Expert Q&A: How To Manage COVID Risk As New Variants Emerge

While the latest COVID surge numbers are constantly changing and new variants continue to be a concern, we know that there are still unanswered questions about how to manage COVID risk.

In this article, we get some answers from two epidemiology experts: Katelyn Jetelina, adjunct professor at UTHealth School of Public Health and author of the newsletter Your Local Epidemiologist and Jessica Malaty Rivera, epidemiology fellow at Boston Children’s Hospital and senior advisor at the Pandemic Prevention Institute.

Your Questions Answered

After this segment aired in August 2022, many of you sent in your COVID-19 questions on social media. Epidemiologist Jessica Malaty Rivera shared her answers below:

I was just diagnosed with COVID. How do I know what variant it is?

The only way to definitively know if it’s BA.5 (or any variant for that matter) is if the sample that was collected is sent for genomic sequencing. At this point (Summer of 2022), given the prevalence of COVID-19 and the fact that BA.5 is the dominant variant, it’s safe to assume that if you are sick with COVID, it’s due to BA.5.

Is it true that lab experiments found that the BA.4 and BA.5 Omicron subvariants are over 4 times more resistant to mRNA vaccines than earlier strains of Omicron?

As of July 2022, there’s still a lot we don’t know about why these subvariants are more infectious. Some theories include immune evasion (vaccine and infection immunity). That said, it’s important to remember the primary goals of the vaccine: to prevent severe illness, hospitalization, and deaths. And the vaccines are still doing an excellent job doing that. Prevention of infection requires layers of protection: masking, distancing, vaccination, proper quarantine, and isolation, etc.

How long should you wait after having COVID to get the second booster?

The only requirement is that you be fully recovered (out of isolation) and symptom-free. Given the risk of reinfection and how prevalent BA.5 is this summer (July 2022)–I would not wait longer than that to get boosted.

Do the boosters/shots lower your chances of developing long COVID?

Preventing infection and severe illness are the best ways we can reduce our risk of long-COVID (PASC). There are still so many unknowns about the condition which is why avoiding the disease is still the “best” protection.

Since these variants are so transmissible, is masking in crowded spaces (schools, businesses, etc..) going to be very effective?

Yes, masking–with high-quality masks (N95, KN95, KF94) –is still very effective in reducing the risk of transmission, especially in crowded spaces.

How do I evaluate my risk level of going to concerts and live events?

This is tricky and there’s no perfect way to measure risk. The first thing to consider is your personal risk tolerance. So I would ask yourself if you’re OK being in crowds with unmasked individuals, where testing is not being conducted, and where vaccine verification is not required? For some, the answers to those questions dictate their decision to attend certain events. There are online tools which use available jurisdictional data to determine the likelihood of being in the same place as someone infected with COVID. Otherwise, I’d be monitoring case counts (which are underreported) and hospitalization trends (more real time).

You talked about how to use PCR and rapid tests. Are antibody tests still useful?

Great question. Antibody tests should be looked at as “rearview mirrors”–they can only tell us about *some* things in the past and they should not be used to gauge current or future immunity/ protection. Immunity is much more layered than antibody levels–it includes T cells and B cells etc. Immunity is also highly variable from person to person so there is no magic number to be checking form. Antibody tests cannot distinguish between antibodies from infection or vaccination. You’d have to get a specific test–one that is checking for antibodies for the nucleocapsid proteins (not the spike proteins) even to see if you have antibodies from an infection.

Is it possible to test for monkeypox in residential wastewater in the same way testing for COVID helped us to “see” outbreak clusters in advance of testing?

This is a great question and it’s currently being investigated! In fact, the virus has already been detected in wastewater sources around the country.

Questions From The Radio

Am I more likely to get reinfected with the latest Omicron variant?

Reinfection is much more likely now than in past variants. According to Jetelina, 25% of new cases are from reinfections. Because an infection from the latest variant causes milder symptoms, your immune system mounts less of a defense the first time around (compared to earlier variants), making reinfection more likely.

How soon could I get reinfected now?

Before less infectious variants, earliest reinfections often occurred after roughly 90 days. Now, that number seems to range from 60 to less than 30 days.

“The purpose of vaccines is not to prevent infection,” said Jetelina. “The purpose of vaccines is to prevent severe disease and death.”

Should I just get infected to get it over with?

