Category Archives: Corona Virus

In the bustling corridor outside Northeast High Schools gymnasium, a 15-year-old told one of Philadelphias best-known COVID-19 vaccination advocates he had doubts about what she was promoting.

I dont know, the boy said. I dont know about the vaccine.

His grandfather didnt want him to get it, he told Ala Stanford, pediatric surgeon and founder of the Black Doctors COVID-19 Consortium, dedicated to ensuring equity in the vaccination effort. If he did, he said, he might have his video games taken away.

Its up to you whether you get it or not, Stanford replied, but I will listen to you.

There were several interactions like that Wednesday morning, at the beginning of a two-day vaccination clinic hosted at the school by Stanford and the Federal Emergency Management Agency, who have been visiting city schools and will continue to do so through much of February. About 54% of the citys 12- to 17-year-olds and 47% of 5- to 11-year-olds are vaccinated, and thats not nearly enough, Stanford said.

In Philadelphia, anyone 11 or older may be vaccinated with or without parental consent, according to a health department spokesperson. The city school district has its own consent policy, Stanford said, requiring parental permission for shots administered to children in 8th grade or below, regardless of age. Allowing teens old enough to understand to understand the need for vaccination to make their own decisions eliminates an onerous process of obtaining permission, she said.

Students could check out of their lunch period and get the shots immediately. Staff hoped to vaccinate between 200 to 300 by the end of Thursday.

It was also a chance to ask questions of Stanford, who was treated as a visiting celebrity by staff and students.

We were so glad you were coming here, really, said Amy Leaness, a school nurse who described months of struggle managing COVID-19 at the school.

READ MORE: These doctors and nurses share COVID-19 falsehoods. They can become misinformation superspreaders.

Keeping track of student vaccinations, which determine whether a child needs to quarantine after a COVID-19 exposure, has been a logistical nightmare. Efforts to keep the virus out of the school hit a wall shortly after the holidays, when as many as 10 to 20 students a day were testing positive for COVID-19. Things have gotten better since.

Yet the vaccine refusals continue.

Weve had kids come in and say their parents arent allowing them to get it, said Margaret Beyer, another nurse.

Stanford said repeatedly Wednesday that students in ninth grade and up dont need parental permission to get vaccinated. Whether its to protect older family members who are more vulnerable to the worst effects of the virus, or to stay involved in youth sports, she kept the focus on the benefits of getting vaccinated.

After a morning assembly that introduced Stanford and the rules of the clinic to students, student Janiah Burris told Stanford she had gotten her second shot two months ago but was reluctant to get a booster when she became eligible. The 16-year-old later said she was worried it would make her sick. But instead of quizzing her on her motives, the doctor initially validated Burris concerns, telling her it was possible by the time she could get a booster in a few months COVID-19 might be less prevalent. If it wasnt, though, the booster would provide a big benefit.

Stanford described her own experience with a COVID-19 infection, told the girl how sick she got, and said being able to keep attending school and her job at Honeygrow would be easier if she was boosted.

You can even reach out to me in three months, Stanford said. Once Easter happens, think about reaching out to me.

Burris said later that the conversation clarified why boosters are helpful, but she still wasnt sure how much the shots mattered.

Im not sure its actually protecting me, she said.

Kaher Abuali, 16, said vaccination is not a big topic in his group.

READ MORE: Omicrons toughest foe is a booster shot, yet many in the Philly region are skipping theirs

They think corona wont affect us because were young, he said.

Abuali got his first dose Wednesday after being convinced by a friend and distant relative, Ayham Muhanna, 15. All morning, Muhanna worked his phone, calling friends and family within the schools Palestinian community to persuade them to get their shots.

He motivated me, bro, said Abuali, slapping hands with Muhanna. It was all him.

Muhanna didnt have plans to get his booster shot Wednesday, and didnt start the day intending to rally classmates around vaccination, but a presentation from Stanford at the beginning of the day inspired him.

Maybe Ill get my vaccine today, he described his thinking, and maybe Ill bring my friends along with me.

Many have young children in their families, he said, something he used to encourage them to go to the clinic.

Later, Muhanna strode across Northeast High Schools gymnasium toward a table where federal medical workers signed students up for vaccination.

I brought another family member! he shouted.

In a school where less than half of the roughly 3,200 students are vaccinated, a new proselytizer for vaccination was more than welcome.

He was the first to call me up right here, said the new kid Muhanna brought to the clinic, Ahmad Abuali, Kahers cousin.

As the morning passed, the boy whose grandfather didnt want him vaccinated didnt reappear. Stanford said she wished she had more time to talk to him. During their brief interaction, she emphasized that getting vaccinated was a confidential medical decision the boy was old enough to make.

I dont have to tell him, she told the boy, referring to his grandfather. You dont have to tell him.

The boy looked away from her as she spoke, considering. Then a distraction from security staff broke their conversation, and without a word the boy walked away, vanishing into the crush of students bustling through the hallway.

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Philly teens greet COVID-19 vaccination efforts with interest and skepticism - The Philadelphia Inquirer

COVID-19 case counts are beginning to fall again in the San Francisco Bay Area. But for many of the hundreds of thousands of residents infected in the past month, a huge question lingers: Am I going to develop long COVID?

To get answers, we reached out to several experts who are working with long COVID patients in the Bay Area and beyond. They helped us understand what, exactly, researchers know so far and what there still is to find out.

There isnt a good definition of long COVID yet. The U.S. Centers for Disease Control and Prevention starts the clock on long COVID four weeks after people are infected, while the World Health Organization defines it as symptoms that stick around longer than four months. Many researchers also believe extended symptoms can be separated into several distinct syndromes.

One issue is post-intensive care syndrome, a serious condition related to post-traumatic stress disorder that can affect people in the ICU for any reason.

Whether or not you end up in the ICU, COVID can cause injuries that take a long time to heal. Some of those are common to other respiratory illnesses. If you develop severe pneumonia from any virus or bacteria, including COVID, it can take as long as six months to get back to normal; in the meantime, you might have shortness of breath, coughing and fatigue.

Severe COVID also increases your risk of heart disease. In one study before vaccines were widely available, about 1 in 1,000 people diagnosed with COVID-19 also developed a type of heart inflammation called myocarditis within a month. In another pre-vaccine study, which has yet to complete peer review, 15% of people with confirmed COVID infections were diagnosed with heart disease within the next year. When researchers looked at data from 2017, only 10% of similar people had developed cardiac problems.

Some people develop symptoms that look very similar to chronic fatigue syndrome, also known as myalgic encephalomyelitis. That kind of post-viral syndrome can develop after all kinds of infection, including after mild or even asymptomatic cases of COVID. People may feel extremely tired, no matter how much they sleep; have extreme difficulty concentrating, also known as brain fog; and get exhausted just from walking across the room.

