BOSTON – With COVID-19 cases once again cause for concern in Massachusetts, Jewish doctors in the Greater Boston area are searching to understand why.
Dr. Katherine Gergen Barnett, the vice chair of primary care innovation and transformation in the Department of Family Medicine at Boston Medical Center, is worried about a new Omicron subvariant called BA.2.12.1.
“We think it may be part of the reason we’re seeing a rise in cases yet again,” Gergen Barnett said, citing a statewide positivity rate of between 5 and 6 percent – “certainly climbing in the wrong direction” – as well as 3,000 positive cases reported in Massachusetts on May 4.
Among the 34,567 confirmed cases reported over the most recent two-week period tracked by the state, the most – 7,237 – were among those ages 20 to 29. There were 78 deaths reported during that same period, with the most – 46 – among those 80 or older.
“It could be it is as good as it gets for the virus,” Dr. Daniel Kuritzkes, chief of the Infectious Diseases Division at Brigham and Women’s Hospital, said of the Omicron subvariant. “That’s why it’s not being replaced by another variant. Instead, it’s just fine-tuning its ability to be transmitted or to replicate without making major changes to the virus.”
Dr. Shira Doron, the hospital epidemiologist and antimicrobial steward at Tufts Medical Center, cited data from the Centers for Disease Control and Prevention on the BA.1, BA.2, and BA.2.12.1 subvariants.
“Each one of the three is more contagious than the last,” she said.
Among the Omicron subvariants, BA.1 is down to under 2 percent of COVID cases in the United States, BA.2 represents 62 percent, and BA.2.12.1 is up to 36.5 percent. In New England, BA.2 represents 70 percent of cases, with BA.2.12.1 at 28 percent.
Looking at the curve in Boston, Doron noted, COVID “plummeted at the end of the Omicron wave. It started rising again, started to replace BA.1 with BA.2. It started coming down recently, then plateaued, maybe even going back up. I think it’s BA.2.12.1.”
Kuritzkes noted that the BA.4 Omicron subvariant in South Africa is reportedly 25 percent more infectious than BA.2, but added that it is too early to tell how important this may turn out to be.
He even mentioned some encouraging news: “We’re continuing to see Omicron, by and large, less virulent, certainly, than Delta or Beta. The disease is milder than what we’ve seen in the initial waves. Some of this is partly compounded by much of the population having some immunity to COVID through past exposure or vaccination.”
One decision weighing on many is whether or not to get a second booster shot.
“It really needs to be based, at this point, on how much at risk you are,” Gergen Barnett said. “A lot of people are having this conversation with their doctors, their loved ones. It’s available for anybody older than 50 who has not had another booster for one month or greater. It’s available for anybody with chronic medical conditions, at high risk of getting very sick.”
Kuritzkes noted that while second boosters have been approved for certain populations, whether that translates into a recommendation is a harder question to answer.
He said this is “partly because the CDC has really not issued any clear guidelines. When the first booster was approved, they were very emphatic – everybody who had been vaccinated should get boosted. This time, the [second] booster is available, they said, these are the people who should consider it – there was no recommendation.”
Doron said she has been experiencing a spectrum of responses from people.
“Some of them have said ‘It’s safe, it’s available, I’ll get it, as much as I can get, as soon as I can get it,’” she said. “Others are saying, ‘I don’t see any evidence, my specialist said not to get it.’ I should add, the data show it decreases severe disease, hospitalization, death from a very low number to a lower number. It does not protect against infection more than a few weeks.”
“My personal view,” Kuritzkes said, “is that it’s clear an additional booster offers some additional protection, from a pretty low risk to an even lower risk. It’s not clear to me that for most people, it’s either necessary or the right time. I’m convinced an additional booster will be needed at some point.”
Asked about whether another wave is on the horizon, Kuritzkes said, “I do think it’s possible we could see more significant spikes after [either] Memorial Day gatherings or the Fourth of July.” He explained that although many people will be outdoors, travel will “bring infection to susceptible populations.”
“It is entirely possible,” Doron said of a new wave. “We just never know what’s around the corner. If in the summer, it would be due to a new variant. If in the fall, it could even be whatever was circulating in the summer, or it could be an effect of the colder weather.” She noted that summer weather might make people gather indoors less, but a new variant or subvariant of Omicron might arise.
“One of the things COVID has taught us is, we need to be incredibly humble in the face of the unknown,” Gergen Barnett said, “use all the tools we’re using now to vigorously take care of ourselves if we get sick. What we’re seeing in New York is a gentle wave, an uplift, a large increase in New York City. The question is, are we going to follow suit in New England?”
Although patterns here are different, she said, “the infection rate is going up. We need to be vigilant.”
