BA.2, and the Next Public Health Crisis

Dr. Bradly Bundrant

BALLINGER - BA.2 is the newest sub-type of Omicron (COVID) to receive attention, and according to the latest information from Texas DSHS, it now accounts for about 40% of the COVID cases in our region of Texas. The other 60% of cases are due to the original Omicron, that is now known as BA.1

Dr. Bradly Bundrant is the chairman of the Health & Wellness Coalition of Runnels County. The coalition is gearing up to start hosting health screenings, public education classes and podcasts.

The same publication also noted that our region is seeing fewer cases of COVID than at any time since January of last year. At that time we were in the relative lull after the initial spike and before the onset of the Delta variant. I would note that locally I have seen more flu than COVID in the last month. I have previously said on these pages that I believe we have seen our last wave of pandemic COVID, but we will continue to see endemic or seasonal COVID, much as we have seen flu since that pandemic early in the last century.

What about this new variant, BA.2? Why should we not expect a new spike due to that variant?

The reason lies in understanding the cause of previous spikes. The initial spike was due to the fact that this was a new germ and no one had an immune system that was well prepared to combat it. The virus replicated and invaded the tissues, especially lung tissue, so quickly that the response mounted by the body was very strong, but late.

Often the response was too strong, and that accounted for a lot of the early deaths, until we learned to give medicines to tamp down the immune response in severe cases. Like all RNA viruses, this one changes continually. That change is the main reason why many people have had COVID more than once. After a person with a normal immune system recovers from a respiratory virus their immune system has developed an array of defenses against that virus. These defenses are usually strong enough that the person will not catch the same virus for a considerable period of time, typically a year or more.

That array of defenses will also provide some protection against related viruses, such that the person may become ill with a related virus, but the body will mount an effective response more quickly than it would have otherwise, and the illness is likely to be mild.

After the initial wave of COVID passed through our community there was a relative lull, and then we had the Delta spike. In a person whose body had learned to fight the COVID we had in 2020, Delta was different enough that their immune system was caught off guard. Delta was also different enough that the vaccinations developed in 2020 were not fully effective against it. In January of 2022, Omicron hit our community hard, in terms of cases, because it was different enough from all previous variants that neither a prior infection with COVID nor vaccination against COVID provided any protection against infection. However, it was similar enough to the previous strains that our immune systems were not caught totally off guard. So, in terms of total cases, Omicron went through our community as if we had never seen a COVID virus, but in terms of severe illness we had considerable protection.

This is a good time to point out how sophisticated the general public has become in regard to respiratory viruses. In 2019 probably not one person in 50 would have had any understanding of ‘herd immunity,’* and even fewer were familiar with the well documented tendency for novel respiratory viruses to be severe initially, and not terribly contagious, and then evolve to be less severe and more contagious.

This is of course due to the fact that the main determinant of success in a virus is how many people are infected by each sick person. People who are dead or confined to a hospital bed are not nearly as good at spreading the virus as people who go to work sick for two weeks and tell everyone, “It’s just allergies.”

In addition to its capacity to infect people who have some immunity due to prior infection or vaccination, Omicron also exhibited these last two characteristics – lower severity of illness and higher infectivity. These are the characteristics of a virus that is transitioning from pandemic to endemic.

BA.2 is a sub-variant of Omicron that is even more infectious than BA.1, and it is similar enough

to BA.1 that the diseases are clinically indistinguishable, and almost nobody who has had BA.1 gets BA.2. In our county and throughout Texas we had so many people get Omicron earlier this year that we finally have, I believe, reached herd immunity. COVID was a monumental public health crisis, a hundred-year pandemic and a black swan event, or so they say.

I do not think that we should take that to mean that we are immune to a public health crisis in the near-term. On the contrary, I think that we may experience something of similar scale before the decade is out, and maybe before the year is out! At any rate, we need to prepare with that thought in mind.

This is one of the main reasons, if not the main reason why I will continue to ask for representatives from all of the health and safety organizations in the county, as well as individuals interested in volunteering, to come together in the Health and Wellness Coalition for Runnels County (HAWC4RC, for short).

Our next meeting has been moved from this week, April 7, 2022, to Thursday April 21, 2022. We will meet at the Conference Room of Ballinger Home Health and Hospice.

*The term herd immunity refers to the fact that protecting an entire population or herd from an infectious disease does not require that every member of the population be immune. All it takes is for enough individuals to be immune so that each individual who does get sick will – on average – pass the disease on to less than one other individual. If that condition is met, the number of infected cases will become smaller with time and eventually go to zero.