(CNN) — The long-awaited lull in coronavirus cases over the summer looks unlikely to come as Covid-19 infections continue to rise across much of the United States.
An earlier increase in cases this year was driven by the BA.2 subvariant of omicron. Now, the US Centers for Disease Control and Prevention (CDC) reports that two other subvariants, BA.4 and BA.5, constitute more than 70% of new infections in the country. These subvariants may partially evade immunity produced by the vaccine and by previous infection, although vaccination is likely to still protect against severe disease.
This evolution comes as more people resume travel and other pre-pandemic activities.
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 vaccinated against 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 they continue to isolate themselves?
To answer these questions, we spoke with Dr. Leana Wen, a CNN medical analyst, emergency room physician, and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health”.
CNN: Do current COVID-19 trends indicate that we are facing another surge in cases in the United States?
Dr. Leana Wen: I’m not sure this is called another increase because the numbers weren’t really down from the previous increase. In the winter, from about December 2021 to February 2022, we saw a huge increase in cases of the original subvariant of omicron, BA.1. There was a small pause; then BA.2 came with that increase in cases. Now, the BA.4 and BA.5 subvariants are displacing the previous omicron subvariants and causing the majority of infections in the United States. In many places, there is an increase in infections from a high base of cases.
It should also be noted that the number of reported cases is much lower than the actual number of cases. I think we could have five to 10 times more cases than are reported, considering that many cases are diagnosed by home antigen tests and not reported to public health authorities.
The good news is that these recent upticks have not been accompanied by a saturation of hospitals, illustrating the powerful effect of vaccines in distinguishing infection from severe disease.
CNN: With these kinds of numbers, how should people think about their risk of Covid-19? Does that mean people should cancel travel and reimpose restrictions?
Wen: I don’t think most people should change their daily activities, but I do think people should be aware of their risk of contracting covid-19 if they don’t take extra precautions.
The good news is that vaccinations and boosters continue to provide excellent protection against severe disease. However, we also know that immunity declines over time, and there appears to be some (evasion) of immunity with BA.4 and BA.5 in particular. This means that vaccinated and boosted people are unlikely to get seriously ill if they get covid-19, but they could still get infected.
The question people need to ask themselves is this: to what extent do they want to continue to avoid infection? There are so many viruses around us, and the variants are so contagious. That means avoiding infection requires extra consideration. Many people may not want to continue planning their lives around COVID-19 precautions, especially if they are generally healthy and well protected against serious illness.
On the other hand, many people may still prioritize not getting COVID-19 due to the risk of long-term symptoms. They may also have underlying medical conditions that predispose them to more serious outcomes, or they may live with others who are more vulnerable and want to reduce the risk to those around them.
CNN: For people who want to be cautious, what do you recommend?
Wen: For people who want to prioritize reducing their risk of COVID-19 infection, I would first advise them to follow CDC guidelines and stay up to date on their vaccinations. Anyone 5 years and older can get a first booster. Those over 50 can get a second booster for a total of four shots.
Some people (who are moderately or severely immunocompromised) may receive five vaccinations. (These people should also find out if they can receive evusheldthe preventative antibody that can further help slow the progression of severe disease).
I also urge you to wear a high quality N95 mask or its equivalent in closed and crowded places. Just because mask mandates have been lifted doesn’t mean people shouldn’t wear them. Many people do not consider masks to be inconvenient. In that case, I would continue to wear masks in all closed public places. For those of you who find them uncomfortable, I encourage you to use them in the highest risk environments, for example, in airport security lines and during boarding and disembarking.
Of course, remember that outdoor gatherings are still much lower risk than indoors. People who want to be extra cautious should try to go to outdoor gatherings if possible, and attend indoor gatherings only if everyone else is testing negative that day.
CNN: A lot of people are sick of hearing about these precautions. What if they just want to live their life, but don’t want to infect vulnerable people?
Wen: I certainly understand this sentiment. It is very hard for society to impose restrictions on individuals and ask people to permanently suspend gatherings like weddings and birthday parties or give up going to activities they like like closed restaurants and gyms. My best advice is to recognize that if you go indoors, you can get sick from covid-19. Be aware of the risk you run and take the necessary precautions.
For example, maybe you can live your life however you want, but before you visit grandma in a nursing home, get a quick test that day. If you attend a wedding with many guests in a closed place, get tested a few days later to make sure you did not get infected with coronavirus. And if you have symptoms at any time, get tested immediately and don’t expose others around you.
CNN: Are you safe if you’ve recently had covid-19?
Wen: The recent infection produces some protection that probably lasts about three months. However, reinfection can occur, and some studies suggest that becoming ill with the original omicron subvariant (BA.1) does not protect against the new variants. Vaccination plus recent recovery conveys better protection, so make sure you’re up to date on your shots and boosters, even if you’ve had covid-19.
CNN: And if you test positive, do you have to isolate yourself?
Wen: Yes, because you don’t want to infect others with covid-19. The CDC’s guidance is to self-isolate for five days and then wear a mask around others for another five days if symptoms are improving.
I think a testing policy is even better than this because people stay infected for different periods. I would encourage people to do home testing daily starting on day four and to end isolation once the home rapid antigen test is negative. Now is the time to make sure you have plenty of home tests available.