There are likely connections between the immune response to the virus and all these diverse symptoms, according to Mady Hornig, an associate professor of epidemiology at Columbia Universitys Mailman School of Public Health, who specializes in myalgic encephalomyelitis. She developed long COVID herself about four months after being infected. For more than a year, even mild exertion could trigger her heart to race and her blood oxygen to drop.

Infection-triggered syndromes are certainly not a surprise, she told SFGATE. Theres so much that we really need to understand about what is actually wrong.

That all depends on the symptoms, said Dr. Lekshmi Santhosh, medical director of UCSFs post-COVID clinic. Someone who was hospitalized and on a ventilator will have different needs than someone who was never hospitalized, who has significant fatigue and post-exertional symptoms. Treating respiratory symptoms is different than treating headaches and brain fog, she told SFGATE by email.

Dr. Linda Geng is the co-director of the Post-Acute COVID Syndrome Clinic at Stanford in Palo Alto, and said the most common symptoms she sees in her clinic include fatigue, brain fog, exertional intolerance and sleep issues.

"Encouragingly, we do see many patients get better over time, though there are patients who have now had symptoms lasting longer than a year, so we need to make sure we continue to provide support and resources for all long COVID patients," Geng wrote in an email.

Even though its now the dominant variant in the U.S., omicron hasnt been around long enough for researchers to get a handle on what happens long-term. Its clear, though, that omicron results in less severe disease than delta does. Thats true even for unvaccinated people, although theyre still much more likely to get very sick, or even die, than people who have been immunized.

Since vaccinated people are much less likely to get very sick, theyre also less likely to have injuries that take a long time to heal, like lung and heart damage. Even if you do get sick enough to go to the hospital, its extremely unlikely youll have to be treated in the ICU. (People infected with the omicron variant are unlikely to need the ICU, whether or not theyve been vaccinated.)

Most of our patients had acute COVID prior to vaccination, Geng said. Thus far we have not seen many new patients who have long COVID from breakthrough vaccinations, but we will need to see as time passes how the patterns emerge.

One of the only published studies looking at vaccination status was published in September 2021, when delta was the dominant strain, and before booster shots were widespread. Researchers in the United Kingdom asked people to self-report COVID symptoms through an app. A month after being infected, people who had received two vaccine doses were about 50% less likely to report symptoms than people who hadnt received any shots.

"We need more data to continue to evaluate the impact of vaccines, specifically boosters in the age of Omicron and whether the probability of infection is the same," said Dr. Peter Chin-Hong, an infectious diseases expert at UCSF, via email.

Research on the prevalence of long COVID is hugely varied, with peer reviewed reports claiming anywhere from 3% to 80% of people will have extended symptoms. (Chin-Hong estimated that number is about 10% to 20%, noting that vaccination significantly reduces the risk.) Obviously, theres a huge disparity between those numbers, even accounting for differing definitions of long COVID.

The biggest issue is that it takes a long time to do this kind of research. Most of the work now being published uses data from patients infected before vaccines were widely available. While lots of vaccinated people with long-term symptoms are being followed, most were infected when the most common strain of SARS-Cov-2 was delta, which causes more severe disease than the now-dominant omicron variant.

Its also very hard to conduct public health research in America, because our medical data is scattered across tens of thousands of systems that cant talk to one another. That means a lot of this research is being conducted in countries with national health systems like the UK, where the most common vaccine uses a different technology than the Pfizer or Moderna shots.

Its hard to say. Vaccines have done such a good job at preventing serious disease that many immunized people either dont know theyve been infected or use at-home tests without reporting positive results to anyone. That means it may take a long time for people to connect long-term symptoms to a COVID infection.

The federal National Institutes of Health has pledged to spend $1.15 billion on research into long COVID.

To Hornig, the pandemic represents an enormous opportunity and obligation to learn as much as we can about this and other post-viral syndromes. So many people got this at the same time, were finally looking at all sorts of nervous system disorders, she said. But we have so far to go before we know what to do.

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Coronavirus cases are dropping. It's time to talk about long COVID. - SFGate

Weekly coronavirus cases in Oregon fell 22% in the past seven days, state data released Monday shows, marking the clearest evidence yet that the highly transmissible omicron variant is receding.

The Oregon Health Authority tallied about 43,600 confirmed or presumed infections in the past week, including 13,443 announced Monday for the preceding three days.

Several closely watched benchmarks show improvement since last week, as well.

The number of Oregonians hospitalized and testing positive for coronavirus stands at 1,099, down slightly from Friday, and new projections have been downgraded to a potential peak of about 1,200. Test positivity rates reported Monday also dipped to a still high 20.6%. And the share of emergency department patients with COVID-19-like illness stayed below the highs from earlier this month.

State officials last week offered their most optimistic statements of the surge, indicating a possible peak in cases and the potential that spring and summer may offer some semblance of normalcy following two years of pandemic precautions.

The decline seen Monday in weekly cases marks the first dip since early December. (Prompted by questions from The Oregonian/OregonLive, state officials acknowledged that a weekly report issued last week erroneously said cases declined by 9.5% when they were instead flat. The Oregonian/OregonLive also erroneously reported cases rose by 14%, based on two weeks worth of incorrect state data that has since been adjusted).

Separately, the state on Monday also reported 15 COVID-19-related deaths.

Where the new cases are by county: Baker (41), Benton (286), Clackamas (1,070), Clatsop (97), Columbia (146), Coos (164), Crook (140), Curry (45), Deschutes (893), Douglas (216), Harney (19), Hood River (61), Jackson (817), Jefferson (208), Josephine (285), Klamath (369), Lake (7), Lane (1,353), Lincoln (127), Linn (611), Malheur (61), Marion (1,622), Morrow (30), Multnomah (1,807), Polk (302), Tillamook (69), Umatilla (281), Union (120), Wallowa (10), Wasco (81), Washington (1,741) and Yamhill (364).

Who died: A 78-year-old woman from Coos County who tested positive Dec. 6 and died Dec. 19 at Southern Coos Hospital & Health Center.

A 60-year-old woman from Polk County who tested positive Aug. 27 and died Sept. 19. Location of death is being confirmed.

A 77-year-old woman from Lane County who tested positive Sept. 6 and died Sept.16 at her residence.

A 50-year-old man from Washington County who tested positive Jan. 11 and died Jan. 25 at Providence St. Vincent Medical Center.

A 76-year-old woman from Washington County who tested positive Jan. 8 and died Jan. 16 at Kaiser Westside Medical Center.

