New crop of COVID subvariants poised to take over this winter
New strains of COVID-19, many already found in New York, stem from the highly contagious omicron variant, which has dominated cases for almost a year. Credit: AP/Mary Altaffer
A new crop of COVID-19 subvariants is poised to take over this winter, appearing to evade some of the immunity provided by vaccines and prior infections while creating more challenges for a wary public enjoying life without pandemic restrictions.
The new strains, many already found in New York, stem from the highly contagious omicron variant, which has dominated COVID-19 cases for almost a year.
They make up an alphabet soup of names: BF.7, BQ.1, BA.4.6 and even XBB.
Experts said it’s too soon to tell which ones — if any — will become dominant in New York and across the country.
“If you look at a map of variants now, it’s honestly much more complicated than a New York City subway map if you never went on a subway,” said Dr. Bruce Farber, chief of public health and epidemiology at Northwell Health. “You just see amazing numbers.”
Farber said many of the emerging omicron subvariants have been shown to infect people even if they were vaccinated or previously tested positive for COVID-19. It's uncertain whether the new subvariants will cause an increase in hospitalizations and deaths.
Like all viruses, SARS-CoV-2 — the virus that causes COVID-19 — is constantly changing.
“It is important to note that the advent of these variants is not surprising,” said Dr. Amesh A. Adalja, an infectious disease expert and senior scholar at Johns Hopkins Center for Health Security. “This virus will never be eliminated or eradicated but will continue to evolve in order to infect an increasingly immune population.”
Dr. Alan Bulbin, an infectious disease specialist at Catholic Health, said he doubts there will be a “doomsday scenario” where prior immunity and vaccination will not provide any protection at all.
“I don’t have a sense that we are going to be in a situation like that," said Bulbin, pointing out that even if they do not prevent all infections, vaccines and boosters are still the best protection against severe illness and hospitalization from COVID-19.
Scientists in New York and around the world are continuously examining COVID-19 samples in an effort to track the mutations of SARS-CoV-2 and find effective methods to slow its spread.
The first COVID-19 booster was formulated before omicron became the dominant variant. The current, updated bivalent booster shot was designed to protect against serious illness from both the original delta variant of the virus as well as omicron and some of its subvariants, especially BA.5.
But that booster might become dated in the coming months as other omicron subvariants start to dominate the COVID-19 landscape, Farber said.
At the end of August, the BA.5 subvariant accounted for more than 86% of cases in the United States. As of Oct. 22, it had decreased to 62%.
In New York, it decreased from 67% of samples collected between Sept. 25 and Oct. 8 to 50% in samples collected between Oct. 9 and Oct. 22.
In its place are the emerging subvariants BA.4.6, BQ.1, BQ.1.1. and BF.7, which appear to be able to spread infection to people even if they were vaccinated or recently had COVID-19.
BQ.1.1 made up just 2.8% of COVID-19 samples collected in the state between Sept. 25 and Oct. 8, but had jumped to 13.3% in the samples collected between Oct. 9 and Oct. 22.
The subvariant XBB has caused a wave of cases in Singapore and concerns over its ability to infect people who have had prior COVID-19 cases. The Centers for Disease Control and Prevention has said it is "keeping a close eye" on XBB, which is still "very rare" in the United States.
“Interestingly enough, [XBB] is not quite as contagious as the BQ.1.1, which is showing up in New York more regularly,” Farber said.
Adalja cautioned that simply because a subvariant has been shown to infect people who have some level of immunity, it doesn't mean they have lost all protection against COVID-19.
“What it means is that protection against infection — not severe disease — is not very robust, even if a person is vaccinated, has had a prior infection, or some combination,” he said. “Immunity is not all or none. There is a spectrum of protection, and what really matters is protection against severe disease … In people who are not high risk, the newer variants will likely cause only mild illness."
That’s why COVID-19 vaccines and boosters are still recommended, especially for those who are elderly or have chronic medical conditions that put them at risk for serious complications from the disease.
“By being up-to-date with your vaccines, you are very assured that you will not wind up in the hospital and die,” said Farber, pointing out that almost 400 people a day die from COVID-19 across the country. “We realize we're not going to be able to stop this cycle of variants and cycle of re-infections … So the goal has to be to prevent us from getting really sick, and that we can do.”
