COVID-19: Where Are We Now?

covid Three years ago, news of a novel illness originating in China was beginning to make its way to media outlets. When the severity of COVID-19 became well-known, and a pandemic ensued, public health agencies across the globe started to ring the bell warning countries of the dangers. Early Spring of 2020, governments implemented quarantine, masking, and social distancing regulations to help protect citizens.

The lessons global, country, and local public health agencies and researchers have learned since the early days of COVID-19 have led us to a greater understanding of how the illness spreads and which populations are the most vulnerable to its symptoms and side effects.

Variants and Vaccines

The U.S. Department of Health and Human Services (HHS) formed a SARS-Cov-2 (COVID-19) Interagency Group (SIG) to monitor emerging variants and their potential impact on vaccines, therapies, and diagnostic tools. HHS included the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the U.S. Food and Drug Administration (FDA), the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense (DOD) so the agencies can effectively coordinate and evaluate the risks the emerging variants pose to people.

COVID-19 is like other viruses; it evolves as changes occur in its genetic code. These changes are caused by mutations or viral recombination as COVID-19’s genome is replicated. A lineage (a related group of variants stemming from a common ancestor) comes from these changes in genetic code. For example, Omicron has several variants and subvariants derived from its genetic code (BA.5, BQ.1.1, and XBB are a few).

Each of these variants has at least one mutation that differentiates it from the other variants of COVID-19. Researchers compare the differences to keep local, state, and national public health agencies up to date with trends and variants.

Throughout 2022, the dominance of one variant of COVID-19 has changed from one familial offshoot (Delta) to another (Omicron). Within the variants, some subvariants have mutated and can circumvent the protections afforded by earlier vaccines and boosters. Experts have improved on vaccines while changing vaccine and booster recommendations to reflect the ongoing effort to prevent and protect people from harmful, sometimes deadly outcomes.

As 2022 progresses, researchers, infectious disease experts, and public health professionals have continued to examine and follow the updates made to COVID-19 vaccinations and boosters. Because COVID-19 maintains its position as a global public health issue, vaccinations and boosters must adapt to the variations and subvariants of COVID-19.

COVID-19 Variants

January 1, 2022, New York reported its highest number of new COVID-19 cases since the beginning of the pandemic. Two days later, the United States became the country with the highest daily infections in the world. In one week, the number of people hospitalized because of COVID-19 increased by approximately 50%.

Currently, Delta, a COVID-19 variant, was the dominant strain. However, a new variant, Omicron, spread quickly throughout the United States. Soon, Omicron’s number of new COVID-19 cases surpassedDelta, making it the dominant strain.

Delta Variant

As 2020 ended, a new variant, B.1.617.2 (Delta), was identified in India. Delta quickly spread worldwide since its transmission rate was higher than its predecessors. The CDC classified Delta as a Variant of Concern. This variant has an increase in transmissibility, more severe disease, a serious decrease in neutralization by antibodies generated in previous vaccination or infection, a reduction in the effectiveness of vaccines or treatments, or failures to detect the variant in diagnostic tools.

Delta’s new infection rates continued to increase during 2021. However, towards the end of the year, a new variant, Omicron, began to spread. With the rise of Omicron cases and a decrease in Delta cases, the CDC downgraded Delta from a Variant of Concern to a Variant Being Monitored in April 2022.

Omicron Variant

Soon after 2022 began, Omicron (BA.1, BA.1.1, BA.1.1.529, BA.2, BA.3, BA.4, and BA.5 lineages) became the dominant variant of COVID-19. While new case rates from Omicron grew, the hospitalization from Omicron is lower than that of Delta.

Omicron is a highly transmissible variant of COVID-19 and is responsible for a surge in COVID-19 cases globally. The World Health Organization (WHO) declared Omicron a Variant of Concern because it has spread faster than all other previous variants.

The surge in Omicron cases posed a new concern from a public health perspective because of its transmissibility and subvariants. Omicron and its subvariants posed new risks to those with compromised immune systems, seniors, and pre-existing conditions, such as a spinal cord injury (SCI). Omicron aggressively attacks the respiratory system causing severe symptoms and side effects in those with respiratory system issues.

BA.5 Subvariant

During late spring and the summer, Omicron’s BA.5 variant became one of the dominant subvariants of COVID-19. During the spring and summer, BA.5 was considered the most contagious. However, its symptoms and side effects were no more severe than previous Omicron subvariants. The vaccines approved by the WHO and the FDA continued to provide protection against infection, severe illness, or death. Yet, the BA.5 subvariant is easily spread and can evade immunity from previous COVID-19 infections or vaccines.

