Why rising costs of food and other essentials are leading to protests around the world.
Sri Lanka’s president finally resigned. Protesters celebrated, and they had reason to: Their mass demonstrations — including a takeover of the presidential mansion — drove President Gotabaya Rajapaksa from office.
Sri Lanka’s economy is in free fall. The country doesn’t have enough money to buy essentials: food, medicine, and especially fuel. Buses can’t run, schools can’t open. The economic crisis was years in the making because of mismanagement, but terror attacks in 2019, and later the Covid-19 pandemic, which shriveled Sri Lanka’s tourist economy, pushed it to the brink.
But the domestic political turmoil unfolding in Sri Lanka also links back to the instability across the globe, including the war in Ukraine and all of its consequences.
It may seem strange to link street protests against the Sri Lankan government to a war in Europe, but food and oil markets are global. A shock in one place ripples everywhere. The Ukraine war compounded supply chain pressure in the wake of Covid-19, and Moscow’s war in Ukraine and Western sanctions against Russia have squeezed agricultural exports — critical supplies like grain and sunflower oil — from the entire Black Sea region. These products can be replaced on the global market, but at a cost. Fuel prices are also up, and if it costs more to buy diesel for a tractor or to transport cargo, food becomes more expensive still. Food becomes all that much harder to afford for poor countries, and for poor people in rich countries.
The United States and Europe are seeing these price shocks. So are people in Ghana and Mozambique and Mexico and Ecuador and Uzbekistan and Afghanistan. Food, fuel, and other essentials are getting more expensive, everywhere. Many of these governments want to intervene, but their economies were already pummeled by the Covid-19 pandemic, and so they don’t have the funds to respond to these crises.
That means standards of living will fall in many countries, and that more people will slip into poverty. The United Nation’s World Food Program has warned that the number of food-insecure people has risen to 345 million; nearly 50 million people in more than 45 countries are at risk of falling into famine conditions.
But the global instability that causes prices to rise also creates more instability. Food prices, for example, are rarely the only reason that a government falls, but they can help crystallize simmering discontent in a country. “If you can point to rising food prices, it is a sign that something is failing in the implicit contract between the government and the governed,” said Cullen Hendrix, a nonresident senior fellow at the Peterson Institute for International Economics and professor at the Josef Korbel School of International Studies at the University of Denver.
Vox spoke to Hendrix about why food costs can coincide with political unrest, and where and when that happens — and why Sri Lanka likely represents just the beginning of the volatility about to envelop the globe.
This conversation has been edited and condensed for clarity.
Jen Kirby
This is a big question, but what is happening, broadly, around rising prices around food and fuel, and political unrest?
Cullen Hendrix
We need to decompose that into thinking about food prices and thinking about fuel prices.
Up until about 2000, the two of those weren’t really correlated. You had periods where you had very high food prices and very low oil prices, or very high oil prices coinciding with low food prices.
The 2000s are when those two things start to trend much more together. In some ways, the current crisis looks the most like the 2007-2008 food price crisis, because we have simultaneous crises in both food markets and oil markets in terms of elevated prices as a response to, in this case, instability caused by the Russian invasion of Ukraine. In 2007 and 2008, it had more to do with climatic shocks, and then the ways that many producer countries — countries that normally export food — decided to institute export bans.
So, having kind of decomposed those two things, we probably need to take food and fuel prices separately.
Jen Kirby
Okay, so how do they work?
Cullen Hendrix
Generally speaking, there is a positive relationship between higher prices for food in international markets and protest activity. This relationship is particularly evident in democratic and semi-democratic countries. Protest dynamics tend to be less responsive to global food prices in more authoritarian countries.
With respect to oil prices as separate from food prices, the research on this topic is a bit more mixed. It’s certainly the case that higher fuel prices can erode real incomes. They can eat into purchasing power, and they can generate significant grievances with incumbent regimes, who are being asked to do something about these higher prices. But it turns out that these higher oil prices are also a source of revenue that many governments that export oil can capture, and they can use that to reinvest back into price supports and mechanisms of ensuring social stability.
