The emergence of the latest variant of COVID-19, which accounts for nearly 80% of new cases nationwide, raises additional health concerns due to its ability to infect people even if they are vaccinated or have already had an infection, and health officials are increasingly recommending precautions such as masking up indoors and keeping up with booster shots.
But those concerns are unlikely to cause the South Dakota government, health care and school officials to move away from an official stance of “living with the virus” rather than pursuing active interventions this fall.
The BA.5 variant, first detected in the United States in late April, is a subvariant of Omicron with molecular spike mutations that make it more contagious than previous variants. This means that a high number of cases is likely, but it does not necessarily mean a drastic increase in hospitalizations and deaths, because vaccines and other forms of immunity, while not impenetrable, can still mitigate the impact of infection.
“The good news is that the virus is evolving as we expect viruses to evolve,” said Dr. Jeremy Cauwels, chief medical officer at Sanford Health in Sioux Falls. “They get better at spreading and they get worse at killing their host.”
As of July 27, the South Dakota Department of Health has reported 4,390 active cases, up from 4,176 the previous week. State data shows that 56 of 66 counties have high community spread, defined as 100 or more cases per 100,000 or a PCR test positivity rate of 10% or more. The state’s overall positivity rate over the 7-day period to July 27 was 23.9%.
State epidemiologist Josh Clayton told News Watch, in response to written questions, that the state will continue its policy of weekly rather than daily COVID data updates, a practice that began in March. He added that the DOH is monitoring hospitalization rates to determine the threat level of the virus. There are 82 people currently hospitalized with COVID-19, according to DOH data, down slightly from 86 the week of July 20. The state reported nine new deaths of people with COVID-19 in the week to July 27, bringing the total during the pandemic to 2,956.
“The number of people currently hospitalized is still well below the peak of 423 during the wave of Omicron variants in early 2022 and 607 during the initial wave in November 2020,” Clayton said.
But he made it clear he wasn’t ruling out the potential threat from BA.5, which recently infected President Joe Biden and has similar symptoms to previous variants, including congestion, headache, cough, fever and fatigue. The CDC also studied and cited the potential for some people to suffer from “long COVIDs,” post-infection conditions that can include “a wide range of persistent health conditions that last for weeks, months, or years.”
“Each new variant means that the virus has the opportunity to further evade the community-wide immunity that has developed (through vaccination or prior infection),” according to Clayton. “The BA.5 subvariant appears to evade the human immune response better, which will likely lead to more COVID-19 infections. This is because people will find it harder to fight off the virus, even if they have been infected or vaccinated. The BA.5 variant may also cause more people to be hospitalized or dead if infected with COVID-19.
Kevin Post, Avera Health’s chief medical officer, said the hospital system is constantly monitoring its ability to serve the community during the ebbs and flows of a pandemic, which means having enough medical staff in place to help those who need it.
“Access to health care is a key metric,” Post said. “Part of that will be hospitalization rates from COVID itself, but a complicating factor is the shortage of health care workers, as we see everywhere else, and how that affects the access to hospital beds. It all comes down to ability.
VACCINES STILL CONSIDERED IMPORTANT
South Dakota’s rate of fully immunized residents is 63.2%, below the national average of 67.7%. Of those fully vaccinated, only 43.3% received a booster shot, which ranks 39th among all states, according to CDC data. This puts the state behind the CDC’s recommendations that anyone 50 and older (12 and older for immunocompromised people) should receive a “second booster dose at least 4 months after the first.”
Post said that when a person is vaccinated or has an active infection, there are three to four months when that person has “active circulating antibodies” that act quickly to respond to exposure (along with some memory immunity also). As antibodies wane, he said, reminders become crucial to providing protection against serious illnesses — a message that doesn’t always get through political posturing on the topic of vaccines.
“I think it’s the responsibility of health systems to continue to be the voice of what’s up to date on unbiased research to provide reliable medical information to patients,” said Post, who worked as a physician at family and emergency physician. “We live in a world, and not just in South Dakota, where there is so much information and misinformation, I think it behooves health organizations to be that trusted resource when it is sometimes hard to know who you can trust.”
Clayton told News Watch he agrees with the CDC’s guidelines regarding vaccination and booster shots. There are also CDC-approved therapeutics, such as the oral antiviral Paxlovid, that can be used when prescribed once a person is known to be infected.
“Data available for South Dakota and nationally has shown that staying up to date with your COVID-19 vaccination reduces the risk of infection, emergency room visits, hospitalization and death for people of all ages, including young children,” Clayton said.
This message was echoed by Cauwels, who does not dismiss prior infection as a factor, but points to the unpredictability depending on when infection occurred, the robustness of the immune response, and the variant that triggered the disease.
“Our public message remains the same, which is that a vaccinated person is less likely to end up in hospital than the same person next to them who is not vaccinated,” Cauwels said. “In individual welfare, if I was just talking to you, or from a population welfare perspective, if I was talking to all of South Dakota, either way I can say the correct answer is to to get vaccinated.”
In response to a question from News Watch, a representative from Gov. Kristi Noem’s office wrote, “Gov. Noem supports the recommendations of his Ministry of Health. Talk to your doctor about whether COVID vaccinations and boosters are the right course of action for you and your family.