Dr. Anthony Fauci says the United States is no longer in the pandemic phase of the spread of COVID-19, but what does that mean? Numbers are higher this summer than last year.
Why is the BA.5 subvariant causing concern?
What about boosters?
Should kids get the vaccine?
Dr. Armando Paez, chief of Infectious Diseases at Baystate Health, and Dr. John O’Reilly, chief of General Pediatrics for Baystate Children’s Hospital, answer some pressing questions concerning COVID-19.
From Dr. Paez:
Q: Some health authorities, including Dr. Anthony Fauci, have been quoted as saying the pandemic is over, what does that mean since people are still getting sick?
A: The pandemic is not over yet. COVID-19 is still very much in our communities.
What Dr. Fauci meant, which he later clarified, is that we are past the worst of the pandemic. Yes, there are still ongoing infections, but not as high a rate as we have experienced in the past. I also believe there is undercounting of the number of cases, as more home testing is being done and not reported. Hospitalizations and deaths still do occur on the most vulnerable among us, but fortunately less than in the beginning of the pandemic.
Q: Why are there more cases of COVID-19 this summer compared to last year when the hope was that they would be on the decline?
A. There are several factors that contribute to the increasing number of cases this summer.
- Omicron subvariants: The BA.5, which is now the predominant variant that is circulating, is a highly mutated virus that is very different from other variants apart from BA.4, which is closely related to it making it more infectious. Unfortunately, this can escape the immunity from the vaccination and from the natural infection from previous variants making it a highly contagious virus that can cause reinfections.
- Relaxation of the infection control measures: Measures such as masking, physical distancing, etc. in the communities that we know can help decrease transmission have been relaxed.
- Waning immunity from the vaccination and from natural infection: We know that protection from infection does not last very long, although the vaccine still helps protect us from getting seriously ill and dying from COVID-19.
Last is our overall attitude towards the pandemic. Pandemic fatigue is real - the mindset of not taking this as seriously as before, given the recent experience of milder COVID-19 infections with lower rates of dying or being hospitalized. This led to many people going back to the pre-pandemic way of living with traveling and social gatherings that create opportunities for super-spreader events.
Q: The coronavirus subvariant known as BA.5 is now dominant in the U.S. and appears to evade protection from vaccines and previous infections more easily. How can I be sure I am protected?
A: As mentioned above, the BA.5 is a highly mutated subvariant of Omicron that confers increased infectiousness and can also evade immunity from vaccination and prior infection which makes it a more “fit” virus. Thus, this is a highly transmissible virus that can reinfect individuals who have been vaccinated or have recovered from COVID-19 in the past.
However, there is evidence that being up-to-date with vaccinations, such as having the 2nd booster, particularly in the elderly and those with risk factors for severe illness, can still significantly prevent hospitalization and death from COVID-19. So, getting up-to-date with your vaccinations is recommended.
The ideal situation is having a redesigned COVID-19 vaccine that can effectively neutralize the predominantly circulating variant. There is already a strong consideration for this type of COVID-19 vaccine, but the challenge is keeping up with variants that are evolving. Employing the infection control measures we know of can help prevent transmission such masking in high-risk situations such as indoor public gatherings. This is particularly important among individuals who have risk factors for severe illness and the immunocompromised.
You can never be sure you are protected from infection, but you can help protect yourself from being hospitalized and dying from infection by getting up-to-date with your COVID-19 vaccinations and adopting infection control measures in certain high-risk settings.
Q: Given the transmissibility of the newer variants, should travel be curtailed?
A: The decision to travel should be up to the individual depending on one’s circumstances. If you are moderately or severely immunocompromised or if you are not up-to-date with your vaccinations, the risk of a more severe outcome from COVID-19 is real. There are infection control measures such masking that can help decrease the risk of infection, but it will not eliminate it.
Q: Are monoclonal antibodies still effective in treating COVID-19? What else is available?
A: Yes, bebtelovimab, a monoclonal antibody against SARCoV2 is effective in neutralizing the virus based on laboratory studies, although it has limited clinical data. It currently has FDA authorization for emergency use for those of whom alternative treatment options are not accessible or clinically appropriate.
Currently, the treatment of choice for mild to moderate COVID-19 for those non-hospitalized patients with risk factors for severe illness is nirmatrelvir/ritonavir (Paxlovid), an oral medication. If this cannot be taken or not available, a 3-day course of an intravenous infusion of remdesivir (Veklury) should be considered.
Q: Why are many people who take Paxlovid experiencing rebound COVID?
A: Recurrent COVID-19 symptoms have been reported between 2-8 days after taking Paxlovid. These “rebound” of symptoms have been accompanied by a positive viral antigen or PCR test after being negative following Paxlovid treatment. It is currently unclear how often this occurs.
