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HEALTH
HOW WORRIED SHOULD WE BE ABOUT XBB.1.5?
Yet another new and highly transmissible subvariant of the coronavirus is taking over.
JANUARY 05, 2023
After months and months of SARS-CoV-2 subvariant soup, one ingredient has emerged in the United States with a flavor pungent enough to overwhelm the rest: XBB.1.5, an Omicron offshoot that now accounts for an estimated 75 percent of cases in the Northeast. A crafty dodger of antibodies that is able to grip extra tightly onto the surface of our cells, XBB.1.5 is now officially the country’s fastest-spreading coronavirus subvariant. In the last week of December alone, it zoomed from 20 percent of estimated infections nationwide to 40 percent; soon, it’s expected to be all that’s left, or at least very close. “That’s the big thing everybody looks for—how quickly it takes over from existing variants,” says Shaun Truelove, an infectious-disease modeler at Johns Hopkins University. “And that’s a really quick rise.”
All of this raises familiar worries: more illness, more long COVID, more hospitalizations, more health-care system strain. With holiday cheer and chilly temperatures crowding people indoors, and the uptake of bivalent vaccines at an abysmal low, a winter wave was already brewing in the U.S. The impending dominance of an especially speedy, immune-evasive variant, Truelove told me, could ratchet up that swell.
But the American public has heard that warning many, many, many times before—and by and large, the situation has not changed. The world has come a long way since early 2020, when it lacked vaccines and drugs to combat the coronavirus; now, with immunity from shots and past infections slathered across the planet—porous and uneven though that layer may be—the population is no longer nearly so vulnerable to COVID’s worst effects. Nor is XBB.1.5 a doomsday-caliber threat. So far, no evidence suggests that the subvariant is inherently more severe than its predecessors. When its close sibling, XBB, swamped Singapore a few months ago, pushing case counts up, hospitalizations didn’t undergo a disproportionately massive spike (though XBB.1.5 is more transmissible, and the U.S. is less well vaccinated). Compared with the original Omicron surge that pummeled the nation this time last year, “I think there’s less to be worried about,” especially for people who are up to date on their vaccines, says Mehul Suthar, a viral immunologist at Emory University who’s been studying how the immune system reacts to new variants. “My previous exposures are probably going to help against any XBB infection I have.”
SARS-CoV-2’s evolution is still worth tracking closely through genomic surveillance—which is only getting harder as testing efforts continue to be pared back. But “variants mean something a little different now for most of the world than they did earlier in the pandemic,” says Emma Hodcroft, a molecular epidemiologist at the University of Bern, in Switzerland, who’s been tracking the proportions of SARS-Cov-2 variants around the world. Versions of the virus that can elude a subset of our immune defenses are, after all, going to keep on coming, for as long as SARS-CoV-2 is with us—likely forever, as my colleague Sarah Zhang has written. It’s the classic host-pathogen arms race: Viruses infect us; our bodies, hoping to avoid a similarly severe reinfection, build up defenses, goading the invader into modifying its features so it can infiltrate us anew.
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But the virus is not evolving toward the point where it’s unstoppable; it’s only switching up its fencing stance to sidestep our latest parries as we do the same for it. A version of the virus that succeeds in one place may flop in another, depending on the context: local vaccination and infection histories, for instance, or how many elderly and immunocompromised individuals are around, and the degree to which everyone avoids trading public air. With the world’s immune landscape now so uneven, “it’s getting harder for the virus to do that synchronized wave that Omicron did this time last year,” says Verity Hill, an evolutionary virologist at Yale. It will keep trying to creep around our defenses, says Pavitra Roychoudhury, who’s monitoring SARS-CoV-2 variants at the University of Washington, but “I don’t think we need to have alarm-bell emojis for every variant that comes out.”
