As new COVID variants emerge, such as XBB and BQ.1 and BQ.1.1, they're also generating new names like the "nightmare variant" or "scrabble variants." But what does that mean and how worried should you actually be?
While the BA.5 subvariant remains the dominant strain in the United States this week, several other new forms of the virus are gaining ground, and physicians warn that some treatments against the illness may not be effective against them.
According to reports, the terms "Scrabble" variants was first used by Peter Hotez, co-director of the Center for Vaccine Development at Texas Children's Hospital, during an interview with the Houston Chronicle, referring to letters like B, Q and X, which are valued at high points in the game.
One important thing to note is that the XBB variant, also being called the "nightmare" variant in some reports, has not yet been detected in the U.S. But BQ.1 and BQ.1.1 are seeing some rapid increases, even in the Midwest, which has some experts worried.
According to the latest data from the Centers for Disease Control and Prevention, BA.5 is making up approximately 62.2% of COVID cases in the U.S. That subvariant has been the dominant strain of COVID since early July, but it’s rapidly declining as other strains take hold.
While the BA.4.6 subvariant is still the second-most prevalent at 11.3%, several descendants of BA.5 are rapidly gaining round. According to the CDC, BQ.1 is now responsible for 9.4% of cases, while BQ.1.1 is responsible for an estimated 7.2% of cases.
These numbers are causing some concern in the medical community, as the National Institutes of Health warns that some emerging subvariants could be resistant to monoclonal antibodies, robbing physicians of a key tool in pushing back against COVID.
News
Here's what we know so far:
BQ.1 and BQ.1.1
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"The ones that are particularly concerning are BQ.1 and another related one called BQ.1.1. Those are two that are expanding fairly rapidly in the United States," Roy Gulick, chief of the division of infectious disease at Weill Cornell Medicine and NewYork-Presbyterian Hospital, told CNBC this week.
BQ.1 and BQ.1.1 are likely to be resistant to the bebtelovimab treatment, while BF.7 is also likely to be resistant to tixagevimab and cilgavimab. Both BQ.1 and BQ.1.1, as well as BA.4.6, could also be resistant to the latter two treatments.
The aforementioned monoclonal antibodies are recommended by the CDC for use when Paxlovid or remdesivir cannot be safely prescribed to nonhospitalized adults who are at high risk of severe COVID infection.
Paxlovid does interact with certain other drugs, and is not recommended for patients with severe kidney illness or certain other ailments, according to a factsheet from the Food and Drug Administration.
Another concern is whether the new variants can evade treatment from Evusheld, which is used to prevent infections in those who are immunocompromised and not generating enough response from the vaccine.
The U.S. Food and Drug Administration earlier this month updated its information for health care providers to state that those receiving the treatment could be at an "increased risk for developing COVID-19 when exposed to variants of SARS-CoV-2 that are not neutralized by Evusheld."
Other COVID treatments are expected to remain effective against the new variants, and the new bivalent COVID vaccines are also expected to help prevent serious illness or death.
XBB
The XBB variant has been making headlines for its role in a recent wave of COVID cases in Singapore.
"The XBB variant wave in Singapore will soon be their 2nd worst for the pandemic," Dr. Eric Topol, founder of the Scripps Research Translational Institute, tweeted earlier this month. "The reinfection rate prior to the wave was 5% and now up to 17%, which tells us about the immune escape properties of this variant (akin to BQ.1.1, very high level of immune evasion)"
But late last week, he noted that the wave was starting to see a decline, which he attributed in large part to high vaccination rates in the country.
Referred to as the "nightmare" variant in some reports, XBB is the combination of two omicron subvariants - BA.2.10.1 and BA.2.10.75 - and is said to have a "significant growth advantage," said Dr. Maria Van Kerkhove, an infectious disease specialist and the technical lead for COVID-19 response at the World Health Organization.
Van Kerkhove explained data about the latest strain remains limited, but said the one study that was conducted with XBB shows "significant immune invasion." However, is it really any different than any of the other omicron strains that also appear to be more immune-invasive?
"We do know this recombinant has a significant growth advantage. All of the subvariants of omicron are showing increased transmissibility and properties of immune escape," Van Kerkhove said. "With this XBB recombinant we have one study based on a pseudo virus, so not a live virus, that is analyzing antibody escape and it's showing significant immune evasion. And this is of concern for us because we need to ensure that the vaccines that are in use worldwide will remain effective at preventing severe disease and death."
What Else to Know
Van Kerkhove said there have been no signs of increased severity in the XBB, BQ.1.1 and BQ.1 variants, "but it's very early, and we have very little data to assess this."
"We need to be prepared for this," the doctor said. "Countries need to be in a position to conduct surveillance, deal with increases in cases and perhaps deal with an increase in hospitalizations. We don't see a change in severity yet and our vaccines remain effective, but we have to remain vigilant."
Although there are increases of specific variants of the virus, the U.S. as a whole is not seeing an increase in cases. Recent decreases in cases have begun to slow, however, and officials are warning that precautions may need to be taken to avoid a fall and winter surge of the virus.
That warning was also issued in Illinois, as experts warn of a potential surge in RSV and COVID cases. RSV cases are already on the rise, especially in children, and officials fear that COVID cases could also rapidly increase due to the slow rate of uptake of the new bivalent COVID boosters.
“As health professionals, I think we can say that we are concerned,” Cook County Health Dr. Gregory Huhn said. “Historically, we know that the upcoming months typically lead to a surge in COVID.”
Cases in Illinois are showing some signs of increase, with the state now averaging 1,818 cases per day. That number is still significantly lower than what the state saw during the summer, but does represent a 25% increase over data from last week.
Three Illinois counties are now at “high transmission” rates of COVID, meaning the CDC is recommending individuals to wear masks in those areas.
Illinois has seen large surges in COVID in successive winters, including the omicron-driven surge in the winter of 2021-22 that ultimately led to a wave of illness that was sickening more than 30,000 Illinois residents per day.
Speaking during a Facebook live question-and-answer session last week, Dr. Allison Arwady, commissioner of the Chicago Department of Public Health, explained that any of the subvariants that have recently circulated are related to omicron. Because XBB, BQ.1.1 and BQ.1 all have characteristics of omicron, the vaccine and treatments for the strain should be effective, at least to some degree.
If a variant without any relation to omicron were to emerge, that could be particularly troubling.
"So I am less worried about these little ones although I don't love the more rapid increase, and I'm more concerned if we start to see something, and then not only remember how we talked about Delta didn't help us," the doctor said.
Arwady has noted that seasonal shifts could play a role in the rise of new variants.
"The way COVID, like any other virus, mutates, creates new variants is by spreading," she previously said. "Every time there's a new COVID infection, there is an opportunity for the virus to mutate just a little bit in the genetics of it. And when we start to see more COVID infections happening, we also start to see more variants. That's just how it works. So the fact that we're heading into colder weather, it doesn't surprise me at all that we would see more mutations."
Dr. Anthony Fauci, White House chief medical advisor, said it does appear that the new bivalent COVID boosters, specifically formulated to combat omicron subvariants, are still effective at preventing serious illness and death even with the new variants that are emerging. However, he did note the data was preliminary.
Arwady agreed, encouraging people to take prevention measures with the possibility of a COVID surge this winter.
"We're not in quite as stable place as we were six weeks ago... but the best news is everything is still omicron," she said. "And so getting your fall 2022 vaccine should give us that extra protection we're going to need... remember that the updated variant is specifically good for the BA.4, BA.5, which is more than 80% of what we're seeing right now."
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