A 75-year-old woman from Wasco County who died Nov. 27 at her residence. The death certificate listed COVID-19 as a cause or significant condition contributing to death.

A 64-year-old man from Wasco County who tested positive Jan. 24 and died Jan. 28 at Mid-Columbia Medical Center.

A 56-year-old man from Umatilla County who tested positive Jan. 13 and died Jan. 27 at PeaceHealth Sacred Heart Medical Center at Riverbend.

A 68-year-old man from Lane County who tested positive Jan. 26 and died Jan. 27 at PeaceHealth Sacred Heart Medical Center at Riverbend.

An 89-year-old woman from Lane County who tested positive Jan. 21 and died Jan. 26 at McKenzie Willamette Center.

A 55-year-old man from Douglas County who tested positive Nov. 21 and died Jan. 29 at Mercy Medical Center.

A 52-year-old woman from Jackson County who tested positive Jan. 2 and died Jan. 28 at Providence Medford Medical Center.

An 83-year-old woman from Clackamas County who tested positive Jan. 24 and died Jan. 25 at her residence.

A 69-year-old woman from Clackamas County who tested positive Jan. 26 and died Jan. 28 at Kaiser Sunnyside Medical Center.

An 89-year-old man from Clackamas County who tested positive Jan. 7 and died Jan. 14. Location of death is being confirmed.

Each person had underlying health conditions or the presence of conditions was being confirmed. State officials also removed a previously announced death of a 60-year-old man from Clackamas County announced Dec. 15. He did not die.

Hospitalizations: 1,099 people with confirmed coronavirus infections are hospitalized, down 26 since Friday. That includes 187 people in intensive care, up 11 since Friday.

Since it began: Oregon has reported 633,876 confirmed or presumed infections and 6,100 deaths, among the lowest per capita numbers in the nation. To date, the state has reported 7,193,854 vaccine doses administered, fully vaccinating 2,826,410 people and partially vaccinating 300,373 people.

To see more data and trends, visit https://projects.oregonlive.com/coronavirus/

-- Brad Schmidt; bschmidt@oregonian.com; 503-294-7628; @_brad_schmidt

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Coronavirus in Oregon: Weekly cases fall 22% in surest sign omicron is receding - OregonLive

People are suffering from pandemic fatigue. It has been a long two years and most of us have had to endure harsh and often unpredictable restrictions on our daily lives. Millions of people have died, livelihoods have been lost and economies have suffered. So it is understandable that many would cling to any hope that the COVID-19 pandemic is coming to an end. In some countries, the easing or complete removal of restrictions has given them that hope.

This sentiment has, in some ways, been fuelled by the Omicron variant, which has been shown to cause less severe disease, in adults at least, with one study from Imperial College London reporting that people infected with it were 40-45 percent less likely to be admitted for an overnight hospital stay than those infected with the Delta variant.

But the arrival of the Omicron variant, with its increased transmissibility and ability to evade at least some of the protection conferred by vaccines and previous infections, should remind us of how volatile the course of this pandemic can be.

The head of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, issued a stark warning this month when he said, Its dangerous to assume that Omicron will be the last variant and that we are in the end game.

While Omicron may be milder than Delta, although not mild, cases are continuing to soar, particularly across Europe. This suggests any hope that COVID-19 may soon become endemic, is misplaced.

In its most scientific terms, a disease is considered endemic once the number of cases becomes stable or static, not when the illness becomes less deadly. By this definition, COVID-19 is not yet endemic as cases are still on the rise. On the other hand, diseases such as malaria, which can kill 600,000 people a year, and dengue fever, which kills up to 25,000 people each year, are endemic in certain parts of the world.

So, when people, like the UKs health secretary, Sajid Javid, talk about learning to live with COVID, the question to ask is: What would be considered an acceptable number of COVID-19 deaths in order for the world to carry on as normal? It is, of course, important to note that this approach would put the clinically vulnerable and the elderly, who have a much higher chance of dying from the virus, at a major disadvantage.

Some may argue that flu, which we have all come to terms with, kills up to 650,000 people each year worldwide, so surely we can live with COVID-19. But flu isnt an endemic illness; rather we see waves of it during the winter months. And, although the flu virus and the SARS-CoV-2 virus are frequently compared, I am not convinced they should be. They cause two very different illnesses.COVID-19 is a multi-system inflammatory virus that is not only potentially deadly but can also lead to long-term health problems for people of all age groups. Flu, by contrast, typically affects onlythe respiratory system. This means millions of people worldwide may end up living with long COVID which in itself will have devastating effects on their livelihoods and the wider economy. In addition to this, COVID-19 deaths so far have significantly outnumbered flu deaths (although this includes deaths during the time before vaccines were widely available in wealthy countries and when we were still learning about the virus).

There is also some belief that any new variants that may arise in the future are likely to cause an even milder illness than Omicron. But there is nothing to substantiate this belief. It would only be true if the virus had anything to gain by causing a milder illness and keeping its host alive. Much of the SARS-Cov-2 transmission occurs in the days before a person develops symptoms and the first few days following the onset of symptoms. It is usually the hosts own immune response to the virus that causes much of the illness we have seen in those hospitalised with it. This is because the virus can cause an overstimulation of certain immune cells, which then become difficult to turn off as they start to attack healthy cells as well as infected ones. By the time the host becomes seriously ill, the virus has moved on to another person. This means there is no evolutionary pressure for the virus to become milder; we simply got lucky with Omicron.

So, as unpalatable as this may sound to many people, we are not yet in a position to start living with this virus. We must continue to adopt methods to suppress its spread until we are. This means putting measures in place to protect the most vulnerable by reducing their chances of getting the virus.

As COVIDs mode of transmission is airborne, we should equip schools and other buildings with air filters and look for innovative ways to improve airflow in areas where people might congregate for long periods of time. We must also accept that mask-wearing may become a part of our daily lives, much as it did in parts of Asia after MERS, a type of coronavirus first identified in 2012. But it has to be the right type of mask, with N95 or FFP2 masks being the most effective.

Also, vaccines are key, and getting them into the arms of people across the world remains paramount. Variants are more likely to arise where people remain unvaccinated. Those who are vaccinated are more likely to rid themselves of the virus more quickly compared with unvaccinated people. This means the virus has less time to multiply and less chance to mutate in those who are fully vaccinated. Pushing for global vaccine equity is in everyones best interests. We need to have at least 70-80 percent of the worlds population vaccinated to achieve global protection and significantly reduce the risk of illness. This sounds ambitious but it has been done before with the vaccine for polio, a disease that has been more or less eradicated worldwide. In addition, second-generation vaccines are being developed to tackle emerging variants more effectively and will be key to safeguarding us in the future.

