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Everything We Know About the New COVID Subvariants

An illustration of the COVID virus
Matt Anderson Photography/Getty Images
For the most up-to-date news and information about the coronavirus pandemic, visit the WHO and CDC websites.

What's happening

COVID cases are rising throughout the US. Health officials in places with greater spread are reminding people to wear masks indoors and on public transportation.

Why it matters

COVID-19 is still with us. New versions of the omicron variant are causing most current cases and have reduced the effectiveness of some treatments.

What it means for you

An antiviral pill is available for people at higher risk of getting really sick from COVID-19. Testing before big gatherings, wearing a mask in public and staying up-to-date on your vaccine series will still help protect you and the people around you.

Health officials in some cities and states are recommending people wear masks indoors, including in New York, Los Angeles and Washington state. The US Centers for Disease Control and Prevention recommends masks indoors and on public transportation in communities where COVID-19 levels are high, which accounts for an increasing number of people as winter rolls in. 

COVID-19 cases are rising again in the US, according to data collected by The New York Times and the US Centers for Disease Control and Prevention. Hospitalizations are also up, but not just from COVID-19. We're also in the middle of an unusually harsh flu season and are seeing a swell of RSV cases. 

About 68% of COVID-19 cases in the US are now caused by variants BQ.1 or BQ.1.1, according to the latest estimate by the CDC. Both are subvariants of omicron, which has had a tight grip on the world since last winter. 

BA.5, the highly contagious omicron subvariant that caused a lot of reinfections or first infections in people who hadn't had COVID-19 before this summer and fall, is fading and now only responsible for about 14% of cases. 

Viruses like COVID-19 mutate; we've learned to accept this by now. But not all mutations are created equal, which is why scientists are watching to see how the plethora of omicron forms will affect people this winter, when there are also a high number of influenza and RSV cases circulating. 

Despite an uptick in COVID-19 cases and hospitalizations, deaths reported from COVID-19 are down considerably compared to earlier COVID-19 waves, though somewhere between 250 and 350 people per day are still dying from COVID-19. The stability we had this fall, however, may be coming to an end. 

According to The New York Times' COVID-19 data tracker, hospitalizations are rising again in nearly all states.

As with all new versions of COVID-19, we'll need more time to see how BQ.1 and BQ.1.1 play out in the US -- especially after the holidays, with the travel and gatherings that we may expect to fuel the fire of contagious illnesses like COVID-19 and influenza. Both have also reduced the effectiveness of our monoclonal antibody treatments, which have been reserved for immunocompromised patients.

Here's what we know about the latest versions of omicron.

What are BQ.1 and BQ.1.1? 

BQ.1 and BQ.1.1 are newer versions of the omicron variant -- a "variant of concern" that first emerged last winter and caused a massive wave of COVID-19 infections. According to the World Health Organization, BQ.1 is specifically descended from BA.5 and carries a few extra mutations. BQ.1.1 carries an additional key mutation, making it one to keep an extra close eye on.

Omicron, delta, alpha and earlier strains of COVID-19 were given their own Greek alphabet label and separate distinction as variants of concern because they proved troublesome enough to scientists in the way they evaded vaccine immunity, caused more severe illness or created more serious problems. By contrast, although BA.5 was extremely contagious and caused more reinfections in people who already had COVID-19, it didn't necessitate a big enough change in our public health response to get its own name from the WHO, according to the classification logic.

A red-and-blue rainbow illustration of the virus that causes COVID
Andriy Onufriyenko/Getty Images

Will vaccines and treatments work against them? 

Monoclonal antibody treatments, including Evusheld for immunocompromised patients, will likely no longer work against BQ.1 or BQ.1.1, according to information from the National Institutes of Health. Bebtelovimab (the monoclonal antibody made by Eli Lilly) also doesn't work against the now-dominant subvariants of COVID-19, and the FDA revoked its authorization in the US on Nov. 30. Other monoclonal antibody treatments were removed from the US market earlier in the pandemic as the virus rendered them ineffective. 

There's no indication that Paxlovid, an antiviral for higher risk patients in the first few days of their illness, won't work against the newer forms of omicron.

How much protection will be given against BQ.1 and BQ.1.1 from the new, updated boosters, which are tweaked formulas meant to target the BA.5 subvariant in addition to the "original" form of the virus? Moderna said earlier this month that a small analysis showed a "robust" antibody response against BQ.1.1, though there was about a five-fold drop in antibody titers compared to BA.4/BA.5, Moderna said. Some early research does suggest that BQ.1.1 is neutralized more effectively by the bivalent boosters compared to the original vaccines. 

While there's still some gray area over how much better the new boosters are at protecting people compared to the original formulas, and some scientists have called for a new approach to vaccines in general (which could possibly include a faster track for a nasal COVID-19 vaccine), boosters and vaccines in general have protected against severe disease and death throughout the pandemic and across mutations of the virus. In August, unvaccinated adults were over five times more likely to die from COVID-19 compared to adults aged 18 and up who were up to date on their shots.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.