As we head into another holiday season with COVID-19 still spreading around the United States, it's less clear than in the past two years what we should expect and what precautions to take. Several omicron variants are driving the vast majority of cases, but there isn't a single strain dominating like there usually has been.
Some experts have predicted there will be a COVID-19 surge this winter, as more people gather indoors with fewer precautions and vaccination rates remain low. On the other hand, Dr. Ashish Jha, the White House COVID response coordinator, said he thinks another COVID wave is unlikely in the coming weeks.
"We are in a very different place and we will remain in a different place,” Jha said during a Nov. 14 meeting of health officials, Stat News reported. "We are now at a point where I believe if you’re up to date on your vaccines, you have access to treatments … there really should be no restrictions on people’s activities. I’m pretty much living life the way I was living life in 2019.”
Whatever happens, there's still no harm in taking a COVID test before a holiday gathering, especially if you've recently spent time with a large group of people inside, or if someone high risk for severe illness will be at the gathering, experts previously told TODAY. And given the current surges of RSV and flu, which are straining the U.S. health care system, there's also merit to wearing masks in crowded, indoor spaces, TODAY previously reported.
The possibility of respiratory illnesses like RSV and influenza continuing to spread at the same time as a potential COVID-19 wave is being referred to as a "tripledemic." Experts are fearing this could occur because cases of RSV (a common childhood virus) and flu are already sending so many people, including kids, to hospitals.
"These things typically don’t peak until the December to February timeframe, and we’re not in December yet,” said Dr. John Torres, NBC News senior medical correspondent, in a Nov. 14 segment. "This trajectory (is going) really high, and we don’t know what’s going to happen."
With the new omicron variants becoming more prevalent and the several other respiratory viruses spreading at high numbers, it can be hard to know what a cough or sore throat might mean this time of the year. Here's what to know about omicron symptoms now and the possible winter COVID-19 surge.
New COVID variant symptoms
As of Nov. 12, three omicron subvariants are vying for the lead, according to the most recent data from the Centers for Disease Control and Prevention. The BA.5 variant, which has been dominant since July, is responsible for nearly 30% of COVID-19 cases in the U.S. while BQ.1 and BQ.1.1 are each causing about 20% of cases.
Together, BQ.1 and BQ.1.1 have overtaken BA.5, NBC News reported. Emerging variants BA.4.6 and BF.7 are still in the mix as well.
Research from the ZOE Health Study, which is conducted via a smartphone app, recorded these as the most common symptoms of COVID-19 for people who’ve had two vaccine doses:
Meanwhile, some of the symptoms that were previously considered classic signs of COVID-19 — loss of taste or smell, fever, shortness of breath — are not ranking as highly anymore, a report from the company says.
“The general impression among clinicians is that omicron tends to stay more in the upper respiratory tract,” Dr. Otto Yang, professor of medicine in the division of infectious diseases and of microbiology, immunology and molecular genetics at the David Geffen School of Medicine at UCLA, told TODAY. “And that’s probably related to why it’s less deadly: It’s not affecting the lungs as much.” So doctors are seeing more things like sore throat and runny nose than they did with previous versions of the virus, he said.
Another recent study published in medical journal Cureus found fever to be the most common symptom among a group of 228 people in India infected with variants descending from BA.2. About 82% of respondents had fever, followed by just under half having a cough. Fatigue and headache were common, too. It's worth noting, though, that BA.2 and its descendants haven't been prevalent in the U.S.; according to CDC data, they comprise about 3.4% of cases.
Even as scientists investigate the current, most common COVID symptoms, it can be challenging to truly track changes in symptoms over time, Yang said, because so many fewer positive cases are officially recorded now. The protection gained from vaccination and previous infections could also have reduced the overall severity of symptoms over time, the experts noted.
“Someone that’s fully vaccinated and up to date may have such mild symptoms that they don’t even test themselves,” Yang said.
The current landscape of COVID-19 variants
Having a group of emerging omicron-related variants rather than one clearly dominant strain may signal a shift in the pandemic, experts told TODAY. Or it might just be a sign that the virus has found its optimal form — for now.