It is not only the vaccines that need to be shared across the world. Antiviral treatments like molnupiravir and paxlovid, which have been shown to reduce the risk of hospital admission for those in the high-risk category who test positive for COVID-19, must also be made available. These drugs help stop viral replication which, in turn, can reduce the length of time someone is ill with COVID. A shorter illness means there is less time for mutations and variants to emerge. That is something we would all benefit from.

Continuing research into long COVID and a better understanding of the different ways this virus can affect our bodies may also lead to a time when we can consider living with this virus.

I have hope that a time will come when we are better protected from the effects of COVID-19 and equipped to deal with any emerging variants, but sadly that time is not quite now. We are in a much better position than we were two years ago and that is largely down to science, but we cannot yet claim that we are nearing the end of this pandemic.

Recent data and analysis from the UK Health Security Agency (UKHSA) shows that in mid-late 2021 there was an increase in the number of cases of meningococcal disease in teenagers and young adults, mainly caused by group B meningococcal disease (MenB) with the majority of these cases detected in university students.

Meningitis B is caused by the bacteria Neisseria meningitidis. Meningitis can attack the brain and spinal cord and cause swelling in those areas as well as a serious infection of the bloodstream, called septicaemia. Approximately 10-15 percent of people infected with meningococcal disease will die, sometimes as quickly as within 24 hours after symptoms first appear. For those who survive, about one in five may experience a variety of long-term disabilities including hearing loss, brain damage, nervous system problems, kidney damage, loss of limbs, and scarring of the skin.

Commons signs and symptoms of meningitis and septicaemia are:

Early COVID-19 restrictions across the UK saw meningitis B cases fall to an all-time low in September 2021. But as restrictions eased and people were able to mix again, cases in teenagers, in particular, have begun to rise to levels higher than before the pandemic.

In the UK, teenagers are offered the meningococcal ACWY vaccine in an effort to protect them from some of the different bugs that can cause meningitis and the MenB vaccine is offered to infants. It is unclear exactly what is causing the rise in cases in these young people. One theory put forward by the authors of the report is that fewer people were exposed to the bacteria as a result of reduced mixing at the height of the pandemic. This meant that fewer people became immune,so when university campuses opened up there was an immunity debt which put them at risk of getting the illness.

The best thing students and young people can do to protect themselves from this serious illness is to take up the ACWY vaccine and to be alert to the symptoms of meningitis B so that they can seek medical help sooner rather than later.

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Are we nearing the end of the COVID-19 pandemic? - Al Jazeera English

Some PCR tests look for three genes of the virus to diagnose the infection. The delta variant, which was detected in India and was dominant across the world until the end of 2021, would show up these three genes, but the classic version of omicron only showed up two. This characteristic allowed for the assumption to be made as to whether a person was infected with delta or omicron via a simple PCR test, without the need to sequence the complete genome of the virus. The subvariant BA.2, however, does not have this mutation and is indistinguishable from delta with these specific tests, prompting the name the stealth variant, a term that is not popular among many experts, including the virologist Mara Iglesaisa, from Spains National Microbiology Center.

It has made a lot of noise for something that is supposedly silent, jokes Iglesias, in reference to the media attention received by BA.2 in recent days. The moniker of stealth is very deceptive. A person infected with this subvariant tests positive with no problem in an antigen or PCR test, the only difference is that now it is not so simple to deduce which kind of coronavirus it is in the aforementioned tests that seek these three specific genes.

Mara Iglesias points out that 83% of cases in Spain are caused by the BA.1 subvariant of omicron, the classic strain. The delta variant is behind the other 17%. BA.2 is already being detected, albeit residually, in the Spanish regions of Madrid, Catalonia, Asturias and the Balearic Islands. We are not seeing the explosion of cases that there has been in Denmark, the virologist explains. Obviously the variants need to be monitored, but on a scientific level. This is not to say that each one deserves a front page in all media outlets, Iglesias argues, given her fears of excessive attention contributing to so-called pandemic fatigue. We dont know anything, its all speculation. People are starting to get tired and not believe anything, she warns.

On January 21, the World Health Organization (WHO) called for research into BA.2 to be prioritized, after there was a rise in the proportion of cases in India, South Africa, the United Kingdom and Denmark. In Berlin, around one in every three infections is already due to BA.2. In the world, however, nearly 99% of omicron cases continue to be caused by BA.1, according to the WHO.

Doctor Roger Paredes, from the Germans Trias Hospital in the Spanish city of Badalona, huffs and puffs when imagining the future. There is no sign that suggests that BA.2 is a more serious variant than its predecessor, but it is true that it could be a bit more transmissible, he explains. The consequence of the arrival of BA.2 could be that the end of this wave is delayed, which is what is happening in England: cases were falling and now they have stabilized. In his area, Paredes explains, only two cases of BA.2 have been detected for now.

Three doses of a Covid-19 vaccine have practically the same efficiency, up to 70%, when it comes to avoiding symptomatic infections with either of the two sub-variants of omicron, according to a report from the UKs Health Security Agency published on Thursday. The document confirms 95% protection against deaths caused by BA.1, but there is no data on BA.2 for now.

We are not seeing the explosion of cases that there has been in Denmark

Roger Paredes takes for granted that the success of vaccination combined with the fact that omicron is 25% less serious than delta in the same conditions will imminently lead to a new stage. The majority of society has reached a situation where they are fed up and are against more restrictions, so we are going to enter a new phase, basically without restrictions, Paredes predicts. Fundamentally, what is happening is the pressure is passed on to hospitals. We are likely to have waves with hundreds of patients in ICUs over the coming years. We are going to need good monitoring systems to know when things are getting out of hand, Paredes warns.

Biologist Iaki Comas, from the Valencia Biomedicine Institute (CSIC), is calm. It doesnt look like the face of the epidemic will change much even if we go from BA.1 to BA.2, he explains. In the absence of control measures, such transmissible variants as these will continue to find people who are susceptible to infection, which is going to mean that the fall in cases will probably be slower than in other waves. But we have already learned in the past that the variants can be controlled in the same way: vaccination, ventilation and masks, above all indoors, Comas adds.

The idea that SARS-CoV-2 is destined to become a more benign version has become generally accepted, but this is not the case, as pointed out by geneticist Emma Hodcroft, from the University of Bern. In fact, omicron did not come from delta, nor did delta come from alpha. We will see new variants, she explains. The important thing is whether these variants will be worrying and will have an impact on the pandemic and on our way of responding. And that we dont know. Perhaps SARS-CoV-2 has been left without any new tricks that will change its behavior, she continues. But perhaps there is another combination that will increase its transmissibility, severity or ability to escape our defenses even more. Unfortunately, there is no way of predicting that. This is why its so important to continue investing in the monitoring of the virus, she concludes.

