XBB.1.5

Covid-19: What do we know about XBB.1.5 and should we be worried?

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What is XBB.1.5?

XBB.1.5 is yet another omicron subvariant, and follows on from XBB and XBB.1. Scientists have nicknamed it “kraken” to distinguish it from the “variant soup” we are all navigating three years into the pandemic.1 The X signifies that these subvariants came about through a recombination of two or more sublineages—in this case BA.2.10.1 and BA.2.75.2

According to UCL Genetics Institute director Francois Balloux, a professor of computational systems biology, XBB.1.5 differs from XBB.1 through the addition of a F486P mutation in the spike protein. “This mutation makes it slightly less immune evasive than its XBB.1 ancestor but more infectious, probably because it increases binding affinity to the human cell receptor ACE-2,” he said.

Where is XBB.1.5 spreading?

The World Health Organization has reported that XBB.1.5 is present in 38 countries.3

The UK Health Security Agency (UKHSA) said it is one of two variants most likely to become dominant in the UK, despite representing less than 5% of all SARS-CoV-2 samples sequenced in the last week of 2022. The agency has described the variant as having a combination of “immune escape properties” and a higher ACE-2 binding affinity, which it said could lead to higher transmissibility. “It is plausible that XBB.1.5 will cause an increase in incidence after the current wave, however it is currently too early to confirm this trajectory,” UKHSA said.4

Meanwhile, the European Centre for Disease Prevention and Control (ECDC) has said there is a “moderate probability” that XBB.1.5 will become dominant across the European Union and European Economic Area and cause a “substantial increase in the number of covid-19 cases within the next one to two months.”

In the US the Centers for Disease Control and Prevention has said the variant is “spreading quickly” and is estimated to make up around 28% of cases in the country (week ending 7 January 2023).

“XBB.1.5 is widely anticipated to go up in frequency globally, and may cause a sizeable fraction of cases globally in the near future,” Balloux said. “That said, it remains questionable whether XBB.1.5 will cause a major wave on its own.”

Does it cause more severe illness?

This is still under review. According to WHO, however, XBB.1.5 “does not carry any mutation known to be associated with potential change in severity.” This appears to be supported by the ECDC, which said that there are no indications that XBB.1.5 will be any more severe than the other omicron sublineages that have circulated.

Do the current covid vaccines protect against XBB.1.5?

Specific vaccine effectiveness estimates are not yet available for XBB.1.5, but WHO has warned that it may have the “highest immune escape to date.” Its evidence suggests people who have had three or four doses of an mRNA covid-19 vaccine (such as Moderna or Pfizer) plus a BA.5 infection, or three doses of the Chinese Coronavac vaccine plus previous infection with BA.1, BA.5, or BF.7 “do not induce high neutralisation titers against XBB.1.5.5.”

The ECDC has also warned that its predecessors—XBB and XBB.1—showed “significant reductions in the neutralising capacity of serum from vaccinated people.” Despite this, the agency has said the available vaccines “still remain effective against severe disease because of previous and current omicron variants dominant in the EU, even though there is some evidence of waning over time.”5

It is not yet clear whether an XBB-specific booster vaccine could be needed, but experts have called on those eligible to get available booster vaccines where possible.

Is XBB.1.5 a cause for concern?

While much of the evidence surrounding XBB.1.5 is still being collected and reviewed, experts have said there is currently no need to be alarmed by this variant.

Ashall professor of infection and immunity at the University of Oxford Andrew Pollard, who led the team that developed the Oxford AstraZeneca vaccine, told The BMJ, “We should be cautious not to drive fear that each new variant heralds a new crisis in the pandemic. There is no reason to think that XBB.1.5 is of any more concern than other variants that come and go in the ever changing landscape of covid-19 mutants.”

Pollard said that, in the UK at least, the focus needs to be on ensuring the healthcare system can cope with not just covid-19, but all patients.

“In the UK today, the problem is not new infections with covid-19, which is just one of many non-pandemic viruses that make us sick, but the chronic shortage of capacity, funding, and staff in our health and social care system. We have to plan for expected winter pressures from infections and need to develop the resources to accommodate a growing elderly population over the decades ahead,” he said. “These are not easy problems to solve but, unlike pandemics, they are not easily solved by leaps in science or short term fixes but by a long term vision for our health shared across the political divide.”

