Why the omicron offshoot BA.5 is a big deal

So we're talking about Covid today. Um tell me what you guys are seeing. Um In terms of Covid here here in new Hampshire at the hospital within Dartmouth fell. Sure, so I think we really are looking at the trend since late March or early april when we reached *** plateau and we've seen *** five fold increase in the number of cases in the community across the United States. We've seen *** fourfold increase in hospitalizations in the New England area. We actually peaked in kind of mid too late May and have been heading down *** little bit since that time elsewhere in the country. Hospital rates are still on the rise across all age groups and we're waiting anxiously to see what happens with the newest variant, the B. ***. Five that became dominant as of july 9th. What do we know so far about what kind of impact that variant has on people who test positive with it? So we know *** few things and it actually has been um in other countries before it came to the shores of the United States. So we do have some data um and really some really important data recently coming out out of the Middle East. What we know is that there is some degree of immune escape, particularly if you were infected earlier in the pandemic or if you're far out from your last booster shot, it also tends to have *** faster growth rate and to have *** better ability to invade cells within the body. And so it can spread more quickly once you're infected. Um There are some encouraging data. However, we know many people were infected this past spring when we had *** large surge with the earlier variants in the omicron wave. And if you were actually infected this past spring with one of the earlier ο variants that actually provides about 76% effective prevention Protection against the BA five. And so it's really those that were infected, say in the early days *** year ago or more in the pandemic. We also know that if you're in the first three months after you've received your booster, There is some protection and it's really those that are beyond that three month And many are eligible for *** second booster, particularly if they're over 50 if they are compromised. And we want to be encouraging folks to come out and get that booster because that would be protective even with *** five. Is that the v. ***. five variant seem any more contagious than the other variants that we've seen so far. So um when we're looking at the amount of virus that is in someone's nose or upper respiratory tract, that's how we think about transmissibility, it doesn't seem to be more present would be *** five than with earlier omicron variants. Once you're exposed to it. However, as I mentioned, it grows quicker and can invade cells quicker. So it is more transmissible in that way because once it lands in your nose it will grow quicker as far as the severity of infection. Um Not just with the ***. Five but other variants that people may test positive for right now. I know B *** five is the dominant one. Are we seeing those numbers go up? Are we seeing people become severely sick to the point where they need to be hospitalized or are the vaccines doing their job even if it's kind of been *** while since somebody got their booster or initial dose? So the nice thing is thus far, we are not seeing *** large rise in patients requiring ICU level care or or dying from this virus. And so those who have either been protected from prior infection or from vaccination are not seeing the severe illness that we saw earlier in the pandemic. We are seeing more breakthrough cases. We are seeing people come into the hospital either for covid itself or hospitalized for something else and testing positive, we will know over the next few weeks whether you're going to see *** rise in ICU or deaths related to be *** five, there's usually *** two week lag between when the community cases start to increase. When we see the impact on hospital stay going into the fall. Um that's it seems like been *** concern every year. The summer, people are outside more. Um kids aren't in school in close quarters together. What does the outlook for fall look like? Do we even know right now? Well, I think we've learned *** lot, you know, we've been multiple years now in this pandemic. We've learned how to mitigate some of this risk. Um what are we doing in terms of mask use indoors? What are we doing around air handling? Actually not working. We're not going to school when you're six, you can prevent the transmission to others and so you know, you'll see *** lot of those same things that are playing out. Obviously the use of masks in indoor environments will be driven by what the local case counts are. And so overall we've seen them going down. If you look across our states in new Hampshire and Vermont community transmission is quite low. We'll see as we go into the fall if it begins to optic and if we need to think about masks in certain settings to prevent that spread. So you may see some communication around that. Probably think there is the most excitement about going into the fall is that we're going to have *** new by valent vaccine which is *** combination of protection against the original circulating variants of covid 19 and then the addition of protection against oh macron and it was protection against the earlier variants of McCrone, particularly kind of be *** one and two. But it does include protection for these more recent ones, the B *** four and five. So we will recommend that those who are eligible to get vaccinated as soon as possible and remain up to date with all the recommendations around vaccines. Maybe this is getting into um two technical um waters here but me for example, I had gotten my vaccine back in november I think uh March, excuse me at 2021. Got the booster in november and then I had the unfortunate lack of getting covid in this past May, I don't believe that I am eligible for *** second booster yet. So what should people do who had gotten their booster, you know, months and months ago that are worried about their immunity. Now at this point, so again, for for you with the combination of the primary series, the booster and then *** breakthrough infection this spring which many people had experienced thankfully many mild in terms of symptoms. You have *** pretty good protection at this point. Again, I mentioned for those who were recently infected this spring, Even with the BA5 we're seeing protection kind of above 75%. That's much better than we see with the flu vaccine in most years for instance. Um And so what I would say is I would look forward to when you are eligible for the vaccine that should be available in the later fall and early winter. Um you're gonna see some recommendations and just like we get *** new flu vaccine every year. There's gonna be recommendations for folks to come forward and get the bi valent vaccine. We'll see how much is available. It will be likely made available to those at highest risk obviously focus on the elderly, those living and kind of nursing home environments, those because of work that may be at higher risk, but they're really ramping up production and we expect that there should be enough vaccine for everyone who wants an updated booster very shortly as we go kind of through december. Anything else you'd like to add that? I might have missed. You know, I think that one thing that we continue to think about is how can people mitigate their their own risk. It's ***, it's *** season where we see lots of parties and some of those are are indoors, you're going to *** large wedding, you're going to *** large work gathering or sporting event, particularly for those who are indoors. Um, there are people that are recommending that you do testing before you go to that site. Um the goal there is really to lower the risk of spread to others. Um, and so you'll see certain groups that ask for that and I've had plenty of times where people said we really want to have this event who are asking everyone to test, we have widely available rapid tests that you can do in the community. Um, so whenever anyone asked that I said, that's great, I'm happy to do whatever it is that that makes people feel the most comfortable and particularly as those get larger, more people and they're indoors without good um kind of air movement. That is something you can do to lower that risk.