A good way of thinking about this is to look back at the Arab Spring, and the places where the Arab Spring protests got the most traction, like Tunisia and Egypt, are small oil exporters, if they export oil at all. Whereas countries like Kuwait were able to weather the storm because although they were paying a higher bill for their food imports, they were also reaping these windfall profits associated with higher commodity prices for their main export, being oil. They were able to invest in lavish public spending at a time when, in the wider region, many governments were having to go on austerity diets and slash social spending at precisely the time when doing so was most likely to enrage the populace.
Jen Kirby
So people are frustrated with inflation in places like the United States and Europe, but as yet, we haven’t seen a mass wave of protests over, say, gas prices. That may happen, but I’m also wondering if this is more likely to happen in countries with less-developed economies, and where the government may have limited ability or capacity to respond.
Cullen Hendrix
We know less about the ability of the government to respond, but your point about average incomes is definitely well taken. If you’re in a developing country, and you’re spending 50 percent of your take-home income on food, and much of that food is unprocessed — you’re actually buying bulk wheat, or maybe wheat flour — the increase in food prices hits you much harder than it does, say, for you and me, where we spend a much smaller proportion of our income on food. It’s not as significant a source of hardship. And a lot more of the money that we spend on food, actually, is money spent on packaging and marketing and the like, as opposed to people who are living maybe half a step removed from the underlying bulk commodity.
So higher-income countries see less of this kind of protest. We have seen things like the antecedents of what you’re talking about. If you remember back to the yellow vest protests in France and Belgium, those were protests in response to reductions in the subsidies for diesel fuel.
Jen Kirby
One of the things I sometimes struggle with in covering protests is that food and fuel prices can factor among them, or be the “spark,” but they ultimately lead to a longer list of grievances against a government. It can be hard to disentangle, and I am wondering, how do you make sense of exactly what role food and fuel prices play in protest movements?
Cullen Hendrix
At any sufficiently large protest, people are going to be there for a variety of reasons. Food and fuel prices may be significant for some participants, but they may not be particularly significant for others.
It’s not typically the most food-insecure people that wind up participating in these protests. It’s not the truly hungry. It’s that if you can point to rising food prices, it is a sign that something is failing in the implicit contract between the government and the governed, in terms of being able to secure people’s ability to have plentiful and appropriate food at a bearable price. If you think about that as being the bedrock of the social contract in these regimes going all the way back to Roman times — that’s where the concept of “bread and circuses” comes in — then, yes, they’re kind of a canary in the coal mine for the broader inability of the government to address the grievances and the needs of the populace.
Jen Kirby
And so I think part of the challenge now, and correct me if I’m wrong, but for countries like Sri Lanka, where you have that fundamental breakdown of the contract, because of what’s happening around the globe — specifically, the war in Ukraine — it is much harder for those countries to figure out an adequate response because they have less tools at their disposal?
Cullen Hendrix
One hundred percent. The issue in a place like Sri Lanka — and if you look through the list of other places that are experiencing these kinds of inflation protests, like Albania, Argentina, Panama, Kenya, Ghana — these are not places with a ton of what economists would call fiscal space. They do not have the ability to offset these price increases with ramped-up government spending and targeted transfers and subsidies to offset the pain. These are cash-strapped governments; they went into the crisis cash-strapped, many of them because of the ongoing effects of the Covid pandemic.
Jen Kirby
You mentioned the food crisis in 2007 and 2008. But what are some historical precedents for when higher global food prices created political instability?
Cullen Hendrix
I was getting ready to say — I hate to bang on Russia, but I don’t hate to bang on Russia, as this has been their fault before. If you go back to 2010-2011 and the Arab uprisings, the food price spike occurred because Russia decided unilaterally to impose an export ban on wheat, barley, a bunch of other kinds of grains, in response to heat waves and wildfires that were projected to decimate their harvest. In order to maintain domestic food supplies and lower prices, they decided to not export.