Is XBB.1.5 the Most Transmissible Variant?

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It's still unclear what to expect from the XBB.1.5 variant. (Shutterstock)

It’s still unclear what to expect from the XBB.1.5 variant. (Shutterstock)

Omicron XBB.1.5, also called the “Kraken” variant, is currently responsible for nearly 50 percent of new cases this month, the U.S. Centers for Disease Control and Prevention (CDC) estimates. The World Health Organization (WHO) recently warned that XBB.1.5 could start a worldwide escalation in COVID-19 infections.

However, it also noted that growth advantage estimates are only from the United States, so the organization rated its confidence in their escalation assessment as “low,” while warning the variant could more easily evade protective measures.

“Along with BQ.1 variants, XBB variants are the most antibody-resistant variants to date,” the WHO said in a statement (pdf).

Steep Rise in Cases

By end of December 2022, XBB.1.5 accounted for just under 12 percent of infections, but by the first week of January, that number has risen to 43 percent, according to CDC data.

In a Jan. 4, Twitter post, White House COVID-19 coordinator Ashish Jha called this a “stunning increase.”

Jha said that while XBB.1.5 could be more contagious, but it’s still unclear whether it causes more severe disease.

A new, not yet peer-reviewed study reveals a likely reason why this variant is spreading so fast.

The researchers found XBB.1.5 binds more tightly to human ACE receptors compared to other circulating variants. This may be due to a rarely seen amino-acid change, called F486P, in the spike protein.

“Over time, the SARS-Cov-2 ancestral strain has been replaced by variants which are more easily transmissible and immune-evasive,” Dr. Miriam Smith, chief of infectious disease at Long Island Jewish Forest Hills in Queens, told The Epoch Times.

“Most recently, the XBB.1.5 subvariant arose through genetic recombination between other Omicron variants,” she continued.

The prefix “X” in the variant’s name is how virologists label a pathogen that evolved through genetic recombination between two or more subvariants.

Most Transmissible COVID-19 Variant Yet

Last week, the New York City Department of Health announced that Omicron XBB.1.5 accounted for 73 percent of all sequenced COVID-19 cases in the nation’s most populated city.

“It may be more likely to infect people who have been vaccinated or previously had COVID-19 compared to prior variants,” the agency cautioned.

According to the most current CDC data, the Northeastern United States is most affected by XBB.1.5, with around 80 percent of cases in the region being caused by the variant.

Dr. Eric Cioè-Peña, director of Global Health for Northwell Health, explained that XBB.1.5 is different in similar ways that previous variants differed from what was circulating when they emerged.

This means it has many mutations that help it dodge existing immunity and is very infectious.

“It takes less time with someone who’s sick, and less quantity of viral exposure to get infected,” said Cioè-Peña.

But does this mean it’s an entirely new variant—something novel that COVID-19 vaccines may not work against? Cioè-Peña said it is, and it isn’t.

“COVID vaccines are less effective in preventing infection,” he said. “Until now, it seems like they are still effective in protecting you once you are infected, from needing oxygen, hospitalization, or [from dying].”

However, it’s still too early to tell if the vaccine will continue to provide protection from XBB.1.5.

Cioè-Peña thinks the most recent booster that targets Omicron subvariants is more effective than the original vaccine.

The New Bivalent Vaccine

In December 2022, the CDC reported that the bivalent vaccines had demonstrated protection against hospitalization and mortality versus the unvaccinated population or recipients who have been vaccinated and boosted—especially for those 65 years of age or older.

“This protection has been shown to hold for the XBB.1.5 subvariant as well,” said Smith.

The elderly population, patients with major underlying co-morbid conditions that put them at risk for severe disease, and patients with underlying immunosuppressive disorders should receive the bivalent vaccine, advised Smith.

However, she emphasized that while not yet clearly known, “the durability of the protective effect from these vaccines will likely decrease after six months.”

But the shots are controversial.

Some studies indicate the bivalent shot might not be more effective at preventing COVID-19 infections than the original shots. One study was co-authored by Dr. David Ho, a professor of microbiology and immunology at Columbia University, and another by Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center.

As the virus mutates over time, is it possible that available vaccines won’t offer any protection against a new variant? Could we, at some point, be facing a new and deadlier phase of the pandemic?