Once again, COVID-19 seems to be everywhere. If you feel caught off-guard, you aren't alone.After the omicron tidal wave washed over the United States in January and the smaller rise in cases in the spring caused by the BA.2 subvariant, it might have seemed like the coronavirus could be ignored for a while. After all, the U.S. Centers for Disease Control and Prevention estimated in December that nearly all Americans had been vaccinated or have antibodies from a past infection. Surely all that immunity bought some breathing room.Video above: Doctor talks about omicron BA.5 variantBut suddenly, many people who had recovered from COVID-19 as recently as March or April found themselves exhausted, coughing and staring at two red lines on a rapid test. How could this be happening again -- and so soon?The culprit this time is yet another omicron offshoot, BA.5. It has three key mutations in its spike protein that make it both better at infecting our cells and more adept at slipping past our immune defenses.In just over two months, BA.5 outcompeted its predecessors to become the dominant cause of COVID-19 in the United States. Last week, this subvariant caused almost 2 out of every 3 new COVID-19 infections in this country, according to the latest data from the CDC.Lab studies of antibodies from the blood of people who've been vaccinated or recovered from recent COVID-19 infections have looked at how well they stand up to BA.5, and this subvariant can outmaneuver them. So people who've had COVID as recently as winter or even spring may again be vulnerable to the virus."We do not know about the clinical severity of BA.4 and BA.5 in comparison to our other omicron subvariants," CDC Director Dr. Rochelle Walensky said at a White House COVID-19 Response Team briefing Tuesday. "But we do know it to be more transmissible and more immune-evading. People with prior infection, even with BA.1 and BA.2, are likely still at risk for BA.4 or BA.5." A 'full-on' waveThe result is that we're getting sick in droves. As Americans have switched to more rapid at-home tests, official case counts -- currently hovering around 110,000 new infections a day -- reflect just a fraction of the true disease burden."We estimate that for every reported case there are 7 unreported," Ali Mokdad, professor of health metrics sciences at the University of Washington's Institute for Health Metrics and Evaluation, wrote in an email.Other experts think the wave could be as much as 10 times higher than what's being reported now."We're looking at probably close to a million new cases a day," Dr. Peter Hotez said Monday on CNN. "This is a full-on BA.5 wave that we're experiencing this summer. It's actually looking worse in the Southern states, just like 2020, just like 2021," said Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Houston.That puts us in the range of cases reported during the first omicron wave, in January. Remember when it seemed like everyone everywhere got sick at the same time? That's the situation in the United States again.It may not seem like a very big deal, because vaccines and better treatments have dramatically cut the risk of death from COVID-19. Still, about 300 to 350 people are dying on average each day from COVID-19, enough to fill a large passenger jet."That is unacceptable. It's too high," Dr. Ashish Jha, coordinator for the White House COVID-19 Response Team, said at Tuesday's briefing.Daily hospitalizations are also climbing in the United States. The fraction of patients needing intensive care is up by about 23% over the past two weeks. And other countries are experiencing BA.5 waves, too."I am concerned that cases of COVID-19 continue to rise, putting further pressure on stretched health systems and health workers. I am also concerned about the increasing trend of deaths," said Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, at a news briefing Tuesday after the agency's decision to maintain its emergency declaration for COVID-19.The pandemic, he said, is "nowhere near over."What's at stake with continued spreadThere are also more insidious health risks to consider. A recent preprint study that compared the health of people who'd been infected one or more times with COVID-19 found that the risk of new and sometimes lasting health problems rose with each subsequent infection, suggesting that reinfections are not necessarily benign.Although vaccination reduces the risk of getting long COVID, a certain percentage of people have lasting symptoms after a breakthrough infection.That's another reason why high numbers of COVID-19 cases are a big deal: Because the virus is still spreading wildly, it has every opportunity to mutate to make even fitter and more infectious versions of itself. It's doing this faster than we can change our vaccines, leaving us stuck in the COVID-rinse-repeat period of the pandemic.On Tuesday, Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases, pleaded with Americans to use all available tools to stop the spread of the virus, including masking, ventilation and social distancing."We need to keep the levels of virus to the lowest possible level, and that is our best defense. If a virus is not very robustly replicating and spreading, it gives it less of a chance of a mutation, which gives it less of a chance of the evolving of another variant," Fauci said in a news briefing.In fact, this is already happening.Meet BA.2.75Even as the U.S. comes to terms with BA.5, variant hunters around the world are closely watching another omicron descendant, BA.2.75. It's been detected in about 10 countries, including the United States, and seems to be growing quickly in India.BA.2.75 has nine changes in its spike region that distinguish it from BA.2 and about 11 changes compared with BA.5, according to Tom Peacock, a virologist at Imperial College London.Several of the mutations in BA.2.75 are in a region of the spike protein known to be an important place for antibodies to bind to stop the virus, said Ulrich Elling, a scientist at the Austrian Academy of Sciences who monitors coronavirus variants for that country.There's little information to go on: It's still not known, for example, how BA.2.75 may compete against BA.5 or whether it causes more severe illness. But experts say it has all the hallmarks of a variant that could go global."It spread to many different countries already, so we know that it has some sort of staying power," said Shishi Luo, associate director of bioinformatics and infectious disease for Helix Labs, which decodes virus samples for the CDC and other clients.Because of that and changes in the region of the virus that our antibodies look for to shut it down, "we sort of know ahead of time that this one will cause some trouble," Luo said.Based on what we know now, she expects this subvariant could drive a fall COVID-19 wave in the United States.In the meantime, Jha said, people should get boosters that are available to them to keep their immunity as strong as possible. U.S. health officials emphasized that people who are boosted now will still be able to get an updated shot this fall that includes the BA.4 and BA.5 strains.Jha specifically urged Americans who are 50 and older, "if you've not gotten a vaccine shot this year, go get one now. It could save your life," he said.