The problem was that many of the countries that were counting on those exports — the same way as it is now, the countries that are counting on Black Sea exports, both from Russia and Ukraine — were the countries in the Middle East and North Africa, which are deeply food import-dependent. Then, as now, they’re basically thrust back into international markets at much higher prices to try and satisfy their need for food imports.
There were obviously elements to the Arab uprisings that had nothing to do with food prices, but it is important to understand the contributing factor that food prices can play.
The Arab Spring protests were largely coordinated and organized by people who had lots of anti-regime sentiment and had been organizing around it. But what brings otherwise apolitical people out into the streets to participate in these mass movements often are these kinds of political issues that are much more picayune, as opposed to the broader dissatisfaction with the regime, or indeed, the regime type.
Over time, a lot of those protests that were related to food and fuel prices metastasize into protest movements around the form of government, like, “Why don’t we get to elect our government? Why are we run by these corrupt authoritarians?” But there was a significant part of it that began with the food and fuel price spikes.
Jen Kirby
Is there something of a tipping point when it comes to food price spikes — like when they reach certain levels, the likelihood of instability increases?
Cullen Hendrix
I’m hesitant to say that there is a tipping point where I can say, “Once food gets above X price, then it’s on.” I don’t think there’s sufficient evidence for that.
I will say that the prices we’re currently seeing are, if not historic, near historic. The last time we saw food prices this high in international markets was in 1974. Back then, global food trade was a much smaller share of actual food consumption. Higher global prices mattered less for people’s ability the world over to feed their families.
Jen Kirby
What are the places you’re paying attention to when it comes to political unrest as a result of rising food prices?
Cullen Hendrix
I would keep an eye on West Africa, particularly Ghana and Nigeria. I think that there is potential for maybe Pakistan. The non-oil-rich Middle East and North African countries, and maybe Central America. I think that’s a significant issue, because it’s co-occurring with droughts. But it’s also the case that these countries, because of rapid rates of urbanization, are becoming increasingly dependent on global markets, and these are countries with fragile governance systems to begin with.
Jen Kirby
Basically sounds like the whole world.
Cullen Hendrix
I mean, the outlook isn’t great. These markets are being reined in a little bit. The higher oil prices that are a function of these kinds of political instability tend to be relatively short-lived. They’re persisting longer now, just because of how large an exporter Russia is and the scale of instability. Typically, in the past, other big exporters have increased exports to offset the effects of this kind of destabilization. But I wish I had better news for you.
Jen Kirby
What are some possible interventions that the United States or other wealthier governments might be able to do to ameliorate some of these brewing crises in poorer parts of the world?
Cullen Hendrix
The G-7 and then the G-20 both attempted to push through agreements not to use export bans. India gets a carve-out because India is, you know, a developing country, and I think it’s more political theater than it is actual constraint on food supply and food exports.
In terms of longer-term — and this is where we get really speculative — ultimately, we need to reform the global food producing system in ways that increase resilience, not just to climate change, but also to these kinds of geopolitical shocks, because I don’t think this is going anywhere. If you look at the projections of the kinds of countries that are going to be seeing increasing yields and potentially larger harvests moving forward, it is places like Russia, Kazakhstan, the United States, and Canada.
That said — and this is the thing that I think is potentially more controversial — I’m of the opinion that we probably need to see more subsidization of agriculture in developed countries, as opposed to less. I wish it were the case that we could convince voters in Iowa to subsidize food production in places like Thailand or Kenya; unfortunately, electoral politics don’t work that way. But the subsidies that are paid by taxpayers in developed countries are actually subsidizing consumption at the global level.
That’s not necessarily a super popular opinion, especially among folks who are fairly wedded to agricultural development in developing countries as a mechanism for growth. But I do think that’s something we need to be getting serious about, because I don’t think, in the near term, we’re going to be able to offset these kinds of volatility that can be created by these countries with very large market shares having their supply just go offline. There’s not enough slack in the global food system to make up for that.
Jen Kirby
If I’m understanding you correctly, the global food market basically works the way it works. But having a place like the United States or Canada, which does have the capacity to supply more people, they could make up for some of the pressure when Russia or another major area is taken offline or creates major disruptions?