The virus doesn’t work like that, as we’ve seen with recent variants and increasing rates of reinfection. It’s not a good strategy, according to Rivera. She points out that there is still a risk of getting long COVID—and there are so many unknowns with that disease. (Learn more about the effects of long COVID, from a previous Science Friday segment.)

Am I more or less likely to have a severe infection the second time around?

You’re less likely to have a severe infection. Jetelina said she’s seen studies that show 60-90% lower odds of hospitalization and death with a reinfection compared to a primary infection. But that number is not 100%. People that are unvaccinated, older, or have comorbidities are more likely to have serious infections.

Should I get a second booster if my age group is eligible?

Boosters can prevent infection, especially if taken recently. They do this by increasing the number of antibodies that neutralize the virus. “The purpose of vaccines is not to prevent infection,” said Jetelina. “The purpose of vaccines is to prevent severe disease and death.”

Those who have received two boosters versus just one are about four times less likely to die from COVID-19, said Jetelina. Currently, less than 50% of the eligible population in the U.S. has received a booster dose. 

Will the Omicron boosters coming out this fall help protect against new variants?

By the time the Omicron booster is rolled out in October, there will likely be a new Omicron subvariant taking hold. However, this booster will still broaden our protection no matter what Omicron subvariant is circulating. 

“The purpose of boosters and variant-specific boosters is not to chase the variant. We’re never going to win that rat race,” said Jetelina. 

Will there be another completely new variant, like Delta or Omicron, that’ll spread before or during the new booster release?

Jetelina says the last estimate she saw gave that about a 30% chance of occurring. “So, it’s not zero, but it’s not a 100% chance,” she said.

Rivera cautions that while these new boosters will improve our protection against the virus, they are not a silver bullet to ending the pandemic. She urges people to continue masking, distancing, testing, and isolating if they are symptomatic, even once they receive the newest booster.

“Wearing a mask is a responsible thing to do,” said Rivera.

Should I be using rapid tests (antigen tests) or PCR tests?

While both are effective tools, they do different things. Rapid tests are a great indicator of active infection, less so for determining infectiousness. If you still have a dark second line on your test, odds are you have lots of virus in your system and you should be isolating. 

PCR tests, however, are extremely sensitive to the virus. You might’ve heard stories of people testing negative on rapids after a week or so, but positive on PCRs for weeks and even months after their initial COVID infection passed. Jetelina highly recommends rapid tests.

What if I have symptoms but I’m testing negative?

If you have symptoms, Jetelina says to assume you have COVID-19. You should isolate, and retest in about 24-48 hours. If, after that time, you test negative, you can be pretty sure that you had a false positive. 

While rapid tests are a great tool, they have a slightly harder time detecting the virus at the beginning of the infection, especially with Omicron variants. Jetelina says she’s seen strong evidence that an Omicron infection lasts 8-10 days. 

The CDC’s current quarantine guidelines are to isolate for five days after the onset of COVID symptoms, then wear a mask around other people for five additional days. Is that enough time?

“It’s not enough,” said Rivera. These guidelines are based on data from the Delta variant, not the Omicron variant, which is much more transmissible. 

“I have yet to meet a person who is asymptomatic and negative within five days in an Omicron infection,” said Rivera. 

False negatives are common in the early days of infection, so using a standard five day-long isolation and then five days of masking is not long enough to prevent spreading it to others. If you have any symptoms and if you are testing positive, that is a good sign that you are infectious. Rivera recommends staying home until you test negative on a rapid test and are asymptomatic. 

However, many people are required to go back to work after five days, even if they are still testing positive. If you must leave isolation, Jetelina recommends wearing a well-fitted and high-quality mask everywhere you go until you test negative again. 

Should I be wearing a mask indoors despite mask mandates being dropped around the country?

With the current high transmission rates, it’s a good practice to wear a mask when indoors or in large gatherings, said Rivera. 

The latest variants (BA.4 and BA.5) have shown us that outdoor transmission is possible. Outdoor transmission has always been possible, it’s just a little bit more likely now. Consider wearing a mask if you are in a crowded outdoor space like a concert or festival. 

Rivera also recommends masking around folks who are at a high risk for serious infection or immunocompromised. If you have recently done something high risk and have even minor symptoms like a tickle in your throat—mask up. 

“Wearing a mask is a responsible thing to do,” said Rivera.

For the full picture, listen to our radio segment from August 2022, as new omicron variants surged.