Iti Salun-At Yo

The Rise of Omicron Subvariant BA.5

Errol Buntuyan, M.D., FAAFP

The month of July has unfortunately seen the rise of a new subvariant, BA.5, to disrupt our summer festivities. This variant is concerning experts and spurring a lot of discussions about how to proceed in the coming months with our ongoing battle with COVID-19.

It appears this new BA.5 subvariant of Omicron is the most contagious of all. This variant is managing to infect those who have completed the original vaccination series against COVID and even those that have received one booster dose over four months ago. BA.5 also has infected those that were previously infected with other strains, including those positive with earlier Omicron subvariants. This means the acquired immunity from vaccinations, boosters and prior infections are not keeping people from getting infected with BA.5.

The BA.5 subvariant is also causing a range of symptoms more intense than the milder ailments from earlier Omicron subvariants at the beginning of the year. There are more reports of intense sore throat, severe headaches, loss of taste and fatigue. The BA.5 subvariant is believed to have some gene and structural similarities to the Delta variant and thus tends to attack deep into the lung cells. This means many with BA.5 infection will have a lingering cough lasting for many weeks after the infection. Some experts are dubbing this subvariant as the true “Deltacron.”

In July, the U.S. was seeing over 100,000 reported positive COVID cases a day. With the advent of COVID home testing kits and with some people foregoing any testing at all, this number is expected to be much higher. It is without a doubt you know someone in your family, coworker or friend group who recently was infected in the last few weeks. Throughout the country and in Hawai‘i, because of the large amounts of infected people, we are again starting to see some increased hospitalizations as well as a small rise in COVID deaths. Those that are young, healthy, with no risk factors and not usually accustomed to getting ill are getting infected and feeling sick with BA.5.

The good news is we are not yet seeing a sharp rise in either of these numbers for Maui. For the most part, those infected with BA.5 are able to feel better and recover without needing hospitalization within five to ten days but it’s still not a great feeling to be sick with these symptoms.

Many wonder how BA.5 became the subvariant it is today? The lifting of the mask mandate and the return to “normal” life is one key factor to the spread of COVID infection. The more opportunity the virus has to infect people and replicate, the higher the increased chance genetic mutations and variants will occur. The COVID virus only wants to continue to live in our society among us, continue to spread and continue to multiply. These variants and subvariants are the tweaks the COVID virus makes to maintain its survival.

Another reason why BA.5 has risen to be the dominant strain is our vaccination rates for those eligible for boosters have been really low. Vaccination still is the only effective strategy to prevent COVID infection. On Maui, as of July only 71 percent completed the original series; only 41 percent received the first booster while only 8 percent received the second booster. The vaccines for our teens and keiki are also off to a slow start. This low rate of completed vaccination of course has allowed the Omicron surges that have occurred since the beginning of the year to continue, promoting more chances for these subvariants to form. Living in an endemic state only works if the population keeps up with the recommended vaccinations to limit continued infections and virus replication.

The most concerning thing is BA.5 is evading or dodging our current acquired immunity. This subvariant has morphed to change its surface protein so our antibodies can no longer recognize and neutralize the virus. Scientists throughout the world are looking at developing new vaccines more generalized to fight against coronaviruses in general and are also looking at developing a bivalent vaccine that includes components of both Delta and BA.5. The earliest expected launch of these is later this year.

Regardless, it is still important to get vaccinated. Any vaccine acquired immunity is still helpful to slow the positive infection rates, spreading the disease and fighting symptom severity. These antibodies and memory cells we get by vaccination or prior infection can last for four to five months in our bodies. So if you have not been fully vaccinated and boosted or became sick with COVID within four to five months, it is highly likely you no longer have immunity effective against BA.5. Coming down with BA.5 thus far, is not a pleasant or easy experience. People are feeling more sick than the earlier Omicron subvariants. The great news is those who are fully COVID vaccinated and completely boosted within the last four to five months, are not getting the severe illness or being hospitalized for COVID symptoms.

If you have not received your first booster and more than four months has passed since your series was completed, get it now. If you are over 50 or have comorbid conditions, and risk factors, you can get your second booster. Based on our Maui COVID vaccination data, there are many who are eligible and are not getting their boosters.

The latest data is BA.5 is spreading mostly through the under 50 year old population. This group is the least likely to have completed their vaccine and booster series. At the time of the writing of this column, the FDA is considering making those under 50 eligible for their second booster.

With the emergence of BA.5 infecting many millions of people, there may be multiple strains and subvariants on the way. In fact, there is another Omicron subvariant BA-2.75 (nicknamed “Centaurus”) currently being monitored as one of interest. The worst thing that could happen is the rise of a new more virulent and deadly strain of COVID that could trigger our world into another lockdown.

With more COVID subvariants emerging we are guaranteed to see the development of new vaccines to tackle these mutations. Stay tuned for these COVID vaccine developments, be aware of any upcoming recommendations and remain updated on your COVID vaccine eligibility. Completed COVID vaccinations with boosters are still our best hope to protect us from getting severe disease from COVID infection.

Errol Buntuyan, M.D. is a Family Medicine Practitioner and the Physician in Charge of Maui Primary Care at Kaiser Permanente. Born in Quezon City and raised in Southern California, he has been practicing medicine on Maui since 2007. Dr. Buntuyan promotes whole food, plant based nutrition, regular physical activity, stress mindfulness and sleep hygiene as keys to optimum health and wellness. He enjoys cooking, playing tennis and travel.