How Bad Could BA.2.86 Get?

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I'm Hannah Rosen and this is Radio Atlantic.

There's something that happens to me when I see the word COVID in a headline.

My brain freezes.

It's like a tiny background panic that stops me from doing what I want to do, which is click on the headline, read the story by some smart science writer, find out what's going on with COVID so I can know how to live my life.

I know a lot of people in this situation.

So today's conversation is our attempt to slow down and understand some things, like some basic things, like this new COVID variant that experts seem concerned about, this updated vaccine that's about to come out, and the old question of when and where should we mask.

But also, I want to get a broader perspective because humans and viruses have lived together for hundreds and thousands of years, and we've only had COVID for a few.

So I'm talking to two Atlantic science writers, Katie Wu and Sarah Zhang.

Hi, Katie.

Hi, good to be here.

Hey, Sarah.

Hey, hello.

Hi.

So just this morning, I was on a walk with a friend.

I was telling her that we were going to tape this episode about COVID, and she says, oh, my daughter has COVID.

And I bring that up just because anecdotally, it seems like all of a sudden everyone once again knows someone who has COVID or who's tested positive in the last few weeks.

So Katie, are we in one of those mini waves that we seem to have every summer?

It's a great question.

And honestly, I could give you an answer, but it's likely to differ from the next person's answer and the next person's answer because there is still no universal definition for what a wave is.

Cases are definitely increasing, but they're not super, super high.

So what do we call this?

I think the trend is there, but whether or not to call it a wave is an existential question.

Suffice it to say, there's more COVID now than there was a few weeks ago.

Maybe we need more metaphors, like it's a wave let,

or because a wave, I imagine, is not an official scientific term.

Well, maybe this isn't the right word, but why do we seem to get these summer spikes?

This is a really complicated question because it's really about, you know, is COVID seasonal?

We're used to thinking about a bunch of other respiratory viruses, including classically the flu, as being, you know, cold weather diseases.

Like, oh, fall is when you get your flu shot in advance of winter, which is respiratory virus season.

And we have seen for the past, you know, three and a half years that COVID has kind of, well, gone bananas over winter, but it has had these summer bumps too, even sometimes risen in the spring or the fall.

It just doesn't stick to a single season.

And there's just not enough information at this point for experts to definitively say, okay, that probably means it's not seasonal.

This is going to be a year-round thing and that's going to just kind of suck in perpetuity.

Or, you know, this disease is still quite new.

You know, it's been around for less than four years and maybe eventually it will be more predictable.

I think a lot of experts kind of lean toward the latter, that this probably will be a cold weather disease, but there's really not a guarantee of that.

We don't even fully understand why diseases that are known to be predictably seasonal, why they are predictably seasonal, which is kind of a mind-boggling thing.

So the fact that cases are rising now could be anything from, oh, you know, a lot of people are congregating indoors, but that's not a full explanation because we're indoors a lot of the year in different parts of the country.

It could be that, you know, it's been a while since a lot of us have been infected and so immunity is collectively kind of at a low point.

It could be that our circadian rhythms are a little bit different in the summer versus winter and that affects how our immunity works.

It could just be we just happen to get a new batch of variants.

It could be all of the above, could be none of the above.

It's messy.

Now, Sarah, the last time there was a major new variant was almost two years ago that was Omicron.

Now there's another variant that has Omicron-like

superpowers.

What is this new variant and how bad could it get?

Yeah, so this new variant is called BA.2.86, which is a name that rolls right off the tongue.

The reason scientists sort of got really interested in this a couple weeks ago is that, as you were saying, it was kind of like a big evolutionary jump like Omicron was two years ago.

It had something like more than 30 mutations in its spike protein, which is really like a huge, and before Omicron, totally unprecedented thing to see.

So scientists were like, hey, like, this really looks really different.

Based on what we know, it's probably going to be pretty good at evading our existing immunity.

And why is it important to know how many mutations a virus has?

Like, why is that a measure of anything?

Yeah, the more mutations it is, like, just the more different the virus looks, right?

So, the more different it is, the harder it is for our immune system to recognize it.

It's like if a virus went away and like put on a whole new outfit, and then you're like, hey, is that like something I've seen before, or is that something totally new?

