CHICAGO — Covid-19 is once again spreading across the United States in what experts consider to be the most transmissible variant of the pandemic yet.
But something is different this time: the health authorities are holding back.
In Chicago, where the county’s Covid alert level was raised to “high” last week, the city’s top doctor said there was no reason for residents to let the virus control their lives. The state health director in Louisiana likened a fresh spike in Covid cases there to a downpour – “a wave within a wave” – but described the situation as worrying but not alarming.
And King County, Washington Public Health Officer Dr. Jeffrey Duchin said Thursday officials are discussing reissuing a mask mandate but would prefer the public to voluntarily mask themselves. “We’re not going to be able to have an endless series of mandates that force people to do this, that, and that,” he said.
The recent spike, driven by a spike in BA.5 cases in that country since May, has seen infections surge in at least 40 states, particularly in the Great Plains of the west and south. Hospital admissions have risen 20 percent in the past two weeks, leaving more than 40,000 people in American hospitals with the coronavirus on an average day.
But more than two years into the pandemic, public health officials are issuing only faint warnings amid a picture they hope vaccines, treatments and rising immunity have changed. The number of deaths is increasing, but only modestly so far in this new wave. And state and local public health officials say they must now also consider a reality evident on the streets from Seattle to New York City: Most Americans are meeting a new wave of Covid with a collective shrug, avoid masks, shut down crowds indoors and are moving from the endless barrage of virus warnings of the past few months.
“I firmly believe that you can’t just cry all the time,” said Dr. Chicago Public Health Commissioner Allison Arwady, who said she would wait and see if hospitals get tight before considering another citywide mask mandate. “I would like to save the requirements regarding masks or updating vaccination requirements in case there is a significant change.”
The country’s understanding of this BA.5 wave is complicated by a lack of data. Since the first months of the pandemic, there has never been so little accurate information about the number of actual infections in the United States. As public testing sites have closed and at-home testing—if testing has been conducted at all—has become common, publicly reported data has become scarce and patchy.
However, experts say the outlines of a new wave are undeniable.
“You don’t have to count every drop of rain to know it’s raining,” said Dr. Joseph Kanter, Louisiana Health Officer and Medical Director. “And it’s pouring right now.”
In this state, the health department analyzes a variety of data to track the spread of the virus, including case numbers, samples from a growing network of sewage testing sites, test positivity rate, and hospitalization metrics.
The BA.5 subvariant, which was first spotted in South Africa in January and has spread to a number of European countries, was responsible for 1 percent of cases in the United States in mid-May, but now accounts for at least two-thirds of new cases in the United States Country.
Anita Kurian, deputy director of the San Antonio Department of Health, said cases have been rising in the area for the past six straight weeks. However, some measures, such as the low number of deaths so far, suggest the nation is entering a newer and less deadly stage of the pandemic where vaccines and treatments have greatly improved the chances of survival, she said.
“We’re nowhere near the level that we were in the previous waves,” she said.
So far, the number of hospital admissions and deaths in the current wave pales in comparison to previous peaks. During the peak of the Omicron wave in early 2022, nearly 159,000 people were hospitalized each day.
Experts warn that it is difficult to predict the coming months, especially given BA.5’s high portability. The words of warning from national health leaders have slowly increased in intensity in recent weeks.
Even as federal health officials have repeatedly called for people to be tested for Covid before attending large indoor gatherings or visiting particularly vulnerable, immune-compromised people, they strike a delicate balance and tell Americans that while they are not turning their lives upside down have to ask but must be aware of the covid threat.
“We shouldn’t let it interfere with our lives,” said Dr. Anthony S. Fauci, President Biden’s senior medical adviser on the virus, at a White House news briefing, adding that new variants could continue to emerge. “But we cannot deny that it is a reality that we must confront.”
With health officials in many places avoiding enacting new virus restrictions during the recent surge, California has emerged as the exception. Health authorities there have issued sharp warnings and decided to reintroduce restrictions.
The alerts were spurred by worrying data, experts said. Walgreens said more than half of the Covid tests conducted at its California stores have returned with positive results. Studies of Bay Area wastewater suggest this increase could be the largest yet.
And the number of weekly deaths from the coronavirus in Los Angeles County has doubled from about 50 a month ago to 100 in the past week. The death toll is still below the level of the winter Omicron surge, when more than 400 died weekly in the county.
Officials in Los Angeles say they plan to reinstate a statewide mandate for indoor masks as early as later this month. Barbara Ferrer, the county’s director of public health, said even a small increase in masking would help slow transmission of the virus.
“I’m like everyone else: I hate wearing this mask. But more than that, I hate the idea that I could accidentally transfer to someone else,” Ms Ferrer said. “That’s my biggest fear — that we’re so intent on dealing with this virus that we’re getting complacent.”
Charles Chiu, an infectious disease specialist and virologist at the University of California, San Francisco, says data from patients suggest BA.5 does not cause more severe disease in patients than other Omicron variants. But he says he’s concerned the variant is so contagious that it can bypass protection from vaccination and prior infection in a way that makes it unstoppable.
“It looks like we can’t control it,” he said.
dr Chiu said he understands the plight of government officials trying to stem the spread of the virus. You’re dealing with a public resentful of renewed policies, even in parts of the country where people were previously most likely to go along with it. In places where Covid mitigation measures are mandatory, like New York City subways, compliance with masking rules is becoming increasingly patchy.
“Public health officials have an impossible task here,” said Dr. chiu
Rates of positive tests, cases and hospitalizations are rising in New York City. But health officials have resisted reinstating mask mandates, and many residents have said they are not concerned and are counting on vaccines, immunity from previous infections and antivirals to protect against serious illnesses. The city no longer has a contact tracing system or requires proof of vaccination to enter restaurants.
In Louisiana, officials have seen a spike in hospitalizations for people with Covid in the state, but they say those numbers are still far lower than previous waves when more than 2,000 residents were hospitalized at times.
“I feel much more empowered that we are able to protect ourselves,” said Dr. canter.
During the peak of the delta wave in Louisiana in 2021, according to Dr. Kanter, the state health commissioner and medical director, said about 20 percent of hospitalized Covid patients were on ventilators. That number fell to 10 percent during the state’s initial Omicron surge and is now below 5 percent.
For people most at risk of serious illness from Covid, feeling that public health warnings have eased has been of little consolation and actually made them more concerned than ever about catching the disease.
Neyda Bonilla, 48, of Mission, Texas, was diagnosed with breast cancer in April. With the number of cases rising in South Texas, she now worries that becoming infected while undergoing chemotherapy could prove disastrous to her health.
She’s had all the vaccines and boosters available to her, she said, and now wears a surgical mask in public and rarely leaves the house except to work as an administrator at an ambulance company.
“I hope people open their eyes,” she said. “We should never have taken our masks off. It’s not over.”
But even in some cities, whose residents have been taking precautions against Covid throughout the pandemic, the recent spike hasn’t sparked widespread concern.
In Berkeley, California, Jeff Shepler, the general manager of Spanish Table, a specialty store that sells Iberian wine and groceries, said he went to the Giants games across the bay in San Francisco and recently a Pearl Jam concert at the Oakland Coliseum and doesn’t hesitate to shake hands.
“It became exhausting for me to wear a mask all day, every day,” he said. “I got to that point in my life where I got the vaccine and I had Covid. I think I’m pretty sure.”
Julia Bosman reported from Chicago, Thomas Fuller from San Francisco and Edgar Sandowal from San Antonio. Reporting was contributed by Soumya Karlamangla, Eliza Fawcett, Sarah Cahalanand Holly Second.