Scientists are concerned about how the new subvariants will impact one of the most vulnerable segments of the population, immunocompromised people for whom the vaccine may not provide as strong a response as in those with healthier immune systems.
In many cases, they rely on additional treatments such as Evushield, a monoclonal antibody they can receive as a pre-exposure medicine.
However, the CDC has noted that Evushield could have a “decreased efficacy” against BA.4.6, BF.7 and BA.2.75.
Another treatment, bebtelovimab, appears to not be as effective against the BQ.1 and BQ.1.1 subvariants.
Monoclonal antibody treatments are also used by anyone who is likely to get seriously ill due to a COVID-19 infection.
Bulbin said other existing treatments might be able to fill that gap.
“We have Paxlovid. We have remdesivir,” he said. “And I do think the bivalent booster should still be viewed as an effective and prominent strategy, especially in the high-risk groups.”
With interest in the updated COVID-19 booster low, the White House launched an effort last week aimed at getting more people, especially older adults, to take the shot. Officials said more than 225 million Americans have completed their primary COVID-19 vaccinations, but only about 20 million have received the new booster so far.
Dr. Ashish Jha, White House COVID-19 Response coordinator, pointed out the subvariants BQ.1 and BQ.1.1 are derivatives of BA.5, which the updated booster was designed to target.
It’s still unclear whether these new subvariants will lead to a winter surge of COVID-19, but flu and respiratory syncytial virus appear to be having an active, early season both in New York and across the nation, health officials have reported.
"We know the winter is a time when viruses like COVID spread more easily," Jha said during a media briefing. "This is literally about saving lives of tens of thousands of Americans this fall and winter."
A new crop of COVID-19 subvariants is poised to take over this winter, appearing to evade some of the immunity provided by vaccines and prior infections while creating more challenges for a wary public enjoying life without pandemic restrictions.
The new strains, many already found in New York, stem from the highly contagious omicron variant, which has dominated COVID-19 cases for almost a year.
They make up an alphabet soup of names: BF.7, BQ.1, BA.4.6 and even XBB.
Experts said it’s too soon to tell which ones — if any — will become dominant in New York and across the country.
WHAT TO KNOW
- A new group of COVID-19 subvariants in New York and across the United States is causing some concern because they seem to infect people who are vaccinated and recently tested positive for COVID-19.
- The Centers for Disease Control and Prevention has warned that certain monoclonal antibody treatments, often used to treat COVID-19 patients with compromised immune systems, may not provide protection against these subvariants.
- Infectious disease experts say the best way to protect yourself, especially older adults, against severe illness and hospitalization from COVID-19 is to make sure you are up-to-date with vaccines and boosters.
“If you look at a map of variants now, it’s honestly much more complicated than a New York City subway map if you never went on a subway,” said Dr. Bruce Farber, chief of public health and epidemiology at Northwell Health. “You just see amazing numbers.”
Farber said many of the emerging omicron subvariants have been shown to infect people even if they were vaccinated or previously tested positive for COVID-19. It's uncertain whether the new subvariants will cause an increase in hospitalizations and deaths.
Like all viruses, SARS-CoV-2 — the virus that causes COVID-19 — is constantly changing.
“It is important to note that the advent of these variants is not surprising,” said Dr. Amesh A. Adalja, an infectious disease expert and senior scholar at Johns Hopkins Center for Health Security. “This virus will never be eliminated or eradicated but will continue to evolve in order to infect an increasingly immune population.”
Dr. Alan Bulbin, an infectious disease specialist at Catholic Health, said he doubts there will be a “doomsday scenario” where prior immunity and vaccination will not provide any protection at all.
“I don’t have a sense that we are going to be in a situation like that," said Bulbin, pointing out that even if they do not prevent all infections, vaccines and boosters are still the best protection against severe illness and hospitalization from COVID-19.
Scientists tracking virus
Scientists in New York and around the world are continuously examining COVID-19 samples in an effort to track the mutations of SARS-CoV-2 and find effective methods to slow its spread.
