Seven-day COVID-19 case averages in Virginia have been climbing over the spring, from about 700 cases a day in early April to nearly 3,000 daily last week.
Hospitalizations, currently with a seven-day average of 573, have seen a comparatively modest increase, but tend to lag behind case counts as infections take time to develop and worsen. Though overall case numbers and hospitalizations aren’t close to the surge seen over the winter, the test positivity rate—18.9 percent—is hovering near the peaks in both the initial wave and Delta wave of the pandemic, even though the figure only includes lab PCR tests and not the at-home rapid tests that are widely used by people to diagnose infections.
The CDC has categorized 77 of the state’s 133 localities as having either medium or high community COVID-19 transmission levels. A medium transmission level is triggered automatically in any area where there have been more than 200 cases for every 100,000 people within the past seven days. A high level takes into account seven-day case averages and hospitalization capacity as well.
But in an interview last week with the Virginia Mercury, State Health Commissioner Dr. Colin Greene said that the priority should be trying to get back to something approaching normal life, and that individuals should assess their own risk tolerance and medical situation when determining how they should conduct their lives amid the virus.
“At some point we have to go back to living our lives,” Greene said. “But we want people to be reasonable.”
He urged every adult to get the vaccine, as well as “children whose parents choose to have them do so.” As of Monday, 73.8 percent of Virginians are fully vaccinated for COVID-19 and of them, 49 percent have gotten boosted with a third dose.
Greene emphasized that “we need to return to something resembling our normal human interaction”, part of which means “being able to see somebody’s face.” The CDC, however, recommends that those in places with high community levels should wear a mask indoors regardless of vaccination status, including 12 counties in Virginia.
Children under 5, who constitute just under 6 percent of the state population, could be able to get vaccinated as early as the end of June, per an announcement by the White House coronavirus response coordinator Dr. Ashish Jha.
This latest surge in case numbers seems to be the result of a war for dominance between subvariants of the omicron variant, which itself was extremely infectious and led to the highest case numbers seen at any point in the pandemic. Less than two weeks after the BA.2.12.1 subvariant became the dominant permutation of the virus in new cases, cases of the BA.4 and BA.5 subvariants have already increased almost 80 percent in the U.S. However, these still only made up 6.1 percent of new cases as of last week.
BA.2.12.1 is thought by the CDC to be about 30 percent more transmissible than its BA.2 parent, which itself is an estimated 33 percent more transmissible than the ‘original’ omicron BA.1. An early paper claims that the BA.4 and BA.5 is four times more resistant to antibodies, better evading the immune response even of those with a booster shot or previous Omicron infection.
Experts emphasized that current vaccines continue to do a good job of mitigating against serious outcomes from the virus, such as hospitalizations or death.
“I think what we’re seeing is a reflection that there is a pretty good foundation of immunity that is lessening the impact of this current wave of the pandemic,” said Dr. William Petri, the chief of the division of infectious diseases and international health at UVA Medical School. “Most people have either been vaccinated, or they have had omicron.”
He also pointed to the development and distribution of the “miracle” antiviral drug Paxlovid, a treatment which can dramatically reduce the chance of hospitalization and death and is broadly available by prescription, generally for those at high-risk of developing severe COVID-19. .
Dr. Lisa Thanjan, public health physician at the Virginia Department of Health, also said vaccines protect most people from serious illness or death, but pointed out that even vaccinated people can have complications. A recent CDC study shows that 1 in 5 of those under 65 who’ve had a COVID-19 infection have some lingering condition that could be attributed to that previous infection.
“Even though we see more mild illness, it is still best to try to avoid a COVID-19 infection, even in people who are not high risk,” Thanjan said. “That’s because of long COVID or these lasting effects from a COVID 19 infection. We’re seeing that this happens even in people that have a mild illness. This could be cardiac issues, neurologic issues or respiratory issues.”
However, Greene, the former director of the Lord Fairfax Health District in northwest Virginia who was appointed by Youngkin in January, said the risk of infection “has dropped substantially to the point where the benefit from stricter prevention measures is just not that great anymore.”
“I think the main thing right now is people need to understand that, while the risk is not zero and for particularly susceptible people they still need to be on guard, for most people, particularly younger and healthier ones, it is not 2020 anymore,” said Greene. “We’re reaching a more steady state situation with this virus — the epidemiologists refer to it as an endemic stage. We’re going to reach an end stage, and we need to adjust, we need to adapt, we need to decide how we’re going to live our lives.”
The Biden administration — in an effort to advocate for an additional $22 billion it is seeking from Congress for pandemic mitigation — warned last month of models predicting that almost one-third of Americans could be infected with COVID-19 through the fall and winter if more funding for testing, vaccines and treatment is not secured. An estimated 130 to 140 million Americans were infected during the omicron surge.
Greene’s approach leaves the responsibility to individuals to make judgements about risk and stay on top of information such as fluctuating infection data, adapting public health guidance and emerging variants.
“There are many more factors, there’s a lot of information to keep up with for sure,” said Thanjan. “It’s difficult to stay on top of some of the vaccination guidance, but you know the CDC has a website on staying up to date and when to get those boosters and who’s eligible. That’s really the most important thing at this time.”
Some experts, including Greene, believe that COVID-19 will become endemic, meaning that it will likely stay in a steady state and continue circulating in the population. However, Dr. Petri points to the global efforts to eradicate polio through vaccination as a source of optimism. Key to such an effort would be to develop a vaccine that has “broadly neutralizing protection” that would prevent the virus from mutating its way past the immunization, as omicron and its subvariants have.
“I think it’s quite possible to eliminate SARS-CoV-2,” said Dr. Petri. “This year, in the entire world, there’s only been eight cases of wild polio so we’ve gone from hundreds of thousands of children being paralyzed every year to a handful and so that’s evidence that we can do this. It’s going to take a huge international effort.”
Virginia Mercury columnist Roger Chesley contributed reporting.