Cullen Hendrix
I tend to believe in markets, but I will say that markets for basic necessities like food, these are not markets you want to operate according to cold economic logic. The market for food is not a market where you want to wind up at the end of the sale with no available supply. We can’t have that because we need to have buffers in the system precisely because of events like the ones we’ve seen. And so if that’s physical grain reserves, [or] if it’s governments willing to use what they call virtual reserves, which are basically governments, in a coordinated fashion, intervening in markets to short these futures contracts to drive prices back down.
There are things that can be done. It’s just going to take an investment of resources and, I think, broader awareness of the enlightened self-interest that it does not make the United States any safer and more prosperous to exist in the world where many of our trading partners and many of our strategic partners around the world are facing instability because they can’t feed their populations.
Lawmakers are scrambling to get a deal done before August.
Democrats are struggling to resurrect parts of the Build Back Better Act after the broader package imploded last year.
They’d hoped to put together a trimmed version of the original $2 trillion package, narrowly focused on health care, climate, and tax reforms. Sen. Joe Manchin (D-WV), however, has expressed opposition to additional climate and tax policies, and it now seems the party will have to settle for a smaller bill than leaders wanted, one that centers on lowering prescription drug costs and extending health insurance subsidies.
The Washington Post reported July 14 that Manchin told Democratic leaders he doesn’t want to proceed on climate spending or tax hikes due to concerns about inflation. He is still reportedly open to supporting Democrats’ prescription drugs package as well as an extension to Affordable Care Act subsidies, which are due to sunset at the end of this year. And he has said he may be willing to negotiate again on taxes and climate in September.
If Democrats stay united on these aspects of the bill, they could still pass a substantial piece of legislation that would enable Medicare to negotiate drug prices and help reduce health care costs for millions of people. That said, this version of Build Back Better would fall far short of the transformative climate and social spending package that many lawmakers and activists have been pushing for for months.
What Democrats have agreed on
Thus far, Democrats are aligned on their prescription drugs plan as well as an extension of ACA subsidies.
The drug provisions could be significant, though they are narrower than what Democratic lawmakers were considering last year — the plan doesn’t include proposals some in the party were fighting for, like a $35 per month cap on insulin costs.
Here are the provisions that Democrats agree on so far:
Prescription drugs plan
- Allowing Medicare to negotiate drug prices: Medicare has historically been barred from negotiating on most prescription drug prices, meaning it pays drug prices set by manufacturers. This bill would change that. In doing so, it could mean drastic price reductions on specific drugs for people covered by Medicare, since the government has huge buying and negotiating power.
The savings would not apply to people covered by private insurance, however, Reuters reports. The legislation guarantees that Medicare can begin negotiations in 2023, starting with 10 drugs, which will be chosen by the Department of Health and Human Services.
- Capping out-of-pocket drug costs for Medicare recipients: The legislation would cap annual out-of-pocket drug costs for Medicare recipients at $2,000. After that, Medicare would pay for additional expenses. It would be a major change since there is currently no cap, meaning people sometimes spend thousands more for a single drug.
- Requiring rebates for price hikes: If pharmaceutical companies raise the costs of a drug at a rate faster than the rate of inflation, they would be forced to refund the difference to people paying for the drug. This tenet is intended to check companies that try to make exorbitant annual increases on a drug.
- Expanding prescription drug subsidies for low-income seniors: Currently, seniors who are at or below 150 percent of the federal poverty line are able to receive a partial subsidy for their prescription drugs. The legislation would enable them to receive a larger subsidy for these expenses.
- Making vaccines free for seniors: The legislation would make all vaccines free for seniors, a notable change in coverage. Currently, Medicare covers some vaccines, like the flu shot, but not all immunizations are included.
ACA subsidy extensions
- ACA subsidies: As part of the American Rescue Plan, Congress expanded the subsidies available for health insurance coverage under the Affordable Care Act, including reducing premium costs for those who fall between 100 percent and 400 percent of the federal poverty level. These subsidies, however, are due to sunset at the end of the year if Congress does not renew them; Manchin has said he’s willing to consider a two-year extension.
