The COVID-19 Pandemic and More: BA.5 is the latest winner in the subvariant competition, and back to politics and public healthJul 11, 2022
Not much changed over the last week in Colorado’s COVID-19 pandemic, and the epidemic curve remains plateaued. Whether this is good news or bad news—given the predominance of BA.5, the Omicron subvariant that is more transmissible than its predecessors—is not clear. The subvariants BA.4 and BA.5 continue to rise in Colorado, and nationally, BA.5 now accounts for the majority of cases. In the Darwinian competition among variants, BA.5 is the most transmissible to date and is associated with rising epidemic curves in a number of countries, in spite of high rates of prior infection and vaccination in some. With Colorado’s epidemic curve on a plateau for several weeks, its direction is uncertain, but the hospitalization count remains relatively low compared with prior spikes.
Fortunately, BA.4 and BA.5, while more transmissible than earlier subvariants, are not more virulent. However, these two subvariants appear to have structural changes that facilitate immune escape. They arrived when population immunity was relatively high from prior Omicron variants and vaccination, likely tamping down the numbers of more severe infections. In his commentary, "The BA.5 story," Eric Topol laments that the variants are outstripping our development of vaccines against them. Both Moderna and Pfizer have submitted data to the FDA concerning vaccines directed at the ancestral strain and BA.1, but the variants have moved on. The FDA considered the challenges of determining the composition mix of future vaccines at a June 28 meeting of the Vaccines and Related Biological Products Advisory Committee.
A preprint from the Institute for Health Metrics and Evaluation (IHME) provides further evidence on the immune escape properties of the more recent variants. The IHME team identified 43 studies from 17 countries that provided evidence on reinfection risk for variants prior to and after Omicron. The pooled estimate for effectiveness against reinfection by the Omicron variant was 38.8% compared with much greater effectiveness against the prior strains, 78.2% at 40 weeks. The warning is clear; the variants have the upper hand—for now.
For the public health workforce, one of the most disturbing consequences of the pandemic has been the vehemence of the backlash against public health and the public health workforce. This is one topic of the May issue of the American Journal of Public Health. The centerpiece of the discussion is an article by Ward et al. that combines evidence from a media search and a survey of local health departments to characterize actions against members of the public health workforce and their consequences. From March 2020 through January 2021, the media search identified 222 departures, 36% accompanied by reports of harassment. The survey, limited by a 24% response rate from local health departments, provided equally troubling findings. Of the responding departments, 43% reported some form of leadership targeted harassment. Merging the two evidence streams, the authors identified five themes: “underrecognized expertise, ‘matchsticks and Scotch tape infrastructure,’ the lifesaving villain, politicized public health, and disillusionment.”
Accompanying commentaries amplify these messages. Michael Fraser, CEO of the Association of State and Territorial Health Officers (ASTHO), poses two appropriate questions: “How have we arrived at this point? How can a small but vocal segment of the population believe it is appropriate to threaten and harass health officials whose primary job for the last two years has been to protect us from a novel infectious disease that has claimed the lives of more than 900,000 Americans?” We know that public health became politicized during the pandemic in order to curry favor with those who rebelled against non-pharmaceutical interventions, particularly masks. Unfortunately, the harassment of public health officials appears to be a strategy that has gained traction and will be played out in the future. It needs to be called out and our graduates need a new competency to deal with it.
A May 2022 survey by the Pew Research Center documents the political divide on public health. On questions related to the effectiveness of specific measures, e.g., masks and vaccination, there are substantial differences between the responses of those self-identified as Republicans and Democrats or leaning towards either party. For masks, for example, 21% of those identifying as Republicans view them as effective when worn around others indoors, versus 71% for those identifying as Democrats. At the pandemic’s start, most Republicans and Democrats viewed public health officials as doing an excellent/good job, but in the latest survey, the gap was 42% (72% positive among Democrats versus 29% among Republicans). Unfortunately, the solution to this politicization and its consequences is not evidence, even of the damage that political considerations have inflicted on all of us.
Stay well and stay cool,
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health