English version by Simon Hunter.

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BA.2: A new version of the omicron coronavirus variant that is even more contagious but not more serious, acco - EL PAS in English

ROME The entire family is vaccinated, even the relatives, and all abide by masking requirements and respect Italys tough coronavirus restrictions. They are also all over the place in how they are living their lives.

Mariagiovanna Togna is willing to accompany her children to outdoor play dates after school. But her husband, more anxious by nature, is still wearing rubber gloves, wiping down groceries and turning away visitors. One of her sisters in Rome is more laid back and goes to yoga class and to work, and her 15-year-old daughter had a birthday party indoors. Her brother, in the northern region of Trento, who finally agreed to get vaccinated, she said, to keep going out to bars, recently vacationed along the Amalfi Coast. But when Christmas vacation rolled around, their parents, in their 70s, asked him to stay in a bed-and-breakfast.

Everyone who went home to Benevento had to take a rapid test, including another sister, who depends on their mother for babysitting. Even though the government shot down the efforts in the Campania Region, where she lives, to delay in-person school, she prefers to keep her child out of nursery school.

We are all vaccinated, many with the third dose already, we all have a civic sense about being careful for ourselves and for others, she said. But we have different styles of life.

As the Omicron variant of the coronavirus personally touches or swirls around so many individuals, vaccinated and largely protected families are strained by varying comfort levels. It is much the same the world over, especially where significant portions of the population have been vaccinated, like Italy, which now has one of the highest rates in the world.

Initially slammed by the virus, Italy today holds the promise of a near future where the schism in society is no longer between the vaccinated and the unvaccinated, or the socially responsible and the scofflaws, but between the risk takers and the risk averse.

For many with booster shots, life has become a constant negotiation between those who want to resume dining in restaurants, those still reluctant to accept deliveries and those who just want to get the virus already and get their mandatory quarantines over with.

For many vaccinated families, the recent holiday season and New Years celebrations hammered those variations home, as teenagers stumbled in after parties to take a swab test and reunite with shut-in uncles petrified of the virus, or grandparents unsure just how protected their booster shots left them. In Italy, where generations of families often see one another, and frequently live together, navigating the vagaries of Omicron decorum is a constant exercise.

In my world, there are no no-vax, said Giuseppe Cavallone, 73, who walked in the Villa Doria Pamphili park in Rome with his wife. But that did not mean they lived carefree. They had given up on going to the movies, in part because of the discomfort of wearing a mask for three straight hours, and had abandoned their annual travel to Paris and London. But their son, also fully vaccinated, was less cautious, flying to Patagonia for vacation.

The young feel much more free, said Mr. Cavallones wife, Maria Teresa Pucciano, 74. She added that they recently went to a wedding, but a friend of theirs stayed outside in the cold the whole time.

An increasing number of people who have received a third vaccine dose have, emboldened by the apparent light symptoms of Omicron for the vaccinated, entered a bring-it-on phase of the pandemic. Some are trying to time their resulting quarantines to a social and school calendar, or to have infections coincide with those of friends. Others are instead still coming to terms with a virus that is seemingly everywhere, and forcing themselves to adjust their comfort levels and do more, to be more social, to even dine inside an actual restaurant.

On a recent Sunday at the Il Cortile restaurant in Rome, where the front door bore a large reminder that all diners needed to present a health pass and its proof of vaccination, Isabella Carletti, 65, got up from lunch with her husband and walked outside.

Jan. 31, 2022, 9:57 p.m. ET

I felt uncomfortable in there, I wanted to get some air, she said. We usually book outside, but we couldnt find a table.

She lit a cigarette and suggested the smoke was less dangerous than the air inside. But then she went back in.

In Italy, more than 80 percent of the population, including children, has had two doses of the vaccine. That number is expected to tick up as 90 percent of the population, including many children who only recently became eligible for vaccination, already has one dose.

The Italian government has gradually tightened the screws on the unvaccinated, and on Tuesday, new restrictions will come into force requiring vaccination for people 50 and over.

Most of the problems we are facing today depend on the fact that there are unvaccinated people, Prime Minister Mario Draghi said. He added that unvaccinated people have a much higher chance of developing the disease and severe forms of the disease and were putting hospitals under pressure.

To force vaccinations, the health care system will forward the names of the unvaccinated people over 50 to tax authorities so they can be fined. But the real deterrent remains the isolation from public life, with everything from entering a cafe to taking a public bus or going to work banned for the unvaccinated.

Since the government announced its plans, around 600,000 people a day, about 1 percent of the population, have received a dose of a vaccine, including the now 45 percent of Italians who are receiving their third dose. But among them are also about 60,000 to 90,000 people who are receiving their first dose. Many are probably children, but the government is also confident the new rules are motivating more people over 50, who are more vulnerable, to be vaccinated. There are still an estimated 10 percent of Italians who are unvaccinated, many in their 40s and 50s.

Advocates for a speedier vaccination campaign would like the government to mandate the vaccine to people 40 and up, as about 15 percent of 40-year-olds remain unvaccinated. But the current delicate political moment in the wake of a destabilizing election for president has put that off for now. In any case, the government is pleased with the progress.

Maria Claudia Di Paolo, 71, and her husband, Natale Santucci, also 71, said they, too, had been encouraged by the success of Italys vaccination campaign and worried that the vaccine skeptics were getting too much attention. The couple, who contracted Covid last year after having friends over for dinner, decided recently to have their first nonrelated guest over for a meal.

Then the guest, a doctor like Mr. Santucci, called to say that one of his patients had tested positive, but he himself had tested negative and could still come.

We said, Better to wait, said Mr. Santucci, who added that the couple had moved their weekend family lunches to an outside table at a local restaurant. But they did celebrate Christmas together at home with their children and grandchildren, spaced apart at a big table, avoiding hugs and kisses and feeling out everyones comfort level. There is a great variability inside the vaccinated families, he said.

Ms. Togna said that she felt isolated and at wits end. Seeing so many people around her infected, quarantined and then going on with life, she said, had encouraged her to try to move ever so slightly off the extremely cautious end of the spectrum. But it was hard.

On one side, I think I have to change my behavior, and drag my whole family along, but it will be very difficult, she said. Even if its endemic, there is always the risk.

Gaia Pianigiani contributed reporting.

