Opinion | How to fight covid-19 variant BQ.1.1

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Brace yourself: Another Covid wave is on the horizon due to a new immunity-avoidant subvariant, BQ.1, and its offshoots. The Centers for Disease Control and Prevention says, based in part on models, that BQ.1 and BQ.1.1 now account for nearly 17 percent of infections in the United States, up from zero a few weeks ago. The prevailing BA.5 variant is beginning to fade. Those who have not been vaccinated and those who have not received the new booster vaccinations are particularly at risk.

Right now, the pandemic is in the doldrums in the United States, and overall levels remain relatively low. There are 260,808 new reported cases per week and 2,566 weekly deaths, the CDC said, based in part on modelling. Covid-19 has been a leading cause of death in the United States, but the numbers are far lower than during last winter’s omicron surge.

What is not yet known is whether or how well an immunity wall built by both natural infections and vaccines could protect against a new wave. One concern is that BQ.1.1 evades the immune system to a greater extent than other variants and subvariants. The new variant already has the potential to render obsolete Evusheld, a key antibody protecting immunocompromised individuals. Cases appear to be starting in New York and could spread across the country in the coming months. Another subvariant, known as XBB, can also easily evade the immune system. So far it has spread widely in Singapore but little in the United States.

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BQ.1.1 evolved from BA.5, so there is hope that the new bivalent boosters being offered by Pfizer and Moderna will also protect against it. The United States has ordered 171 million doses that became available in early September, but uptake so far is just 19.4 million doses. “The US is pathetically under-vaccinated and under-supplied,” says Dr. Eric Topol, Professor of Molecular Medicine at Scripps Research. A preliminary study of the bivalent boosters, which has not yet been peer-reviewed, showed that they offer similar protection to the previous monovalent boosters, but are not as effective against BA.5 as some had predicted; more research will be required.

Another factor is that people are desperate to return to normal, relaxing precautions as they move indoors and gather in close contact for the upcoming holidays. A surge in Europe is likely the result of this shift, and everywhere there are signs of an earlier influenza season and a surge in RSV in children, leading to overwhelmed children’s wards.

Nobody will welcome a new surge, but everyone should prepare for it. The most important step is that all eligible persons are vaccinated and refreshed. In some places, especially crowded close-contact areas, it will be necessary to wear masks again. Everyone should test themselves often and stay at home if the result is positive – for their own good and that of others. Good ventilation – with fresh air – and air filtration are essential to minimize transmission in workplaces and other places where people are.

The virus hasn’t stopped and the pandemic isn’t over yet. But there are ways to keep it in check.

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