How might California respond to potential BA.2 COVID spike and is a fourth shot coming?

Just when coronavirus cases have subsided and safety measures have been lifted, COVID-19 infection rates are shooting back up across the globe. But it’s not clear yet what this means for California.

The BA.2 omicron subvariant, or the “stealth omicron,” is driving cases up throughout Europe and Asia. In South Korea, the number of cases and deaths have been reaching new highs each week, with the death toll increasing by almost 600 from the week before on March 14. Hong Kong, mainland China and New Zealand are seeing spikes in reported infections too.

The subvariant has been in California since late January and was previously detected in other parts of the United States, including New Mexico, Texas and Washington. And as the proportion of BA.2 variant cases is steadily climbing in the California region, according to the Centers for Disease Control, health officials are anticipating another spike in cases.

When could cases spike?

According to KGO-TV, the ABC affiliate in San Francisco, University of California San Francisco epidemiologists Dr. George Rutherford and Dr. Monica Gandhi said they believe a surge will come to the California region either in the next month or two, or in a few weeks.

In an interview with NPR, White House Chief Medical Advisor Anthony Fauci said it’s possible that the U.S. may see a surge since over the last year, what happened in the U.K., eventually occurred in the U.S. weeks later.

“So I would not be surprised if in the next few weeks we see either a plateauing ... of cases or even (the curve) rebounds and slightly goes up,” Fauci told the station. “That is entirely conceivable. And we’re just going to have to follow it carefully.”

Dr. Stuart Cohen, chief of infectious diseases at UC Davis Health, said he can’t predict whether there will be a surge but he thinks there will probably be a slight uptick in cases.

Cohen said that while it is important to be cautious in thinking the pandemic is completely over, he doesn’t think the subvariant “should cause people to lose sleep.”

He said although Europe is seeing a spike in cases, hospitalizations have stayed steady.

In the U.K., there has been a upturn in the number of COVID-19 patients in the hospital, whereas hospitalizations in Italy, Spain and Belgium have remained flat, according to Our World in Data.

“The disease seems to be sort of similar to what we saw with the original omicron,” Cohen said, “which in high risk, unvaccinated individuals can still cause some major problems.”

And while it could be an issue for some individuals who are fully vaccinated and boosted, Cohen said he’s not expecting to see hundreds of people in the hospital, as seen during the peak of omicron in January.

Could California mask mandate return?

The California Department of Public Health said it will be monitoring and evaluating data, and will make safety recommendations accordingly.

Masks are still strongly recommended in the state and required in high transmission settings like public transportation.

Sacramento County’s health department said it will also be keeping an eye on infection rates.

“Public Health continues to monitor cases, strongly recommends vaccination as it is the best protection again COVID and though there is no mask mandate in place Public Health still recommends masking in crowded public places,” the department said in a statement to The Bee.

Although mandates have since been rolled back statewide and locally, Governor Gavin Newsom announced a long-term plan last month to help guide California residents through the uncertain future of COVID.

It outlines approaches for shots, masks, awareness, readiness, testing, education and Rx treatment. Part of the plan includes providing vaccinations and boosters equitably, and assessing data for vaccine requirements.

The plan also encourages masking in high-risk areas and public indoor spaces when transmission is high or a new variant has high virulence.

Newsom’s administration will continue to hold emergency powers during the coronavirus pandemic. Despite push back from Republicans, state lawmakers decided to not suspend Newsom’s COVID-19 State of Emergency on March 15, which started two years ago and enabled the governor to use federal funds and overrule state rules as a part of pandemic response.

State of omicron in California

The department of health said that although the proportion of BA.2 is growing, omicron remains the dominant variant in the U.S. and California.

The CDC regularly tests COVID-19 specimens to track variants. According to data from March 13 to March 19, areas in the region of California, Nevada, Arizona, and some U.S. territories, BA.2 was estimated to make up 41.3% of variants and the original omicron 58.7%. Just last month, BA.2 represented 2.9% in California.

The increase in the proportion of BA.2 does not seem to be associated with increases in total cases in the state, the health department said. According to the state’s COVID dashboard, confirmed cases have been on a downward trend since the omicron surge in January.

Is there a fourth COVID shot coming?

Moderna and Pfizer have submitted data to the Food and Drug Administration for approval of a fourth shot for all adults and seniors, respectively, this month, following the omicron variant.

“Immunity wanes,” Cohen said, “particularly to coronaviruses.”

He cited common coronaviruses, such as colds, in which people contract and get sick year after year because their immunity to it does not last that long.

“I’m assuming the vaccines will wear down,” he said. “It appears they still protect from severe disease and from hospitalizations and from death if you’ve had three doses of the vaccine, but I suspect we’re going to need more.”

As of now, the fourth shot is not recommended, the CDPH said, but it will follow closely to the FDA’s review.