Back in late August, BA.5 hit its peak and accounted for nearly 85% of all COVID-19 infections in the U.S. This omicron subvariant is still in the lead and now responsible for just about 30% of COVID-19 cases, CDC data show. But a few other strains are beginning to cause an increasingly large share of cases.
Previously, when alpha and delta emerged in one part of the world, “they were clearly way more transmissible than everything else that was circulating worldwide,” Anne Hahn, Ph.D., a postdoctoral researcher studying viral evolution at the Yale School of Public Health, told TODAY.
At that time, there were still travel restrictions and other public health precautions in place, so it was harder for these variants to spread, she explained. But now, it’s easier for the virus to spread, and there are “way more possibilities for different lineages to exist in parallel.”
But all of these emerging variants are still related to omicron, and "it's been quite a while since a completely new variant popped up," Yang said.
"It's been overcrowded for quite a while, and all these subvariants of omicron are kind of jockeying for the lead," he said.
Of all the emerging variants, Hahn said experts are getting "the most worrying signal" from BQ.1, which now accounts for just over 20% of COVID-19 infections in the U.S. In lab studies, BQ.1 seems to be more resistant to neutralizing antibodies and better able to bind to human cells than previous strains, she explained. While this data is still early, there's concern among experts that this could eventually translate to less protection against infection from the vaccines and less effective antibody treatments.
"This is the one where we now see a strong indication for a gross advantage in comparison to other BA.5 lineages," Hahn said. It also already has a sublineage — BQ.1.1. — that's responsible for about 24% of coronavirus infections in the U.S. right now, according to CDC data.
Around 6% of cases are now due to BA.6, a subvariant of BA.4, according to CDC data. And variant BF.7 is responsible for 8% of COVID-19 cases right now.
Will one strain become dominant?
So, will one of these emerging variants pull ahead and become the new dominant strain? Or will we continue to see multiple strains circulating alongside each other?
“That’s the question right now,” Hahn said.
And there are examples of both scenarios in previous infectious diseases, Yang explained. With hepatitis C, for example, “there are a few different genetic variants, and they all co-circulate,” he said. We also see multiple season flu strains circulate every year, he added.
Hahn emphasized that these variants, while different in some ways, are all still quite similar to each other. That suggests that the coronavirus has settled on its omicron form for now, as experts predicted might be the case.
“Although the virus is continuing to evolve, it looks like it’s fine-tuning,” Yang agreed.
It may be comforting in the sense that there aren’t likely to be any completely new variants on the horizon. But these developments are still worrying because our current slate of antibody treatments for COVID-19 may become less effective in people who’ve contracted one of the newer strains.
“With BA.5, we were already down to only a handful of antibodies (for treating COVID patients),” Hahn said. “But now with BQ.1 — and especially BQ.1.1 — it looks like we might lose all the antibodies we can use in the clinic right now.”
How severe will the winter surge be this year?
Whether or not we'll see a major surge in COVID-19 cases this year depends on a few factors, the experts said.
First, it depends on our behavior and whether or not we're still willing to take precautions, like masking and avoiding crowded indoor events. Second, the number of people who get boosted will affect the severity of this COVID-19 season. (Only 10% of those ages 5 and up have gotten an updated booster, CDC data show.)
Early increases in both cases and hospitalizations for illnesses like the flu and RSV suggest we’re no longer taking the precautions that helped us prevent the spread of these diseases in the past, Yang said. "I worry that's a marker for how the gate is also going to be opened up for COVID," he added.
Finally, the emergence of a new surprising variant may lead to a severe coronavirus season. But experts are now "mostly certain" that there won't be another omicron-like event in the near future, Hahn said, meaning that — for now at least — they expect COVID-19 variants will continue to be omicron subvariants like those circulating now.
It would take a significantly more contagious strain to push out the omicron subvariants and, at this point, it's hard to see how the virus could become more contagious, Yang said. "There has to be a ceiling."
Still, it's not impossible that another variant could come up that's even more contagious and also more deadly, Yang continued. "COVID has thrown us surprises many times, but it's unlikely."
This article was originally published on TODAY.com