“That’s always a risk,” said Cioè-Peña, “but the more we get ‘used’ to COVID, immunity-wise, the less chance [there is] of that occurring.”

He added that there’s always a risk that there could be a major shift, “almost so it’s a completely new coronavirus,” and that could be a game changer for the pandemic.

People who haven’t had COVID will likely catch XBB.1.5 – and many will get reinfected, experts say

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Variant XBB.1.5 is very contagious, meaning everyone is at risk even if you’ve already been infected. As the U.S. enters year 3 of the pandemic, here’s an update on the state of COVID.

The newest COVID-19 variant is so contagious that even people who’ve avoided it so far are getting infected and the roughly 80% of Americans who’ve already been infected are likely to catch it again, experts say. 

Essentially, everyone in the country is at risk for infection now, even if they’re super careful, up to date on vaccines, or have caught it before, said Paula Cannon, a virologist at the University of Southern California.  

“It’s crazy infectious,” said Cannon, who is recovering from her first case of COVID-19, caught when she was vacationing over the holidays in her native Britain. 

“All the things that have protected you for the past couple of years, I don’t think are going to protect you against this new crop of variants,” she said. 

The number of severe infections and deaths remains relatively low, despite the high level of infections, she said, thanks to vaccinations – and probably – previous infections. But the lack of universal masking means that even people like her, who do wear masks, are vulnerable.

A look at the state of the COVID-19 pandemic, according to data from the CDC.

The latest variant, called XBB.1.5, grew exponentially over the month of December, from about 1% of cases nationwide to 27% as of Jan. 7, according to data from the Centers for Disease Control and Prevention. The variant is likely behind the vast majority of cases in New York and New England. 

Its growth is probably due to XBB.1.5’s characteristics – it appears to bind even more tightly to receptors in the human body than its predecessors – as well as human behavior, such as traveling and not masking.

It’s a good idea to do what you can to avoid getting infected, said Dr. Ziyad Al-Aly, chief of research and development at the VA St. Louis Health Care System and a clinical epidemiologist at Washington University in St. Louis.

It’s still early and there are a lot of unknowns about XBB.1.5, he said. Every infection makes someone vulnerable to a bad course of the disease and to the lingering, miserable symptoms of long COVID, Al-Aly’s research shows.

“Reinfection buys you additional risk,” he said.

As the United States enters the fourth year of COVID-19, we’re providing an update on the state of the pandemic. Here’s a preview of what you’ll learn in this article: 

What to know about XBB.1.5 symptoms and how long they last

COVID-19 symptoms typically last around five to seven days and can include fever, sore throat, muscle aches, exhaustion, nausea, cough and sinus congestion, among other problems.

Symptoms with XBB.1.5 are the same as with earlier variants and can range from almost nothing to shortness of breath and low oxygen levels that require emergency medical attention.

Early in the pandemic, COVID-19 often cost people their sense of taste and smell, at least temporarily, but that symptom seems less common, possibly because of vaccination or previous infection rather than a change in the virus, said Dr. Peter Hotez, an infectious disease specialist and co-director of the Center for Vaccine Development at Texas Children’s Hospital. 

How long does COVID last? How long are you contagious? 

It takes anywhere from two to 14 days for exposure to lead to symptoms and a positive test.  

People with COVID-19 are contagious as long as they remain positive on a rapid test, typically for about 10 days, but often longer. 

The CDC recommends people isolate for at least five days and wear an N95 or similarly protective mask for at least 10 days when around others. Day One is considered the first full day after symptoms start.

A PCR test, which is considered the gold standard for diagnosing COVID-19, can remain positive for months because it detects viral fragments as well as the whole, infectious virus. To confirm the end of the contagious period, experts instead recommend a negative rapid test after 10 days or two within 48 hours if sooner.

Can you get COVID more than once?

Yes. While a previous infection provides some protection, that fades over time and as the virus evolves into different variants. 

Some people who had a mild case with a first infection get hit harder the second or third time, while others might suffer less. 

“Even if you’ve had it before, that doesn’t mean your next bout is going to be the same,” Cannon said. There are lots of factors at play in determining the seriousness of an infection, she said, including prior immunity, the nature of the variant and how long it’s been since your last infection or vaccination.