The first COVID-19 booster was formulated before omicron became the dominant variant. The current, updated bivalent booster shot was designed to protect against serious illness from both the original delta variant of the virus as well as omicron and some of its subvariants, especially BA.5.
But that booster might become dated in the coming months as other omicron subvariants start to dominate the COVID-19 landscape, Farber said.
At the end of August, the BA.5 subvariant accounted for more than 86% of cases in the United States. As of Oct. 22, it had decreased to 62%.
In New York, it decreased from 67% of samples collected between Sept. 25 and Oct. 8 to 50% in samples collected between Oct. 9 and Oct. 22.
In its place are the emerging subvariants BA.4.6, BQ.1, BQ.1.1. and BF.7, which appear to be able to spread infection to people even if they were vaccinated or recently had COVID-19.
BQ.1.1 made up just 2.8% of COVID-19 samples collected in the state between Sept. 25 and Oct. 8, but had jumped to 13.3% in the samples collected between Oct. 9 and Oct. 22.
The subvariant XBB has caused a wave of cases in Singapore and concerns over its ability to infect people who have had prior COVID-19 cases. The Centers for Disease Control and Prevention has said it is "keeping a close eye" on XBB, which is still "very rare" in the United States.
“Interestingly enough, [XBB] is not quite as contagious as the BQ.1.1, which is showing up in New York more regularly,” Farber said.
Adalja cautioned that simply because a subvariant has been shown to infect people who have some level of immunity, it doesn't mean they have lost all protection against COVID-19.
“What it means is that protection against infection — not severe disease — is not very robust, even if a person is vaccinated, has had a prior infection, or some combination,” he said. “Immunity is not all or none. There is a spectrum of protection, and what really matters is protection against severe disease … In people who are not high risk, the newer variants will likely cause only mild illness."
That’s why COVID-19 vaccines and boosters are still recommended, especially for those who are elderly or have chronic medical conditions that put them at risk for serious complications from the disease.
“By being up-to-date with your vaccines, you are very assured that you will not wind up in the hospital and die,” said Farber, pointing out that almost 400 people a day die from COVID-19 across the country. “We realize we're not going to be able to stop this cycle of variants and cycle of re-infections … So the goal has to be to prevent us from getting really sick, and that we can do.”
Joan Hitchcock , 75, of Elmont, gets a COVID-19 booster shot from nurse Lisa Sperling-Leicht on Oct. 20 at Elmont Senior Center. Credit: Debbie Egan-Chin
Decreased treatment effectiveness
Scientists are concerned about how the new subvariants will impact one of the most vulnerable segments of the population, immunocompromised people for whom the vaccine may not provide as strong a response as in those with healthier immune systems.
In many cases, they rely on additional treatments such as Evushield, a monoclonal antibody they can receive as a pre-exposure medicine.
However, the CDC has noted that Evushield could have a “decreased efficacy” against BA.4.6, BF.7 and BA.2.75.
Another treatment, bebtelovimab, appears to not be as effective against the BQ.1 and BQ.1.1 subvariants.
Monoclonal antibody treatments are also used by anyone who is likely to get seriously ill due to a COVID-19 infection.
Bulbin said other existing treatments might be able to fill that gap.
“We have Paxlovid. We have remdesivir,” he said. “And I do think the bivalent booster should still be viewed as an effective and prominent strategy, especially in the high-risk groups.”
Push for updated booster
With interest in the updated COVID-19 booster low, the White House launched an effort last week aimed at getting more people, especially older adults, to take the shot. Officials said more than 225 million Americans have completed their primary COVID-19 vaccinations, but only about 20 million have received the new booster so far.
Dr. Ashish Jha, White House COVID-19 Response coordinator, pointed out the subvariants BQ.1 and BQ.1.1 are derivatives of BA.5, which the updated booster was designed to target.
It’s still unclear whether these new subvariants will lead to a winter surge of COVID-19, but flu and respiratory syncytial virus appear to be having an active, early season both in New York and across the nation, health officials have reported.
"We know the winter is a time when viruses like COVID spread more easily," Jha said during a media briefing. "This is literally about saving lives of tens of thousands of Americans this fall and winter."
Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.
