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Covid cases rise in Northeast as BA.2 omicron subvariant takes hold

A pedestrian walks in downtown Philadelphia on Tuesday. (Michelle Gustafson for The Washington Post)

PHILADELPHIA — Coronavirus cases are again climbing in the Northeast as the BA.2 omicron subvariant — which is even more contagious than its predecessor — becomes the predominant strain in the United States.

But experts say early signs suggest Americans do not need to fear a repeat of the explosion of winter cases that overwhelmed the health-care system and led to mass disruptions across the economy as millions fell ill at once.

The Northeast recorded at least 126 new infections per 100,000 people last week, double the rate one month ago. It’s still far short of the 2,200 cases per 100,000 people recorded during the mid-January peak in the Northeast, amid the omicron surge. New infections in the Northeast were more than twice as high as in the West, Midwest and southeast last week, according to federal data.

It remains to be seen whether the latest uptick in the Northeast is the start of a larger surge or if it reflects a smaller bump on the road to recovery from the punishing omicron wave. Several experts said the more optimistic future appears likely, pointing to promising recoveries in Britain and other European countries that often portend the pandemic’s path in the United States. Experts also expected an uptick with mask mandates ending and more people mingling after the omicron wave.

The BA.2 “stealth” omicron variant is expected to soon become the dominant strain. Here is what you need to know about a possible new wave of infections. (Video: Brian Monroe, John Farrell/The Washington Post)

What you need to know about omicron and the BA.2 subvariant

“It’s premature to call this a wave as opposed to a period of increased transmission,” said David Rubin, who tracks coronavirus trends for PolicyLab at Children’s Hospital of Philadelphia. “This is what living with the virus means: You are aware of what’s going on, you are hearing about cases in your own community, and you may decide to wear your mask at the market or alter your routine for a couple of weeks.”

Official case counts do not provide a full picture of the pandemic because many at-home test results are not reported to government agencies.

Other data points suggest the Northeast is now bearing the brunt of BA.2 because states reporting the largest increases in infected patients admitted to hospitals and visiting emergency departments are largely concentrated along the Interstate 95 corridor.

Those increases are modest, and overall hospitalizations have been stable in the Northeast and beyond after bottoming out a month ago. Waves of BA.2 infections have taken mixed tolls on hospitals in other countries, leading to rising admissions in Britain and Hong Kong but not in South Africa.

Some experts think U.S. hospitals are faring better because of immunity from the explosion of omicron cases, though that can change if elderly and vulnerable people who laid low to avoid omicron in the winter are infected by BA.2.

Tracking coronavirus cases

“BA.2 is going to infect a lot of people who have so far evaded the virus,” said William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health. “The question is how many of them are vulnerable to severe outcomes. Hopefully it is not many, and hopefully it will be easily handled.”

The Centers for Disease Control and Prevention has moved away from relying on infections to portray the pandemic’s severity in a community, shifting to numbers showing the strain on the health-care system. Most of the Northeast remains a green zone under CDC metrics, with some exceptions in parts of Upstate New York and northern Maine.

“What we are seeing now does not require community-level action,” said Shira Doron, hospital epidemiologist at Tufts Medical Center in Boston. “That doesn’t mean that nothing is happening behind the scenes as a result of the increased cases. We in health care are watching. We are readying our systems to do what we need to do to scale up testing and treatment should there be a need to do that.”

Craig Spencer, an emergency room physician who works in two hospitals in northern Manhattan, says he hasn’t seen any coronavirus patients in recent weeks, even as average daily cases in New York City rose from 700 at the start of March to about 1,900 last week, according to city data. It’s the first time during the pandemic a surge in infections circulating in the city hasn’t shown up in the emergency room, he said, although he expects more patients in the coming weeks.

“We want to continue to remain vigilant, but we should also celebrate the fact as of right now, really sick covid patients don’t seem to be inundating the hospitals,” Spencer said.

The uptick of BA.2, now estimated by the CDC to account for 86 percent of new infections, provides an early test for Democratic policymakers who have recently said it’s time to learn to live with the virus and for vulnerable people to protect themselves.

Anthony S. Fauci, President Biden’s chief medical adviser for the pandemic, cautioned against dismissing milder infections associated with BA.2 as inconsequential.

“We should not pooh-pooh getting infected. It isn’t as if there’s death, hospitalization, and anything short of hospitalization is okay,” he said, adding that some people may be sick for many days, and “there’s always the risk of long covid.”

The Biden administration is weighing whether to extend the mask mandate for planes, subways and other forms of public transportation set to expire next Monday. Ashish Jha, the new White House coronavirus czar, told NBC News’s “Today” show Monday that an extension is “absolutely on the table.”