It’s possible that her recent infection was much milder than her husband’s, for instance, because she had caught a head cold a few days earlier, while her husband hadn’t. A respiratory virus can put the immune system on high alert and might have provided some protection when she was exposed to COVID-19.

“It’s part of the bigger dance between our bodies and our immune system,” Cannon said.

How to avoid infection 

The methods for avoiding infection haven’t changed, though it can be hard to stick with them when no one else is: Get vaccinated, wear a mask and avoid crowded spaces.

First is getting vaccinated. This will protect against severe infection as well as reduce the risk of passing the virus to others, said Hotez, also dean of the National School of Tropical Medicine at Baylor College of Medicine.

The newer boosters, which take aim at both the original virus and the BA.4/BA.5 variants common this summer, are more protective against XBB.1.5 than earlier boosters. People who are up to date on their COVID-19 shots probably don’t shed as much virus for as long, so they’re also less likely to pass it on, he added.

Past infection provides some protection against severe disease, but that protection is “highly unreliable,” Hotez said.

Second is wearing a mask. Good quality, well-fitting masks, like an N95 or KN95 can reduce the risk of infection.

N95 and KN95 masks offer more protection in comparison to other masks.

Cannon said people sometimes get annoyed at her mask-wearing “because it’s like I’m reminding them that (COVID) is still a problem.” But she doesn’t want to accidentally pass COVID on to someone who might be more vulnerable to the virus. 

Third is avoiding crowded indoor spaces. You’re less likely to get infected in large indoor spaces with high ceilings and lots of ventilation than in cramped, airless ones.

What to do if you get sick  

It’s a good idea to have a plan ready in case you get sick, Cannon said. She suggests every plan include: 

  • How to isolate from others in your household
  • The contact number for a health care provider who can prescribe an antiviral
  • Equipment such as rapid coronavirus tests, extra masks, a thermometer and a pulse oximeter to make sure the patient’s blood oxygen level doesn’t drop below the low 90s

Every U.S. household is eligible for four free coronavirus tests from the government that can be ordered from this link: covid.gov/tests.

For someone over 60 or with medical conditions like obesity that raise the risk for serious disease, the first step after a positive test should be a call to the doctor to get the antiviral Paxlovid, she and others said. The government has pre-bought millions of doses, so they are available for free.

This image, provided by Pfizer in October 2021, shows the company’s COVID-19 Paxlovid pill that patients can take at home to head off the worst effects of the virus.

Some doctors are hesitant to provide the antiviral because people may need to stop taking common medications during the five-day treatment course, but it’s essential for people at high risk for serious disease, Hotez said. “Any senior going on Paxlovid is not dying,” he said.

“We can’t stop people getting infected,” Cannon added, “but we absolutely can stop people from being seriously ill. Gosh, why wouldn’t you take it?”

Why it’s better not to get infected   

Every COVID-19 infection increases your risk for serious disease and for long COVID, which brings sometimes debilitating symptoms that can linger for a year or more.

More than 3,500 people have died from long COVID-19 in the US, CDC reports.

Older adults are more vulnerable, Al-Aly said, “but it doesn’t mean younger people are totally shielded.” Long COVID, too, can strike people at any age from childhood through to the 101-year-old recently treated at his hospital, he said. 

Vaccination reduces the risk of long COVID by 15% to 30%, according to a study he recently published. Another study he is working on shows Paxlovid reduces the risk by 26%.

Cannon’s daughter works in a long COVID clinic and regularly sees patients who are in their 20s or 30s, “healthy people who didn’t even have a particularly bad bout of COVID who now have a massively debilitating set of symptoms.”

All six experts interviewed by USA TODAY this week dismissed the idea that there is somehow an upside to getting infected: Vaccination provides better protection against future infection without the risk.

“I’d be happy if I never got any virus again,” Cannon said. “And I say this as a professional virologist.”

Could we be nearing the end of COVID?

COVID-19 has been perhaps the most successful virus in all of human history, Cannon said, infecting billions of people across the planet.

While she worries about how it might continue to evolve, she hopes it’s a good sign that for the last year, all the variants have been descendants of omicron.

Before that, the original virus, alpha, beta and delta had been “radically” different from each other.

