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Cases are spiking and new variants are coming, but so are new boosters which remain ‘highly effective,’ Duke medical experts said this week. 

COVID-19 cases in North Carolina quadrupled over the last two months amid reports of two new variants with lots of mutations. That’s the bad news.

The good news, Duke medical experts said on Wednesday, is that vaccines continue to provide protection against severe illness, updated vaccines are on the way, and the most troubling of the new variants “doesn’t look nearly as bad as scientists feared.”

During the height of the pandemic, Duke experts, many of whom were studying the virus, provided frequent briefings like this one, adding context and facts to an information-starved landscape. But in a sign of how far the pandemic has receded from the day-to-day concerns for many North Carolinians, Duke’s last COVID briefing was in July of 2022.

The spike in cases and increase in hospitalizations, however, shows that even after the national emergency has ended, the danger remains.

COVID is “with us constantly,” said Dr. David Montefiori, a professor at Duke University Medical Center who has studied the vaccines’ effectiveness against emerging variants.

“As immunity wanes in the population, we’re going to continue to see increased numbers of infections and associated increases in hospitalizations and deaths,” he said.

This pattern, however, is in keeping with the last few years, he said, when late summer and winter surges were inevitable. It’s too early to tell if the two new variants will cause sustained surges, the doctors said. 

The New Strain in Town

The most concerning variant, BA.2.86, hasn’t yet been given a name, but is as different from Omicron as Omicron was from Delta, Montefiori said.

“It’s a major leap in terms of the additional mutations,” he said.

Those differences lie predominantly in the virus’s spike protein, the tool it uses to break into a body’s cells and run amok. These mutations make the new strain much better at causing illness and avoiding defenses.

BA.2.86 “has been found in multiple countries and in multiple locations in the United States,” Montefiori said, but the current numbers are likely an undercount, he said, because testing is less vigorous than in years past. 

“We really don’t have a good idea of how widespread it is,” he said.

That’s the bad news.

The good news? 

Early data suggests that the current vaccines still provide some protection from severe illness against BA.2.86. And the new booster, which should be available this month, is “highly effective against that variant and all the currently circulating variants,” Montefiori said.

Boosters. Boosters. Boosters.

The new booster should get final clearance from federal health officials in September. While there is some debate on whether it’s best for people to wait until October to get the shot, medical experts say updated vaccines remain the most important thing people can do to fight the virus.

“We know immunity to this virus wanes over time,” Montefiori said. “So the best thing people can do to maintain a normal way of life is to continue to get their booster shots. And the good thing is the booster shots are working.”

A hard lesson from the pandemic, one that seems to be largely unheeded, is that many of the deaths and severe cases could have been prevented if the patients’ vaccines had been up-to-date. 

“We have 55 people in the hospital today (with COVID),” said Dr. Cameron Wolfe, an infectious disease specialist at Duke Health. “Many if not all of whom could have been avoided if they tried to maintain their immunity.”

So Now What?

Even with the uncertainty of the new variants and the risks for another surge this winter, COVID’s other hard lessons “are well-held through the last few years,” Wolfe said. 

Doctors have a far better understanding now of how the virus transmits, the symptoms are well known, and at-home tests and current treatments remain effective against the new variants.

While the new variants are better at breaking through previous immunity, there’s no evidence yet that they cause more severe illness than other strains, the doctors said. 

And though reinfections are increasing, these cases, for the most part, “tend to be a little less severe,” Wolfe said.

Still, he said he’s “cautious not to be too cavalier” about the health risks of repeated infections, because these multiple bouts can affect a patient’s overall health, which then makes them more susceptible to significant illness.

Long COVID also remains a huge problem, he said.

“I remain unable to predict who is left with long COVID symptoms,” he said. “I’ve had very high-functioning colleagues who’ve had to move out of medicine because of long-covid symptoms.”

Beware ‘Complacency’

Perhaps the biggest risk factor, however, is “complacency,” Wolfe said.

 “That’s the reason for these sessions to make people aware that this has not gone away.”

The doctors recommend stocking up on at-home tests and following the familiar script, which however tired the public may be of it, works and keeps people safe. 

If you’re sick, test. If you test positive, isolate and mask up. If you are at high risk, wear your mask.

That hasn’t gotten any more complicated, the doctors said.

“The potential for [COVID] to escalate in certain patients is still greater,” than other respiratory diseases, Wolfe said.

Neither doctor saw the need for widespread mask mandates yet, but Wolfe said he recently wore a mask on a flight for the first time in a while. 

Two things are true at the same time: People are beyond weary of worrying about COVID and COVID is still here.

And though the virus may have winter and summer surges, that doesn’t mean it’s seasonal, and it doesn’t mean it can be as easily dismissed as a common cold. 

“We still see people die of COVID. This is still orders of magnitude larger than the flu. And we should view that as unacceptable,” Wolfe said.

COVID is still dangerous, both to the body and to lives waiting to be lived. Increased cases mean missed work, missed school, and additional burdens on  mental health after three long years of collective trauma.

“If vaccines are a pathway to try to avoid that,” Wolfe said, “and happily for many decades we have accepted that as a truism for influenza, how do we not view COVID through the same lens?”