Read: The coronavirus’s next move
Some particularly worrying variants and subvariants will continue to arise, with telltale signs, Roychoudhury told me: a steep increase in wastewater surveillance, followed by a catastrophic climb in hospitalizations; a superfast takeover that kicks other coronavirus strains off the stage in a matter of days or weeks. Omens such as these hint at a variant that’s probably so good at circumventing existing immune defenses that it will easily sicken just about everyone again—and cause enough illness overall that a large number of cases turn severe. Also possible is a future variant that is inherently more virulent, adding risk to every new case. In extreme versions of these scenarios, tests, treatments, and masks might need to come back into mass use; researchers may need to concoct a new vaccine recipe at an accelerated pace. But that’s a threshold that most variations of SARS-CoV-2 will not clear—including, it seems so far, XBB.1.5. Right now, Hodcroft told me, “it’s hard to imagine that anything we’ve been seeing in the last few months would really cause a rush to do a vaccine update,” or anything else similarly extreme. “We don’t make a new flu vaccine every time we see a new variant, and we see those all through the year.” Our current crop of BA.5-focused shots is not a great match for XBB.1.5, as Suthar and his colleagues have found, at least on the antibody front. But antibodies aren’t the only defenses at play—and Suthar told me it’s still far better to have the new vaccine than not.
In the U.S., wastewater counts and hospitalizations are ticking upward, and XBB.1.5 is quickly elbowing out its peers. But the estimated infection rise doesn’t seem nearly as steep as the ascension of the original Omicron variant, BA.1 (though our tracking is now poorer). XBB.1.5 also isn’t dominating equally in different parts of the country—and Truelove points out that it doesn’t yet seem tightly linked to hospitalizations in the places where it’s gained traction so far. As tempting as it may be to blame any rise in cases and hospitalizations on the latest subvariant, our own behaviors are at least as important. Drop-offs in vaccine uptake or big jumps in mitigation-free mingling can drive spikes in illness on their own. “We were expecting a wave already, this time of year,” Hill told me. Travel is up, masking is down. And just 15 percent of Americans over the age of 5 have received a bivalent shot.
The pace at which new SARS-CoV-2 variants and subvariants take over could eventually slow, but the experts I spoke with weren’t sure this would happen. Immunity across the globe remains patchy; only a subset of countries have access to updated bivalent vaccines, while some countries are still struggling to get first doses into millions of arms. And with nearly all COVID-dampening mitigations “pretty much gone” on a global scale, Hodcroft told me, it’s gotten awfully easy for the coronavirus to keep experimenting with new ways to stump our immune defenses. XBB.1.5 is both the product and the catalyst of unfettered spread—and should that continue, the virus will take advantage again.
Katherine J. Wu is a staff writer at The Atlantic.
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WELLNESS
The Symptoms Of COVID Variant XBB That Doctors Are Seeing Right Now
Pay attention to these common signs of infection.
01/06/2023 03:00AM EST
If you’ve been following COVID news, then you’re likely well aware there’s a new variant in town that’s concerning the scientific community. Known as XBB, the variant is believed to be the most immune-evasive to date and currently accounts for over 40% of infections in the United States, according to data from the Centers for Disease Control and Prevention. 
That percentage is expected to grow exponentially in the coming weeks as XBB out-competes other omicron variants like BQ.1. Look at what transpired in New England: Within three weeks, the percentage of cases in the region caused by XBB jumped from 11% to 75%. 
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Because XBB is relatively new, scientists are still working to figure out if and how the variant behaves differently from other recent variants. Though XBB’s symptoms are expected to be on par with past omicron infections, doctors say they are seeing some issues becoming more prevalent than others.
“Viruses typically mutate to become more contagious and less severe; it appears that this is happening with this strain of the coronavirus,” Dr. Henry Redel, the chief of infectious disease at Saint Peter’s University Hospital in New Brunswick, New Jersey, told HuffPost.
We asked infectious disease experts what they’re seeing in the hospital right now. Here’s what they said:
The most common XBB COVID symptoms appear to be congestion and body aches.