“The virus is now in this committed lineage,” Cannon said, which might mean it won’t evolve away from the protection against serious disease thatnearly everyone now has from vaccinations and previous infections.

New Omicron Subvariant Is ‘Crazy Infectious,’ COVID Expert Warns

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The newest subvariant of Omicron, XBB.1.5, is so transmissible that everybody is at risk of catching it, even if they’ve already been infected and are fully vaccinated, a health expert told USA Today.

“It’s crazy infectious,” said Paula Cannon, PhD., a virologist at the University of Southern California.  “All the things that have protected you for the past couple of years, I don’t think are going to protect you against this new crop of variants.” 

XBB.1.5 is spreading quickly in the United States. It accounted for 27.6% of cases in the country last week, up from about 1% of cases at one point in December, according to the U.S. Centers for Disease Control and Prevention.  It’s especially prevalent in the Northeast, now accounting for more than 70% of the cases in that region.

It’s spreading across the globe, too. Maria Van Kerkhove, PhD., technical lead of the World Health Organization, has called XBB.1.5 is “the most transmissible subvariant that has been detected yet.” 

Ashish Jha, MD, the White House COVID-19 response coordinator, tweeted a few days ago that the spread of XBB.1.5 is “stunning” but cautioned that it’s unclear if the symptoms of infection will be more severe than for previous variants.

“Whether we’ll have an XBB.1.5 wave (and if yes, how big) will depend on many factors including immunity of the population, people’s actions, etc.,” he tweeted. 

He urged people to get up to date on their boosters, wear a snug-fitting mask, and avoid crowded indoor spaces. He noted that people who haven’t been infected recently or haven’t gotten the bivalent booster likely have little protection against infection.

The symptoms for XBB.1.5 appear to be the same as for other versions of COVID-19. However, it’s less common for people infected with XBB.1.5 to report losing their sense of taste and smell, USA Today reported.

Here’s What to Know About XBB.1.5

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Its immune evasiveness didn’t come at a cost in transmissibility, virologist says

A computer rendering of COVID viruses in an urban night scene.

The new Omicron subvariant XBB.1.5 is growing rapidly in the U.S., becoming one of the most common strains along with BQ.1.1 and BQ.1.

XBB.1.5 now accounts for an estimated 18.3% of COVID cases in the U.S., up from 11.5% the week prior, according to CDC dataopens in a new tab or window. [Editors’ Note: And up to 27.6% for the week ending January 7.]

Just 1 month ago, in the first week of December, XBB.1.5 accounted for only 2% of all COVID cases in the U.S., CDC data show.

It’s particularly prevalent in the Northeast, found in about 60% of infections there, according to the agency.

Overall in the U.S., the BA.5 variant has all but disappeared, while BQ.1.1 is the second most common variant, at 37% of cases, followed by BQ.1 at 24%.

XBB.1.5 evolved from XBB.1, which evolved from XBB — an Omicron subvariant that emerged in India in mid-August and quickly became predominant there, as well as in Singapore and other regions in Asia, according to a paper in Cell Reportsopens in a new tab or window.

XBB involved a recombination of two descendants of the BA.2 variant, according to virologist Jesse Bloom, PhDopens in a new tab or window, of Fred Hutchinson Cancer Center in Seattle.

Notably, in Singapore, XBB was responsible for a surge in cases, but it didn’t cause an increase in hospitalizations or death, Ali Mokdad, PhD, of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, previously told MedPage Todayopens in a new tab or window.

Currently there’s no indication that XBB.1.5 causes more severe illness than other Omicron subvariants, as there hasn’t been a greater increase in hospitalizations in regions hit hardest by the strain.

Still, it remains to be seen whether this variant will drive an overall surge in cases given its increased transmissibility, Bloom said.

Bloom said that while XBB.1.5 is equally as immune evasive as the two other XBB lineages — which had a significant amount of antibody escape, according to a paper in Natureopens in a new tab or window — it has a higher affinity for ACE2, which explains its increased transmissibility.

Driving that higher affinity for ACE2 is a change at site 486, which has been a “major site of antibody escape going back to the earliest variants,” Bloom tweetedopens in a new tab or window.

