How Concerned Should We Be About The Emerging New COVID Subvariants?

Say goodbye to BA.5, there are some new kids in town, and it’s unclear at this point if we should be concerned.

However, there are worries that XBB could change the COVID picture internationally and that the COVID-19 virus subvariants BQ.1 and BQ1.1 will pose a serious threat in the United States.

Experts on infectious diseases can only make forecasts at this time.

The worst-case scenario would be a spike of one or more strains that circumvent our immune defences just when the United States is anticipated to see an autumn and winter surge.

At the same time, we are far more knowledgeable about SARS-CoV-2 than we were when COVID initially gained widespread recognition. At this stage, people are aware of the fundamentals of protection in case it becomes essential – gulp – to return to masking, obsessive handwashing, and keeping a safe distance from our neighbours. This is despite some universal pandemic fatigue.

According to the most recent CDC data, BQ.1 and BQ.1.1 subvariants have increased to 12% of the viral strains that are currently circulating in the United States, doubling in the past week, from 1% a month ago.

Hannah Newman, MPH, adds, “I don’t think we should panic, but I am a bit concerned.” As we go into the respiratory season and in light of the appearance of new subvariants, I wouldn’t be surprised to see an increase in infections.

As a result of these circulating subvariants, says Newman, director of infection control at Lenox Hill Hospital in New York City, “we are already seeing COVID on the rise in some European nations.”

According to Amesh Adalja, MD, the introduction of BQ.1 and BQ1.1 in the US and XBB internationally is not entirely unexpected. “These mutations should not be surprising,” the author writes, “since this is a virus that will continue to mutate to become more capable of infecting us.”

Better Defense Against Bivalent Boosters?

How successfully the novel bivalent mRNA vaccination boosters might protect against these particular subvariants is one outstanding topic.

Adalja, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore, claims that although the new booster is a better match to what is already circulating than the old booster, “we don’t know what that means in real life.” Because no one intends to compare the two booster types in a clinical experiment, it is challenging to provide an answer.

Newman has greater confidence. We really simply need people to roll up their sleeves and receive it, she adds, adding that there is some good news in that the bivalent COVID booster will offer some protection against these strains.

According to Eric Topol, MD, founder and director of the Scripps Research Translational Institute in La Jolla, California, and executive editor of Medscape, WebMD’s sister site for medical professionals, the XBB subvariant, which is currently booming in Singapore, could be a warning sign for the United States.

For instance, Singapore’s COVID reinfection rate was 5% prior to the emergence of XBB. It is now 17%. So many people who previously contracted an infection will likely contract it once more, according to Topol. Singapore reports that 92% of its citizens have received vaccinations, and their rate of vaccination boosters is double that of the United States.

Despite this, he adds, “they have a very important wave that will be bigger than anything besides the original Omicron.”

Fewer options for treatment

According to Adalja, the medication Paxlovid will continue to be crucial in averting more serious COVID results. In contrast to these changes that circumvent immunity, paxlovid “functions on a whole different region of the virus.”

Contrarily, the research to date indicates that monoclonal antibody treatments won’t work against these novel subvariants. Because it could expose our most vulnerable to worse outcomes, Newman adds, “the ability to avoid monoclonal antibody therapy is a concern for me.”

“We can anticipate to observe more severe symptoms in high-risk persons who might otherwise benefit from these treatments,” she says. “If strains are able to bypass antibody immunity and monoclonal antibodies are ineffective.”

According to Adalja, certain monoclonal antibodies and combinations, such as bebtelovimab and Evusheld, may be less effective against the novel subvariants.

Does Protected Mean Recently Infected?

According to Adalja, the majority of persons who had COVID-19 within the last 3 to 6 months will probably have antibody levels that will protect them, at least from serious illness. This is one of the reasons Canadian and American experts advise waiting 6 months after infection before getting a booster shot.

Adalja continues, “You’re definitely going to be safeguarded against serious illness. Your susceptibility to infection will depend on how long you will be immunely protected, how immune-evasive these variants are, and the extent of their immune-evasiveness.

These immune-evasive versions could re-infect someone once natural protection has worn off, but Adalja believes that person is more likely to only get a minor infection.

Newman concurs. “Recent infection results in a certain level of natural immunity. But it becomes weaker with time. The most tried-and-true method of ensuring uniform protection is to maintain current vaccination and booster schedules.

What is known is that COVID is probably going to stick around for a while, according to Adalja. I used to be extremely honest about this, saying that it would never go away. I didn’t consider this to be a hurricane that would eventually pass. I assumed that this was the new normal,” he claims.

He continues by saying that the effort to treat COVID as an outpatient condition is progressing.

Future Events Are Uncertain

According to the data now available, Gregory Poland, MD, an internal medicine specialist at the Mayo Clinic in Rochester, Minnesota, it is difficult to make precise predictions about what will occur this fall and winter.

But throughout the pandemic, developments in the UK and India have regularly foreshadowed developments in the US. Furthermore, he claims that “substantial upticks in the subvariants” are occurring in these other nations.

Unfortunately, at this time there is no crystal ball that can tell with certainty what a future wave would look like. The effectiveness of preventive measures and the ability of a variety to outcompete other strains will be key factors.

She is especially worried about the flu and COVID converging this winter.

The combination of impending Christmas parties and prevention fatigue could increase the likelihood of superspreading incidents, according to Newman.

According to Topol, one concern is the Americans’ comparatively low use of the bivalent boosters. We will be facing a really large wave in a few weeks, so this is going to be pretty unpleasant.

According to Topol, other worrying trends include the loosening of pandemic protection measures and a decline in immunity as more and more Americans go longer than six months since their last inoculation. “The cracks in our immunity wall only keep becoming bigger and bigger.”

Before the BQ1.1 actually takes effect, Topol thinks that “we’ll see a wave.” The two factors taken together could result in a disastrous December or January.

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