Do you know someone with COVID right now? You’re not alone.

California is in the midst of its third-largest COVID surge of the pandemic, with roughly 19,000 new cases being reported each day, according to The New York Times’ tracker. The true number of people falling sick is undoubtedly even higher, since most at-home tests aren’t included in official case counts.

The good news: Most people testing positive aren’t becoming severely ill. In fact, the number of people dying from COVID in California is currently lower than at almost any point in the pandemic. (This trend holds across much of the country.)

We can thank vaccines and boosters, immunity from prior COVID infections and therapeutics such as Paxlovid — all of which seem to reduce the risk of severe disease.

Now on to the bad news.

Omicron subvariant BA.5 has rapidly become dominant in the United States. And it is especially good at infecting people and bypassing their immune system’s defenses, even if they’ve been vaccinated, boosted and already had COVID, experts say.

“It’s highly immune-evasive, and that is why it’s causing trouble,” said Dr. Eric Topol, a professor of molecular medicine at Scripps Research in San Diego. “And it comes along in California at the same time that we basically have this delusion that the pandemic is over.”


More on the COVID-19 pandemic

The CDC considers COVID risk to be high in 38 of California’s 58 counties and recommends indoor masking in those places.

But unlike earlier in the pandemic, officials across California are reluctant to enact new restrictions. Alameda County reinstated an indoor mask mandate last month but rescinded it three weeks later.

Experts predict that without tighter rules or behavioral changes, the hyper-transmissibility of BA.5 will lead to a continued surge in cases in the coming weeks in California. There will also most likely be a modest increase in hospitalizations and deaths, said Dr. Robert Kim-Farley, an infectious disease expert at the University of California, Los Angeles, Fielding School of Public Health.

“There is a bit of déjà vu that is occurring as we begin having another surge,” he told me. “I think we’ll continue to see increases for a while, but I don’t anticipate we’re going to see anywhere near the prior level of infections of the first omicron wave.”

That’s because people who were infected with earlier omicron strains, such as BA.1 and BA.2, probably have some protection from BA.5, even if reinfection is possible. In other words, there are fewer Californians susceptible to COVID infection than there were when omicron first emerged on the scene last year.


So, with all that in mind, how should we be thinking about risk?

Dr. Bob Wachter, chair of medicine at University of California, San Francisco, explained it this way: It depends on what you’re trying to avoid.

If you’re vaccinated, COVID doesn’t carry the same risks of death and hospitalization that it once did. Keep up to date on your boosters to maintain that level of protection.

But even if you have all your shots, each COVID infection still opens the door to the possibility of developing long COVID, a wide range of symptoms that can be debilitating for some people.

Wachter has recently talked about how his wife’s lingering fatigue after a COVID infection intensified his desire to avoid catching the virus. More than 1 in 5 adult COVID survivors in the United States may develop long COVID.

So, if you’re trying to avoid infection altogether, now isn’t the time to be in public spaces indoors without a mask, such as at a restaurant, Wachter says.

At UC San Francisco, surgery patients without COVID symptoms are swabbed for the virus as a precaution. About 6.5% of those patients are testing positive, which suggests that roughly 1 in 16 people in the Bay Area who don’t seem sick at all are infectious with COVID, Wachter said.

“If 1 in 16 people who feel fine actually has COVID, spend enough time maskless indoors & it’s near-certain that you’ll get it,” Wachter recently wrote on Twitter.