New Omicron subvariants BQ.1, BQ.1.1 make gains as BA.5 fades

The rise of new coronavirus subvariants continues to erode the grip Omicron strain BA.5 has held for months, worrying health officials that a winter resurgence of COVID-19 could be imminent.

BA.5’s longstanding dominance is tempered by a pair of his own offspring: BQ.1 and BQ.1.1. Like BA.5 are the two subvariants of the original strain of Omicron coronavirus that swept the world last fall and winter.

BA.5 has long been responsible for the vast majority of new coronavirus cases nationwide, according to data from the US Centers for Disease Control and Prevention. However, that these other two strains are increasing in their respective proportions of cases may indicate that they are enjoying an additional growth advantage.

But what that ultimately means for this fall and winter — a time when many health experts have already predicted some level of COVID-19 resurgence — remains to be seen.

Los Angeles County Director of Public Health Barbara Ferrer recently noted that “emerging variants and subvariants of the virus have played a large role in driving past flare-ups.”

“We should prepare for the possibility of another winter flood. We want to be realistic because every surge in COVID comes with an additional risk,” she said Thursday. “However, we are also optimistic because we have powerful tools at our disposal, including therapeutics and the new bivalent boosters that can mitigate the effects.”

At this point, BA.5 remains the most circulating version of the coronavirus in the United States — accounting for an estimated 49.6% of new cases in the week-to-Saturday period, CDC data show.

Just a month ago, federal health officials estimated it was the culprit behind nearly 82% of new cases.

During the same period, BQ.1 increased its estimated share from 1.2% to 14%, CDC data shows. BQ.1.1 has grown from an estimated 0.5% to 13.1%.

“While there are no data on severity or immune escape from human studies, BQ.1 [and its sublineages are] It shows a significant growth advantage over other circulating Omicron sublineages in many settings, including Europe and the US, and therefore requires close monitoring,” said a statement by the World Health Organization’s Technical Advisory Group on SARS-CoV-2 virus development, dated Thursday.

“It is likely,” the statement continued, “that these additional mutations conferred an immune escape advantage over other circulating omicron sublineages, and thus a higher risk of reinfection is a possibility that requires further investigation.”

According to the statement, there is currently no epidemiological data to suggest that BQ.1 or its derivatives are associated with increased disease severity or that they significantly reduce vaccine protection against serious disease.

Even if BQ.1 or BQ.1.1 doesn’t make people sicker, that doesn’t mean their ascension is without risk. As has been shown throughout the pandemic, higher infection rates threaten to put additional strain on the healthcare system.

Coronavirus-positive patients, whether admitted because of COVID-19 illness or with an accidental infection, need special attention and resources to prevent them from spreading the virus to others. Increased community transmission can also sicken healthcare workers, causing staff disruptions and even shortages.

Circulating other respiratory illnesses — namely influenza and respiratory syncytial virus (sin-SISH-uhl), or RSV — could also exacerbate any challenges of a coronavirus rebound. Both RSV and influenza are now much more active than usual for this time of year, a development that may indicate some concerns about particularly difficult times of the year.

“We know that winter is a time when viruses like COVID spread more easily,” said Dr. Ashish Jha, the White House COVID-19 response coordinator, last week. “We are also seeing increases in other seasonal viruses such as influenza and RSV. And we know that COVID is still evolving. We see new subvariants. We are seeing an increase in cases and hospital admissions in Europe.”

But while “some challenges lie ahead,” Jha said, “the good news here is that unlike winters past, we’re in control.”

“We have the tools we need to ensure people have a safe and healthy holiday season,” he said. “And the most important tool is the updated COVID-19 vaccine.”

As immunization protection decreases over time, many could be at higher risk depending on how long it has been since they were last vaccinated.

In mid-October, the California Department of Health said about 21.9 million people — about 78% of all vaccinated recipients — were at least six months away from their last dose.

Uptake of the updated bivalent boosters, designed to protect not only against the original coronavirus strain but also against the Omicron subvariants BA.5 and BA.4, has also been slow.

About 11.4% of eligible Californians received the extra dose, state data shows. According to the CDC, nationwide bivalent coverage among eligible recipients is 7.3%.

That percentage includes President Biden, who was filmed on camera last week to promote the updated vaccine.

“It’s incredibly effective, but the truth is not enough people are getting it,” he said. “We need to change that so we can all have a safe and healthy holiday season.”

Regarding booster coverage, “we’re nowhere near where we need to be to actually step into the colder months, the holidays, with this kind of added protection for the community,” Ferrer said.

“We are so fortunate to live in this country where we have ample access to one of the best safeguards against serious consequences of influenza or COVID that will ensure we get our vaccine,” she said Thursday. “So we want to make sure everyone understands that we’re not helpless here. And most importantly, we are not helpless in trying to mitigate the impact that multiple transmissions can have on our healthcare systems.”

In LA County, coronavirus cases are no longer declining as quickly as they were in the summer and appear to have reached a plateau. In the seven days ended Monday, LA County recorded an average of 979 cases per day, a 7% increase from the previous week. On a per capita basis, LA County recorded about 68 cases per week per 100,000 people.

“We’re not seeing a steady decline in cases anymore,” Ferrer said. LA County’s case rate began increasing week-on-week just after mid-October.

Cases could also increase nationwide. The daily average number of cases in California rose 18% from 2,681 to 3,152 in the most recent week of available data. On a per capita basis, the state was recording 56 cases per week per 100,000 residents.

Virus concentrations in sewage — a key metric since many coronavirus cases are self-diagnosed using home testing and are not formally reported to public health officials — are also increasing in LA County. The level is now 31% of the summer high recorded in July, up from 21% a week earlier.

Ferrer described the increase as “slight” and “no cause for concern.” Nonetheless, it suggests that “locally, there is no longer a consistent decline in COVID-19 transmission.”

LA County’s death rate has remained broadly stable over the past month, averaging 65 to 84 COVID-19 deaths per week. That’s an improvement from the summer Omicron peak of 122 weekly deaths, but still well above the spring lull in May, when weekly deaths fell to a low of 24 COVID-19 deaths per week.

The US recorded an average of about 400 COVID-19 deaths per day in October, up from the spring break of about 300 daily deaths.

“We still have hundreds of people dying of COVID every day in this country — hundreds. That number is likely to increase this winter,” Biden said. “But this year is different than in the past. Almost every death this year is preventable.”

For the one-year period ended October 26, approximately 315,000 U.S. citizens were reported dead from COVID-19. That’s nine times the national average number of flu deaths a year, which is about 35,000.

Ferrer noted that BQ.1 and BQ.1.1 have attracted considerable attention “because they have observed a doubling nationally in a very short period of time and we have to pay attention to that.”

So far, however, they remain at low levels in LA County. In the week ended Oct. 8, both accounted for just 2.7% of LA County’s weekly copies.

“With the relatively small number of recently sequenced specimens of these new sublineages in LA County, there is not a single candidate that we can say with certainty that is likely to outperform other circulating strains,” Ferrer said. But it’s important to monitor trends elsewhere to see what might come next, she added. New Omicron subvariants BQ.1, BQ.1.1 make gains as BA.5 fades

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