Comment: Only way to live with covid is not to ignore it

The U.S. might follow the U.K.’s course with omicron’s BA.2 subvariant. But there are distinctions.

By Therese Raphael and Sam Fazeli / Bloomberg Opinion

Covid cases are on the rise in several European countries. Upticks are visible again in France, Italy and the United Kingdom. Infection rates in both Austria and Germany eclipse previous waves of the virus (based on cases per million). China is grappling with new highs in terms of case counts. The U.S. may soon follow.

This fifth wave of the virus is likely to be mercifully short-lived in many areas, but the picture varies around the world. This divergence gives us something of a report card on the efficacy of the covid policies in place.

The new wave is mostly being driven by countries removing pandemic restrictions right around when the more transmissible omicron BA.2 subvariant began to spread. In the U.K., the end of mask mandates on public transport and required self-isolation if infected has led many people to drop their cautionary behavior and allowed BA.2 infections to gather pace.

From this week, Britain has made 5 million older and more vulnerable residents eligible for a fourth jab. Health Secretary Sajid Javid has suggested over-50s may be offered a fourth shot in autumn. That may be sensible, but just as with earlier boosters, any effect will likely be short-lived; we’ll see a three- to four-month reduction in cases, rather than a fundamental change.

Data from Denmark and Sweden, the two countries where BA.2 got an early foothold, suggest that waning immunity isn’t so much driving the rise in infections as is BA.2’s superior ability to infect people. Denmark experienced an early, massive omicron wave; that arguably provided a high level of immunity against BA.1 and BA.2, preventing its resurgence. But even Sweden, which had a smaller wave of BA.2 infections, is not seeing a bounce in infections now. Both have similar vaccination coverage. The infection curve would look very different if what we were seeing was waning immunity rather than the arrival of BA.2.

Although hospitalizations from covid are rising in the U.K. and other places where BA.2 has spread fast, the rate of hospitalizations and ICU admissions per case remains low and there is no evidence so far that the BA.2 subvariant is leading to any increased severity of illness. Javid said Monday that the government has not changed its view and noted that 60 percent of those in the hospital with covid had not been hospitalized for covid, suggesting many are incidental cases.

The picture in the U.S. is less clear. In the past two covid waves, the trajectory of U.S. infections lagged Europe’s by a few weeks, so the same thing may happen this time too. For now, the percentage of BA.2 omicron cases in the U.S. is between 10 percent and 15 percent, the same level as the U.K. in early February. As the subvariant proliferates, infections will likely start rising again.

One factor in the U.S.’s favor is that the BA.1 omicron wave probably infected a larger proportion of the U.S. population than in most European countries, so the immunity from that could limit the duration of the BA.2 wave as well as its severity. However, the U.S. can’t afford to be too relaxed. Its vaccine coverage is not as good as that in most European countries.

The more transmissible subvariant will also be better at finding pockets of unvaccinated people, keeping U.S. severe disease rates at higher levels compared with Europe. Congress just rejected $15 billion in coronavirus funding. Less testing and fewer treatments could make it harder especially for more vulnerable parts of the population. “Without funding, the United States will not have enough additional boosters or variant specific vaccines, if needed, for all Americans,” said the White House in a statement. “The federal government is unable to purchase additional life-saving monoclonal antibody treatments and will run out of supply to send to states as soon as late May.”

Rising infections pose the most serious challenge to countries such as China that pursued zero-covid policies. Those highly restrictive regimes prevented infections from earlier variants and kept death rates low, but their vaccines have been less effective against the more transmissible omicron variant and its faster-spreading BA.2 subvariant.

In New Zealand, strong vaccine coverage is helping manage disease severity, with deaths per million at a relatively low level. That’s in sharp contrast to the picture in Hong Kong, where a rapid rise in infections is translating into one of the highest death rates, at close to 40 per million.

The difference there is vaccines. Hong Kong mostly used the Chinese vaccine Sinovac and has only managed to deliver booster shots to 26.8 percent of its population. New Zealand, which mostly used mRNA vaccines, has boosted 50 percent of its population. China is in a very similar situation as Hong Kong: Zero-covid policies resulted in low levels of population immunity, plus there are insufficient rates of vaccination (especially among the elderly) and relatively less effective vaccines. That’s left higher levels of severe disease and puts enormous pressures on the health care system.

And yet even in countries with high levels of immunity and vaccination, high rates of infection come with costs even where there are low rates of hospitalization and death. Although vaccination has been shown to reduce the risk of Long Covid or Post Acute Sequelae of Covid (PASC), it doesn’t eliminate it. It’s also not clear whether there’s a residual risk of Long Covid when an infection has been curtailed through the use of treatments such as oral antivirals and monoclonal antibodies.

Mild to moderate covid infections are often not cost-free either. Across Britain and other countries, testing positive is already leading to lost school days and lower productivity. These things add up. Higher infection numbers also increase the chance of new variants emerging.

The current covid wave should reassure us that vaccines and treatments remain our best defense against an evolving virus. But it is also a reminder that while we are learning to live with covid, we can’t ignore it.

Therese Raphael is a columnist for Bloomberg Opinion. She was editorial page editor of the Wall Street Journal Europe.

Sam Fazeli is senior pharmaceuticals analyst for Bloomberg Intelligence and director of research for EMEA.

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