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Covids New Divide: Risk Takers vs. the Risk Averse - The New York Times

Fauci: Covid may not end, hopes to find normalcy

White House officials say hopefully we will get to where COVID-19 is acceptable and "it doesn't disrupt our capability to function in society in a relatively normal way." (Jan. 26)

AP

To keep up with our comprehensive COVID-19 coverage in Florida, sign up for our free weekday newsletter, Coronavirus Watch.

From No. 37 ... to No. 37.

Florida spent a nerve-wracking six weeks on a Top 10 list of states where coronavirus was spreading the fastest. From late December to mid-January, the state saw a spike in COVID-19 cases brought on by the more infectious, but less severe omicron variant. Last week the state was barely in the Top 40.

How are we doing this week?

Florida reported far fewer coronavirus cases in the week ending Sunday, adding 197,768 new cases. That's down 30% from the previous week's tally of 282,520 new cases of the virus that causes COVID-19.

Florida ranked 37th among the states where coronavirus was spreading the fastest on a per-person basis, a USA TODAY Network analysis of Johns Hopkins University data shows.

COVID and omicron variant in Florida: What to know if you're exposed or test positive for coronavirus

Do at-home COVID tests still work if they get cold? What if they freeze in my mailbox?

In the latest week coronavirus cases in the United States decreased 30.3% from the week before, with 3,451,287 cases reported. With 6.45% of the country's population, Florida had 5.73% of the country's cases in the last week. Across the country, 10 states had more cases in the latest week than they did in the week before.

Here's a snapshot of the previous seven weeks (click on the hyperlinks to read those COVID-19 reports):

In the week ending Jan. 23, Florida ranked No. 37 in the nation when the state department of health added 282,520 cases. That figure was down 30.9% from the previous week's tally.

In the week ending Jan. 16, Florida was knocked out of the Top 10 list, ranking at No. 11, and reporting 408,841 cases, a 3.4% dip from the week before.

In the week ending Jan. 9, Florida ranked fifth, reporting 423,150 cases, a 40% rise from the week before.

In the week ending Jan. 2, the state ranked fourth when Florida Department of Health reported 302,179 cases, a 142% rise from the week before.

In the week ending Dec. 26, the state ranked ninth, reporting 124,865 cases, a 332.9% rise from the week before that.

In the week ending Dec. 19, the state had reported 28,841 cases of the virus that causes COVID-19, a 142% increase from mid-December.

It should be noted that while Florida ranks 37 on a list where coronavirus spreads the fastest and health officials have said COVID cases are falling here, the state still is reporting more than 100,000 new cases a week, compared with almost 29,000 cases in the week ending Dec. 19.

Long COVID: Why aren't my symptoms going away? Why did they come back? Am I a long-hauler?

Do COVID-19 boosters protect against omicron? Where and when can I get a booster in Florida?

Palm Beach County reported 8,711 cases and 51 deaths in the latest week. A week earlier, it had reported 15,075 cases and 27 deaths. Throughout the pandemic it has reported 350,714 cases and 4,407 deaths.

Martin County reported 1,097 cases and nine deaths in the latest week. A week earlier, it had reported 1,358 cases and eight deaths. Throughout the pandemic it has reported 29,796 cases and 541 deaths.

Okeechobee County reported 403 cases and zero deaths in the latest week. A week earlier, it had reported 588 cases and one death. Throughout the pandemic it has reported 10,157 cases and 164 deaths.

Across Florida, cases fell in 58 counties, with the best declines in Miami-Dade County, with 23,019 cases from 46,959 a week earlier; in Broward County, with 11,917 cases from 23,063; and in Palm Beach County, with 8,711 cases from 15,075.

>> See how your community has fared with recent coronavirus cases

Florida ranked 19th among states in share of people receiving at least one shot, with 77.2% of its residents at least partially vaccinated. The national rate is 75.3%, a USA TODAY analysis of CDC data shows. The Pfizer and Moderna vaccines, which are the most used in the United States, require two doses administered a few weeks apart.

In the week ending Sunday, Florida reported administering another 254,074 vaccine doses, including 70,765 first doses. In the previous week, the state administered 390,947 vaccine doses, including 226,645 first doses. In all, Florida reported it has administered 35,340,821 total doses.

Within Florida, the worst weekly outbreaks on a per-person basis were in:

Taylor County with 2,717 cases per 100,000 per week

Madison County with 2,487 cases

Baker County with 1,862 cases

The Centers for Disease Control says high levels of community transmission begin at 100 cases per 100,000 per week.

Is it the flu, a cold, or the omicron variant? How to know, and when to get tested for COVID

Adding the most new cases overall were:

Miami-Dade Countywith 23,019 cases

Hillsborough Countywith 13,524 cases

Orange Countywith 12,455 cases

Weekly case counts rose in nine counties from the previous week. The worst increases from the prior week's pace were in Taylor, Franklin and Madison counties.

In Florida, 1,192 people were reported dead of COVID-19 in the week ending Sunday, Jan. 30. In the week before that, 605 people were reported dead.Johns Hopkins University data shows64,955 people have died from the disease since the pandemic began. In the U.S., 884,260 people have died.

A total of 5,522,206 people in Florida have tested positive for the coronavirus since the pandemic began, Johns Hopkins University data shows. In the United States, 74,333,001 people have tested positive.

>> Track coronavirus cases across the United States

USA TODAY analyzed federal hospital data as of Sunday, Jan. 30.

Likely COVID patients admitted in the state:

Last week: 12,792

The week before that: 14,710

Four weeks ago: 10,854

Likely COVID patients admitted in the nation:

Last week: 170,411

The week before that: 183,931

Four weeks ago: 147,900

Hospitals in 13 states reported more COVID-19 patients than a week earlier, while hospitals in 15 states had more COVID-19 patients in intensive-care beds. Hospitals in 18 states admitted more COVID-19 patients in the latest week than a week prior, the USA TODAY analysis of U.S. Health and Human Services data shows.

Vaccination is the best way to protect yourself and reduce the impact of COVID in your communities.

The same precautions still apply:

wash your hands

social distance

wash your hands frequently or use hand sanitizer to prevent the spread of germs

avoid crowds in which you are unsure of vaccination status

Please consider subscribing to a USA TODAY Network-Florida newspaper atoffers.usatodaynetwork.com/network-regional-florida.

The USA TODAY Network is publishing localized versions of this story on its news sites across the country, generated with data from Johns Hopkins University and the Centers for Disease Control. If you have questions about the data or the story, contact Mike Stucka atmstucka@gannett.com. Follow Mike on Twitter at @mikestucka.

