Why big swells in COVID cases could continue to happen in Bay Area for years

The tide of coronavirus infections rising over California, and the Bay Area in particular, in recent weeks offers a glimpse of what “living with COVID” may mean for a few years yet, health experts say, as the virus continues to evolve at breakneck speed .

This springtime swell, coming so close on the heels of the winter omicron surge, underscores the challenges still facing the state and nation against a virus that is proving infuriatingly adept at causing widespread transmission, even in populations with high rates of community immunity due to previous infection and vaccination.

“I never thought here, this far along, we’d have a tough road ahead still. But unfortunately we do, and we have to face it,” said Dr. Eric Topol, executive vice president of Scripps Research in La Jolla (San Diego County). “This damn virus is so bedeviling.”

Infection rates in the Bay Area are at least as high now as they were at the peak of last summer and fall’s delta surge. As of the end of last week, the region was reporting roughly 2,500 coronavirus cases a day, though health officials say the actual number of infections is much higher due to people testing at home or not getting tested at all.

Critically, most people are not becoming severely ill, and hospitalizations remain far below the peaks of any previous surges. Deaths have remained stably low in California for the past six weeks and have never approached the darkest days of the pandemic.

A cable car with passengers wearing masks stops at Lombard Street in San Francisco, Calif., on Friday, February 4, 2022. Masks are currently required on public transportation in the city. As the Covid-19 virus becomes endemic, wearing masks may become a permanent cultural phenomenon long after mandates are lifted.

Laura Morton / Laura Morton

Experts say even highly immune places like the Bay Area probably should expect these kinds of swells regularly for at least another year or two, until the virus settles into a — hopefully — milder, more predictable pattern, and more tools are developed to effectively stop transmission . There’s no guarantee such a pattern will ever emerge, though experts agree that the virus is unlikely to spread chaotically forever.

For the foreseeable future, though the coronavirus may never cause the large-scale death and devastation of the first two years of the pandemic, it likely is going to continue to play an outsize role in daily living, experts say.

It may cause frequent disruptions to school and work schedules, force people to constantly assess when and where to don face masks, and make tasks as simple as going to a grocery store potentially risky for years to come for those who are vulnerable to severe illness.

“This surge really speaks to the fact that we do not have all the answers with COVID,” said Dr. Nicholas Moss, the Alameda County health officer. “Not only should we expect to continue to see it circulating, it’s probably best to continue to plan for these waves for the time being. It’s not going to settle into just a slow burn.”

The state is planning for surges twice a year — possibly in the spring and again in the late fall and winter — for the foreseeable future, said Dr. George Rutherford, an infectious disease expert at UCSF and former health officer for the California Department of Public Health. But he and others didn’t rule out that a wave could wash over the state again this summer.

California may be facing yet another brutal surge in the fall and winter, “especially if there’s a new variant,” Rutherford added. And given how rapidly the coronavirus continues to evolve, a new variant seems likely, he said.

In just the first five months of the year, four new variants have developed from omicron that are wreaking havoc in spots around the globe. In the United States, first the BA.2 subvariant, and increasingly BA.2.12.1 — essentially the child and grandchild of omicron, respectively — are driving infections. Each is 20% to 30% more infectious than its parent, experts say.

Employee Drexel Dorsey, 26, stocks the shelves while at Alameda Natural Grocery in Alameda, Calif.  on Wednesday, Feb.  16, 2022. This morning, California health officials lifted the statewide COVID-19 indoor mask mandate allowing vaccinated Bay Area residents to enter maskless in public settings.  The grocery store's employees will continue to wear their masks despite the expiring mandate.

Employee Drexel Dorsey, 26, stocks the shelves while at Alameda Natural Grocery in Alameda, Calif. on Wednesday, Feb. 16, 2022. This morning, California health officials lifted the statewide COVID-19 indoor mask mandate allowing vaccinated Bay Area residents to enter maskless in public settings. The grocery store’s employees will continue to wear their masks despite the expiring mandate.

Bronte Wittpenn / The Chronicle

Two other subvariants — BA.4 and BA.5 — are propelling cases in South Africa and Portugal, and were recently labeled “variants of concern” by the European Center for Disease Prevention and Control.

“This disease is approaching the level of transmissibility of measles, which is the most transmissible disease that we know of,” Rutherford said.

All four of the new subvariants are showing signs of increased ability to evade immunity, whether from infection or vaccination. For example, infection from omicron does not appear to confer much protection against getting reinfected with most of its subvariants.

The coronavirus is “relentless” in its evolution, Topol said. It appears to be picking up “functional” mutations — changes in its genetic structure that give it an evolutionary advantage, such as making it easier to spread or evade immunity — faster over time. And it’s constantly shuffling mutations in new arrangements that may give variants a further competitive edge.

Shaking off this cycle of surges may require much more powerful tools than the vaccines currently available, Topol and others say. Those could include nasal or oral vaccines that are better able to block infections than the shots currently available. Such vaccines are being studied and developed, but none are yet close to authorization.

Until such neutralizing vaccines become available, the virus is likely to keep circulating widely and potentially surging every few months as immunity wanes and new variants arrive, experts say.

“I don’t know how long this is going to continue — how many new variants and more variants there will be,” said Dr. Susan Philip, the San Francisco health officer. “There’s always going to be a chance that there will be new and more infectious subvariants.”

People wearing masks ride the escalator and walk up stairs from the platform at Powell Street BART station on Tuesday, April 19, 2022 in San Francsico, Calif.  BART police officers were told not to enforce the transit agency's mask mandate, according to a person familiar with the matter who was not authorized to speak publicly on BART's behalf.

People wearing masks ride the escalator and walk up stairs from the platform at Powell Street BART station on Tuesday, April 19, 2022 in San Francsico, Calif. BART police officers were told not to enforce the transit agency’s mask mandate, according to a person familiar with the matter who was not authorized to speak publicly on BART’s behalf.

Lea Suzuki / The Chronicle

For better and worse, future waves likely will play out similarly to what’s happening now, assuming the vaccines continue to hold up well against severe illness.

National, state and local responses probably will carry on much as they have in this current wave. Broad public health mandates — such as masking requirements — may never return unless hospitals are overrun again. Schools and businesses probably will stay open and at full capacity. Large events, such as basketball games, high school proms and music festivals, likely won’t be canceled even if they seed further community transmission.

People will need to incorporate COVID precautions into their lives just as they do dozens of other decisions for staying safe and healthy, said Dr. Bela Matyas, the Solano County health officer.

“Welcome to being human: You put your seat belt on every time you get into the car, you stop at stoplights, you try not to eat rat poison,” Matyas said. “You do the things you can live healthy.”

Indeed, health officials like Matyas said that though people may be fed up with this sixth wave and the prospect of many more to come, the situation is not entirely dire.

“I feel very strongly that we’re in better shape than at any other time in the pandemic,” said Moss, the Alameda County health officer. “But it’s exhausting.”

“We have been saying for some time that COVID is going to be with us, for years if not forever. But seeing what looks like is still hard,” he added. “I still believe that we will reach a point where things are more predictable. But that doesn’t mean it’s going to happen anytime soon. It could take several more years.”

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