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The short answer: No, of course not. One look at this graph should disabuse you of that notion. We’re nowhere near the peak we reached this past winter.

The longer answer: No one knows. But the wave we’re in at the moment is really big, much more so than you might assume given the fall-off in media coverage of COVID over the last three months. Check this out:

At 17.9 percent, the national positivity rate has reached its second-highest point of the pandemic, even higher than the peak of the first winter wave in 2020-21 — and it’s still on the way up. The same is true in America’s largest state, California. But ask any scientist about that number and they’ll tell you that it’s a gross undercount. That’s because at-home rapid tests are more common now than they were this winter, when lab PCR tests were still basically the only game in town for confirming that you had COVID. It wasn’t until mid-January of this year that Biden launched the federal program to ship free at-home tests to any household that wants one.

There’s been a shift since then of some unknown but undoubtedly considerable magnitude of people using their at-home tests rather than lab tests to confirm that they’re infected. Another big chunk of the population is likely getting infected and not bothering to test at all, believing that COVID is no longer the threat that it was and therefore no big deal. Which means a gigantic share of cases are now happening “off the books,” undetected by state authorities and the CDC.

How gigantic? The best guess from Biden’s new COVID czar, Ashish Jha, is that there are 400-500,000 cases happening daily but he allows that there could be as many as there were each day during the ferocious original Omicron winter wave. Scientist Eric Topol speculates that daily infections are closer to a million.

The degree to which this is concerning depends on how you look at it. From the perspective of severe illness and death: Not very. Ed noted a few days ago that hospitalizations and deaths have remained mercifully low even as the newest hypercontagious Omicron subvariant, BA.5, has overrun America. In fact, from the standpoint of excess deaths, America is fully back to pre-pandemic normal.

Wonderful news. So what’s the big deal about BA.5?

Well, for starters, huge waves of infection mean widespread sickness, hardship, and lost productivity.

But the death rate from covid-19 is still much higher than the mortality from influenza or other contagious diseases. Officials have warned of a possible fall or winter wave — perhaps as many as 100 million infections in the United States — that could flood hospitals with covid patients. Beyond the direct suffering of such a massive outbreak, there could be economic disruptions as tens of millions of people become too sick to work.

It’s unclear whether hospitalizations will remain low as the BA.5 wave proceeds. South Africa saw relatively little severe illness during its own wave of BA.5, which is great — but Portugal wasn’t as lucky despite being one of the most heavily vaccinated countries on earth.

Scientists don’t know why Portugal had it worse. It could be demographic differences with South Africa, with the latter boasting a younger population, or it could be that South Africa’s experience with the Beta variant instilled a degree of immunity from BA.5 there that other nations which didn’t see many Beta cases can’t match. That’s the other bedeviling factor about BA.5 — it appears capable of punching through natural immunity instilled by most other COVID variants, including the Wuhan virus, Delta, and even the original Omicron, particularly in those who were infected and recovered months ago. Waning immunity plus an extremely immune-evasive new variant means that practically everyone is at risk of catching BA.5, which is why Topol calls it the worst variant we’ve seen so far.

Yes, I called it the worst variant we have seen so far, which The Washington Post editorial board picked up on (and checked with multiple peers before publishing) because of its severity of immune evasion and transmissibility compared with any prior SARS-CoV-2 variant. Not because it causes worse illness, which is still unclear but possible given its Delta-like cell infectivity feature. It’s also hard to interpret that because of our immunity wall with extensive prior infections, vaccination and boosters. But if BA.5 presented without its BA.1 predecessor, it could have been worse than the massive surges we saw around the world with the arrival of Omicron. Our immunity wall makes a big difference for how we perceive the disease induced by each successive variant.

Circumstantial evidence suggests that regions that experienced waves of BA.2, the first dominant Omicron subvariant, may enjoy some immunity from BA.5, which derives from BA.2. But if you happen not to live in one of those regions, you’re at risk of infection and a nasty (although probably not severe) case even if you’re vaxxed to the gills and/or have had COVID before. Jonathan Last wrote today about his own experience with the new subvariant: “We had an entirely-outdoor family gathering where everyone was double vaxxed+boosted and 15 of the 22 people came down with COVID within 96 hours.” That’s how contagious BA.5 is. It may be the most infectious respiratory disease known to science.

And it’s still evolving rapidly. That’s the real reason to worry about new COVID waves.

“It’s the Wild West out there,” said Ziyad Al-Aly, an epidemiologist at Washington University in St. Louis. “There are no public health measures at all. We’re in a very peculiar spot, where the risk is vivid and it’s out there, but we’ve let our guard down and we’ve chosen, deliberately, to expose ourselves and make ourselves more vulnerable.”…

“I worry that by the time we have a vaccine for BA.5 we’ll have a BA.6 or a BA.7. This virus keeps outsmarting us,” Al-Aly said…

Already there’s another omicron subvariant that has caught the attention of virologists: BA.2.75. First seen last month in India, it has been identified in a smattering of other countries, including the United States. But it’s too soon to know whether it will overtake BA.5 as the dominant variant.

A million new infections per day is a million new opportunities BA.5 gets to mutate into something more threatening. It may have already happened overseas, as the excerpt notes. And needless to say, no one knows what impact being infected and reinfected multiple times in the span of a year or two will have on the average person’s health. Big new COVID waves are always really bad news, although not necessarily disastrous news.

I’ll leave you with Scott Gottlieb, sounding hopeful that natural immunity from BA.2 will confer some protection against BA.5.

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