Omicron BA.5—the rules have changed (outdoors is not as safe; natural immunity is less reliable; and multiple COVID infections might increase likelihood of Long COVID)

Michael CalozBlog: Synthesizing & Simplifying Complexity, Living with the PandemicLeave a Comment

dandelion blowing in the wind

Disclaimer: As always, I’m not a medical professional. I just read a lot of different articles and synthesize the information as best I can from the most reputable sources.

(Updated on July 18, 2022)

(Updated substantially on July 27, 2022, particularly the Reinfection and Long COVID sections)

Reading Time: 12 minutes

Each time I write one of these COVID posts, I somehow think it’ll be the last one. Not because I imagine COVID will disappear anytime soon, but because—like you, I imagine—I’m so tired of thinking about all this. 

But then something like sub-variant BA.5 comes around and I realize yet again how horrible the communication is from the CDC (and other news sources that are supposed to be informing us).

Turns out, some key rules of thumb I’ve been relying on for many months to stay COVID-safe no longer apply, and most people don’t know that.

Because why would they? Only a small number of weirdos like me keep up-to-date with the latest COVID research, so I feel a responsibility to let you know when something big changes.

Like now.

In short: The new sub-variant (BA.5) spreads a lot more easily, even outside. It’s also possible to get it again after only a month or two. And, each time you get it, it has more of an impact on your body (meaning increased odds of Long COVID, which we’re learning can have all sorts of unpleasant long-term effects on your organs, even in young, otherwise-healthy people).

The good news is that distancing and N95 and KN95 masks still work very well—but it’s important to mask up when you get close to other people. Unfortunately, Long COVID is no joke.

I saw first-hand how BA.5 spreads like crazy—even outdoors.

Last week, I attended the amazing Oregon Country Fair festival (here’s the “trailer” video I made).

It was an all-outdoors event in nature with full vaccination required. And still, I saw multiple friends get it while I was there, and I heard about an even longer list of infections from that event when I got home.

So this is why I’m writing this post:

I’ve been operating under the assumption that outdoors is almost completely safe, and that if you get COVID once you’re probably fine for 6 months or more afterward.

But then I began reading more about sub-variant BA.5, and I realized that the rules have changed. Even socializing outdoors is no longer quite as safe. And doctors are now seeing patients get COVID many times in a row—often with more severe symptoms each time.

Most people have settled into a consistent rhythm now around how they think about COVID. That makes sense, of course. We can’t stay hyper-vigilant forever. 

But now’s one of those times when it might make sense to take a step back and revisit some of your personal COVID policies in light of this new sub-variant.

I certainly don’t want to spread anxiety here. I simply want to make sure you have all the information you need to make informed choices.

Here’s what’s changed with BA.5:

Prevalence: Most COVID is now BA.5, and it’s very infectious

BA.5 now represents 60% of COVID infections in the US and rising (7/25 update: now, nearly 80% of cases). This is still being confirmed, but BA.5 is potentially as contagious as measles, the most contagious virus in human history. The good news is that the severity of the symptoms is probably not much worse than previous sub-variants.

However, Omicron in general is often not mild (as has often been claimed), though some people do experience more mild symptoms than others.

It’s hard to predict how it’ll affect you. I personally know multiple people in their 30’s and 40’s in excellent health (careful nutrition and daily workouts) who felt nearly unable to move and who have experienced Long COVID symptoms weeks after recovering. More on this in a moment.

Reinfection: Some people are getting COVID again and again

After recovering from a COVID infection, it used to be that you’d be safe for a long time.

With these newer variants, the natural immunity you get from being infected does not typically apply to other variants. So even if you’ve already had Delta or the original Omicron, you won’t be fully protected from Omicron BA.5. 

Remember that new variants have been emerging quickly too. The original Omicron (BA.1) was first discovered in November 2021. The BA.5 sub-variant appeared just two months later. And six months later, BA.5 was the dominant strain.

So while getting COVID does still provide you with natural immunity against the current strain, that might only last several months. (In some cases, people have been reinfected within 1-2 months.)

So are the vaccines and boosters still important?

Yes! Beeing fully vaxxed and boosted dramatically reduces your chances of hospitalization and death—by 77% and 88% respectively. If you haven’t received at least one booster yet, I strongly encourage it, no matter how young and healthy you are.

You probably shouldn’t wait for the Omicron-specific booster. Just get that one too when it’s avaiable.

Long COVID: Each time you get reinfected could make you more susceptible to Long COVID (which is the real thing to be worried about)

Each additional time you get COVID might also increase your chances of hospitalization the next time by 10% and of experiencing Long COVID the next time by 20% (which can include chest pain, brain fog, heart failure, brain damage, erectile dysfunction, shortness of breath, and more).

New data shows that, for people who are double-vaccinated and boosted, 1 in 25 people who get COVID experience Long COVID.

The degree to which subsequent infections might worsen your likelihood of Long COVID is not fully understood yet, though, and some sources say it’s probably not worth being terribly concerned about.

The study with that 20% number above came out very recently, in June 2022, and it used data from over 5,000,000 people (who were treated via the US Department of Veterans Affairs—so not a super diverse population sample, but still a valid one).

