Health leaders muted as cases rise

The BA.5 subvariant, now the cause of at least two-thirds of U.S. cases, is driving a Covid spike in some 40 states. But Americans, exhausted from repeated surge warnings, are less likely than ever to wear masks or avoid crowds. Many U.S. health officials aren’t speaking out against such practices.

“I think they’re trying to keep their powder dry,” said my colleague Thomas Fuller, our San Francisco bureau chief and one of three reporters on today’s story about the state of the virus. “They seem to believe it’s not realistic to bring back severe measures right now.”

In Chicago, where the Covid warning levels jumped to “high” last week, Dr. Allison Arwady, the health department commissioner, said, “I feel strongly that you can’t just kind of cry wolf all the time.”

Dr. Joseph Kanter, Louisiana’s state health officer and medical director, said that, despite higher Covid levels, he felt “much more empowered that we have the ability to protect ourselves.” Dr. Anthony Fauci said in a recent White House briefing that Americans should not let Covid “disrupt our lives.” (Los Angeles County, however, is planning to reinstate indoor mask mandates on July 29 as the state’s Covid cases increase.)

Home testing makes the current data murkier. Not since the earliest months has so little been known about how many coronavirus infections there are. Slightly higher death rates, a 20 percent increase in hospitalizations and other signs point to a new surge, but hospitalizations and deaths are far fewer than in previous spikes, with many more people vaccinated or able to treat symptoms.

I spoke to Thomas as he drove to Yosemite to check on the Washburn fire. He reiterated health officials are in a tough situation, given extreme pandemic fatigue. In the Bay Area, where he lives, Thomas said most people continue to mask, but some are so frustrated, they’re “throwing caution to the winds. They have a sense of futility that wasn’t as evident in the past.”

The chief concern he drew from his reporting, Thomas said, is that this stage of the virus might be “kind of creating a giant petri dish” for subvariants.

“Chances go up when more virus is circulating,” he told me. “With so many more bodies hosting it, experts told me there’s so much more potential for future variants which may or may not be more serious.”

Dr. Charles Chiu, a virologist at the University of California, San Francisco, stressed to Thomas that it’s crucial new variants be detected quickly, especially in wastewater. (Chiu detected the first U.S. case of Omicron in a traveler, then learned it was in wastewater two weeks beforehand.) That’s the point where public restrictions aimed at prevention could become urgent again, Chiu said.

As officials hold back and the public drops its guard, Thomas told me, “I think we’re at a point of trying to understand the consequences of complacency. We don’t understand them yet. But the more widespread the virus, the higher the risks of a new variant. That’s the concern that the people I spoke to expressed.”

Monkeypox: “Worst pain I’ve experienced”

Over the weekend, Fauci went on CNN to discuss monkeypox’s potential to cause a second epidemic. Cases are increasing in the U.S., especially among gay men, and Fauci warned we might be seeing the mere beginning of the problem. The nation, he said, must start behaving as if the disease “will have the capability of spreading much more widely than it’s spreading right now.”

Monkeypox has typically been considered a fairly mild disease. But my colleague Sharon Otterman spoke to half a dozen patients in New York City, which has about 25 percent of the cases reported in the U.S. She documented excruciating symptoms and systemic health and hospital failures. Gabriel Morales, 27, kept himself isolated for eight days, trying to get treatment and waiting for test results that turned out to be lost. “It was just the worst pain I’ve experienced in my life,” he told Sharon.

Sharon emphasized that there’s a range of symptoms. Some patients have little more than a mild rash. But health officials estimate about 20 to 25 percent in New York have full body rashes or internal lesions that make it agonizing to eat or go to the bathroom.

At that end of the spectrum, Sharon said, “it results in a level of pain we should not wish on anyone. Providers on the front lines have been surprised at how severe some patients are reporting it to be.”

In Africa, where the virus is more common, Sharon said the death rate from a variant closely related to the one spreading now was around 3 to 6 percent (a higher rate than Covid), though no deaths have been linked to the U.S. outbreak. Still, she said her work on the topic had convinced her “the alarm wasn’t sounded to the extent it needed to be” by public health agencies here. Though the federal government owns more than a million vaccine doses that could work against monkeypox, many are snarled in bureaucracy and there is far more demand than availability.

TPOXX medication, which was developed for smallpox, seems to relieve symptoms effectively, but it’s only available for monkeypox treatment through a time-consuming compassionate-use protocol. Only 70 prescriptions have been written citywide.

Overall, monkeypox numbers remain small, with about 1,800 reported U.S. cases. People shouldn’t panic, Sharon told me, especially if they’re not part of the affected community.

Still, she admitted, “It’s very disheartening to see our public health system repeat the same failures as with Covid. There are a lot of the same missteps. It’s no one person or agency’s fault but a result of issues that will repeat until we fix our systemic public health challenges.”

What else we’re following

• Optimism that a new booster rollout this fall will protect against variants is waning among experts, The Atlantic reports.

• The world’s complex economic challenges right now mostly spring from one source: the coronavirus pandemic.

• Floridians hoping to vaccinate their youngest children can’t always find the vaccines, and some blame Gov. Ron DeSantis, The Washington Post reports.

• Experts say waves of Covid surges are coming closer together than might be expected, The Guardian reports.

What you’re doing

Although the financial, physical, social and emotional effects of the COVID-19 pandemic have been shaking my world and my family’s, I have determined to improve my circumstances by going back to college. Single again, 53 and a mom of two kids in college, this may seem difficult, but I’m following my dream of becoming a teacher by earning an elementary education Master’s degree and teaching certificate. I see our lives as fragile and risks are higher but I want to LIVE life and follow my passion for teaching children, even when the going gets tough.

— Debbie Scott, Arlington, Wash.

Let us know how you’re dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter.

Email your thoughts to coronavirusbriefing@nytimes.com. Did a friend forward you the briefing? Sign up here.