Omicron Variants BQ.1 and BQ.1.1 Are Now Dominant in U.S.

Omicron subvariants BQ.1 and BQ.1.1 now make up the majority of new COVID-19 cases in the United States, according to data from the Centers for Disease Control and Prevention (CDC). BQ.1 is now responsible for a fifth of U.S. COVID-19 cases while BQ.1.1 makes up a quarter of cases.

Omicron BA.5 became dominant in the U.S. in July and remained the main driver of COVID-19 infections through the early fall.

Though BQ.1 and BQ.1.1 have mutations that should make them better at skirting immune defenses, many people have immunity from prior infections or vaccination that could keep the virus at bay, according to Sharon Nachman, MD, chief of the division of pediatric infectious diseases and director of the office of clinical trials at Stonybrook University in New York.

But the unique challenge for health systems this winter will be to manage patients sick with COVID-19 while other respiratory viruses like RSV and the flu are on the rise.

“We had this huge Omicron surge last December—everybody at Christmas time was sick. But we didn’t have the RSV that we’re seeing now, and we didn’t have the flu numbers that we’re seeing now,” Nachman said.

The confluence of surges in RSV, flu, and COVID-19 “translates to people being sicker all winter,” she added.

Are BQ.1 and BQ.1.1 More Invasive?

BQ.1 and BQ.1.1 both originate from the same lineage as BA.5. But these new variants may be better at evading immunity than BA.5 due to mutations in the spike protein.

In one preprint study of people who were vaccinated with either the updated bivalent or older monovalent booster shots, antibody levels were seven times lower in those infected with BQ1.1 than those sick with BA.5.

Data from vaccine manufacturers appear more favorable. In an “exploratory analysis” of about 40 people, Moderna showed that the updated booster elicited neutralizing antibodies against BQ.1.1, though at lower levels compared to BA.4/BA.5.

Pfizer hasn’t yet released data on how its bivalent booster performs against BQ.1.1. But the company said that in adults older than 55 years, the booster induced antibody levels against BA.4/5 at levels four times higher than those from the original vaccine.

“If you have protection against Omicron—and this variant is two steps different from Omicron—the vaccine is probably good enough,” Nachman said. “But if you only have the original vaccine or only the original virus, that’s so far distant from this new virus that you’re probably going to get sick.”

So far, the new variants don’t seem to cause more severe infection than earlier Omicron variants. BQ.1 and BQ.1.1 together account for about 60% of the COVID-19 cases in the region including New York and New Jersey—more than any other part of the country. But hospitals there haven’t seen a parallel influx in hospitalizations.

“None of these variants has triggered as much concern as when Omicron first emerged about one year ago,” Andy Pekosz, PhD, a virologist and the vice-chair of the Department of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health, told Verywell in an email. “As long as we don’t see something as highly mutated as Omicron, I’m hopeful we won’t see a very large COVID-19 surge.”

One of the most concerning aspects of this surge that treatments like monoclonal antibodies may not stand up to the new variants. Early evidence indicates that due to mutations in the spike protein of BQ.1 and BQ.1.1, Evusheld and bebtelovimab each lose efficacy against the variants, according to the National Institutes of Health (NIH).

Unlike monoclonal antibodies, the antiviral treatment Paxlovid debilitates the virus without needing to fit the virus’ spike protein. That means it should hold up against BQ,1.1, despite its mutations, the NIH said.

“Antivirals and COVID-19 tests are still working against those variants, so the basic strategy is still in place: vaccinate, test, treat with antivirals—particularly if you are in a population that is highly vulnerable to severe COVID-19,” Pekosz said.

What Does This Mean for the Winter?

The new strains are becoming dominant just as the weather is getting colder and people are planning winter travel. As more people gather indoors, the close quarters and lack of adequate ventilation will make conditions ripe for respiratory viruses to spread.

In these conditions, it is important to continue practicing good hand washing and wearing a mask around others if you feel under the weather, Nachman said.

It’s not yet clear how long a BQ.1/BQ.1.1 wave will last. In France, where BQ.1.1 was first identified, the bump in cases due to the variant is already leveling out.  

In the U.S., however, vaccination rates are far lower than in France. Only about 12% of U.S. adults have received the updated booster.

Despite forecasts, scientists are uncertain how new variants will shape the trajectory of the pandemic, Matthew Frieman, PhD, a professor of microbiology and immunology at the University of Maryland School of Medicine, told Verywell in an email. For now, getting vaccinated and avoiding infection are the best tools to prevent outcomes like long COVID-19 and passing the disease to vulnerable people.

“Vaccines are still effective against protecting from severe disease,” Frieman said. “We will continue to see waves of virus for a while. We are certainly not done with COVID-19 and it will be with us for a long time.”

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