For the last few months, experts had expressed optimism that the BA.5 variant represented nearly all COVID cases as new booster shots, specifically designed to target that variant, rolled out.
But now, other omicron subvariants are growing in numbers and BA.5's dominance is waning just as colder temperatures set in and people head indoors. So what does that mean for the upcoming months, which have historically seen some of the biggest COVID surges of the pandemic so far?
Chicago's top doctor addressed that question during a Facebook Live Tuesday, saying that she's "a little concerned" by the shift in variants.
"But the reason we are still low risk - and that's why we do that low, medium and high risk for variants - is because everything is still omicron," Chicago Department of Public Health Commissioner Dr. Allison Arwady said, noting that the variants currently in circulation remain subvariants of the omicron strain that wreaked havoc on the country last winter.
That's good news, she said, because experts believe the new bivalent COVID booster shots, which were formulated to target the omicron variant, and later tweaked to specifically address the BA.4 and BA.5 variants, may also protect against other omicron subvariants circulating, like the BA.4.6 or BF.7.
The White House on Tuesday said eligible Americans should get the updated COVID-19 boosters by Halloween to have maximum protection against the coronavirus by Thanksgiving and the holidays, as it warned of a “challenging” virus season ahead.
Dr. Ashish Jha, the White House COVID-19 coordinator, said the U.S. has the tools, both from vaccines and treatments, to largely eliminate serious illness and death from the virus, but stressed that's only the case if people do their part.
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“We are not helpless against these challenges," he said. “What happens this winter is up to us.”
So far the Centers for Disease Control and Prevention says only about 11.5 million Americans have received the updated shots. Jha said studies suggest that if more Americans get the updated vaccines, "we could save hundreds of lives each day this winter.”
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"If we don't get a lot of people to get this updated vaccine this fall, we are really set up in a not great way for the potential for a new variant," Arwady said. "I am very hopeful we won't see one, but that really is the question every time there's another COVID infection. That is the opportunity for a new variant to potentially emerge. That's how they emerge."
Still, it remains unclear whether those new bivalent boosters will protect against infection in general, with studies still underway even as Americans get the shots.
Germany's health minister warned at the end of September that the country is seeing a steady rise in COVID-19 cases as it goes into the fall, and urged older people to get the new COVID booster shots. Other European countries such as France, Denmark and the Netherlands are also recording an increase in cases, Karl Lauterbach told reporters in Berlin.
“We are clearly at the start of a winter wave,” he said.
Despite vaccine uptake, Arwady said she is still anticipating a surge in the coming months.
"I haven't seen anything really scary yet on the horizon, but I do think we're going to see a COVID surge. I would be the happiest person alive if we get to February or March and we haven't seen even a small COVID surge, just because it's respiratory season and the way that we see flu and RSV and everything else surge in the winter, I think we're expecting at least some COVID surge," she said. "The question is really what does that looked like with variants?"
As of Oct. 8, data from the Centers for Disease Control and Prevention showed the BA.5 variant continued to drop in numbers, making up 79.2% of U.S. cases, a decline from the 81.5% reported last week. Meanwhile, BA.4.6 rose to 13.6% and BF.7 to 4.6%.
Arwady noted that while mutations have so far remained under the omicron umbrella, a new variant could spawn that isn't a subvariant of omicron, which would lead to a much bigger challenge in the fight against COVID.
"Variants are the million dollar question when it comes to this winter in the COVID," Arwady said. "All of the subvariants... whether it's the new [BF.7], whether it's the BA.4.6 - those are all still subvariants of omicron. So that is good news in that even where we are seeing some continued evolution of the omicron variant, it's all still in the omicron family, which means that people who have had an omicron infection would likely have at least some protection and importantly people who get the updated vaccine will have better protection against anything that continues to evolve in the omicron space. The big question is do we get another emergence of a variant that's very genetically different in the way omicron was very genetically different, Delta was very genetically different, Alpha was very genetically different. We haven't had a big new, genetically different variant emerge since really last December, January. It's been almost a year."
