Public health experts expect the Biden administration to move carefully as it sets future pandemic policies and decides what to do with the current public health emergency because of a growing subvariant of the omicron variant of COVID-19.

The new variant, known as BA.2, is more contagious than previous variants, including the original strain of omicron, BA.1, and is quickly picking up steam across the United States. But the new strain likely won’t slow the administration’s plans to ease some mitigation practices and return the country to a state of pre-pandemic normalcy.

“Increasingly, each of these new variants is unlikely to be able to cause the damage that delta or omicron could because the virus is dealing with a different population, a population that has a lot more immunity,” said Amesh Adalja, a doctor and infectious disease specialist at the Johns Hopkins Center for Health Security in Baltimore.

But the arrival of the new subvariant may become a factor as the administration decides how long to keep the public health emergency.

The new subvariant is causing about 1 in 5 new COVID-19 cases worldwide even as infections begin to drop, according to the World Health Organization. BA.2 is overtaking the original omicron strain in the number of cases in at least 43 countries. Scientists say the subvariant appears to spread about 30 percent faster than the original strain of omicron.

The proportion of BA.2 cases in the U.S. is doubling every week. During the week ending Feb. 26, BA.2 made up roughly 8 percent of cases across the country, up from roughly 4 percent the week before, according to the Centers for Disease Control and Prevention.  

It’s still unclear what this means for the U.S., but many public health experts are not expecting another deadly surge. The Biden administration has eased masking recommendations, and many lawmakers and states are looking to the end of the public health emergency.

“It’s a tricky balance. I mean, the administration is trying to convey that things are looking more normal, but there are always risks or risks around the corner. That could backfire on them,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation.

As cases of COVID-19 decrease in many places across the United States, the CDC on Friday eased the criteria for indoor mask recommendations, signaling an off-ramp for intense COVID-19 precautions.

The administration’s focus now is on reducing the burden on hospitals. CDC Director Rochelle Walensky told reporters she anticipates fewer hospitalizations as COVID-19 declines. And as coronavirus-related hospitalizations go down, care facilities won’t have to screen every patient for COVID-19 or take other pandemic precautions.

Even though the Biden administration is taking its foot off the gas in many respects, Walensky and other public health officials still encourage high-risk people to wear masks indoors and continue with pandemic precautions. If cases tick back up, public health officials may again recommend masking and mitigation policies.

Future pandemic policies in flux

But the administration is confronting the subvariant as it faces a decision on a 2-year-old public health emergency that is set to expire on April 15. The Department of Health and Human Services has pledged to give at least 60 days’ notice before ending the emergency that has been in place since March 2020. That pledge suggests the emergency will last at least through April.

Many Republican lawmakers have urged the administration to end parts of the public health emergency because of decreasing case counts. In a recent letter, more than 70 House Republicans called on HHS to wind down the emergency and said its continuation is hurting Americans’ mental health.

“Although the PHE was certainly necessary at the outset of the pandemic, it was always meant to be temporary. Our country is now in a much different situation than we were when the PHE was originally enacted,” the Republicans said in a Feb. 10 letter to President Joe Biden and HHS Secretary Xavier Becerra.

The HHS Office of the Assistant Secretary for Preparedness and Response did not respond to requests for comment.

But lifting the emergency could jeopardize health care coverage, running counter to many Democrats’ ambitions and posing a political risk in November. The end of the emergency could decrease Medicaid enrollment by at least 10 million people, jeopardize access to telehealth and cut funding that hospitals and states have relied on to combat the pandemic as key flexibilities only allowed under the emergency are lifted.

Increasing coverage in Medicaid and the federal health insurance marketplace has been one of the Biden administration’s main health priorities and most touted achievements. 

A new subvariant

The subvariant raises many questions that remain unanswered. In parts of Europe and South Africa, BA.2 quickly overtook omicron, but that hasn’t happened in the United States, as the original strain of omicron continues to cause most infections.

Some models estimate as many as 40 percent of Americans already have immunity against omicron, which protects them against BA.2. But, like the original strain of omicron, BA.2 can escape vaccine protection, although infection from BA.2 does not cause severe disease.

“The bad news is we have had a horrible omicron surge in our country, with millions of people infected. The good news is we had a bad omicron surge in our country with millions of people infected,” said Carlos del Rio, a professor of medicine in the division of infectious diseases at Emory University School of Medicine in Atlanta, noting that most Americans have some form of protection against COVID-19, either through shots or prior infection.

“BA.2 is not going to be such a big problem as BA.1 was,” del Rio said.

Another potential issue is that monoclonal antibodies are ineffective against BA.2. The COVID-19 antibody treatments from Eli Lilly and Regeneron both don’t work against the original omicron strain or BA.2, but GlaxoSmithKline’s treatment, sotrovimab, can neutralize omicron. A new preprint study found that sotrovimab is no match for BA.2.

Physicians are keeping a close eye on BA.2’s progression and its response to other COVID-19 treatments, Rajesh Gandhi, an infectious disease specialist at Massachusetts General Hospital, told reporters at an Infectious Diseases Society of America briefing last week. He recommended that scientists start focusing on universal COVID-19 treatments that can stand up against all variants.