While outbreaks in Europe and Asia are on the rise— and a spike in cases in the United States likely on the horizon, Congress this week removed $15 billion in Covid-related funding from a $1.5 trillion spending bill. The White House warns this will mean dire cuts to testing, treatment and vaccine distribution, with some services suspended as soon as next week. That same day the Senate voted to overturn the public health order requiring masks on airplanes and public transit.
All of this has left many public health and infectious disease experts—and confused members of the public—concerned about what’s coming our way next, and how we, as a country, are going to deal with it.
What is this new Covid-19 variant?
Omicron, which ravaged the country at the beginning of this year — including a record-shattering 1.35 million new infections reported in a single day — was technically a subvariant of the strain known as BA.1. Its sister, the BA.2 subvariant, has been spreading rapidly throughout Europe and Asia for weeks. On March 16, the World Health Organization (WHO) identified BA.2 as the worldwide dominant variant, estimating that it’s now responsible for approximately 75 percent of new Covid cases (BA.1 accounts for the remaining 25 percent).
Initial reports out of Europe and Asia indicate that BA.2 is spreading faster than BA.1. “I’m not sure what difference that’ll make in the short-term — because a lot of people have been vaccinated or recently had Covid,” says Claudia Hoyen, MD, director of pediatric infection control at University Hospitals Rainbow Babies and Children’s Hospitals in Cleveland. “But it could certainly be a problem for us in the upcoming months, as immunity starts to wane.”
At this point, BA.2 accounts for 23 percent of infections in the U.S., with the highest concentration of cases in New York, New Jersey, and New England, where the prevalence of the emerging strain is nearly 40 percent, the Centers for Disease Control and Prevention (CDC) reports.
Preliminary research suggests that BA.2’s increased transmissibility may be because it has eight more mutations in the gene for the virus’s spike protein than BA.1 — and not because it’s more adept at evading immunity from previous infections or vaccines. In fact, early data from the U.K. and Qatar show that existing vaccines remain highly effective at preventing severe illness and hospitalization from a Covid-19 infection.
According to the WHO, it appears as though the Covid infections from the subvariant are no more severe than those from BA.1. “I mean, it’s not great news to have another variant around,” Hoyen says. “But if you’re going to have one that’s very similar to one you’ve had before, then at least you can hope that because of the underlying immunity resulting from the BA.1 surge, perhaps this would fizzle out and not be a big problem.”
Scientists and physicians are also tracking a hybrid variant, known as “Deltacron.” At this point, Hoyen says it’s too soon to know how much of a threat Deltacron poses, noting that there will be more information on the variant in the weeks to come. “You would worry that if it’s got the protein of Omicron, it’ll be really contagious,” she explains. “And then if the rest is Delta, whether that means it would be more severe.”
Where did the mask mandates go?
Thanks to falling infection rates, on Feb. 25, the CDC introduced updated Covid prevention guidelines based on new metrics. Under these guidelines, more than 70 percent of Americans could ditch their face masks, including in crowded indoor spaces, where they no longer needed to practice physical distancing. Prior to that, several states — including California, New York, and New Jersey — had eased or lifted their mask mandates. Even some of the people who had spent two years diligently following the rules took this as a signal that the pandemic was finally over, seemingly glossing over the roughly 1,300 Covid deaths in the country every day.
While getting rid of widespread mandates as a new variant enters the population may seem risky, it’s important to keep in mind that mask requirements will come back if things start looking bad, according to Howard P. Forman, MD, professor of radiology and public health, as well as the director of the health care management program at the Yale School of Public Health. “We shouldn’t forget that CDC guidance adjusts,” he says. “Prevalence is going down now, so we’re seeing masks come off. But prevalence could very well go back up, as we’re seeing in England, Germany, China, Korea and in so many other places throughout the world.”
But if we’re still in the midst of a global pandemic, why not keep masking rules in place to prevent things from getting worse? “I think we’re lifting mask mandates partly because the public demanded better guidance on masking, and because it just seemed untenable for us to maintain universal mask mandating,” Forman explains. “This is a great example of decision analysis in action: If we really want to save lives and preserve health, we would keep mask mandates in place for as long as possible and recommend the highest quality masks and proper compliance of masks. But the population is fatigued. Municipalities and businesses are finding mandates harder and harder to enforce.”
For now, things are still up in the air. “We may very quickly see a U-turn in our trajectory,” Forman says. “BA.2 may not be anywhere near as severe as the [first] Omicron wave was, but we may still have another wave at our door. I think what makes this a little bit more risky is that at the same time, our federal government is seemingly willing to step away from their financial responsibility and negotiating responsibility over things like testing vaccines and therapeutics.”
What about the White House Covid-19 programs?
At the beginning of this month, the White House requested $22.5 billion in emergency funding from Congress to bankroll the Covid-19 programs that Americans have come to depend on, including free testing, vaccines, and treatments. But Congress opted to leave that funding out of the $1.5 trillion government spending package they passed last week — something Republican lawmakers warned would happen unless the White House first released more information about how the trillions of dollars already granted to Covid-19 programs have been used.
On Tuesday, the White House hit back, sending lawmakers a letter outlining all the cuts to Covid-19 services that will result if they don’t get the money they asked for. “We want to be clear: Waiting to provide funding until we’re in a worse spot with the virus will be too late,” a senior administration official told reporters in a press call that day. “Importantly, when you consider the cost of all these investments compared to the cost of what we will prevent — in terms of hospitalizations, deaths, and damage to our healthcare system and our economy — it is not a close call.”
A scenario like this would look familiar to the millions of uninsured or underinsured Americans who regularly have to make healthcare decisions based on cost. Existing health disparities would be exacerbated if the most basic tools of the pandemic — Covid testing, treatments, and vaccines — are limited to those who could afford them.
But Forman says that if these programs are eliminated, and the federal government is no longer negotiating with pharmaceutical companies and purchasing massive quantities of treatments — like Pfizer’s antiviral drug Paxlovid, for example — it could make them difficult to access for everyone, regardless of financial means.
“States and hospitals may be able to purchase things, but now you’re getting to a situation where an individual who previously would have readily gone for a free Covid test, and then gotten monoclonal antibodies, now has to be afraid of being charged for it, and whether they can afford it,” he explains. “It makes them less likely to get tested, less likely to isolate when necessary, less likely to be treated, more likely, ultimately, to be hospitalized, [and] more likely to die.”
Additionally, if the pandemic gets to the point where hospitals are overwhelmed yet again , Forman says that elective surgeries and other routine procedures that we’ve gotten used to accessing again could fall by the wayside.
“There’s no question that we’re suffering fewer deaths per infection now than we did two years ago, and have more of an understanding of this disease,” Forman says. “But I do think, without any exaggeration, we’re talking about tens of thousands of people that could be at risk if our federal government — specifically, Congress — is not able to get its act together and come up with the funding to support Covid testing, vaccines, and therapeutics for the upcoming year. We cannot undo the progress we’ve made because of political bickering.”
This is not exactly the position we’d like to find ourselves in two years into the pandemic — especially with a new variant spreading, and masking now being the exception rather than the norm. But it’s not March 2020. This time, we do have the tools to prevent and treat severe infections: we just may not be able to access them.
“The pandemic isn’t over,” says Hoyen. “And it’s really important that we don’t dismantle all the really amazing channels — like medicines and vaccines — that we developed during the pandemic. We have learned that we need to stay ahead of these surges, because they can come quickly. This is a game where readiness counts.”