Democrats are trying to do what they can before the midterms
Although Democrats’ electoral chances in the Senate are looking better than they are in the House, it’s possible the party loses control of one or both chambers of Congress following the November midterms. With the elections fast approaching, Democrats are rushing to capitalize on their existing majorities in case they are no longer able to pass legislation next year.
That’s likely to mean passing whatever version of Build Back Better the Senate Democratic caucus can agree on. This reconciliation bill could be the party’s last major chance to approve new prescription drug policy if Republicans retake just one chamber of Congress. If they are able to make quick progress in the coming weeks, it’s possible that Democrats could hold a vote on the reconciliation by the end of July, though Manchin has expressed uncertainty about this timeline.
Republicans have pushed back on these efforts: Senate Minority Leader Mitch McConnell threatened to pull support on the US Innovation and Competition Act, a bipartisan bill aimed at investing in the US’s supply chain, unless Democrats abandon reconciliation. Democrats have responded by claiming McConnell is trying to deter the reconciliation bill in order to protect pharmaceutical companies.
To successfully pass a reconciliation bill, Senate Democrats will need all 50 members of their caucus on board with the legislation, as well as approval from the parliamentarian — who can advise against including provisions if they aren’t seen as sufficiently related to taxing and spending. It seems they now have the former for part of their bill. House Democrats, many of whom have pushed for a more ambitious bill in the past, will need to vote in favor as well.
Update, July 15, 6 pm ET: This story has been updated to include new information on Manchin’s statements about climate and tax policy.
The rise of the latest subvariant, explained.
In a recent edition of his newsletter, the Scripps Research Institute physician and researcher Eric Topol called the BA.5 subvariant of SARS-CoV-2 “the worst version of the virus that we’ve seen.” The Washington Post used the same language in an editorial that soon followed, and earlier this week, the White House announced a strategy for managing BA.5, which stressed the subvariant’s potential to make cases rise in the coming weeks.
Why are experts so concerned about this subvariant?
For one, hospital admissions are now rising concurrently with BA.5, after several months of stable hospitalization rates. Additionally, early evidence suggests the BA.5 subvariant has features that make it better at escaping immune systems, even vaccinated ones, than its ancestors.
Also concerning: pandemic complacency has been rising alongside BA.5. Vaccine booster uptake has been modest in the US, and more than one-fifth of the population has not been vaccinated at all. Many fear that a variant better able to evade immune systems will have a better chance of reaching and harming those who remain unvaccinated.
The good news is we already have the tools to cope with a subvariant like BA.5. “It doesn’t really shake up any of our established countermeasures,” said Anne Hahn, a Yale medical school immunologist who specializes in viral evolution. That means masking and vaccines still work to prevent BA.5’s worst effects. Although, to prevent the subvariant from wreaking major havoc, people need to be willing to reengage with these preventive efforts.
Americans’ willingness to dial up preventive behaviors will determine — and, perhaps, be shaped by — the path BA.5 takes as it rises to dominance.
Is this really the worst form of the virus so far? For now, a lot remains unclear: While BA.5 has some things in common with earlier variants — the symptoms it causes seem the same, for example — scientists see a few signals that it has the potential to cause bigger problems if we don’t take some action.
The early evidence giving scientists the heebie-jeebies about BA.5
As of July 9, estimates from the Centers for Disease Control and Prevention (CDC) indicate that all the SARS-CoV-2 virus currently circulating in the US is the omicron variant and its subvariants. About 65 percent of the subvariants in circulation are of the BA.5 lineage, and the proportion is rising quickly. If BA.5’s rapid expansion continues, it will likely account for nearly all US infections within a month. In South Africa, which had a combined BA.4/BA.5 wave between April and June of this year, case rates grew more quickly than did case rates of the omicron variant that preceded it.
Over the course of the pandemic, new variants have eclipsed old ones many times over — among omicron subvariants alone, BA.5 is the fifth one to rise to prominence in the US. But the first omicron wave created a massive surge in new cases and hospitalizations, while the subsequent ones did not.
