Cold and Flu season will soon be upon us. In addition to the flu we also have to worry about RSV as well as the new COVID Variant.
The exact timing and duration of flu seasons varies, but flu activity in the North East often begins to increase in October. Most of the time flu activity peaks between December and February, although significant activity can last as late as May.
RSV or Respiratory syncytial virus, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious. Infants and older adults are more likely to develop severe RSV and need hospitalization.
RSV enters the body through the nose or eyes, usually from contact with infected saliva, mucus or nasal discharge. This virus usually occurs in the late fall through early spring months. The timing can vary in some parts of the country. RSV is the most common cause of hospitalization in children under age 1 year.
What COVID-19 variants are going around in September 2023?
Currently, the dominant variant nationwide is EG.5, with 21.5% of cases, followed by FL.1.5.1, with 14.5% of cases, and XBB.1.16.6 with 9.2% of cases. "The original omicron variant is gone now," says infectious diseases expert Dr. Mark Rupp. "Currently subvariants of omicron are circulating, including EG.5, XBB.1.5, and XBB.1.16."
When you receive a COVID-19 test, you won't find out which variant caused your infection. That's because COVID-19 tests only detect the presence of the virus – they don't determine the variant.
Genomic sequencing looks at the genetic code of the virus to determine which variant caused the infection.
How contagious is it? Omicron’s subvariants are considered to be especially efficient spreaders of the disease. The original strain of Omicron was more transmissible than Delta was. One explanation was that more than 30 of Omicron’s mutations are on the virus’s spike protein, the part that attaches to human cells, and several of those are believed to increase the probability of infection.
Severity: Scientists are still working to learn more about whether the current Omicron strains cause more severe disease than their predecessors. Data has suggested that the original Omicron strain was less severe, in general, than previous variants, according to the CDC. But it has also been noted that surges in cases may lead to significant increases in hospitalizations and deaths, as they did during the variant’s spread at the beginning of 2022, when the estimated death rates went as high or higher than they were at the time of the Delta variant surge in the previous autumn.
Can vaccination prevent it? The CDC says that while breakthrough infections in vaccinated people are expected, staying up to date with vaccinations is the best protection against Omicron. Scientists are evaluating the effectiveness of a new fall 2023 updated COVID-19 booster against EG.5 and BA.2.86, according to the CDC. Currently, the CDC says the updated vaccine is expected to be effective at reducing severe disease and hospitalization from the two recent subvariants.
XBB.1.5—nicknamed the Kraken—which derived from the BA.2 Omicron subvariant. It is part of the XBB family of variants that emerged a few months ago and caught virologists' attention because it contains more mutations to evade immunity than other variants seen so far.
‘Kraken’ is the name of a mythological sea monster and XBB was given this name by a Canadian biology professor who has been trying to demystify COVID variants by giving them mythological names,” Sandra Adamson Fryhofer, MD, an Atlanta general internist and chair of the AMA Board of Trustees
“Now, it is a little easier to say than the XBB.1.5. But the name sounds scary,” Dr. Fryhofer said. “But just because it's been given the nickname of a sea monster doesn't necessarily mean it's more dangerous. Of course, we need hard data to make that determination.”
Is XBB.1.5 more transmissible?
COVID-19 cases in the U.S. caused by XBB.1.5 have gone from 1% to more than 40% rather quickly. In fact, scientists are reporting that this subvariant “appears to bind more tightly to cells in the human body than the predecessors,” said Andrea Garcia, vice president of science, medicine and public health at the AMA.
“It also seems to be more resistant than earlier variants to immune system antibodies,” Garcia said, noting that “we’re likely going to continue to see that increase in cases.”
Where is XBB.1.5 spreading?
In December, the XBB.1.5 subvariant caused less than 10% of COVID-19 cases in the U.S. During the first week of January, though, it was reported that XBB.1.5 accounted for about 40% of cases. But because of the holidays, there were delays in reporting the data from states, so it was just an estimate.
Now the Centers for Disease Control and Prevention (CDC) has a clearer picture of impact of the XBB.1.5 subvariant. As of Jan. 13, the CDC now estimates that XBB.1.5 accounts for about 43% of cases, making it the most dominant strain in the country. BQ.1.1 is now the second most dominant strain at about 29% of COVID-19 cases. But that could change quickly.
At the moment, XBB.1.5 is the most dominant strain of COVID-19 in the Northeast, making up more than 80% of cases in New York and New Jersey. It has also been detected in at least 28 other countries but is not a dominant strain.