This is important because so many people nowadays have the attitude that getting COVID multiple times is no big deal, “just like getting the seasonal flu.” But, from that study:

“The authors found those with two or more documented infections had more than double the risk of dying and three times the risk of being hospitalized within six months of their last infection. They also had higher risks for lung and heart problems…, fatigue, digestive and kidney disorders, diabetes, musculoskeletal disorders, mental health disorders, and neurologic problems… The risks were most pronounced in the acute phase, yet most were still evident at six months after reinfection.”

Check out my post from April for more details on why Long COVID is very worth being careful of.

Environment: Socializing outdoors is no longer guaranteed safe

Many of us have been staying careful indoors but letting down our guard more if we’re with friends outside.

Unfortunately, you’re no longer safe just by staying outside. This variant is more transmissible even outdoors if you’re close to people—unless you wear an N95 or KN95.

That said, outdoors is still much safer than indoors, and more ventilation in general is still much better (e.g., being in a tent without walls versus one with walls).

Whether indoors or outdoors, distance is still key. Don’t get too close outside and you should be fine.

And if you’re inside, even distance isn’t enough—masks are important because COVID particles can easily remain in the air for 5-20 minutes after an infected person leaves the area (and potentially for hours beyond that). 

Length of Time: short encounters are also no longer guaranteed safe

It used to be that you’d have to spend 15 minutes or so with an infected person to be likely to get COVID, but that’s no longer true. It’s possible to get BA.5 even with shorter exposures.

I personally used to not wear a mask outside unless I was going to be very close to people for an extended period of time. Now with BA.5, I bring a mask with me almost everywhere I go and I put it on even in light crowds. (This sounds annoying but I promise it’s not terrible at all when you use a comfortable mask.)

Case Counts: basically, just assume it’s always high now

It’s no longer really worth checking the case counts. Since so many people are choosing to not get tested anymore, the real case counts are likely at least five times what the CDC reports.

Testing: stick with Rapid PCR tests if you can

PCR tests work better than at-home tests and pick up the virus days earlier. If you’ve been exposed, quarantine and then get a rapid PCR test after 3-5 days (ideally one after 2-3 days and another—or an at-home test—after 5-6 days).

Isolation Time: What should you do if you test positive?

Yes, the CDC says to only wait five days. The CDC is wrong.

Unfortunately, the pandemic became political, and the CDC succumbed to political pressure to get people back to work as quickly as possible. Many top experts agree that the CDC is doing a terrible job (I’m sure the individuals there are trying their best, but our politicians have done an even worse job around all this, which makes the CDC’s job much harder). Here’s one recent article touching on how the “5-day” period is misguided, and here’s another.

So what’s the truth? This gets complicated, and if you’re smarter than me, I encourage you to dive into the details of recent studies here 🙂

But after a lot of reading, here’s what I would suggest:

If you want to be safest, isolate until a rapid test is clearly negative. On average, that’s 8 days after your first symptoms appeared (or you received your first positive test result). Then, wear a mask until at least day 10. 

But, if we want to strike a balance between that and the 5-day rule, this might be a reasonable approach:

  1. Stay isolated for at least 6 days after your positive test result.
  2. On the 6th day, take your temperature and make sure you don’t have a fever.
  3. On the 7th day, if you still don’t have a fever, you can leave isolation but remain wearing an N95 or KN95 at all times. Keep your mask on until day 10 and you should be fine.
  4. Remember that you can’t be lax now, sorry. Your immunity is now only slightly higher from having had an infection, so it’s possible to get BA.5 again after only a month or two. And if you do, your chances of Long COVID go up 20%.

Future: more of this, unfortunately

This will likely be the new normal for years to come. So, find habits that will work for you to stay safe but that will also be sustainable. There’s also going to be an Omicron-specific shot in the fall, which should help a lot. (Update: looks like it might be available as soon as October.)

In the meantime, for people under age 50, the 2nd booster is currently supposed to be only if you’re immunocompromised. But, it seems like anyone can get it and there’s ample supply. Keep in mind though that its effectiveness wanes after 2 months.

It does however further decrease your risk of serious illness (dramatically so for people over age 50). So, if you haven’t received any booster yet, I highly encourage you to do so as soon as possible.

Bottom Line

It’s possible to stay safe without a huge amount of hardship. I’m doing everything I list below and I promise it’s not horrible 🙂

  • Wear an N95 or KN95 (not a cloth mask) when indoors with people outside your bubble or when close to people outdoors. Wear a mask even if stepping indoors briefly. (This is still my favorite mask after trying many.)
  • Improve ventilation as much as possible (open windows, fans, filters, pop-up tents without walls, etc.).
  • Keep your distance from people and wear a mask (or hold your breath) if you’ll be close for more than a moment.
  • Especially if you’re planning to not wear a mask, get rapid PCR tested right before attending an event where you’ll be close to others (and request that of others you’re interacting with). 
  • Keep practicing self-care. It’s reasonable to feel very frustrated by all this. Take care of yourself by getting enough sleep, prioritizing supportive social contact, and not pushing yourself too hard.

If you want to check my facts or start researching on your own, here are a few good places to start:

Thanks for reading, and I hope you have a nourishing day.

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