BA.5’s pattern is different, and concerning: As the BA.4 and BA.5 subvariants have become a larger share of the virus in circulation, case and hospitalization numbers have also begun to rise in the US.
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Centers for Disease Control and Prevention
This trend suggests BA.5 has biological advantages that previous omicron subvariants didn’t have — and laboratory data has begun to clarify what those advantages are.
A recent publication from researchers at Columbia University suggests BA.5’s genome is genetically pretty different from earlier omicron subvariants, including the one that stole Christmas last year.
Some of the differences are in the virus’s spike protein, a key target for Covid-19 vaccines. Scientists are worried that the more the spike protein changes, the less likely our current vaccines will elicit antibodies that can neutralize it. It’s possible this subvariant could lead to more infections than its predecessors, even among vaccinated people.
Epidemiological data to support this is in its early stages, but it’s highly plausible, based on some lab studies. An early-July report in the New England Journal of Medicine suggested that in vaccine-boosted people, levels of protective antibodies were three times less active against BA.5 than against the first omicron subvariants. While these antibodies are not the only way the immune system protects the body from severe SARS-CoV-2 infections (we’re looking at you, T-cells), this finding suggests vaccines could be less protective against BA.5 infection than against earlier strains.
Although Covid-19 infection has also been thought to boost protective antibody levels against new variants, omicron has changed the game. Research suggests omicron infections don’t help the immune system effectively recognize and protect against subsequent omicron infections. That makes reinfection after having an omicron variant infection more likely than reinfections that occurred after exposure to previous forms of the virus.
Real-world data from South Africa shows how this may play out in humans. BA.5 case rates in that country grew more quickly than did case rates of the omicron variant that preceded it. BA.5’s improved ability to infect people protected by vaccination and previous infection could explain its more efficient spread.
Hahn noted vaccines and, to some degree, prior infections still appear to offer good protection against severe disease due to BA.5. But there are other unknowns: several analyses have raised questions about test sensitivity for omicron subvariants, meaning some diagnostic tests might yield false negatives. There are also open questions about whether monoclonal antibodies, so far an effective treatment for previous Covid-19 variants, will be as effective against BA.5.
Overall, it appears BA.5 has clear differences to the variants that came before it. And while those differences will likely drive case increases, it’s not yet clear how deadly the wave will be.
Hospitalizations are up — but severity is not
Charts showing Covid-19 hospital admissions usually display this figure as a single line, but that line belies a lot of complexity.
For starters, most patients admitted to the hospital are screened for Covid-19, and if they test positive, they’re counted as a Covid admission — even if they’re admitted with a broken hip and are totally asymptomatic for Covid-19.
US data still does not make a distinction between so-called incidental — like the broken hip — and non-incidental Covid-19 admissions. Because of that, it’s hard to determine if the rise in hospitalizations is due to the virus growing more virulent, or if it just means it’s spreading widely in a community. During the first omicron wave — which led to asymptomatic or mild infections in many vaccinated people — some argued that hospitalization figures alone obscured a meaningful number of incidental Covid-19 admissions.
Experts sometimes use intensive care admissions and ventilator use trends in combination with local test positivity data to help understand local Covid-19 trends. Several doctors told me that judging by those criteria, they have not yet seen signs of a severe illness wave — even though US Covid hospitalizations have risen 50 percent since May.
Aaron Glatt, an infectious disease physician who is also the hospital epidemiologist at Mount Sinai South Nassau in New York, was clear: “We have not seen a surge in critical care admissions,” he said.
Although Covid-19 hospitalizations have been slowly creeping up across his region, intensive care unit admissions have stayed relatively low and stable. With incidence so high in the community, those critical care admissions and deaths are better predictors of what is really going on in some ways, Glatt said, “and those have not changed.” Glatt also said he had not noticed any new or unusual symptoms in admitted patients with Covid-19.
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Paul Bersebach/MediaNews Group/Orange County Register via Getty Images
Susan Kline, an infectious disease doctor and hospital epidemiologist at the University of Minnesota Medical Center in Minneapolis, said her hospital has seen Covid-19 admissions jump about 50 percent from their recent low point, and about a third of those admissions have had three or more doses of a vaccine.