So, it's just like a little bit harder for our immune system to recognize and to kind of get a jump on to start defending against.

Got it.

Okay.

So, the idea is our immune system is single-minded.

I recognize you.

I can fight against you.

But if it's slightly different,

it literally doesn't recognize it.

Yes.

Okay.

So we were saying this one has a lot of mutations, but not quite enough to deserve its own Greek letter?

Well, the actual question right now is it has a lot of mutations.

It can probably hide from our immune system in some way.

But the question now is like, well, it's really changed itself, but does that mean it's also just like less good of a virus?

They kind of have this trade-off.

Like the more they change their spike protein, the harder it is for our immune systems to recognize it.

But then maybe they also kind of break their spike protein a little bit.

Maybe it's just not as good.

Sarah, when you say a virus is good, you mean it's effective, like it spreads quickly.

Yeah, it's fit.

It's like very good at spreading from person to person.

Did you say fit?

Yeah, so.

Like the way the British say fit, like a virus can be fit.

I don't know if this virus was that attractive or sexy.

I think if it's actually bad for us, if it's very fit.

You know, evolutionary biologists talk about the fitness of an organs, right?

Like survival of the fittest.

So think about like the fittest virus as the one that's going to sweep around the world and take over.

Love it.

I love it.

I didn't know that.

So looking into fall, we've got this possibly bad BA 2.86.

What's the worst case scenario and then everything down from there?

Yeah, I mean, the worst case scenario is that, hey, we're saying like this looks a lot like an Omicron level jump.

Could this be another Omicron?

This particular variant doesn't seem to be like growing as explosively as Omicron was back in 2021.

So I think that the worst case scenario is starting to look less and less likely, which is good for us humans.

The next scenario, which is probably more likely at this point, is maybe this new variant does have some sort of advantage over the other variants that are currently circulating, but it's not that big.

So it ends up kind of behaving like a lot of the other variants we've seen over the past two years.

The third possibility is that, well, we do see really mutated viruses prop up from time to time, often in people who have chronic infections for immunocompromise.

In most cases, they don't really spread anywhere further than that person.

This one clearly is able to spread to some extent, but maybe it's actually not that good and like eventually it'll just fizzle out and die on its own.

I think these latter two scenarios are looking more likely than the worst case scenario, but we still don't really know exactly which future we're living in yet.

So the viruses may be coming for us.

Health experts are tracking it better, but we ourselves are in a very different place than in November 21 when Omicron emerged.

It's true we have a lot more immunity, but a lot less testing, a lot less vigilance.

Like from a public health perspective, we're just, you know, we're not hanging on every word, you know, rushing to get the vaccine.

It's just a very different mindset.

So even though these variants seem a lot less powerful, we are a lot more indifferent.

And I'm wondering, Katie, like where that leaves us from a public health perspective.

It's a great question.

And I think this is the question on most public health experts' minds right now.

For me personally, it does make me a little bit nervous because we have sort of settled into this weird steady state now, right?

Like all the variables you just identified, it's going to take a lot for them to change drastically.

We've kind of hit this plateau-ish of immunity.

Most people at this point have been infected or vaccinated or both.

And so there's this kind of base layer of immunity that's tamping down severe disease.

But yeah, exactly at the same time, people are behaving.

for the most part as if it were 2019 and it's going to take a lot for that to change.

There's a lot of kind of behavioral inertia right now.

And so with these forces kind of acting against each other, what the rest of this year looks like could be kind of a preview for how COVID continues to affect our society in the years coming forward.

Small things may continue to change and things may continue to settle, especially that seasonality component we were talking about before.

But certainly to see hospitalizations rising at this point, it doesn't necessarily bode well for the winter.

And the concern is, you know, we've learned so much about how to stop this virus from spreading super fast through the community.

And there's not a lot of willpower left to take those measures at this point, even when cases start to rise.

And last fall, we got the bivalent vaccine, which protected against both the original strain of the virus and the Omicron variant.

Now I understand we have a new vaccine coming soon.

What do we know about it?

Yeah, so this is kind of an exciting change.

