The BA. Parade Continues

Are the new BA.4 and BA.5 Variants Bad Boys or more run of the mill Scariants.

I don’t know about you but I was relieved to hear Dr. Fauci tell us emphatically this week that the United States is, “… out of the Pandemic phase now.” Of course he “clarified” that the next day to mean that we are out of, “The acute fomenting stage, but the Pandemic is still ongoing”. I doubt that clarified much of anything for most people, but I bet a healthy majority assume there was a call from the White House involved. I think a simple statement that we are currently in a low period of disease transmission would be accurate and well understood; without implying anything about the future direction of the Pandemic. That would seem to be a judicious assessment, given the fact that cases in the United States have doubled in the last two weeks thanks to the BA.1.12.1 wavelet. Here in the US we have been tantalized by the regression of the disease several times, only to find that we were in a trough, and the next big wave was heading in. We have also been through enough cycles of reassurances that our mounting immunity meant we were strolling out of the woods. For the most part disease activity remains highest in the Northeast, New York and Texas. Surprisingly Vermont is leading the list of case increases, and test positivity last week rose to 13.3%.

Around the world, China continues in its doomed policy of pursuing zero COVID, with daily cases now at 30,000, and severe disruption of the economy and worldwide supply chain as a result. Their decision early on to avoid use of the US developed mRNA vaccines, and instead vaccinate the entire population with their home grown and less effective concoction may have backfired. Their zero COVID policy also had an unexpected consequence; they avoided all the prior waves of COVID after original Wuhan, but now are confronting the most infectious iteration of the virus with zero natural immunity and a less effective vaccine. The very high death rate among the elderly in Hong Kong demonstrates what happens when the “less virulent” Omicron gets going in a susceptible population with no prior immunity. We know all too well here at home that Omicron is no pussy cat, and is a master killer due to its extreme contagion.

South Africa is continuing to have rapidly rising cases and an uptick in hospitalizations, which are attributed to two recently identified variants BA.4 and BA.5. Those variants are rapidly replacing parental Omicron lineages as they drive another increase in cases. It’s too early to say whether they will end up causing more severe disease, and whether they will graduate from ripple to an actual fifth wave. This is disturbing given the very recent Omicron wave in South Africa, and the official estimates that over 90% of the population have partial immunity from prior vaccination and or infection. If the wave there continues to grow, it does suggest the possibility that BA.4 possesses a greater degree of antibody escape and increased transmissibility than Omicron. Predictably, a small number of BA.4 cases have already been documented in the US in the last few weeks. These variants show the S gene target failure on PCR testing, like the original Omicron, but otherwise are PCR detected; we will have to wait for further data on rapid antigen testing sensitivity.

So Bad Boys or just passing Scariants? There is not enough data yet to offer more than an educated guess. There are very substantial differences in the path the Pandemic has taken in South Africa compared to the United States. The failure of a Beta wave to take hold here is a prime example. My current estimate is that the new variants are sufficiently close to Omicron, BA.2 and BA.1.12.1 that they will not be capable of breaking through the significant barrier of partial immunity now present, and create a wave of serious disease with escalating hospitalizations. If these new variants begin to slow down over the next several weeks in South Africa, then I think there is no reason to be concerned this time. There is also no reason to dismiss the possibility that a variant with increased antibody escape might show up at any future moment.

Along the “don’t try this at home” line, we have nothing to compare to the German gentleman last week who took ninety Covid vaccine shots “for the team”. We can however marvel at the still simmering viral gumbo in Washington, and the spectacle of the White House Correspondant’s Dinner. Several hundred people crowded together in a poorly ventilated space that was already the scene of one recent super-spreader event. Dr. Fauci, with typical keen judgement, declined to attend for obvious reasons. The Vice President was absent, since she already has COVID and didn’t need to get another dose at the Gridiron Club. A maskless Joe Biden did attend, no doubt counting on his four shots, and perhaps executive privilege. If you can, take a peak at Trevor Noah, who hysterically said, “Wait, what’s going on here— aren’t you the guys who have been screaming at us to wear masks for the two years? Somebody offers you a free steak dinner and all of a sudden you’re Joe Rogan?” Perhaps comedy will survive cancel culture and the Pandemic after all— that would be nice.

As always, if you find these summaries useful and interesting, please forward to your friends and associates.