North Texas is experiencing a surge in COVID-19 cases, but experts say it isn’t time to panic. Despite this new wave, the healthcare system isn’t experiencing overwhelming hospitalizations or deaths.
Two variants of omicron, BA.4 and BA.5, now account for about 75 to 80 percent of the cases being sequenced by UTSW, according to Dr. James Cutrell, an associate professor at UT Southwestern and the program director of the infectious disease fellowship. (The majority of the new infections is the more recent BA.5.)
Earlier this week, the Centers for Disease Control and Prevention moved Dallas, Collin, and Tarrant counties to a “red” threat level. Dallas County’s own health department recently raised its threat level to “yellow.” The CDC’s recommendations are to wear masks indoors and on public transportation because community transmission is high.
Throughout the month of July, Dallas County Judge Clay Jenkins has been reporting around 500 new COVID-19 cases per day in Dallas County. This number is likely far less than the actual number of cases because of the proliferation of home test kits.
“You’d have to go all the way back to the very beginning of the pandemic when testing was not very available,” Cutrell says about our current understanding of the number of new cases. “We’re blind as to how many actual cases there are and how quickly things are rising.”
But even among the official tests, there was a 58 percent week-over-week increase in number of cases through July 7, and youth cases increased by 57 percent over the same period, according to the Parkland Center for Clinical Innovation. Cutrell says the number of cases being reported is likely a five or six-fold underestimate.
Without reliable testing statistics, public health authorities have to rely on other ways to calculate the spread. The CDC’s COVID-19 wastewater surveillance has been inconsistent in Dallas County, but shows a significant uptick in recent weeks. There is no data for March, April, or May, but the rate of COVID-19 in the wastewater has more than doubled since June 1.
The increase in cases is due to the BA.5 variant, a version of Omicron that represents 54 percent of all new infections across the country. The latest variant is spreading quicker than past versions because of its ability to sneak past our immune system’s defenses, even if we have been vaccinated or had the disease recently.
The shape of the virus is different than past variants, confusing our immune systems. Our defenses normally stop the virus by sticking to the spike proteins on its sphere. Ed Yong at The Atlantic described the newest variant by explaining that the spikes come off the virus’ sphere are different than past versions, making it difficult for existing antibodies to neutralize. For BA.5, the spikes are like “like swords that no longer fit their sheaths,” meaning our immune system cannot recognize and fight off the virus.
“As the virus alters and changes that spike protein, it affects its ability—or how contagious or how transmissible it is,” Cutrell says. “It also affects how well prior infection or vaccine immunity is going to protect against it.”
These changes make the latest variants 20 to 30 percent more contagious than past versions of omicron. Those who were infected with omicron or past variants can be infected again by BA.5.
That’s why people who had previously been protected by a vaccine or who got COVID recently are getting reinfected. The good news is that once someone has caught BA.5, they have immunity against that variant. Trevor Bedford, a virologist at the Fred Hutchinson Cancer Research Center, told Yong that he expects BA.5 to infect 10 to 15 percent of the country.
Thankfully, BA.5 is unlikely to put pressure on our healthcare system in the way omicron and delta did; the vaccines and past immunity are still largely effective at preventing serious infection. On July 13, there were 726 patients hospitalized with COVID-19, representing just 5.2 percent of available bed capacity, and 7.4 percent of ICU patients. “While this is characterized as a wave, it is not anything like our previous surges,” says DFW Hospital Council CEO and President Steve Love.
But hospitalizations are the highest they have been since before March 1. UTSW modeling says that Dallas County alone may have 450 hospitalized COVID-19 patients if conditions remain the same, but that things should level off later this summer. A more worrying statistic in the UTSW modeling is the fact that 30 percent of all tests are coming back positive.
At omicron’s peak last winter, the positivity rate peaked around 35 percent. It could be a sign that people are only getting tested once they have symptoms, but it could also be a sign that the virus is spreading nearly as fast as it was during the winter.
COVID-19 vaccines, which are still effective at keeping people out of the hospital even with BA.5, are trickling along. Around 74 percent (1.9 million people) of Dallas County has received at least one shot as of July 7, but there were just 1,450 first doses administered that week. Only 24 percent of the local population has received a booster.
Looking ahead, Cutrell says he wouldn’t be surprised to see the CDC recommend all healthy adults to receive the second booster (previously the recommendation was limited to elderly adults and the immunocompromised). This fall, there will likely be an additional booster designed to protect against the original version of the virus as well as the latest omicron variants.
But as for now, Cutrell recommends heeding the recommendations of public health experts by taking precautions, including our old friends: masking and social distancing. But with hospitalizations and deaths so low, why bother?
For one thing, each new infection increases the likelihood of long COVID, where symptoms like fatigue and brain fog can persist for months. With worker shortages in nearly every industry, increased cases can mean stress for industries that need their employees, especially healthcare.
“Within the healthcare system we’re as busy as ever taking care of non COVID patients,” Cutrell says. “If doctors and nurses and staff are out because they have mild COVID, that’s one more person who’s on the sideline from being able to provide care.”
Of course, more cases could eventually expose someone who is unable to get vaccinated, putting them at risk. And, finally, more replication means a greater likelihood that a more dangerous mutation of the virus can form. Allowing unchecked spread is playing roulette with a potentially deadly or evasive variant.
While COVID fatigue is a hurdle for public health officials to battle, Cutrell encourages people to stick with precautions. He finds a balance between fatalistic attitudes and losing all hope. “Don’t panic. But use common sense about getting vaccinated, being up to date with boosters, and wearing masks in crowded indoor spaces.”