What to look for as subvariant spreads

The omicron variant of the coronavirus has been dominant in the US since December, but the version of omicron that drove the major infection surge during the winter now accounts for less than 7 percent of new cases.

A more transmissible subvariant, BA.2, accounts for around three-quarters of US cases. And BA.2, in turn, has spawned its own sublineage, BA.2.12.1, which appears to be gaining steam: It rose from 7 percent of US cases in early April to 19 percent last week. The New York State Health Department said last week that BA.2.12.1 was most likely contributing to the state’s rise in case numbers.

So far, the key difference between the newer versions of omicron and the one that previously rocketed through the US is transmissibility. The White House’s chief medical adviser, Dr. Anthony Fauci, has estimated that BA.2 is 50 percent more transmissible than the original omicron lineage.

But the coldlike symptoms vaccinated and boosted people feel as a result of an omicron infection are mostly the same regardless of the subvariant.

“The omicron symptoms have been pretty consistent. There’s less incidence of people losing their sense of taste and smell. In a lot of ways, it’s a bad cold, a lot of respiratory symptoms, stuffy nose, coughing, body aches and fatigue,” said Dr. Dennis Cunningham, the system medical director of infection control and prevention at Henry Ford Health in Detroit.

Symptoms of the BA.2 subvariant

The Zoe COVID Symptom Study in the UK has enabled millions of thousands of people to self-report their symptoms through smartphone apps.

One of the apps’ co-founders, Tim Spector, a professor of genetic epidemiology at King’s College London, said that based on Zoe data, a runny nose is still the most common symptom of omicron, followed by fatigue, a sore throat, sneezing and headache.

“The changes from BA.1 to BA.2 have been quite subtle — perhaps runny nose and fatigue [are] going up,” he said.

Spector said 84 percent of people in the UK who logged symptoms lately said they had runny noses, compared to around 73 percent in early January. Seventy-two percent said they had fatigue, up from 68 percent during the first omicron wave.

But it’s hard to attribute those changes directly to a subvariant, Spector said, because there are many confounding factors.

What should we make of all these omicron lineages?

BA.1 and BA.2 are about as genetically similar as delta was to alpha, experts said. Differences between the subvariants could influence the effectiveness of monoclonal antibody treatments.

“We know even with BA.1 and BA.2, which are both subtypes of omicron, that different monoclonal antibodies work for one but don’t work for the other,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.

But experts generally agree that the public shouldn’t worry too much about the emergence of each omicron subvariant.

“At some point, you just can’t get nervous every time there’s a new variant, because there’s always going to be a new variant,” said David Montefiori, a professor at the Human Vaccine Institute at Duke University Medical Center. “We’ve been through multiple waves of variants that really mattered a lot, but we might be coming out of that because there’s so much immunity built up in the population.”

Adalja said people who have recovered from an omicron infection in the winter are likely to have protection against BA.2 for at least several months.

“If they share enough of the mutations to be classified as an omicron variant, there’s likely going to be a lot of cross-protection. But over time, we know with all coronaviruses that reinfection becomes common as antibody levels fall,” he said.

Those factors make experts optimistic that previous omicron infections will also protect against BA.2.12.1.

But your level of protection could depend on how sick you got. Montefiori said immunity from an omicron infection might last anywhere from a month for people who were asymptomatic to a year for those who got seriously ill.

“When we look at the immunity that’s built up from infection, the milder the infection was, the less immunity you get from it,” he said.

Still, Adalja said, even for those who got mild cases, “it’s unlikely to see erosion of protection against severe disease, which I think is what really matters.”

What about those who haven’t yet gotten Covid?

BA.2.12.1 isn’t the only version of BA.2 that has caught scientists’ attention. Another sublineage, BA.2.12, also seems to be pushing up cases in New York, and several more are circulating in other parts of the world.

“What I’m actually more concerned about is the number of subvariants of BA.2 that are showing some signs of spread,” Montefiori said. “It’s as though the virus is trying to find a way to punch a hole through the immunity that’s built up in the population.”

Still, vaccinations, masks, testing and social distancing can help control the spread of the prevailing omicron strains, experts said.

Although scientists are still studying how vaccination protection fares in the face of the new subvariants, Adalja said, healthy people probably won’t need a fourth shot.

“With these first-generation mRNA vaccines, it’s hard to get anything more than protection against severe disease over a longer period of time because of the evolution of variants like omicron,” he said.

Rapid tests, meanwhile, easily pick up BA.2, although they’re generally less sensitive to omicron than they were to delta. Data from the Zoe COVID Symptom Study showed that at-home tests were 85 percent sensitive to delta and 80 percent sensitive to omicron.

“These home tests are still doing pretty well to get 80 percent accuracy,” Spector said. “They’re not giving false positives, either.”

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