There’s limited data on XBB, but experts suspect the symptoms associated with XBB infections will be similar to the symptoms people experienced with COVID throughout 2022. 
That said, evidence has shown that the symptom profile has shifted a bit with each variant. Omicron caused more cold-like symptoms (like fatigue, runny nose, sneezing and muscle aches), for example, whereas delta and alpha more commonly triggered anosmia (loss of smell) and ageusia (loss of taste).
So, what is on the docket for XBB? “In general, I think people are more achy and still have congestion and headache,” Dr. Julie Parsonnet, an infectious diseases specialist with Stanford Health Care, told HuffPost. You may also expect to see the other usual symptoms: fever, chills, cough and sore throat.
Less common symptoms include loss of taste and smell and shortness of breath.
Anosmia and ageusia appear, anecdotally, to be less common with XBB. Experts don’t expect ageusia and anosmia to make a comeback just yet. “Since XBB is part of the omicron group, I expect that loss of taste and smell will not be common, but I have not seen data yet,” said Dr. Thomas Campbell, a professor in the department of infectious disease at the University of Colorado Anschutz Medical Campus. 
One thing doctors on the front lines are seeing less of: severe shortness of breath, Redel said. Rarely have recent patients needed supplemental oxygen, he added. Redel noted he’s seeing many more COVID patients come in with classic upper respiratory symptoms — like runny nose, congestion and sore throats — along with fever and muscle aches. 
What causes symptoms to change between subvariants?
Because so many people have been infected — in some cases, multiple times — it’s tough to pin down exactly how the symptomatology is influenced by the host versus specific traits of the virus. Parsonnet suspects that immunity plays a pretty big role.
“There is likely a strong element of underlying immunity, but there may also be differences in the virus’s ability to cause symptoms,” Parsonnet told HuffPost.
According to Dr. Martin Krsak, an infectious disease expert at the University of Colorado Anschutz Medical Campus, people’s genetics and underlying health — i.e. whether they have a chronic disease or prior injury — also influence the type of symptoms they develop. 
Like Parsonnet, Krsak said that each variant and the way it infects our cells likely impacts symptoms as well. “Variants have a different capacity to evade prior immunity and also a different capacity to bind to the main target on human cells,” he said. 
Does the latest COVID shot prevent you from getting infected with XBB?
A pre-print study from Japan determined that XBB came to be during the summer of 2022 when two sub-variants of the BA.2 omicron lineage combined. Scientists believe that, in this process, XBB picked up mutations that help it better evade immunity conferred by both vaccination and previous infections. 
XBB’s mutations also let it attach to our cells more easily, enabling it to spread more efficiently than other versions of omicron.
“It binds tighter, appears more transmissible, and is also immune-evasive,” said Dr. Eric M. Poeschla, the head of the Division of Infectious Diseases at the University of Colorado Anschutz Medical Campus. It’s unknown whether those mutations alter the virus’ clinical profile and the symptoms it causes, Parsonnet said. 
The updated COVID shot, which was tweaked in 2022 to target newer variants of omicron, doesn’t work super well at preventing infections of XBB, considering there are so many new infections in the community, Parsonnet said. But the fact that there hasn’t been a rapid increase in deaths shows that the shots, combined with the immense amount of immunity gained from past infections, continue to protect many people from severe outcomes. Together, that immunity will help blunt the XBB wave, according to Poeschla. And though monoclonal antibodies are less effective with XBB, other treatments — including Paxlovid, remdesivir and molnupiravir — appear to hold up well. 
Of course, there’s always the very real risk of long COVID, which is a debilitating condition that can follow even a mild case of the coronavirus. Long COVID can cause lasting fatigue, brain fog, respiratory issues and more. There’s still a lot for us to learn about XBB and the symptoms or potential complications it may cause.
But there’s one thing we know for sure: There’s a benefit to being vaccinated rather than not. “The bivalent booster offers some protection against all omicron-based variants and is highly recommended, especially for those over 65 or with serious other risks,” Poeschla said.
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.
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