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It’s been roughly a year since the Delta variant arrived in Vermont, reversing what had been a nearly Covid-free summer.
Delta caused a surge in cases and hospitalizations, propelling what Health Commissioner Mark Levine deemed a new phase in the pandemic — only for Omicron to arrive in December, leading cases to skyrocket.
Just as Omicron waned and Vermont began to loosen restrictions, BA.2 came, then its close cousin BA.2.12.1. Now, on the heels of recovering from that strain, Vermont’s Covid-19 levels remain “low” according to most indicators — but yet another strain looms on the horizon.
The strain has become dominant in the United States, forming 77% of new cases, according to the U.S. Centers for Disease Control and Prevention. While it’s hard to estimate the rate for Vermont, the CDC reports BA.5 is also the dominant strain in New England.
Experts say BA.5 is about as severe as Omicron, and about as transmissible, too. But they’re concerned that BA.5 seems to be good at evading people’s immunity to the virus, meaning that reinfections are likely.
“It’s as if the population is seeing a completely new virus in some ways,” said Denis Nash, a professor of epidemiology at the City University of New York.
The strain also comes at a time when Vermont has scaled back its efforts to fight the disease, said Anne Sosin, a health equity researcher at Dartmouth College. Businesses, summer camps and social gatherings have largely returned to normal. Testing, vaccination and treatment are available only through medical providers, rather than state-run sites. The state Department of Health tracks less data regarding the state of the pandemic than it did for the first two years of the pandemic.
“Our concern with this surge is that BA.5 will, because of changes in behavior, find Vermonters who are most at risk,” Sosin said. As many people have returned to normal activities, “their exposures in their communities have increased.”
Levine is less concerned. The health department head said that, while BA.5 may cause a rise in infections, it appears unlikely to overrun hospital resources or cause a surge in deaths.
“If you are (vaccinated and) boosted, you are still very, very highly protected from the serious outcomes,” he told VTDigger. “So while we can't promise you that you will not get infected at all, or even have a symptomatic infection that you feel pretty lousy, we can tell you that the vaccine promise still is that you will not get a serious outcome if you've been appropriately boosted.”
He said the number of new hospital admissions for Covid-19 would have to change “dramatically” for Vermont to change its policies.
“If more people become ill, there will be more hospitalizations and serious outcomes, but that doesn't mean they will be (on) such a scale or order of magnitude that you'd have to alter policy in any significant way,” he said.
Covid in everyday life
Sosin said that, while the hospital system may not go over capacity because of this strain, it — and almost every aspect of Vermonters’ lives — is still vulnerable to the economic and social impacts of Covid.
“The surge is coming at an incredibly precarious moment,” she said. Vermont is navigating both economic and health crises, she said, and many of its primary care providers and community service agencies have been overtaxed during the past two and a half years.
The latest strain is already causing disruptions to schooling, child care, work, essential services and other critical industries such as airlines, Sosin said. But Vermonters may not have the resources to attend to Covid policies, such as getting tested as soon as possible.
“The cost of living has increased so much, and so many are really struggling to meet their basic needs,” she said. “The dysfunction of Covid certainly exacerbates that, but it's not the only concern competing for our attention.”
Experts also pointed to particular concerns for high-risk people, who may want to take additional precautions at a time when most Vermonters are going about their everyday lives. Nash said “the news is not good” if you’re trying to avoid Covid infection for your own safety.
“It can be really, really hard unless you're just going to stay on lockdown,” he said.
There are some tools the health department recommends for high-risk people to protect themselves, such as staying up-to-date on boosters, wearing high-quality masks and calling their doctor as soon as they test positive to get antiviral treatment.
But Sosin warned that now may be the time for high-risk people to increase their precautions as much as possible. She recommended taking advantage of outdoor activities when they’re an option.
How do we know when it’s here?
The latest Covid case data from the health department does not indicate a BA.5 surge. The state is reporting about 80 cases per day, barely changed from the week before.
But case data doesn’t show the full story. In fact, Sosin believes we’re already in a “phantom surge,” where people are getting sick but are not being included in state data, which relies on PCR tests — which have dropped in popularity and availability, and whose results lag a day or more behind the time of the test.
This is not a new concern. State officials, including Levine, have warned about the increasing inaccuracy of case data since the Omicron surge, and the health department has worked to establish new metrics, such as syndromic surveillance — which involves examining health data at a population level — or wastewater testing.
Still, it’s a problem that continues to worry experts like Nash, who said “we kind of have to wait” until hospitalizations and deaths have increased to tell that we’re in a surge.
“It's really problematic, because it could be too late to have prevented a lot of hospitalizations and deaths if you wait that long,” he said.
Nash conducted research during BA.2 that tested a random sample of the New York City population. He found that the prevalence of the virus was much higher than officially reported, and was particularly high among people with underlying medical conditions who were at risk of severe complications from the disease.
Ted Cohen, an infectious disease epidemiologist at Yale University, is working on a project that would estimate the true prevalence of Covid across the country using the limited data available on hospitalizations.
“Trying to understand where we are based solely on case records is basically a nightmare,” he said.
Nash said the subvariants of Omicron have caused a “parade of surges” that run closely against each other, making it difficult to distinguish between the different strains and understand their different effects on the population.
Whether or not BA.5 will cause a rise in hospitalizations is difficult to say, Sosin said. The number of hospitalizations for Covid jumped from 10 to 31 in the past week, but remains below the BA.2 high of more than 60 in mid-May.
“We're flying into the BA.5 surge blind to make both individual and policy-level decisions,” she said.
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