America Is Staring Down Its First So What? Wave | The Atlantic - Katherine J. Wu:
April 5, 2022 - "If the United States has been riding a COVID-19 ’coaster for the past two-plus years, New York and a flush of states in the Northeast have consistently been seated in the train’s front car. And right now, in those parts of the country, coronavirus cases are, once again, going up. The rest of America may soon follow, now that BA.2 — the more annoying, faster-spreading sister of the original Omicron variant, BA.1 — has overtaken its sibling to become the nation’s dominant version of SARS-CoV-2.
"Technologically and immunologically speaking, Americans should be well prepared to duel a new iteration of SARS-CoV-2, with two years of vaccines, testing, treatment, masking, ventilation, and distancing know-how in hand. Our immunity from BA.1 is also relatively fresh, and the weather’s rapidly warming.... But ... the country’s capacity to track the coronavirus is on a decided downswing.... Testing is how individuals, communities, and experts stay on top of where the virus is and whom it’s impacting; it’s also one of the main bases of the CDC’s new guidance on when to mask up again. Without it, the nation’s ability to forecast whatever wave might come around next is bound to be clouded.
"'I keep thinking back to this idea of If we don’t measure it, it won’t happen,' says Shweta Bansal, an infectious-disease modeler at Georgetown University.... In reality, 'it’s very well happening, and we just don’t see it yet.' There is still no guarantee that the next wave is nigh — but if it is, the U.S. is poorly positioned to meet it. Americans’ motivational tanks are near empty.... The next wave may be less a BA.2 wave, and more a so what? wave — one many Americans care little to see, because, after two years of crisis, they care so little to respond.
"Colloquially, epidemiologically, a wave is a pretty squishy term, a 'know it when you see it' notion that gets subjective, fast. 'There is no technical definition,' says C. Brandon Ogbunu, a mathematical modeler studying infectious-disease dynamics at Yale. And with COVID-19, there’s no consensus among experts on exactly when waves begin or end, or how sharp or tall one must be to count.... That makes the start of a wave tough to identify even when testing data abound; no single inflection point guarantees a shift from not a wave to definitely a wave. Technically, the BA.1 wave that reached its zenith in mid-January may not have even ended yet, because experts haven’t decided what threshold it would need to reach to do so....
"Watching only the national curve can also be misleading. Country-wide data show only a gargantuan average; these numbers smooth and conceal the case rises that have already been erupting in isolated patchworks. That sort of variability is a product of where humans have carried this new subvariant; of the immune landscape that vaccinations and past versions of the virus have left behind; and of the local defenses, such as masking (or not), that people are leveraging against BA.2....
"And these more regional waves still matter, even if they seem at first easier to ignore. They will, in many cases, mark the places least prepared to weather another surge in infections. Tests, while more abundant, have remained inaccessible to many of those who need them; without tests, treatments, too, will drift out of reach.... Wastewater surveillance, which homes in on virus particles extruded in waste, could help — but these monitoring sides aren’t distributed evenly, either. As things stand, the national map of where the virus is moving is full of blank spots and dark patches. Even unmeasured waves, if they grow big enough, have ways of breaking over us. At worst, the virus could eventually surprise us with a rash of hospitalizations — a sign that the initial bump of cases, one we should have responded to, is already in our rearview mirror.
"Not all case rises have to spell disaster. Since November, when Omicron was first identified, more Americans have been vaccinated for the first time, or boosted, or infected; rapid tests have become more available; and the oral antiviral Paxlovid has hit far more pharmacy shelves. All these factors, plus a springtime flocking into the outdoors, especially in the northern U.S., could help blunt a potential wave’s peak; some may even help uncouple a rise in infections from a secondary surge in hospitalizations and deaths.... It’s certainly a reasonable future to hope for, but not an outcome that can be taken for granted....
"Human actions can slow rises in cases. They can also accelerate them. And when infections take off, it’s not always easy to tell who holds the steering wheel — pathogen or host. 'Every outbreak since the beginning of humankind has a behavioral component, an immunological component, and a viral component,' Yale’s Ogbunu told me. 'Where one ends and another begins is never completely clear.' But Americans are too far along in this pandemic, and too familiar with the tools we need to manage it, to shirk culpability entirely."
Read more: https://www.theatlantic.com/health/archive/2022/04/ba2-omicron-variant-covid-surge/629474/
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