Omicron summer in Oregon: Practical advice for the BA.5 subvariant

A new member of the omicron family is emerging as the dominant variant of COVID-19 worldwide and in Oregon: BA.5. Further down in this story, you can find pointers on how to protect your health from the new strain, but first, here are details on how it’s different from previous COVID-19 variants and subvariants.

It’s a sibling of BA.2,the variant that came before it and triggered Oregon’s seventh wave of COVID-19.

They share most of the same viral RNA, but BA.5 has a few important mutations in its spike protein.

Those changes appear to have given it a dramatic advantage: it’s more effective at re-infecting people who’ve been vaccinated or have had previous COVID-19 infections.

Like other variants in the omicron family, it’s also highly transmissible.

Scientists first spotted BA.5 in Oregon back in May, and say that it’s causing many new infections, though not a sharp increase.

“Rather than spikes or big waves I’m using the word groundswell. It’s broader, sustained, ongoing rate of infection. It’s like a rising tide,” said Dr. Marcel Curlin, an associate professor of medicine at OHSU.

Indicators including the percentage of emergency department visits for COVID-19, wastewater concentrations of the virus and test positivity rates all suggest lots of new cases.

In recent weeks, some headlines have declared BA.5 “the worst variant,” a statement Curlin says isn’t really accurate.

That’s because the answer to the most important question about BA.5 — “does it make people any sicker?” — appears to be “no.”

BA.5 was first detected in South Africa in February and caused a wave of cases there before spreading around the world. Scientists tracking hospitalizations and deaths there found that BA.5 and BA.4 were, like other omicron family variants, comparatively mild. The risk of hospitalization and death from BA.5 is significantly less than it was for the delta variant or the ancestral strain of COVID-19.

Some early concern about BA.5 stemmed from a single lab study that suggested that its mutations could increase the subvariant’s potential to infect lung tissues and cause severe disease – like the more virulent delta variant. But Curlin says that a single study is never conclusive, and it’s been effectively disproven by the emerging clinical data from South Africa.

Top officials with the Centers for Disease Control and Prevention also said they don’t see evidence it’s causing more serious illness at a press conference earlier this week.

Curlin says the pandemic has entered an awkward, intermediate stage since the omicron family of variants became dominant.

On one hand, the virus is spreading so rapidly that virtually everyone in the United States has some degree of immunity now, which is likely reducing the amount of severe illness the virus can cause.

On the other hand, that same rapid spread is giving the virus many more chances to mutate, and speeding up its evolutionary process. As a result, every few months, there’s a new subvariant circulating.

Scientists hope the evolutionary end point will be COVID-19 becoming an endemic virus that we all get frequently but that doesn’t make us very sick — but we’re not there yet.

“We still have to take seriously the destruction it can wreck especially on vulnerable people,” Curlin said.

BA.5 in Oregon: What should I do about it?

With many people likely at increased risk of a (hopefully mild) COVID-19 infection in the coming weeks, here’s some advice from Dr. Jennifer Vines, the lead health officer for the Portland Metro area tri-county region. Some of it may sound familiar.

1. Get yourself and your family members vaccinated if you haven’t yet.

About 85% of adults in Oregon have gotten at least one shot. Vaccines are still the best strategy to avoid outcomes like hospitalization and death.

“We’re still confident that being vaccinated protects you from those more severe effects,” said Vines. “That’s a level of risk reduction that is absolutely worthwhile.”

Getting your primary series — that’s your first and second dose of a Pfizer or Moderna vaccine — is the most important in terms of risk reduction. And it’s beneficial even if you’ve been previously infected with COVID-19.

Pfizer and Moderna have vaccines approved for children as young as six months.

2 . Get a booster or a second booster.

The CDC recommends first boosters for people age 5 and up. It recommends a second booster for people ages 50 and older and for some people 12 years and older who are immunocompromised.

Getting a booster now is unlikely to significantly delay your eligibility for the reformulated-for-omicron boosters Moderna and Pfizer are working on. Those shots will likely first be available to a small number of Americans in October, with a broader roll-out in November and December.

“If you’ve not gotten a vaccine shot this year, go get one now. It could save your life,” said Dr. Ashish Jha, the COVID-19 Response Coordinator for the White House.

3. If you’re high risk, make a plan for how you’d get Paxlovid.

The antiviral drug Paxlovid is effective at preventing hospitalizations due to COVID-19, but it needs to be given within five days of a person first showing symptoms.

It’s being given to people at high risk of complications from COVID-19: people who are older, unvaccinated or only partially vaccinated, or those who have underlying health conditions

Vines says getting Paxlovid within that five-day window can be a challenge, in part because some people don’t test positive for COVID-19 until a day or two after their symptoms begin.

So she recommends making a plan ahead of time. Call your personal health care provider and ask how to get testing and how to get access to the drug if you were to need it.

Anyone who doesn’t have a provider and needs care can become an established patient with the Multnomah County health center. COVID testing and rapid treatment for high risk individuals is part of that care. Anyone who wants to enroll can call 503-988-5558.

4. You’ve been exposed to COVID-19. Now what?

Public health officials are no longer asking people who’ve been exposed to quarantine or stay home. The reason? With highly transmissible variants in wide circulation, we’re likely all being exposed quite often.

But if you’ve had a known exposure to COVID-19, you should monitor yourself for symptoms.

And you should mask up or avoid contact with people who are at higher risk, such as people who are unvaccinated or immunocompromised. If you haven’t developed any symptoms five days after being exposed, you’re probably in the clear.

5. Use testing and masking strategically

It’s not a bad idea to take a rapid test before you see someone who’s at high risk, or before any large indoor gatherings.

But Vines cautions that testing is not airtight. People can be infectious before they develop symptoms of COVID-19 and before they test positive. So avoid gatherings and vulnerable people if you aren’t feeling well, regardless of a negative rapid test.

If you do get COVID-19, stay home and stay away from other people for five days. Then wear a mask when you’re around other people from days 6 to 10.