However, she said, a “fairly high percentage” of people hospitalized with Covid-19 infections were admitted for reasons completely unrelated: they were only counted as Covid-19 patients because a screening test on admission was positive. In other words, she senses a large proportion of those “Covid admissions” were admitted with, but not for, Covid-19 infection.
What’s more, the patients don’t seem to be as sick as in previous waves. “In general, the patients are not showing as severe a disease as we saw early on when we were first admitting patients with Covid-19,” she said.
Even if cases aren’t very severe, a new potential big Covid wave is concerning
Even a variant that’s merely more transmissible — but not more severe — is concerning. The more people the virus infects, the greater chances it has to find the people most vulnerable to it. “The people that were at the highest risk of previously being hospitalized are going to still be at the highest risk of getting hospitalized with variants,” Glatt explained. “[Novak] Djokovic can beat me even if he’s not feeling very well,” and with any new variant, he says, “the people who are sickest, even if they’re in their best condition possible, are still going to do worse.”
Also, hospitalization and death are not the only outcome people want to avoid.
Some people with a personal “Covid-zero” policy may be motivated by concerns about long Covid — and mounting data suggests those concerns are not unfounded. A recent publication in The Lancet suggested that about 5 percent of vaccinated people infected with omicron variants developed long Covid symptoms, compared with 11 percent of those infected with the delta variant, which predominated in mid- to late 2021.
While a one in 20 chance of long Covid represents lower odds of the syndrome than in earlier analyses, the risk is still more than enough to make many want to avoid any Covid-19 infection — even one that doesn’t land them in the hospital.
Lessons from countries where BA.5 has come and gone are mixed
If there’s any reason for optimism, it can be found in countries where cases due to BA.5 have already peaked.
One of those countries is South Africa, where BA.5 began to rise in late March and now comprises about half of all Covid variants in the country (the remainder are mostly BA.4). During this wave, neither cases nor hospitalizations rose anywhere near as high as they were during the country’s first omicron surge last winter.
A group of South African investigators recently compared outcomes between people infected during the uptick of BA.5’s rise and those infected during earlier waves, going all the way back to the first wave in 2020.
In a publication that has not yet been peer-reviewed, the authors explained that the risk of severe illness during the more recent surge was no higher than the risk during the first omicron surge involving BA.1. They also noted that higher levels of community immunity now than at the time of the first omicron wave were likely protective against severe disease.
But the experience of other countries muddies the picture. Portugal also had a surge of cases accompanying a rising proportion of BA.5 beginning in early May, but had a different experience than South Africa’s: Hospitalizations in Portugal came much closer to the levels they reached during the nation’s first omicron wave, and its death rate has been three to 10 times higher than South Africa’s over the last few months.
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Hahn said the difference between the two countries’ outcomes may be related to the difference in ages of their residents: the median age of Portugal’s population is 45, while that of South Africa’s is 28.
Additionally, Portugal had a high level of booster uptake, making their first omicron wave less severe than South Africa’s. But by the time BA.5 came on the scene, a large part of that immunity may have waned, making Portugal’s population less collectively immune than South Africa’s by the time BA.5 arrived.
The US also had a severe first omicron surge, which may mean Americans have some level of protection against a flood of severe outcomes due to BA.5. But that doesn’t mean we should welcome wave after wave of variants to keep building up immunity. “The costs are too high to really see it as a benefit,” said Hahn. “I wouldn’t say that it’s beneficial for society when people continually get sick, have work absence, and maybe even long-term implications from long Covid.”
Instead, Hahn said, we’d do well to take a little more caution when we’re faced with more immune-evasive subvariants like BA.5.
That means wearing masks when in crowded public places and getting vaccinated. And for eligible people unsure whether to get a booster dose now or wait for the omicron-specific shot expected to arrive this fall, she advises getting the additional protection sooner, even if it’s not as finely tuned. “The booster you can get now is more helpful now than the one you can get in a few weeks time,” she said.