Worried About New COVID Variants? Here’s What To Expect.

Whenever a new COVID-19 variant is identified, fear and panic quickly sets in. It makes sense: We’ve been living through two-plus years of a brutal, scary pandemic. Before the data rolls in, many news headlines immediately jump to a worst-case scenario, speculating about whether the new coronavirus variant will be more pathogenic or drastically evade our vaccines. We’re constantly on high alert.

The unfortunate truth is that, when it comes to COVID, there will always be new variants. Right now, we’re experiencing an uptick in BA.2. Experts discovered this week another possible strain, the XE variant, which is a combination of the original omicron variant and BA.2. And in a few months, we’ll likely be looking at an even newer one headed our way. We should expect this, and prepare for it.

A new variant doesn’t have to mean there will be a doomsday situation. We have some really effective treatments now. We have mitigation strategies that we know work, like masking. There is a decent level of immunity in the population — from the vaccines and widespread infection — that it would take a lot for a new variant to offset every bit of the progress we’ve made in the past two years.

That’s not to say we shouldn’t be cautious, but more that we should use what we’ve learned and created over the last two years to our advantage (and so should the people in charge of creating public health strategies).

Here’s what to look at and consider whenever a new variant emerges:

As long as SARS-CoV-2 continues to circulate, it will evolve and mutate into new variants. We now know that there are numerous animals that can contract the coronavirus. Throw in the fact that many people have never been immunized or exposed to COVID and that vaccinated people can spread COVID, and it seems pretty unlikely that COVID will be eradicated, at least anytime soon.

The World Health Organization released a new plan last week suggesting that we exit the emergency phase of the pandemic and prepare for three possible scenarios of how the virus might evolve next.

Scenario one: COVID continues to circulate and evolve, but the severity of illness will decline as immunity increases. The virus will likely become more of a seasonal illness (like the flu) and we may need to booster at-risk individuals on a seasonal basis.

Scenario two: In the best-case scenario, future variants are much milder and eliminate the need for boosters — though we may intermittently get sick, we remain protected from severe disease.

Scenario three: A more severe, more transmissible variant comes along. We already have a ton of immunity in the population, which will likely blunt the impact of the virus, but a widespread booster campaign, likely with updated vaccines, would be initiated to increase everyone’s immunity to that variant.

When Monica Gandhi, an infectious diseases specialist with University of California, San Francisco, hears about a new variant, she first looks at the hospitalization rate in the region that it’s spreading in to see if and how it’s increasing. In areas of high vaccination, cases are no longer a completely accurate indicator of how severe a wave will be — as immunity has increased, hospitalizations have significantly decoupled from cases, Gandhi said. Keep in mind that at-home COVID test results are often not recorded by health departments, which makes it tough to determine what the true case count ― and therefore rate of hospitalization ― is in a given community.

The vast majority of breakthrough infections do not lead to hospitalization, and infectious disease experts expect our immunity to keep protecting us from severe illness, even with other variants. For those who are at-risk, increasing case numbers may indicate it’s time for a booster or a high-quality mask. For those who aren’t high-risk, wearing a mask in public spaces and around someone you know is immunocompromised is an easy way to reduce transmission ― even if mandates aren’t in effect, you still have control over prevention.

Benjamin Neuman, a professor of biology and chief virologist at Texas A&M University, says when it comes to variants, the severity of COVID mostly has to do with what’s going on inside the person, rather than the variant itself.

Look at omicron. “In many countries with high vaccination rates, or high previous incidence of infection, omicron was relatively mild, most likely because there was enough immunity from vaccination or surviving COVID,” Neuman said.

In Hong Kong, however, vaccination rates have been low and strict public health restrictions have been effective, which means there is less natural immunity in the population. As a result, omicron has been very severe. We saw a similar phenomenon during the delta wave — areas with high vaccination rates had low hospitalizations, and places with low vaccination rates saw a surge in hospitalizations.

Long story short: It’s crucial to consider the immunity of the region experiencing an uptick in a new variant — both from vaccination and natural infection — to determine whether a variant is truly more pathogenic.

Another thing to consider is that all of the variants we’ve seen so far — despite the fact that they’ve mutated and become more transmissible — are overall still pretty similar to one another.

“Scientists like to track the variants because it shows how the virus is changing, but the most distant BA.2 variant is still around 99.7% identical to the original virus from 2019,” Neuman said.

Polio, for example, has three main variants, all of which are around 80% identical to one another. “We can still do a reasonable job of vaccinating against all three variants with a single vaccine,” Neuman said, adding that the biggest difference between most SARS-CoV-2 variants, in practical terms, is often the name.

It would take a variant with a lot of new mutations to drastically alter the current landscape.

Gandhi said a red flag would be raised for her if suddenly there was an increase in younger people and vaccinated people being hospitalized for COVID. She would also be concerned if the symptoms changed.

“Right now, it’s quite a predictable course and we know how to treat COVID in the hospital,” Gandhi said. But if COVID started impacting various organ systems differently, that would suggest a new variant picked up some concerning traits.

According to Neuman, the next generation of variants are likely to come from the omicron and BA.2, since that’s what’s circulating. Even if the third scenario mapped by the WHO unfolds, the situation would not be be unassailable, Neuman said.

“It is likely that some combination of more doses and omicron-like vaccines will be needed to keep people protected, at least in the short term,” Neuman 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.