BA.2.12.1 Subvariant: Concerning, but No Need to Panic Just Yet

A new Omicron subvariant is rapidly gaining steam in New York and other parts of the Northeast. Experts are urging caution in the face of BA.2.12.1, and say a number of factors are contributing to its rise. But they're also warning against panic.

As of April 20, BA.2.12.1 accounted for more than 75% of sequenced cases in Central New York -- a region that has seen a dramatic uptick in the subvariant's presence since it was first detected there in February -- according to the state Department of Health. And, across New York, it accounts for about 42% of cases.

But it's not just New York. Other states across the Northeast are seeing a similar climb in the subvariant's proportion of cases, and nationwide, BA.2.12.1 has increased from 3.5% of cases a little more than a month ago to nearly 30% of cases last week.

"What we're seeing right now is a version of the virus that is much more transmissible than previous versions of the virus, perhaps, but also less likely to cause severe disease," Perry Halkitis, PhD, MPH, dean of the Rutgers School of Public Health, told MedPage Today.

"None of this is odd," Halkitis said. "What is problematic is the speed with which it seems to be spreading. And the speed with which it seems to be spreading, to me, has something to do with the virus, but more to do with human behavior."

Individuals have been going about their business without mitigation measures, he explained. They haven't been masking in public places, they've been going to extremely large gatherings, and they haven't been getting boosted and have waning antibodies.

"All of this in combination puts us in the situation that we see right now," Halkitis said.

However, there hasn't been the same magnitude of hospitalizations and deaths as with previous iterations, he added.

On April 13, less than a month ago, the New York State Department of Health announced the emergence of what it called "recently identified, highly contagious Omicron subvariants," including BA.2.12.1, in the state.

The department said in a statement at the time that its findings were the first reported instances of significant community spread due to the new subvariants in the U.S. However, it noted in a response to questions from MedPage Today that "this was not the first reported incidence of these subvariants in existence."

BA.2.12.1 has indeed been detected in a number of different countries.

However, due to its prevalence in Central New York in particular, the state Department of Health has continued to recommend that residents in all counties there mask up in public indoor settings, regardless of vaccination status. The department has also continued to recommend that all New Yorkers get fully vaccinated and boosted when eligible; consider wearing a mask in public indoor settings; test after exposure, symptoms or travel; stay home and consult with a provider about treatments if COVID-positive; and improve air ventilation or gather outdoors.

When asked about the transmissibility and severity of BA.2.12.1, the department pointed MedPage Today to its prior statement that, while currently "there is no evidence of increased disease severity by these subvariants," it is "closely monitoring for any changes."

The department has also stated that, when comparing BA.2.12 against BA.2.12.1, the latter "has been noted to be of higher concern, given additional mutations."

Tomoko Udo, PhD, associate professor in the School of Public Health at the University of Albany, noted the importance of taking precautions.

"We do know that, when the transmission rate is high in the community setting, it is helpful to wear a mask to slow down the spread of virus," Udo told MedPage Today.

"It's important to remember that the virus is here to stay, and it's going to keep mutating," Udo said. "We need to pay attention to variants, for sure."

At the same time, there is no need to panic on the initial news of each one, she said.

What is important, Udo said, is to pay attention to current CDC and state guidance and to get vaccinated and boosted according to recommendations.

Steven Sheris, MD, executive vice president and chief physician executive for Atlantic Health System in New Jersey, concurred.

It's important for the public to "learn how to be agile to changing conditions," Sheris told MedPage Today.

Sheris, who is also president of Atlantic Medical Group physician network, noted that, while the virus has been circulating and there have been more cases in the community, the uptick hasn't translated to a significant impact on the healthcare system, or to hospitalizations and deaths. There has been an increase in individuals presenting to the emergency department and outpatient locations, he said.

Variants occur all the time, he noted. For example, there is a new influenza virus every flu season.

"This is not a new concept, and it doesn't necessarily make the virus more dangerous -- it may or may not, that's why you have to listen to the public health authorities," Sheris said.

Overall, Halkitis agreed that the detection and increasing prevalence of BA.2.12.1 is no surprise.

"The fact is that the virus continues to circulate in the population, and it was never going to disappear in the population until you reached a point where everyone in the world was immunized or had antibodies, and you had herd immunity," Halkitis said. "But we never got there in the United States, and we certainly never got there in the world."

BA.2.12.1 likely will pick up speed in other parts of the country, as it has in the Northeast, Halkitis said -- with one caveat.

"The advantage we have right now is that we're at a time of the year where respiratory disease tends to decline because of the weather, so maybe we're not going to see that surge," Halkitis said. "But beware, September and October are just around the corner."

It's also important to remember that there are a number of people who are testing at home and not getting the genetic sequencing of their virus, so the subvariant's true proportion of current cases is hard to know, he said.

In light of new variants, the reformulation of the COVID vaccine will be significant, Halkitis said. "That is the future, right there," he said.

And though he likened BA.2.12.1 to a gnat -- pesky and annoying -- he said he does not believe it will be tragic.

"If people want to stay safe, and they want to protect their health and protect the people around them, there are things they can do...no big crowds, wear your mask, stay on top of your boosters...these are just good public health strategies," Halkitis said. "But don't panic."

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