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New COVID Variants Are Gaining Ground. Is a Winter Wave Coming?

The proportion of U.S. cases caused by omicron offshoots, including BQ.1, BQ.1.1 and BF.7, is on the rise

New COVID variants are emerging.
MARVIN RECINOS / Getty Images

Omicron’s BA.5 is still the dominant subvariant of the coronavirus circulating in the U.S., but a few strains are quickly catching up to it, and experts are keeping a close eye on their potential to upend the progress made since last winter’s surge as we head into another cold-weather season.

Among the emerging subvariants are BQ.1 and BQ.1.1, two offshoots of BA.5 that together account for roughly 44 percent of coronavirus infections in the U.S. (BQ.1 causes about 20 percent of COVID-19 cases; BQ.1.1 accounts for about 24 percent.) In some areas of the country, their proportions are even higher, data from the Centers for Disease Control and Prevention (CDC) shows. 

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Trailing them is BF.7, also an omicron descendant, which is behind about 8 percent of COVID-19 cases in the country. Then there’s BA.4.6, which accounts for nearly 6 percent of coronavirus infections.

It’s unclear whether the new crop of subvariants will drive a new wave of illness this winter, like we’ve seen when delta and omicron surfaced. But we do know that viruses, including the one that causes COVID-19, spread more quickly and easily in the winter when people spend more time inside, White House COVID-19 Response Coordinator Ashish Jha, M.D., told AARP.

It’s also become apparent that BQ.1.1 has “a very high degree of immune escape,” Jha said, meaning its mutations make it better able to slip past the body’s defenses. If it’s been nearly a year since you’ve been boosted for COVID-19 or infected with the virus, “you're not going to have very much protection against BQ.1.1,” Jha said.

COVID-19 cases in the U.S. have remained relatively low this fall compared to summer counts, though the University of Washington’s Institute for Health Metrics and Evaluation (IHME) predicts that infections will pick up in December and January.

And although an average of more than 3,300 Americans are hospitalized each day with COVID-19, new hospital admissions have declined. (Projections from IHME show a slight increase in hospitalizations through January 2023.)

Booster shots could keep hospitalizations low

One thing that could help subdue a storm of hospitalizations this winter: the updated COVID-19 bivalent booster shots, which are available to vaccinated people 5 and older. These shots target omicron subvariants BA.4 and BA.5 and the original strain of the virus for a broad swath of protection. Because BQ.1 and BQ.1.1 are descendants of BA.5, “we believe that the brand-new updated COVID vaccines should provide a high degree of protection against BQ.1.1 and other subvariants that emerge,” Jha told AARP.

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A report from the Commonwealth Fund says that if 80 percent of eligible Americans roll up their sleeves for the newly updated shot, 936,706 hospitalizations due to COVID-19 could be averted and nearly 90,000 lives could be saved.

If the booster uptake is even equivalent to the recent flu vaccine uptake (about half of adults got their flu shot in 2020-2021, the latest data available shows), more than 75,000 deaths and 745,409 hospitalizations due to COVID-19 could be prevented.

Only about 10 percent of Americans 5 and older (about 31.4 million people) have received this new shot, CDC data shows.

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At-home treatments work against subvariants    

Another factor that could affect the winter outlook: COVID-19 treatments. The U.S. Food & Drug Administration (FDA) said in a Nov. 4 news release that the monoclonal antibody bebtelovimab “is not expected to neutralize Omicron subvariants BQ.1 and BQ.1.1.”

What’s more, subvariants BA.4.6, BF.7, BQ.1 and BQ.1.1, among others, are likely to be resistant to Evusheld, a monoclonal antibody treatment used as a pre-exposure prophylaxis in immunocompromised individuals, according to the National Institutes of Health.

The oral antiviral Paxlovid, however, is still expected to work against the latest subvariants, the FDA said. The same goes for antiviral medications molnupiravir (also a prescription pill that can be taken at home) and remdesivir, which is given by IV.

A layered approach is key

The emergence of these variants tells us that the pandemic isn’t over and that taking a layered approach — and not relying on one tool alone — is going to be key this fall and winter, says Sabrina Assoumou, M.D., a professor in the section of infectious diseases at the Boston University School of Medicine.

First, make sure you’re up to date on your COVID-19 vaccines. And just like you check the weather for the week to prepare your wardrobe, pay attention to COVID-19 cases in your area.

Will There Be A COVID Surge This Winter?

“I bring an umbrella [if] it’s raining. And you know, if cases are going up, I’m going to be masking up during that time period, until cases start going back down,” Assoumou says.

Another important tool to keep on hand: COVID-19 tests. Even if you’re experiencing just mild symptoms — a sore throat or cough — it’s important to test, says Aditya Shah, an infectious disease specialist at the Mayo Clinic. (There’s no indication that the new variants have affected the capabilities of our testing tools to detect infections, he adds.)

If you’re positive for COVID-19, your health care provider may recommend Paxlovid or another treatment to help keep a mild infection from progressing to something more severe.

“And you will not be eligible for [treatments] if you cross a certain threshold of time from the start of your symptoms or if you don’t get tested,” Shah says. “You should not be sitting home waiting it out, saying, ‘Oh, I think I’ll be fine in a couple of days.’ You may be, but you may not be too.”

study recently published in The New England Journal of Medicine found that older adults who took Paxlovid during the Omicron surge had a significantly lower risk of being hospitalized for COVID-19 or dying from the disease than those who didn’t take the antiviral.

“The best thing is to be vaccinated and to use tools like rapid tests and Paxlovid,” says Amesh Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security. “That’s how we tame this virus, by using all those tools.”

Finally, it’s important to remember that COVID-19 is not the only contributor to spikes of illness during the cold-weather months. Influenza sends more than 200,000 Americans to the hospital each year, and some areas of the country are already being hit hard by the virus.

Likewise, cases of respiratory syncytial virus (also known as RSV), which is most dangerous in infants and older adults, typically spike in the winter. There is no vaccine available for RSV, and cases in the U.S. are surging.

“The best thing people can do in terms of protecting themselves at this moment is getting both the updated COVID vaccine and the flu vaccine,” Jha said. “And if they do, I really do think that we're going to get through this fall and winter without a lot of disruption, without a lot of people getting sick.”

Editor's Note: This story, originally published Oct. 7, 2022, has been updated to include new information.