This will be our first ever version of the COVID vaccine here in the U.S.

that does not contain any of the original strain, which makes good sense.

That original strain has not been around for years.

We probably don't really need to be putting that in our vaccine for comparison.

You know, we update our flu vaccines pretty much every year.

We're not still putting in strains from like the 70s.

And yeah, the vaccine is updated to be kind of within the Omicron family, which is still the family that is bothering us now, even though the virus has undergone a lot of evolution within that family.

So this should be a closer match to whatever it is that is the dominant strain this fall.

I think there is a little bit of concern that because we have gotten a lot of these sub-variants that have changed significantly, it's not going to be a perfect match.

So people probably will still get infected if they encounter the virus after getting vaccinated, but this should give people's protection against severe disease a boost and that matters a lot.

What is the guesswork involved in deciding which vaccine you're going to administer in the fall?

There's always guesswork, right?

Right.

There is always guesswork and part of it is a timing issue.

So, you know, when we select strains to include in fall flu vaccines and now, you know, fall COVID vaccines, which seems like it'll be a norm going forward, those decisions are being made in February or maybe at the latest June, depending on which vaccine you're talking about.

Even with a pretty tight timeline, you need to give manufacturers time to test out those doses, manufacture them, ship them out, make sure pharmacies have them in stock, and then start administering them.

That's months of delay.

The virus doesn't care about our vaccine schedule.

It is going to be doing whatever benefits it in the meantime.

And so, if that means evolving new strains, producing new family members within this Omicron family, that is what it's going to do.

And that is what it has done.

There will probably be a little bit of that Russian roulette phenomenon with COVID going forward as well.

These viruses just move too quickly, evolutionarily speaking.

But the upshot is still that it is still going to be a way better bet to get the vaccine anyway because it is going to refresh your immune system's conception of the virus rather than sticking with last year's model i mean all the language around viruses is really like video games it like it has certain powers like we try and get in ahead of it we try to get i wonder how do you guys conceptualize it as like for as people who write about it a lot is it like a video game a race a war like what's your favorite category of metaphor i think my favorite metaphor is like a dog chasing a rabbit.

You can think of the rabbit as a virus.

It's just like running around all over the place, and our immunity is sometimes always trying to play catch-up, right?

Like, the virus is constantly evolving.

It's always becoming a little bit different, and our immunities are like playing a little bit of catch-up.

People keep saying, like, when is the virus gonna stop evolving?

Well, the rabbit can just kind of keep running forever, like, even if it's just running in circles.

So, the virus is never going to stop evolving, and our immune system is always going to be playing catch-up.

And that's sort of basically what happens with flu every year.

And I think that's probably where COVID is going to settle.

Katie, do you have one?

I love the metaphor.

So if you do have one, please share.

I love Sarah's dog and rabbit metaphor, but I also really like a textbook student metaphor.

So you can picture your immune system as a student learning, you know, from a syllabus.

We know that, you know, as scientific knowledge evolves or whatever knowledge evolves, textbooks do have to get updated.

Sort of refreshing your immune system with a booster is kind of like updating a textbook and handing it to a student in advance of an exam.

It is updating them with the most recent knowledge.

We know that knowledge changes.

We know that we have to refresh our memories.

And the longer we go without reviewing material, the more easily it's going to fade from our brains, the longer it's going to take to remind ourselves of it if someone hands us a pop quiz.

So I like to think of, you know, annual vaccinations like flu and probably COVID as doing practice tests, reading most up-to-date versions of textbooks in advance of big exams, which is respiratory virus season.

Oh my God, spoken like a true public health expert.

I also have to say, now I feel like the kind of loser in the class because mine was a video game metaphor and yours was like a textbook and sort of like a beautiful animal dance.

All right, we're going to take a short break.

We'll be back in a moment.

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I feel like we've covered the fall, like we understand how to get ourselves ready for the fall, but then there's the rest of our lives.

I mean, both of you have mentioned in different ways it becoming flu-like.

So if you step back, you know, because this dance of new wave, new variant, new vaccine, it's pretty familiar.

Are we right to think it is becoming flu-like and how should we think about that?

Yeah, so the short answer is yes, it is becoming more flu-like, but.