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COVID: Florida reports 197,768 cases and 1,192 deaths in a week, still on list where virus spreads fastest - Palm Beach Post

DC Health released updated coronavirus isolation and quarantine guidelines Monday night, calling for a negative test before ending isolation and detailing what it means to be up-to-date with COVID-19 vaccinations in a school setting.

DC Health released updated coronavirus isolation and quarantine guidelines Monday night, calling for a negative test before ending isolation and detailing what it means to be up-to-date with COVID-19 vaccinations in a school setting.

The changes, which city officials alluded to in a call with council members last week, are in some ways stricter than the guidelines that the Centers for Disease Control and Prevention recommended.

In its instructions for people who test positive for the coronavirus, DC Health says the minimum isolation period is five full days. Unlike the CDC, though, DC Health says a five-day isolation period can be used if a negative antigen test is completed toward the end of the five-day period, and the patient is fever-free for at least 24 hours without the use of fever-lowering medications, such as Tylenol or ibuprofen. If those conditions are met, isolation can be ended on day 6, the city says.

The CDC doesnt call for a negative antigen test to end isolation, but the updated D.C. guidelines call for the negative test result and states the person who tests positive to wear a well-fitting mask around others through day 10 because a negative COVID-19 antigen test does not guarantee that you are not infectious to others, so continuing to wear a mask is essential.

People with severe or critical COVID-19 or who are immunocompromised should isolate for at least 10 days, DC Health said.

The updated DC Health guidance also calls for a five-day isolation period and negative test for people who test positive without symptoms.

Fully vaccinated people, which the CDC considers anyone who has received two shots, dont need to quarantine if exposed unless they develop symptoms.

The updated DC Health policies also include new guidelines for schools.

In a school setting, according to city guidelines, anyone 18 and older is considered up to date on vaccinations if they have received a booster shot. D.C. Mayor Muriel Bowser previously required all adults working in schools to be vaccinated unless a medical or religious exemption is granted.

For students ages 5-17, fully vaccinated still means completing a primary two-dose vaccine series.

In school settings, independent of vaccination status, the minimum isolation period is seven days, DC Health said.

The updated guidelines also include information for implementing test-to-stay programs, the practice that allows unvaccinated students who are exposed to the virus to remain in class if they get tested regularly and remain negative. D.C. Public Schools recently launched a test-to-stay pilot program for pre-K students, and the practice is being used in some Fairfax County, Virginia, schools.

In order to be eligible to participate in a D.C. test-to-stay program, exposure must have occurred at school and involved two people who were properly masked. Students and staff participating in test-to-stay programs, DC Health said, should to be tested at minimum two times in the seven-day period after their last exposure, including: immediately (defined as within 24 hours of their exposure notification) and again five to seven days after exposure.

A source familiar with the school systems testing programs said the Office of the State Superintendent of Education typically reviews DC Health guidance before making its recommendations for local education agencies.

All of the new guidance is available online.

More Coronavirus News

Looking for more information? D.C., Maryland and Virginia are each releasing more data every day. Visit their official sites here: Virginia | Maryland | D.C.

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DC Health updates coronavirus guidance to include negative test result before ending isolation - WTOP

Britains Foreign Secretary Liz Truss tested positive for coronavirus Monday evening just hours before a planned trip to Ukraine.

Thankfully Ive had my three jabs and will be working from home while I isolate, Truss said on Twitter.

Truss had been due to travel to the eastern European country Tuesday for talks with Ukrainian President Volodymyr Zelensky, amid mounting tensions over Russias military build-up at the border. Prime Minister Boris Johnson is still due to make the trip.

Truss is the second U.K. cabinet minister to contract coronavirus in a matter of days after the Education Secretary Nadhim Zahawi confirmed he had tested positive Sunday.

Earlier Monday the foreign secretary addressed the House of Commons, announcing a toughened sanctions scheme aimed at hitting Russian individuals and businesses if Moscow goes ahead with an invasion of Ukraine. She also sat three seats along from Johnson without a mask while he answered questions about the civil servant Sue Grays report on the partygate scandal.

According to Sky News, Truss also attended a meeting of the 1922 committee of backbench Tory MPs on Monday evening, along with Johnson and several other cabinet ministers.

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UK's Liz Truss tests positive for coronavirus on eve of Ukraine visit - POLITICO Europe

To understand how the coronavirus keeps evolving into surprising new variants with new mutations, it helps to have some context: The viruss genome is 30,000 letters long, which means that the number of possible mutation combinations is mind-bogglingly huge. As Jesse Bloom, a virologist at the Fred Hutchinson Cancer Research Center, told me, that number far, far exceeds the number of atoms in the known universe.

Scientists try to conceptualize these possibilities in a fitness landscapea hyper-dimensional space of peaks and valleys. The higher peaks the coronavirus discovers, the fitter, or better at infecting people, it becomes. The more the virus replicates, the more mutations it tries out, the more ground it explores, and the more peaks it may find. To predict what the coronavirus could do next, we would simply need to know the topography of the entire fitness landscapewhich, maybe youve guessed, we do not. Not at all. Not even close. We dont actually know what peaks are out there. We didnt know the Omicron peak was out there, says Sarah Otto, an evolutionary biologist at the University of British Columbia. We cant really guess what more is possible.

What we can say is that the overwhelming majority of mutations will make a virus less fit (valleys) or have no effect at all (ridges), but a very small proportion will be peaks. We dont know how high those peaks are or exactly how frequently they appear. When Delta took over the world, it seemed like it would sweep all other lineages away. I would have for sure thought the next variant was going to come from Delta, says Katia Koelle, a biologist at Emory University. Then Omicron popped up on a distant peak, in a direction no one had thought to look.

The next variant may surprise us again. It could, by chance, become more virulent. It could become more transmissible. It will definitely alight upon new ways to escape the antibodies weve built up. The virus will keep finding those fitness peaks.

To make predictions about viral evolution even harder, the fitness landscape is continuously being remodeled as our mix of immunity shifts through vaccination and infection by new variants. This in effect changes what it means for the virus to be fit. Some mountains will sink; some hills will uplift. Still, the virus is extremely unlikely to mutate so much that our immunity against severe infection is reset to zero. As more and more of the world gains initial immunity from vaccines or infection, that will dampen the most severe outcomes. Whether future variants will still cause huge numbers of infections will depend on how quickly the virus can keep evolving and how well our immunity holds up after repeated exposures. Unlike other pathogens that have been criss-crossing the fitness landscape in humans for a very long time, the coronavirus has only just gotten started.