Democratic governors in the Northeast who lifted mask mandates and other measures to control the virus in February and March have not signaled any plans to bring back sweeping measures to control the latest uptick. At the local level, Philadelphia emerged as an exception this week when it became the first major jurisdiction to reimpose a mask mandate, effective Monday, in response to the rising infections.

After emerging from the omicron surge, Philadelphia set metrics to automatically bring indoor mask requirements back if the city recorded a sharp increase in infections and recorded more than 50 hospitalizations or 100 average daily cases. The city will bring back a vaccination requirement to enter restaurants and other public establishments if conditions grow worse.

Tracking the global spread of BA.2

Philadelphia Health Commissioner Cheryl Bettigole said the city is trying to intervene before a surge in hospitalizations, noting racial and class disparities in fatalities in one of the country’s poorest big cities.

‘I just pray God will help me’: Racial, ethnic minorities reel from higher covid-19 death rates

“We lost 750 people in omicron. That’s the reason we are trying to step in,” Bettigole said, and with a mitigation method that allows the city to remain open and with any luck will be short-lived. “We want people to be enjoying their lives — but with a mask on.”

As residents processed the news of the mandate’s return, some were resigned to masks as a staple of life.

“I kind of suspected it was coming back,” said Imani Sullivan, 22, who works as a caregiver and has had to continue masking even when the city lifted its mandate. Some family members have also insisted on masking when they got together. “At this point it’s just normal.”

Hannah Dart, 26, a masters student at Drexel University, said the new mandate would help by clarifying some rules that made little sense to her. At Drexel, she said, she had been asked to mask in class but not in the corridor.

“I’m going to do it personally, until we don’t see any more spikes,” she said.

Julia Raifman, assistant professor of health law, policy and medicine at Boston University, commended Philadelphia for quickly bringing back a mask mandate before a potential spike.

“What looks like a small increase can quickly turn into a much larger increase with exponential spread. Acting only once we see the surge go straight up is too late,” Raifman said.

While omicron was less likely to cause severe illness for individuals, it was so highly contagious and infected so much of the nation that more than 100,000 died, hospitals were overrun and the country endured disruptions to the economy as essential workers called out sick.

In Philadelphia, residents and businesses adjust to life without vaccine mandate

“When we downplay the threats of the virus, when we don’t take steps to address it, we end up with a lot more harm,” Raifman said.

In Philadelphia, cabinet makers Eric Nay, 51, and Colin Scarborough, 34, scoffed at the return of mandatory masking.

“I don’t like it,” said Nay, who commutes in from a nearby suburb that doesn’t have a mandate. “If you want to wear a mask, it’s up to you. Same if you don’t want to wear one,” Nay said.

“It’s real hard to breathe in the summer,” Scarborough added. “It’s a pain to come down here to work in a mask.”

As 31-year-old Hugo Chavez cut sausages for his lunch in the downtown Rittenhouse Square, he questioned why the city wasn’t imposing its mask mandate immediately if conditions were so bad.

“Philadelphia has so many problems. But all we care about is masks and plastic bags,” he said, referring to a recent ban on single-use plastic bags.

Recent polls have showed many Americans are treating the pandemic with less urgency.

An Axios-Ipsos survey conducted over the weekend found 73 percent of Americans described the coronavirus as a manageable problem. In addition, 17 percent did not believe it was a problem at all, and only 9 percent thought it presents a serious crisis.

In the Washington region, there are signs of escalation from the very low rates of viral transmission a few weeks ago. The seven-day average case rate per capita has ticked up in the past week in the District to 22 per 100,000, and more sharply in Virginia and Maryland to 16 and 14 per 100,000, respectively. That still puts the case rate vastly below the winter omicron peak.

An official in the D.C. mayor’s office said shortly after Philadelphia brought back its mask mandate on Monday that D.C. had no current plans to do so.

Nirappil, Achenbach and Keating reported from Washington. Julie Zauzmer Weil in Washington contributed to this report.

Coronavirus: What you need to know

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot designed to target both the original virus and the omicron variant. Here’s some guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

Variants: Instead of a single new Greek letter variant, a group of immune-evading omicron spinoffs are popping up all over the world. Any dominant variant will likely knock out monoclonal antibodies, targeted drugs that can be used as a treatment or to protect immunocompromised people.

Tripledemic: Hospitals are overwhelmed by a combination of respiratory illnesses, staffing shortages and nursing home closures. And experts believe the problem will deteriorate further in coming months. Here’s how to tell the difference between RSV, the flu and covid-19.

Guidance: CDC guidelines have been confusing — if you get covid, here’s how to tell when you’re no longer contagious. We’ve also created a guide to help you decide when to keep wearing face coverings.

Where do things stand? See the latest coronavirus numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people. Nearly nine out of 10 covid deaths are people over the age 65.

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