And the but, you know, the reason I say but is because there are actually still a lot more people dying of COVID than they are dying of flu every single year.

And why that is, or sort of maybe a couple ways of thinking about it.

The first is that if you look at just the fatality ratio, you know, how many people are getting COVID, how many people are dying of it, it's about the same as flu.

You know, on an individual basis, if you get it, your chance of dying of it is probably similar to flu.

but the difference is that it's just still a lot more infectious than flu is it's infecting a lot more people so even though like your percent is the same you just have like a much larger denominator so more people are still dying of covid i think there's the question then of like in the long long term will this change when we're very young our immune systems are encountering new viruses all the time right and they're generally pretty good at dealing with a new virus that's never seen before because when you're a baby you're born with a blank slate and you have to learn how to deal with every single virus out there.

But as we get older our immune systems just become less agile, they're less good at learning about a new virus and that's the reason COVID is so deadly and why it's so deadly still particularly to people who are older.

So even though everyone who is older most likely has been infected or vaccinated at this point they were not infected or vaccinated for the first time when they were very young.

Basically, we don't really know what the equilibrium with this virus is until everyone who is alive had like like encountered this virus for the first time when they were very young.

So maybe that will get better.

But it does seem like the older you are when you encounter this virus the first time, the sort of less good generally your immunity will ever be.

Of course, since this virus just emerged a few years ago, we still have like a large percentage of the population who fall under that.

In 50 and 100 years, they'll be really different.

And that may mean this virus just becomes a lot more routine than it is right now.

Interesting.

I feel, Katie, like that just puts us back in the same logic, which is protect granny.

Like the reason you should wear a mask and not go outside and not walk around the pharmacy without your mask on is because you could infect someone older whose immune system is much less strong than you are.

And then we're right back to two years ago.

Right.

Protect the elderly, protect the immunocompromised, I think will continue to be a very resounding goal for COVID mitigation going forward.

I think one more thing I would add on about the flueness or lack thereof of COVID is long COVID remains this really big question mark.

As we sort of progress through the generations and as the virus starts infecting people for the first time, younger and younger, Maybe long COVID incidents will drop or as more people get vaccinated, long COVID will become less of a thing, but that's not necessarily a guarantee.

We know that the long-term consequences of COVID are still much more common and much more severe and debilitating than anything we have seen with flu in recent memory.

So I think we do need to figure out how we're going to address that going forward and figure out this seasonality question as well.

Yeah, the 100-year arc you mentioned is really interesting and helpful because one of the tensions of the moment is, you know, we want to be done.

We're emerging from a long pandemic.

It feels more stable, but it's so early in the life of this virus that, you know, anybody intelligent you have a conversation with will say we just don't know enough.

Yeah, I know, what is it, like three and a half years feels like so, so long, but on a scientific time scale, on a time scale of evolution, it's really just the blink of an eye.

I mean, we're really still at the very beginning of humanity's relationship with SARS-CoV-2.

And where that goes in the end, we don't know.

We just have so few data points to extrapolate from.

The last thing I'm going to ask about is sort of the infrastructure.

So the Biden administration ended the public health emergency in May, which means we are in a non-emergency season of COVID.

If we we enter a season of COVID, does that change anything?

Was that a good idea?

Oh, gosh, that's a tricky question to answer.

I think it was a fair decision for the time.

I think crisis-level management from up top, it's not designed to last forever.

This had to end at some point.

I think it was arguably a bumpy off-ramp.

I remember speaking to a lot of researchers at the time who felt like they were just kind of being dropped without a really good landing pad.

And I think there will be a lot of differences that subtly or not so subtly pop up this winter.

Like, what are hospitals going to do around masking?

What are schools going to do around testing?

You know, how are we going to handle a big influx of cases if that happens, you know, without like automatic federal support for supplies, that sort of thing.

We are now reverting back to a business as usual system where a lot of different institutions are trying to manage the situation on on their own.

And what's likely to happen is kind of a patchwork of outcomes.

We're figuring it out for ourselves, which

is tricky to square with public health, right?

Like we want to do the thing for the greater good.

But what happens if one place has fewer resources than another?

Will there be worse outcomes there?

And is that a fair allocation of what we have on a national scale?