Once again, COVID-19 seems to be everywhere. If you feel caught off-guard, you aren't alone.

After the omicron tidal wave washed over the United States in January and the smaller rise in cases in the spring caused by the BA.2 subvariant, it might have seemed like the coronavirus could be ignored for a while.

After all, the U.S. Centers for Disease Control and Prevention estimated in December that had been vaccinated or have antibodies from a past infection. Surely all that immunity bought some breathing room.

Video above: Doctor talks about omicron BA.5 variant

But suddenly, many people who had recovered from COVID-19 as recently as March or April found themselves exhausted, coughing and staring at two red lines on a rapid test. How could this be happening again -- and so soon?

The culprit this time is yet another omicron offshoot, BA.5. It has three key mutations in its spike protein that make it both better at infecting our cells and more adept at slipping past our immune defenses.

In just over two months, BA.5 outcompeted its predecessors to become the dominant cause of COVID-19 in the United States. Last week, this subvariant caused almost 2 out of every 3 new COVID-19 infections in this country, according to the from the CDC.

Lab studies of antibodies from the blood of people who've been vaccinated or recovered from recent COVID-19 infections have looked at how well they stand up to BA.5, and this subvariant can outmaneuver them. So people who've had COVID as recently as winter or even spring may again be vulnerable to the virus.

"We do not know about the clinical severity of BA.4 and BA.5 in comparison to our other omicron subvariants," CDC Director Dr. Rochelle Walensky said at a White House COVID-19 Response Team briefing Tuesday. "But we do know it to be more transmissible and more immune-evading. People with prior infection, even with BA.1 and BA.2, are likely still at risk for BA.4 or BA.5."

