So, what’s the deal with the recent rising Covid-19 cases, and this new variant? Luckily, the usual suspects from the University of California, San Francisco Grand Rounds have reconvened just in time to offer some guidance.
Dr. Monica Gandhi, Dr. George Rutherford and Dr. Peter Chin-Hong held a wide-ranging discussion Thursday, including tips on when to get the upcoming vaccine and masking around preschoolers. It was moderated by Dr. Bob Wachter, who pressed the experts to be as specific as possible, and even proposed situational examples.
In short, a new variant has arrived, but appears to be less virulent than past ones, like omicron, per recent data. A booster vaccine will likely be available within the next two weeks and, by fall, locals can expect shots for RSV (respiratory syncytial virus) and influenza. Everyone should get the new covid booster, but it benefits the sickest or more vulnerable the most.
As for masking, the panelists said that they wear them very occasionally — mostly in situations to protect those at greater risk.
Let’s see what the doctors ordered.
What’s the state of things?
Yes, people are getting sick from covid again this summer, across the country and in San Francisco, similar to summers past.
The variant accounting for roughly 21 percent of cases nationwide presently is called Eris, or EG.5, a descendant of the omicron variant.
However, the mortality rate is still decreasing, and has been since the omicron variant. Omicron and its descendants have lower fatality rates compared to earlier strains, Rutherford said.
Why has there been an uptick in cases lately, and how worried should we be? Though covid is officially endemic, surges can happen when there’s a new subvariant, like EG.5, which is more transmissible. Still, while cases are on the upswing nationwide, Hong said he wouldn’t quite call it a “surge.” He ventured that one factor leading to higher cases this summer is hotter weather, which drives people indoors, similar to cold winter weather, and may increase exposure in groups. Traveling and waning immunity could contribute, too.
Meanwhile, the experts are alluding to the latest B.A.2.86 variant — different than the Eris variant, and not yet showing up on all variant maps — as a “paper tiger,” and saying the initial “scary” theories probably have no bite.
“I think there’s a fair amount of research in the last week or two that’s pretty reassuring,” Wachter said.
At first, scientists worried that B.A.2.86’s high number of mutations in the spike protein — more than 30 — could have meant the virus might affect people more severely. The last time that many mutations occurred was when the delta variant became omicron.
“And we all remember what happened when delta went to omicron,” Hong said.
However, “we’ve had at least four labs around the world, two in the U.S., one in Sweden, one in China, showing that [the] existing immunity that we have can result in an increase in antibodies, sort of like neutralization against this ‘scary’ variant,” Hong said.
The study suggests people who have both been recently exposed to covid or who have been previously vaccinated should have sufficient immunity to guard against it.
Gandhi also pointed out that the Centers for Disease and Control announced in November 2022 that the public had built up a lot of natural immunity.
“All these sub-variants are less virulent, but now we have a profound wall of immunity,” Gandhi said.
A new vaccine is expected in the next week or two and, like other vaccines, it takes about two weeks to kick into full force. Doctors encourage people to get it when it comes out.
While the experts agreed vaccines should go to those 65 and older, those who are immunocompromised, and those with multiple comorbidities, Dr. Wachter asked: Should 30-somethings — like many of those in the audience — get the shot as well?
After much prodding, Hong said yes. From an infectious disease perspective, he would recommend a 30-year-old in that scenario to get one, because it would help mitigate contagion.
Rutherford agreed, and said that, even if the benefits are fewer for younger people, vaccines still protect against severe disease and long covid. Overall, the benefits outweigh the risks, even for healthy young people, he said.
Gandhi said there’s certainly no “harm” in receiving it, and if a younger person wants it, they should get it, “absolutely.” But Gandhi also said that the benefits of receiving one in that age group are substantially less, as they are less at risk for hospitalization. Per Wachter’s questioning, she said if her hypothetical 30-year-old kid had asked her whether to get it personally, she would tell them not to.
Her big-picture worry focuses less on the individual, and more on how inconsistent or unclear medical messaging could have cost Americans trust in the public health system over time, as the lower rate of vaccination with the bivalent shot suggest. About 21 percent of adults got a bivalent booster, and only 43 percent of those 65 and older received one. It “should have been 100 percent,” she said.
“I’m actually more in favor of being very clean about who gets the booster or not. And I think we should go the way of the W.H.O., on March 28, 2023, they put out the SAGE guidance. The U.K. has done the same thing.” Both recommend those 65 and older, who have comorbidities, or who are immunosuppressed get it.
“I’m sure you can get it when you’re 30, but when the world does something different, and we [were] the only ones recommending it for the young, then people stop listening. And that means we get less trust and maybe they won’t take their measles vaccine,” Gandhi said.
Who should get the flu, RSV or covid vaccine — and when?
The latest covid vaccine can be taken when it comes out in the next two weeks, and is especially recommended for those 65 and older, those with comorbidities, and those who are immunosuppressed.
The RSV vaccine is for those 60 and older, and those who are between 32 and 36 weeks pregnant, and can also be taken as soon as it is available.
The flu shot is recommended for most everyone six months or older. While it would be ideal to get the flu shot right before the flu season’s peak, it is hard to know when that will be. Rutherford said he would get his in October, personally, when it usually becomes available.
Testing and masking
Hong keeps his mask in his pocket, and decides when it’s “judicious” to put one on — say, when he’s visiting his 90-year-old mom. Day-to-day, he hasn’t needed it as much. Rutherford feels similarly, and said maybe only in crowded indoor settings, like a bus across the country, might he consider it. Until the situation worsens, he’s fine doing “nothing” to prevent covid.
Gandhi has publicly taken a stance to decrease masking in the past year, in part because a study from England suggesting universal masking did not make a significant difference in preventing transmission within hospitals. She worried that excessive mask mandates could harm trust in public health settings.
She noted San Francisco, Santa Clara, and Alameda counties are the only ones statewide that have continued to require masks in hospital patient settings, despite the state health department relaxing that rule.
Advice for young or old people?
One concerned audience member asked whether masking could help prevent covid transmission between his preschool age child or his 80-year-old, diabetic, vaccinated mother, who has not contracted covid.
The parent needn’t worry; Rutherford said it was more likely the child would be infected from somewhere else. Masks can help if worn right, but …
“The chances of a three-year-old wearing a mask correctly aren’t zero … ” Rutherford said, “but it’s just, the likelihood of success is going to be very low.”
As for the mother? “What’s going to protect her is you being vaccinated and she being vaccinated,” Rutherford said. “That’s the bottom line.”