The latest sub-variant of the novel coronavirus, which is becoming dominant in Europe, the United States and other countries, is also, in many ways, the worst yet.
The BA.5 subvariant of the basic Omicron variant appears to be more contagious than any previous form of the virus. It’s also apparently better at dodging our antibodies – meaning it’s more likely to break through and repeat infections.
Vaccines and boosters are still the best defense. There are even Omicron-specific boosters in development that could make the best vaccines even better in the coming months effective against BA.5 and its genetic cousins.
Still, BA.5’s continued romp across half the planet is a powerful reminder that the COVID pandemic isn’t over yet. “We’re far from done,” wrote Eric Topol, founder and director of the Scripps Research Translational Institute in California, on his substack.
A high level of at least partial immunity to vaccines and previous infections continues to prevent the worst outcomes — mass hospitalizations and death. But across the world, sheer case numbers are rising, with serious consequences for potentially millions of people who are at increasing risk of long-term illness.
Equally worrying is that the recent wave of infections is giving the coronavirus the time and space it needs to mutate into even more dangerous variants and subvariants. “Developing variants is now a freight train,” Irwin Redlener, the founding director of Columbia University’s National Center for Disaster Preparedness, told The Daily Beast.
In other words, unstoppable.
BA.5 first appeared in virus samples in South Africa in February. By May, it was dominant in Europe and Israel, supplanting previous forms of the simple Omicron variant while driving global daily COVID cases from about 477,000 per day in early June to 820,000 per day this week.
In late June, BA.5 became dominant in the United States. Cases are yet to pick up – the daily average has been around 100,000 since May. But that could change in the coming weeks as BA.5 continues to outperform less transmissible subvariants.
Topol offered a succinct explanation for the rise of BA.5. Where the mutations that produced many earlier variants mainly affected the spike protein – the part of the virus that helps it to latch onto and infect our cells – BA.5 has mutations above its structure. “BA.5 is quite different and very fit, which is a distinct difference from all previous variants,” wrote Topol.
The widespread mutations of BA.5 made the subvariant less recognizable to all the antibodies we’ve built from vaccines, boosters, and past infections. BA.5 was able to sneak past our immune system like a ninja and contribute to the increasing rate of breakthrough cases and reinfections.
This comes as no surprise to epidemiologists, who have warned for many months that persistently high case numbers – which they largely attribute in part to a stubborn anti-vaccination minority in many countries – would allow for ever more infectious and evasive variants and subvariants. The more infections, the more chances for significant mutations.
In that sense, BA5 could be a preview of the months and years to come. A year ago we had a chance to block the main transmission routes of SARS-CoV-2 through vaccines and social distancing.
But we didn’t. Restrictions on businesses, schools and crowds have become politically toxic around the world. Vaccination rates have remained stubbornly low, even in many countries with easy access to vaccines. In the US, for example, the percentage of fully vaccinated has stalled at around 67 percent.
So COVID persists 31 months after the first case was diagnosed in Wuhan, China. The longer the virus circulates, the more variants it produces. BA.5 is the almost inevitable result of this tragic dynamic.
The situation is not entirely hopeless. Yes, BA.5 appears to reduce the effectiveness of the best messenger RNA vaccines. Vaccine manufacturer Moderna has released data suggesting that a booster vaccine it is developing specifically for Omicron and its progeny is only one-third as effective against BA.5 as compared to previous subvariants.
But vaccines, boosters, and past infections still provide significant, albeit reduced, protection against BA.5. “Even an amplification of the original genome or a recent infection will do this [produce] some cross-protective antibodies to reduce the severity of a new omicron subvariant infection,” Eric Bortz, a University of Alaska-Anchorage virologist and public health expert, told The Daily Beast.
The more extra jabs you get on top of your main course, the better protected you are. Arguably the best protection comes from two prime shots of either Pfizer or Moderna’s mRNA vaccines plus a few booster shots. “Get your bloody fourth shot!” said Redner.
The problem in the United States is that only people over the age of 50 or with certain immune disorders are eligible for a second booster shot. And the US Food and Drug Administration won’t say if or when it might allow second booster shots for younger people. “I have nothing to share at this time,” an FDA spokesman told The Daily Beast when asked about boosters for under-50s.
It’s an obvious bureaucratic error. Up to a million booster doses are about to expire in the US, all for lack of buyers. “A serious waste that should be made available to all people under the age of 50 seeking additional protection,” Topol wrote.
To be fair, Pfizer and Moderna are both working on new ones Boosters that they tailor specifically for Omicron subvariants. On June 30, an FDA advisory board approved these variant-specific boosters. The FDA announced it could approve them for emergency use for some Americans as early as this fall.
But there is a risk of these jabs appearing too late, especially if they are highly optimized for just a current sub-variant and therefore ineffective against future sub-variants. “Variant chasing is a flawed approach,” Topol wrote. “Who knows what the predominant strain will be when a BA.5 vaccine booster may become available?”
Fortunately, there are fallbacks. Masks and voluntary social distancing, of course. Post-infection therapies with the antiviral drug Paxlovid also help. “This is not the time to abandon non-pharmaceutical interventions,” Redlener said.
But wearing masks voluntarily and Paxlovid are band-aids on a suppurating global wound. The rise in BA.5 infections creates the conditions for this next major subvariant – BA.6 if you will. It could be even worse.
It’s looking more and more likely that COVID will be with us, well, forever. “COVID is going to be like the flu,” Ali Mokdad, a professor of public health at the University of Washington Institute of Health, told The Daily Beast.
That is, endemic. A pervasive public health threat. The big difference, of course, is that COVID is much more dangerous than today’s flu. And it keeps mutating in ways that make it worse.