Understanding the New Threat of Omicron BA.2

COVID-19 is still a pandemic for the unvaccinated.

We may be done with COVID, but it’s not done with us. No surprise, but there’s a new variant in town.

Omicron BA.2, otherwise known as “stealth Omicron,” is the genetic offspring of Omicron. This new variant has led to a spike in cases in Europe, is disrupting China’s zero-COVID strategy, and is now the cause of COVID in ~40 percent of cases in the northeastern United States. And BA.2 isn’t the only Omicron offspring here.

Wasn’t the pandemic supposed to be over? How could this be happening now? Easy. First, COVID-19 public health measures have been relaxed or eliminated. Second, the protectiveness of the vaccines (and previous COVID infections) continues to wane over time. And third, this variant appears to be even more transmissible than the highly contagious original Omicron variant that caused a massive outbreak in cases in December and January.

Am I concerned? No, and yes. I’m not concerned for any American who is fully vaccinated and boosted. Although BA.2 is super contagious, it doesn’t appear to result in increased hospitalizations and deaths in that group. Case in point: former President Obama and 95-year-old Queen Elizabeth both recently tested positive for COVID without experiencing significant illness.

I am concerned about the relatively low vaccination rates in the United States, when compared with other developed countries around the world. Sixty-five percent of Americans are fully vaccinated. The booster rate is only 29 percent. Neither are good enough.

COVID-19 is still a pandemic for the unvaccinated. The data is clear. The unvaccinated comprise the vast majority of hospitalizations and COVID deaths. We tend to forget that nearly a thousand Americans still die daily from this infectious disease – numbers that would be markedly reduced with improved vaccination rates. It’s almost inconceivable that we will surpass one million COVID deaths in April. Have we become numb to this daily carnage?

These are some of the questions I’m getting from my vaccinated patients:

• Do I need a booster shot if I’m fully vaccinated? I would argue that you’re not fully vaccinated without a booster shot. There are some experts who believe that the mRNA vaccines should have been a three-shot series to begin with. We know that immunity wanes over time, especially after six months, and that the booster shot substantially increases protection. It’s easy to get a false sense of security with the huge drop in daily new cases over the past six weeks, but the new variant case spikes in China and Europe may be heralding a new wave here.

• I had Omicron just after Christmas. Will that infection protect me from this new variant? Yes, for now. The new variant is genetically very similar to the original Omicron virus. We just don’t know how long the protection will last – but it’s assumed that it will be at least 3-4 months, with diminishing protection over time. Of course, that doesn’t mean that a previous Omicron infection will protect you from a genetically much different future variant. It likely won’t.

• Should I get a second booster shot? Studies from Israel suggest that a second booster shot has a limited and only minimal short-term benefit. Personally, I’m going to wait for the likely development of an Omicron-specific booster (or a booster that targets future variants).

COVID-19 will become endemic, meaning it will never completely go away. As I’ve stated recently, just like with the flu, annual booster shots may become a reality.

My recommendations are as follows:

• Wear a mask, and wear it correctly, wherever it’s required. If it’s not required, wear one if it will make you feel safer, and then pick the one that is most protective.
• These vaccines are very safe. Please get vaccinated if you haven’t already done so. It will protect you, your loved ones, and a fragile healthcare system that has seen an exodus of workers, to a large degree from COVID fatigue.
• Get boosted if you’re fully vaccinated. And wait on a second booster shot, unless you are significantly immunocompromised.

Do not fear BA.2. COVID-19 isn’t going to go away, but we can end the pandemic for everyone if we can improve our vaccination rates.