Fortunately, there are no reports of severe illness associated with this rebound, but only mild symptoms that later improved or resolved often around 3 days without additional treatment. There is no associated increased risk of hospitalization or death, but possible viral transmission can still occur.
At this point, there is no current evidence that additional treatment for COVID-19 is necessary. However, re-isolation for at least another 5 days if no fever is present for at least 24 hours without use of fever-reducing medication is recommended by the CDC.
Q: What protective measures, especially masking, should we still be taking?
A: Given the risk of reinfection with the predominantly circulating variant despite vaccination and prior COVID-19 infection, infection control measures such as masking in public indoor gatherings or even outdoor activities where people congregate will help stop the spread of COVID-19. This is particularly important for those individuals who are at risk of having severe illness from COVID-19, such as older adults and the immunocompromised.
Q: If I am eligible for a COVID booster shot now, should I get it or wait for the newest version of the Omicron-specific booster being readied for the fall? And who will be eligible to receive it?
A: Given the increasing number of COVID-19 cases with the predominant Omicron subvariant BA.5, it is important to get up-to-date with COVID-19 vaccinations and your booster shot(s). Yes, it may not completely prevent you from infection from this variant, but it can still offer protection from risk of hospitalization and dying from COVID-19. This is particularly important among the elderly and those with risk factors for severe COVID-19.
An Omicron-specific booster shot is still being evaluated by the FDA and not available for emergency use yet. Of note, this vaccine is directed towards the original strain of Omicron, BA.1 and not BA.5, which is currently the predominantly circulating subvariant. However, it will likely still offer some protective immunity, but we do not know to what extent.
Q: Are the vaccines working? I have resisted being vaccinated, which ones should I consider for their effectiveness and how many will I need spaced out for how long? What about boosters after the initial vaccine?
A: The currently available COVID-19 vaccines can still offer protection from being seriously ill and dying from COVID-19. Thus, they are still “working” and are not completely useless.
However, we are disappointed and frustrated about the current situation as we had higher expectations about the promise of COVID-19 vaccination in preventing infection in the first place. Unfortunately, the virus mutates and evolves to its own advantage in order to survive.
However, we also need to do our part in studying it and following the science for us to once and for all, end this pandemic.
Regarding spacing of the vaccination and boosters, I would refer you to the currently recommended CDC COVID-19 vaccination schedule. This is continuously being updated based on available scientific data.
From Dr. O’Reilly:
Q: Are children required to be vaccinated against COVID to go back to school?
A: No, not at this point. But parents want to do the most they can to protect their children and getting them vaccinated against COVID-19, even if not required for school admission, is a way to go above and beyond to keep their children safe and healthy.
Although children do not get as seriously ill as many adults with COVID-19, they are at risk for having serious complications and even death from the virus.
With the more contagious Omicron variants, tens of thousands of children have had been hospitalized for COVID-19. Many children have also suffered serious complications of COVID-19, including the multisystem inflammatory syndrome of children (MIS-C) and long COVID. Vaccines are the best way to prevent your child from being hospitalized, being in the ICU with MIS-C, or suffering for months and months with long COVID.
Q: At what age can a child now be vaccinated and how safe are the vaccines? What vaccine choices do they have and is one more effective than another? How many doses will be needed? And what about boosters? And will there be new vaccines in the fall, too, to address the variants?
A: Children 6 months and older are now eligible to be vaccinated against COVID-19. These vaccines have been proven safe and effective. The amount of vaccine in each dose depends on the child's age, and the dosing was chosen to maximize effectiveness while limiting side effects.
Side effects from COVID-19 vaccination in children are very similar to those in adults and are usually limited to:
- Local soreness at the site of vaccination
- Low-grade fever
- Perhaps a day or two of body aches or decreased activity level
These mild side effects are nothing in comparison to the COVID-19 illness itself, which has hospitalized tens of thousands of children and killed over 400 children in the United States.
For children under 5, Pfizer has a 3-dose COVID-19 COVID vaccination regimen and Moderna has a 2-shot vaccination regimen. Although there are differences between the vaccinations, both are safe and effective. Parents should discuss with their pediatricians about which vaccination might be most appropriate for their individual child.
For children 5 years old and over, booster vaccinations are an important way to keep your child’s immune system on the lookout for COVID-19, and to increase your child’s protection against a serious infection with the virus. Children 5 and older should get their booster shot 5 months after the completion of their initial 2 dose series. Both companies are looking to create vaccines that are more specific for the Omicron variants. As we have seen with the vaccines in the past, there will need to be vaccine trials with the new formulations to ensure that they are safe and effective. Although we hope to see these new more specific vaccines available as soon as possible to protect our kids, we will not be giving these new vaccines until they are proven safe and effective for each age group.