Like the goal is not to go back to 2019, but the goal was also not to stay stay in peak 2020 forever in terms of our response.

Right.

I mean, and the way you just put it made me feel like we're actually not incorporating the lessons, that everybody's out there on their own.

That doesn't seem great.

Like, why can't we apply the lessons in some clever way?

It's a great question.

I mean, I think

the why is tricky, but what I will say is this is maybe not surprising.

There's been a lot of discussion about the very typical panic neglect cycle in public health.

When new threats arise, we often end up scrambling to meet them head-on, as if we've never encountered these same threats before, you know, reinventing the wheel constantly, running into the same mistakes, finally mounting some responses, getting through the end of the crisis.

Everyone goes back to normal, and it's as if the past however many years have been erased.

There's not systems level rearrangement.

There's not infrastructural change.

There's not added resilience in the system in most cases.

And that does set us up worse for the next crisis.

It sort of just erodes stability over time.

I think that's kind of the long-term concern here.

Like, yes, COVID is very much still a big issue, but we have mostly made it through the absolute worst of this.

And that's good.

But what next?

This will not be our last pandemic.

This won't even be our last big outbreak of this year.

So it's long-term.

Maybe, maybe if we're going to be generous, we'll say that everyone needs a breather and then they'll turn to long-term resilience.

That's the best case scenario.

That would be great, but it sure is easier to do nothing.

Yes, it is always easier to do nothing.

Okay, last thing.

I remember during the height of the COVID era,

the articles that everybody read a lot.

was when they asked experts like, well, what are you doing?

You know?

So I'm going to ask you guys, like, what are you doing?

Would you go to a big wedding?

Would you go to a big party unmasked?

Like, how are you going about your life?

And is it any different than you were, you know, six months ago?

So I am currently kind of in my middle ground state.

I am seeing friends.

I'm actually going to be traveling this weekend, but when I get on a plane, when I get into the Uber that I'm taking to the airport, I will be wearing a mask.

I'm going to an event with a lot of people, but it's going to be outdoors.

So I won't be masking there.

And apart from that, you know, I'm trying to sort of take each event as its own isolated case.

Am I seeing someone who is older and a little immunocompromised, like my mom?

I'm going to act very differently around her than like a young, healthy friend who has, you know, just gotten a flu vaccine, for instance.

And so I think that's the kind of thing that I've gotten more or less used to doing.

I think I was a little more chill a few months ago, but since cases have gone up, up, I'm trying to be vigilant, especially because I am about to be seeing some vulnerable people, especially as we approach the holidays.

And it's them I'm keeping in mind more so than myself.

Sarah?

I have a somewhat specific variety situation, which is that I have a daughter in daycare who is getting me sick approximately every other week.

I have been sick, I think, six times in the past three months.

Oh, God.

So I think from my perspective, I don't think I'm going to treat COVID much more differently than all of these other rice issues bring home.

Because even if I sealed myself in a hermetic bubble, went about my life and then picked up my daughter from daycare, I am still going to get sick.

But that said, like, you know, if I am sick, I'm not going to come into the office.

If I have to go somewhere, like a pharmacy, I'm going to wear a mask.

I might start masking on the subway just because it's such like a dense, frankly, often smelly place anyways.

Like I don't feel like wearing a mask on the subway is like a big ask.

And if I'm I'm going to visit anyone, I always disclose that I'm sick and say, would you like me to stay home?

If I'm visiting my parents, especially, I will try not to be sick around them.

But I think for me, there is just so many viruses that I'm going to be sick with.

And this is just my personal situation that I'm just going to be villigilant with that like every single one.

Right.

So to each his own, basically, like make good decisions, but you can make them particular to your situation.

Well, Katie, Sarah, thank you guys so much for joining me and guiding us through this moment.

Thank you for having us.

Yeah, thank you for having us.

This episode of Radio Atlantic was produced by Kevin Townsend.

It was engineered by Rob Smirciak and fact-checked by Stephanie Hayes.

The executive producer of Atlantic Audio is Claudina Bade, and our managing editor is Andrea Valdez.

I'm Hannah Rosen.

We'll be back with a new episode every Thursday.