Don’t let latest COVID surge overshadow progress, says Harvard epidemiologist – Harvard Gazette

With a further rise in COVID cases, hopes for a relatively pandemic anxiety-free summer seem doomed. William Hanage, an epidemiologist at Harvard TH Chan School of Public Health and co-director of the Center for Communicable Disease Dynamics, spoke to the Gazette about the latest surge shortly after the United States reached another grim milestone: 1 million death. The interview has been edited for clarity and length.

GAZETTE: How does this surge compare to Omicron’s surge in January?

HANAGE: Nowhere even close to January. What we see is driven by a sub-variant of BA.2, which itself was pretty lackluster, at least in those parts. But we have seen more and more cases due to BA.2.12.1, which is a lineage first detected in upstate New York. It has a mutation in the spike protein which we believe makes it better able to re-infect people who have recovered from previous infections – including BA.1 – and which is shared by BA.4 and BA.5, growing in South Africa. That’s why we’re seeing a lot of cases, but they’re much lower than in January, even taking into account that we’re underestimating cases because more people are doing rapid tests and not being counted in the official figures.

For many people, myself included, it may seem like COVID is everywhere right now. But you must remember that this is a virus that spreads through networks. If you and your network have not been overwhelmed with BA.1, it means you are in a network that is more likely to get BA.2 because the people involved are less likely to have had the extra dose of immunity that came from BA.1. So that’s one of the reasons the transmission schemes look so distinctive. It is also certainly the case that we are seeing more transmission and more cases in schools now than we were with BA.1. When schools close — that means colleges like Harvard and K-12 education — it’s going to change contact patterns and things just might change.

GAZETTE: It feels like we’re in a decidedly different phase.

HANAGE: We are.

GAZETTE: Would you say we are in a post-pandemic phase? Could this be the first of the post-pandemic waves?

HANAGE: I don’t like having a cut because COVID is not going to be eradicated. There’s going to be a transition from acute pandemic risk to a point where people like me – infectious disease epidemiologists – pay a lot of attention to it the same way we pay attention to influenza. We are heading in that direction but we are not there yet. To give some context, I think you’ll agree that right now the country is doing relatively well, in terms of deaths and hospitalizations. But if the weekly death numbers were added up over the year – no fluctuations, no flare-ups, just continuous “good” death numbers – it would still equal two bad flu seasons. When this virus is “good”, it is still something that would be considered historically bad in terms of respiratory infections. And, of course, we can expect things to get worse in the South in the summer and pretty much everywhere before the winter, and that’s assuming there aren’t any new variant curveballs.

“When schools close — that means colleges like Harvard and K-12 education — that’s going to change contact patterns and things may well change.” Photo by Kent Dayton

GAZETTE: If you had a case in your household at this point in the pandemic, how would you handle it?

HANAGE: I can tell you what we did — our children got infected. First, sign up for ongoing household transmission studies. There’s one being done in Beth Israel. We were lucky to have air purifiers, which we turned on. We wore masks, but not continuously, not religiously. We kissed while wearing masks. We ate outside when we could and when it was cold we ate inside. For what it’s worth, neither my wife nor I got infected. We also did very regular rapid tests – we actually did daily PCR tests because we were in the household transmission study.

My advice to a member of the public would be to remember that you could be contagious and not know it. Whenever you leave the house and go to a place with high transmission, such as meeting with vulnerable people or attending a large gathering where you could trigger a superspreader event, try to do a quick test beforehand. If you’re not going to have close contact — like at the grocery store — wear a good quality mask. If you have symptoms, don’t go outside, but don’t assume that having no symptoms means there’s no chance you’ll have them. If the person in your household has had it for five days, don’t assume they are no longer contagious. A large number of people in this category will still be contagious. The CDC’s advice — and my recommendation — is that if the infected person has to leave the house, make sure they’re wearing a well-fitting, good-quality mask. This will greatly reduce the risk of transmission to others.

GAZETTE: What about mandatory restrictions? Are we already there?

HANAGE: I wear a mask whenever I’m outside the house indoors in a public space and honestly can’t see that’s a big deal. I would take off my mask for things that are important to me, if that’s a risk I want to take. For example, this weekend is the end of the Premier League and I am a tortured Arsenal fan. I would normally go watch this with friends at a bar. I would test first, but if I did become infected, I would have confidence in the ability of vaccines to protect me from the most serious consequences. But I’m not going to because I’m taking a flight next Friday, to the UK, and I don’t want to get infected before the flight.

GAZETTE: We want to be lucid, to understand both the risks and the measures we can take to reduce them.

HANAGE: I also point out that if you are likely to be more severely affected, talk to your doctor about paxlovid. That helps. You hear about rebounds and they happen, but paxlovid is still a beneficial drug. If you’re immunocompromised, talk to your doctor about options, like evusheld, that may offer some protection. Vaccines, therapeutics and masks, taken together, are a powerful way to fight a virus that once threatened to destroy healthcare. A major challenge for public health today is to ensure that the protections we have obtained are equitably distributed.

As I walked around, going places, working and coming back, I watched the lines of people going into nightclubs, I watched people in restaurants, I watched people leading a full life — maybe not like 2019 — and I just marvel that it’s been achieved. This is happening with a similar amount of infection as in January 2021 – one of the worst times of the pandemic. Yet this does not translate into the same impacts on health care. This is quite amazing when you consider that in January 2021 there were considerably more mitigations than we have now. And I feel a real sense of accomplishment.

GAZETTE: He was tortured at times, but society is in a much different place.

HANAGE: As a society, we are in a much better place. In public health, you don’t see the lives you save. The kid who doesn’t die of meningitis at 17 or 18 because he was vaccinated as a child — you don’t see it. And, as we talk about the horror of a million deaths in the United States, we should tell ourselves that it could have been much worse. The people who made the sacrifices in 2020 that delayed the arrival of the virus in people who would have died had they not had the opportunity to be vaccinated deserve endless gratitude. This remains the case now. People who do things to prevent others from getting infected save lives. We don’t see those lives being saved in the ER, so it’s easy to assume that’s not the case. Focus on the positives.

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