

When do we get another shot?

Of course, remember that outdoor gatherings are still much less dangerous than indoor gatherings. People who want to be very careful should try to go to outdoor gatherings if possible and only go to indoor gatherings if others have tested negative that day.

CNN: A lot of people are tired of hearing these precautions. What if they just want to live their lives but don’t want to infect vulnerable people?

Wen: I definitely understand that feeling. It is very difficult for society to impose restrictions on individuals and require people to permanently suspend gatherings such as weddings and birthday parties or give up activities they love such as indoor restaurants and gyms. My best advice here is to realize that if you go indoors, you could catch Covid-19. Be aware of your risks and take precautions accordingly.

For example, maybe you can go ahead and live your life as you please, but before you visit Grandma in a nursing home, take a quick test that day. If you go to a crowded indoor wedding, get tested after a few days to make sure you haven’t contracted the coronavirus. And if you ever develop symptoms, get tested right away and don’t expose others around you.

CNN: Are you safe if you have had Covid-19 recently?

Wen: A recent infection produces some protection that may last for about three months. Re-infection can certainly occur, and some studies suggest that having the original Omicron BA.1 does not protect against newer variants. Vaccination as well as last recovery provides better protection, so make sure you keep up with your vaccinations and boosters, even if you have Covid-19.

CNN: And what if the test result is positive – should you continue to be isolated?

Wen: Yes, because you do not want to spread Covid-19 to others. CDC guidelines are that you isolate for five days and then wear a mask around others for an additional five days after that if your symptoms improve. I think the testing policy is better than that because people stay infected for different lengths of time. I would encourage people to get home tests daily from day 4 and end the isolation once the home rapid antigen test is negative. Now is the time to make sure you have plenty of home tests!

Leave a Comment