What are the symptoms of XBB.1.5?
Symptoms with XBB.1.5 appear to be similar to the earlier Omicron subvariants. Those can range from typical cold symptoms such as cough and congestion to shortness of breath and low oxygen levels that require emergency medical attention.
But as XBB.1.5 continues to spread, the signs and symptoms of COVID-19 may seem different than what was seen earlier in the pandemic with Alpha or Delta variants. Symptoms such as the temporary loss of taste and smell can still happen in some instances, but it has become less common with the Omicron variant and subvariants.
Other symptoms may include fever, chills, fatigue, muscle or body aches, sore throat, nausea or vomiting and diarrhea. Symptoms can last between five to seven days but vary from person to person.
Is XBB.1.5 infection more severe than other COVID-19 variants?
“The experts generally believe that the symptoms of COVID have become less severe over time,” Garcia explained. “That could be because they tend to remain in the upper respiratory tract and don't affect the lungs as much as earlier variants.”
“But it could also be because people in the U.S. have some level of immunity from vaccines or prior infection,” she said, noting that “many people who are infected now are reporting those mild symptoms like cough, congestion and a headache that could be confused with symptoms of the cold or flu.”
“Although XBB.1.5 is one of the most antibody-resistant variants, it doesn't seem to carry any mutation known to be associated with a potential change in severity. However, studies of disease severity are now ongoing,” said Dr. Fryhofer who also serves as the AMA’s liaison to the CDC’s Advisory Committee on Immunization Practices (ACIP) and is a member of ACIP’s COVID-19 Vaccine Work Group.
How long does XBB.1.5 last?
Other symptoms may include fever, chills, fatigue, muscle or body aches, sore throat, nausea or vomiting and diarrhea. Symptoms can last between five to seven days but vary from person to person.
Should I still be testing for COVID-19?
Many people who are infected with SARS-CoV-2 have been reporting mild symptoms such as cough, congestion and headaches. These symptoms can often be confused with the cold or flu. But if you notice any of these symptoms, it is important to test for COVID-19. This can differentiate between COVID-19, the cold and flu as well as help discern what treatments to follow.
How long are COVID test good for? You’ve got a fever, a cough and feel exhausted — symptoms that are common with COVID-19. You’d like to take an at-home test, but when you go to grab one from your medicine cabinet, you realize it’s expired.
What should you do? Is it OK to still use an expired COVID-19 test? Are expired COVID-19 tests accurate? Microbiologist and pathologist Daniel Rhoads, MD, explains why at-home COVID-19 tests expire and what kind of results you may get if you use one.
Do COVID-19 tests expire?
Yes. At-home rapid antigen COVID-19 tests expire. These at-home tests are used to collect a sample from inside your nose to measure it against COVID-19 antibodies that are stored in the testing strip.
While certain parts of the at-home test kit like the swab don’t expire, there are parts like the vials of liquid and testing strips that do.
“There are SARS-CoV-2-antigen-specific antibodies in the test — that’s what the test relies upon for its reliability. The antibodies in the test capture the antigen that’s part of the virus,” Dr. Rhoads explains. “So, those antibodies can go bad over time. They’re little pieces of protein, so they can deteriorate over time.”
If there’s liquid in the test, it can potentially evaporate over time, which means you won’t have enough liquid volume to properly conduct the test.
Do expired COVID-19 tests work? First, it’s important to make sure that your at-home test is actually expired.
“The expiration date listed on the package might not be its actual expiration date,” notes Dr. Rhoads. “When manufacturers first released these tests, they had conservative expiration dates. As they do additional studies and demonstrate that the expiration date can be pushed back, then they can extend it. But the boxes have already been distributed, with the original expiration date already listed on it.”
To check your COVID-19 test expiration date, Dr. Rhoads recommends verifying it with the U.S. Food and Drug Administration’s (FDA) website. It lists the manufacturer’s name, the name of the test and any extended expiration dates. In some cases, you can compare lot numbers from an at-home test box against the list. Many tests have had their expiration dates extended anywhere from 15 to 22 months.
If you have a test that has an extended expiration date, your test should work and give you accurate results. But if you have an expired test, Dr. Rhoads says the FDA advises against using it to determine if you have COVID-19, as the results might not be accurate.
Until Next time: Stay Safe, Stay Healthy and be Careful out in the World.
James A Vito, D.M.D.