“It’s easy to understand why it took longer for variants to emerge at site 486: mutations at 486 reduce ACE2 affinity, so benefit they provide in antibody escape comes at cost to receptor binding,” he tweetedopens in a new tab or window. “Differenceopens in a new tab or window between XBB.1.5 and its immediate parent XBB.1 is that it has traded the more costly F486S mutation for F486P. Therefore, XBB.1.5 isn’t expected to have more antibody escape than XBB.1 (which already had mutated F486), but it should have greater ACE2 affinity.”

XBB.1.5 finds ‘evolutionary sweet spot,’ becomes most transmissible subvariant

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The XBB.1.5 omicron subvariant has evolved to become the most transmissible SARS-CoV-2 subvariant yet, rapidly replacing other variants, although its ultimate impact on the pandemic is unclear, according to experts.

XBB.1.5 now accounts for nearly 28% of new cases of COVID-19 nationally, up from 4% just 4 weeks ago, according to CDC tracking.

IDN0123CovidXBB_Graphic_01_WEB

The White House and WHO have both noted that the subvariant has surprised many with its rate of spread.

“It is the most transmissible subvariant that has been detected yet … and we are concerned about its growth advantage,” Maria Van Kerkhove, PhD, COVID-19 technical lead for WHO, said at a press conference this week, noting that the subvariant has been detected in 29 countries.

In the Northeast U.S., the subvariant now accounts for more than 71% of new infections, according to the CDC.

“The evidence suggests that XBB.1.5 is spreading rapidly because it’s been able to find an evolutionary sweet spot that allows it to both hide from the immune system and efficiently infect our cells,” Jonathan Z. Li, MD, MMSc, associate professor of medicine at Harvard Medical School and director of the Harvard/Brigham Virology Specialty Laboratory, told Healio. “The set of mutations in XBB.1.5 creates a variant that is by far the most immune-evasive variant that we have seen.”

XBB “is the first documented example of a SARS-CoV-2 variant increasing its fitness through recombination rather than single mutations,” according to a preprint study published in December. It is a recombinant of two BA.2 sublineages, BJ.1 and BM.1.1.1, and “harbors both the immune escape-associated substitutions and the infectivity-enhancing substitutions” present in the two precursor subvariants, the authors wrote.

Li said another preprint study, uploaded on Jan. 5, suggests the subvariant has “found a new mutation that allows it to restore the ACE2 binding properties that likely allow it to infect and transmit more efficiently,” adding that it “appears to be resistant” to both Evusheld and bebtelovimab, but not the antivirals Paxlovid, remdesivir and molnupiravir.

“It has the immune escape properties of the other newer omicron subvariants — I sometimes refer to them as ‘Scrabble variants’ — but in addition, mutations at the 486 amino acid position appear to confirm improved interactions with the ACE2 receptor, and this may account for increased transmissibility,” Peter J. Hotez, MD, PhD, dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children’s Hospital for Vaccine Development, told Healio.

According to the CDC, the most common circulating subvariant currently is BQ.1.1, making up roughly 34% of new cases, followed by XBB.1.5 at 27.6%, BQ.1 at 21.4% and XBB at 4.9%.

“We still aren’t completely sure, but it’s important to note that while the percentage of cases being caused by XBB.1.5 is going up, the total number of COVID-19 cases is increasing at a slower rate,” Andrew S. Pekosz, PhD, professor and vice chair of the department of molecular microbiology and immunology at the Johns Hopkins University Bloomberg School of Public Health, told Healio.

“This may mean that XBB.1.5 has some increased ability to spread, but it’s not a massive increase,” Pekosz said. “If it were a massive increase, we would see total case numbers increasing at a much higher rate.”

Kerkhovesaid there is no indication yet that the severity of illness caused by XBB.1.5 is greater compared with other subvariants.

“But that is something that we are watching very closely through experimental studies in the lab [and] also in real world data,” she said.

Pekosz said SARS-CoV-2 continues to do “what viruses like influenza do,” picking up mutations that eventually allow new variants to dominate, but that the coronavirus is doing it much more frequently. Even so, he expects severe disease and death will not increase with new subvariant.

“The XBB group of omicron variants has a large number of mutations that make it less recognizable to vaccine- or infection-induced immunity,” Pekosz said. “However, bivalent boosters should still provide protection from severe disease, even though [they] won’t be as good at stopping infections. It should still [also] be susceptible to the antiviral drug Paxlovid.”