A 'full-on' wave

The result is that we're getting sick in droves. As Americans have switched to more rapid at-home tests, official case counts -- currently hovering around 110,000 new infections a day -- reflect just a fraction of the true disease burden.

"We estimate that for every reported case there are 7 unreported," Ali Mokdad, professor of health metrics sciences at the University of Washington's Institute for Health Metrics and Evaluation, wrote in an email.

Other experts think the wave could be as much as 10 times higher than what's being reported now.

"We're looking at probably close to a million new cases a day," Dr. Peter Hotez said Monday on CNN. "This is a full-on BA.5 wave that we're experiencing this summer. It's actually looking worse in the Southern states, just like 2020, just like 2021," said Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Houston.

That puts us in the range of cases reported during the first omicron wave, in January. Remember when it seemed like everyone everywhere got sick at the same time? That's the situation in the United States again.

It may not seem like a very big deal, because vaccines and better treatments have dramatically cut the risk of death from COVID-19. Still, about 300 to 350 people are dying on average each day from COVID-19, enough to fill a large passenger jet.

"That is unacceptable. It's too high," Dr. Ashish Jha, coordinator for the White House COVID-19 Response Team, said at Tuesday's briefing.

Daily hospitalizations are also climbing in the United States. The fraction of patients needing intensive care is up by about 23% over the past two weeks. And other countries are experiencing BA.5 waves, too.

"I am concerned that cases of COVID-19 continue to rise, putting further pressure on stretched health systems and health workers. I am also concerned about the increasing trend of deaths," said Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, at a news briefing Tuesday after the agency's decision to maintain its emergency declaration for COVID-19.

The pandemic, he said, is "nowhere near over."

What's at stake with continued spread

There are also more insidious health risks to consider. A recent preprint study that compared the health of people who'd been infected one or more times with COVID-19 found that the risk of new and sometimes lasting health problems rose with each subsequent infection, suggesting that reinfections are not necessarily benign.

Although vaccination reduces the risk of getting long COVID, a certain percentage of people have lasting symptoms after a breakthrough infection.

That's another reason why high numbers of COVID-19 cases are a big deal: Because the virus is still spreading wildly, it has every opportunity to mutate to make even fitter and more infectious versions of itself. It's doing this faster than we can change our vaccines, leaving us stuck in the COVID-rinse-repeat period of the pandemic.

On Tuesday, Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases, pleaded with Americans to use all available tools to stop the spread of the virus, including masking, ventilation and social distancing.

"We need to keep the levels of virus to the lowest possible level, and that is our best defense. If a virus is not very robustly replicating and spreading, it gives it less of a chance of a mutation, which gives it less of a chance of the evolving of another variant," Fauci said in a news briefing.

In fact, this is already happening.

Meet BA.2.75

Even as the U.S. comes to terms with BA.5, variant hunters around the world are closely watching another omicron descendant, BA.2.75. It's been detected in about 10 countries, including the United States, and seems to be growing quickly in India.

BA.2.75 has nine changes in its spike region that distinguish it from BA.2 and about 11 changes compared with BA.5, according to Tom Peacock, a virologist at Imperial College London.

Several of the mutations in BA.2.75 are in a region of the spike protein known to be an important place for antibodies to bind to stop the virus, said Ulrich Elling, a scientist at the Austrian Academy of Sciences who monitors coronavirus variants for that country.

There's little information to go on: It's still not known, for example, how BA.2.75 may compete against BA.5 or whether it causes more severe illness. But experts say it has all the hallmarks of a variant that could go global.

"It spread to many different countries already, so we know that it has some sort of staying power," said Shishi Luo, associate director of bioinformatics and infectious disease for Helix Labs, which decodes virus samples for the CDC and other clients.

Because of that and changes in the region of the virus that our antibodies look for to shut it down, "we sort of know ahead of time that this one will cause some trouble," Luo said.

Based on what we know now, she expects this subvariant could drive a fall COVID-19 wave in the United States.

In the meantime, Jha said, people should get boosters that are available to them to keep their immunity as strong as possible. U.S. health officials emphasized that people who are boosted now will still be able to get an updated shot this fall that includes the BA.4 and BA.5 strains.

Jha specifically urged Americans who are 50 and older, "if you've not gotten a vaccine shot this year, go get one now. It could save your life," he said.

��vlog