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BQ.1 and BQ.1.1 Subvariants

As summer turned to fall, the CDC announced that the BQ.1 and BQ.1.1 subvariants reported new cases had surpassed BA.5 new cases. Public health, medical, and infectious disease experts expect a surge in BQ.1 and BQ.1.1 cases this winter, especially during the holiday season. Adding to the potential for a rise in BQ.1 and BQ.1.1 cases is the ability of these subvariants to evade immune defenses like previous infections, vaccinations, or booster shots. Despite the increased chance of the subvariants evading immune defenses, the CDC and other experts recommend that people stay up to date on their booster shots or schedule an appointment for a vaccine shot.

Vaccines

The FDA has approved or authorized for emergency use four COVID-19 vaccines, and any subsequent booster shot developed.

mRNA Vaccines

The FDA has approved Moderna and Pfizer BioNTech’s COVID-19 mRNA vaccines. Unlike many vaccines that put a weakened or inactive germ into your body to build immunity and trigger immunity, mRNA vaccines use a different approach. Scientists created mRNA in a laboratory. Once in your body, the mRNA teaches your cells how to make a protein, or a strand of protein, that generates an immune response. The immune response produces antibodies that can prevent or decrease the symptoms of COVID-19.

Protein Subunit Vaccines

Novavax was recently authorized for emergency use by the FDA. It’s more like other vaccines, like the whooping cough vaccine, because it contains spike proteins from the COVID-19 virus. Novavax combines the proteins with an adjuvant that teaches your immune system how to respond to COVID-19.

Viral Vector Vaccines

Johnson & Johnson’s COVID-19 vaccine is a viral vector vaccine. Viral vector vaccines utilize a modified version of a different virus (vector virus) to communicate essential instructions to your body’s cells. However, the FDA authorized the Johnson & Johnson vaccine for limited use for those 18 years or older.

The CDC released new recommendations regarding primary vaccinations in December. Additional primary vaccine shots are advised for those:

five years or older
with a weakened immune system

The third primary shot should be given within four weeks after the first two shots. Using the same mRNA vaccine for all shots would be best, but you can have a different mRNA vaccine for your third primary dose.

Booster Shots

The recommendations for booster shots vary by age and health. Most people can receive the booster shot two months after their primary shots. However, if you recently were infected with COVID-19, you may want to wait three months after your infection to receive a booster shot.

Bivalent Boosters

The FDA has authorized the use of Moderna’s and Pfizer BioNTech’s mRNA bivalent boosters. To learn more about the boosters and their authorized use, visit the FDA’s COVID-19 booster information webpage.

Bivalent boosters, called “updated” booster shots, comprise an element of the original COVID-19 virus strain and a component of the Omicron variant. Combined, the original strain of COVID-19 and the Omicron variant can provide more protection against Omicron.

How to Protect Yourself

Because COVID-19 and its variants continue to mutate, you may become infected. Your chances of catching COVID-19 during the holiday season increase since you are in social or family situations that can include close contact with others. However, despite the holidays and winter, there are ways you can prevent or decrease the symptoms of COVID-19.

The CDC has advised people to wear masks when indoors. Masks decrease the risk of catching COVID-19 and other seasonal illnesses.
Take a COVID-19 test before attending events or if you think you might have COVID-19. Whether you think you may have the flu, RSV, or COVID-19, taking an at-home test is a good idea. You can ask your pharmacist if your insurance covers the cost of the test. But you can also go to https://www.covid.gov/tests/ and request free at-home COVID-19 tests.
Wash your hands. Good hygiene is a way to prevent or protect yourself from illnesses.
Avoid situations that may put you at risk.
If you haven’t received your primary COVID-19 vaccines, make an appointment.
Follow the CDC’s recommendations regarding booster shots.

Taking extra precautions can help protect or prevent serious symptoms from the current COVID-19 variants and subvariants. But there is an added benefit to being safe. Winter is also a time when the flu and RSV cases increase. Following the CDC’s recommendations, like wearing a mask, can decrease your risk of catching any illness.

Preparing yourself against possible infection from COVID-19, RSV, or the flu protects you from adverse short and long-term effects. But, by staying up to date with the CDC’s and FDA’s recommendations, you can remain aware of potential diseases that can threaten your well-being.

As you look towards 2023, you can take with you the information public health, medical, and infectious disease professionals have made available. You can also ask your doctor about COVID-19, its variants, and subvariants. During the conversation, you can discuss vaccines and boosters. Stay up to date by following the CDC’s or FDA’s COVID-19 information web pages. Another way to know what’s happening near you is to follow your local public health information sources.

Christina Sisti, DPS, MPH, MS is a bioethicist and health care policy advocate. She works to create awareness and improve health care policy for those with long-term health issues.