The coronaviruss variants keep surprising us because its evolutionary leaps look like nothing else weve seen before. Omicron racked up more than 50 mutations, with more than 30 in its spike protein alone. Of the four seasonal coronaviruses that cause common colds, two accumulate only 0.3 or 0.5 adaptive mutations a year in their spike proteins. A third doesnt seem to change much at all. The fourth is a mysterywe dont have enough long-term data on it. Influenza is capable of big jumps through a process called reassortment, which can cause pandemics (as H1N1 did in 2009), but the seasonal flu averages just one or two changes a year in its key protein, Koelle told me.

There are three possible explanations for why the evolution of SARS-CoV-2 looks so different from that of other viruses, and they are not mutually exclusive. First of all, we really havent looked that hard at other respiratory viruses. More than 7.5 million genomes of SARS-CoV-2 have been sequenced; just a few hundred or a few dozen for each of the four seasonal coronaviruses have been. When scientists try to reconstruct the relationship among these sequenced viruses in evolutionary trees, the trees are so sparse, says Sarah Cobey, a biologist at the University of Chicago. A whole suite of other viruses also cause common colds: rhinoviruses, adenoviruses, parainfluenza, respiratory syncytial virus, metapneumovirus, and so on. These, too, are poorly sampled. More than 100 types of rhinoviruses alone infect humans, but we dont have a great understanding of how that diversity came to be or evolved over time.

Second, the coronavirus could indeed be an outlier that is inherently better than other viruses at exploring its fitness landscape. It helps to be an RNA viruswhich acquires mutations more quickly than a DNA virusand then it helps to be moving really fast, Cobey told me. Measles takes, on average, 11 or 12 days between infecting one person and that person infecting another; the coronavirus takes only 1.5 to three. The more people it can infect, the more of the fitness landscape it can explore.

Third, the coronavirus was a novel pathogen. Whatever intrinsic transmissibility it may have had, it was also unimpeded by immunity when it first arrived in the human population. That means SARS-CoV-2 has been able to infect a simply staggering proportion of the world in two yearsfar more people than older viruses are typically capable of infecting. And each time it infects someone, it copies itself billions of times. Some copies created in every infection will harbor random mutations; some mutations will even be beneficial to the virus. But these mutations can have a hard time becoming dominant in the short course of a typical COVID-19 infection. It takes a while typically for a mutation to go from zero to even 5 to 10 percent of viruses in an infected person, says Adam Lauring, a virologist at the University of Michigan. That person then transmits only a tiny number of virus particles to the next person, so most of that diversity gets lost. Across millions of infections, some of those mutations are passed on, and they gradually accumulate into one viral lineage. Delta seems to have evolved this way. The coronaviruss ubiquity could have also seeded an unusual number of chronic infections all at once, which experts think are another big driver of viral evolution. In a chronic infection, over weeks and months, those beneficial viral mutations have time to become dominant and then transmit. This may be how Alpha originated.

Omicrons origins are still unknown. It may have evolved in a piecemeal fashion like Delta, but some experts think that its ancestors would have been found via sequencing if so. Two other possibilities exist: a chronic infection in someone immunocompromised or an animal reservoir that spilled back into humans. In both cases, the selection pressures within one immunocompromised patient or in an animal population are slightly different from those on a virus that is transmitting between humans. That may be what allowed the virus to cross a fitness chasm and discover a new peak in Omicron. Understanding the evolutionary forces that created Omicron can help us understand the realm of what is possibleeven if it cant tell us exactly what the next variant will look like.

With Omicron, I think we got lucky, says Sergei Pond, an evolutionary biologist at Temple University. The set of mutations that makes the variant so good at infecting even vaccinated people just happens to also make it a little less inherently virulent. Theres no reason this will always be the case. The coronaviruss virulence is a by-product of two other factors under more direct evolutionary pressure: how inherently transmissible it is and how good it is at evading previous immunity. How deadly it is doesnt matter so much, because the coronavirus is usually transmitted early on in an infection, long before it ever kills its host.

Across the immense fitness landscape, the coronavirus has many, many different paths to higher inherent transmissibility or immune escape. Take the example of transmissibility, Otto says. A virus could replicate very, very fast, so that patients shed high levels of it. Delta seems to do this, and it was more virulent. Or the virus could switch to replicating mostly in the nose and throat, where it might be easier to transmit, rather than deep in the lungs. Omicron seems to do this, and it is less virulent. The next variant could go either wayor it might chart an entirely new course. A version of Omicron called BA.2 is now outcompeting the classic Omicron variant in the United Kingdom and Denmark, though its still unclear what advantage it might have.

Omicron doesnt just have a lot of mutations; it has some really unusual ones. Thirteen of the mutations cluster in sites where scientists havent seen many changes before. That suggests mutations there normally make the virus less fit and get weeded out. But according to a preprint from Ponds group, these 13 individually maladaptive changes might be adaptive when present all together. You can imagine, he told me, a virus under pressure to escape from existing antibodies. It acquires a series of mutations that make it less recognizable to antibodies but perhaps worse at entering cells. Under the slightly different selection environment inside an immunocompromised patient or an animal reservoir, the virus still might be able to lingeruntil it finds just the right combination of mutations to compensate for previous changes. In Omicron, this process remodeled key parts of the spike protein so that it both became less recognizable to existing antibodies and found a different strategy for entering cells. The coronavirus normally has two ways of infecting cells, either fusing directly with them or entering through a bubble. Omicron has become a specialist in the latter, which happens to work less well in lung cells than in nose and throat cells, and may explain the variants lower intrinsic severity. To get around the immune system, the virus ended up changing one of its most basic functions.

Do other sets of mutations interact in unknown ways to change key viral functions? Almost certainly. We just dont know what they are yet. Well have to wait and watch SARS-CoV-2 in the years and decades to come. If you look at human influenza or seasonal coronaviruses, theyve been evolving in humans for a long time and they havent stopped evolving, Bloom, the virologist, said.

There are limits to how inherently transmissible the virus can get. Measles, the most transmissible known virus, has an R0 of 12 to 18, compared with Deltas R0 of 5. Omicrons R0 is still unclear, because a lot of its advantage over Delta seems to come from evading existing antibodies rather than inherent transmissibility. As the coronavirus has fewer and fewer nonimmune people to infect, though, immune evasion will become a more and more important constraint on its evolution. And here, the virus will never run out of new strategies, because what is optimal is always shifting. This Omicron wave, for example, is generating a lot of Omicron immunity as it moves through the population, which has in effect made Omicron less fit than when it emerged. The next variant is more likely to be not Omicron, or something as antigenically distinct from Omicron as possible, says Aris Katzourakis, a virologist at the University of Oxford. But exactly what that looks like? Perhaps we know enough now to know we shouldnt try to predict that.

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What Will the Next Variant Look Like After Omicron? - The Atlantic