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It’s a fact of life: Viruses mutate. But it’s still concerning to see headlines touting the latest COVID-19 variant, especially if you’re high-risk for severe illness.
You may feel like you were just getting comfortable enough to rejoin previous activities, then you heard about another strain with an ominous name. The latest one in the press is the XBB.1.16 variant, which is another Omicron strain that has been dubbed “arcturus.”
This variant currently makes up 14.6 percent of cases in the United States, per the U.S. Centers for Disease Control and Prevention (CDC).
The XBB.1.16 variant has been declared a “variant of interest” by the World Health Organization (WHO) and has had a weekly rise in prevalence globally. However, its global risk assessment has been determined to be low. In India, where XBB.1.16 is most prevalent, there has been a slight increase in hospital bed occupancy numbers, but the levels are still much lower than what was seen in previous waves of new variants.
Available data doesn’t suggest that XBB.1.16 poses more public health risk compared to other circulating Omicron descendant lineages. However, it could become dominant in certain countries, according to the WHO. This might lead to a surge in case rates due to the variant’s growth advantage and its ability to evade immune responses (though no changes in severity have been reported in countries where it is circulating).
For those who are immunocompromised, understanding this type of data can be challenging. Here, we break down how worried you should be when a new COVID-19 variant emerges — and what steps you can take to keep yourself safe.
Why Do Viruses Mutate?
Although a virus mutation sounds like a scary plot in a sci-fi movie, it’s actually a very natural process.
Virus variants occur when there’s a mutation to the virus’s genes. Mutations in viruses like SARS-CoV-2, the virus that causes COVID-19, are expected — all RNA viruses mutate over time, per Johns Hopkins Medicine.
“Generally, people should expect this should happen,” says Sydney Ramirez, MD, PhD, an infectious disease doctor and researcher at the University of California San Diego and La Jolla Institute for Immunology. “All of the RNA viruses are pretty prone to having high error rates when making copies of themselves, so it’s not unexpected that we would see mutations in the virus over time.”
Immunocompromised patients are at risk for prolonged infection with SARS-CoV-2. As such, researchers have found that highly mutated variants — which demonstrate fast, multistage evolutionary jumps — can arise during the course of persistent infection in these patients. Research shows that viral evolution in immunocompromised patients may be an important factor in the emergence of variants of concern, per The New England Journal of Medicine.
“People who are going to clear the Omicron variant faster are people who have some preexisting immunity to it,” says Dr. Ramirez. “They’re going to be at the highest risk for not only getting infected in the first place, but not being able to clear the virus quickly. The longer you stay infected, the more chances there are for the virus to mutate.”
How Concerned Should You Be About Virus Mutations?
It’s crucial to be informed and mindful of the potential for virus mutations, but always turn to reliable data to understand how new variants could impact your daily life.
“I wouldn’t want people to be scared just because there’s a new variant, but I do think that people should be aware that if there is a new variant that’s causing a lot more cases, then that’s something to be concerned about,” says Dr. Ramirez. “The mutation rate that we’ve seen throughout the past three years plus has been much faster than what we would see with more established viruses like the seasonal flu.”
There’s no need to panic — but it doesn’t hurt to take every measure you can to protect yourself, especially if you have a weakened immune system.
If you read an article about a new variant, look for clues like how it affects hospitalization rate and how contagious it is (and if research shows it evades current treatments or vaccines). Also talk to your doctor about the overall hospitalization rate (currently, it is less than 10 daily admissions per 100,000 people, according to the U.S. Department of Health and Human Services).
You should also consider your own risk factors: A slightly more contagious virus could be far more serious for someone who is severely immunocompromised compared to someone who is only slightly immunocompromised.
“One reassuring thing is that since Omicron has taken over as the dominant variant, we haven’t seen dramatic shifts or changes in a way that’s rendered further resistance to our currently available vaccines or other treatments,” says Zachary Wallace, MD, a rheumatologist at Massachusetts General Hospital.
Dr. Wallace says he usually tells patients that it’s important to monitor new variants, and to know how new variants affect the therapies and preventive measures currently available to protect you.
What Steps Should You Take From Here?
Start by talking to your doctor about your risk factors, your vaccination status (and if you’re eligible for any new boosters), and available treatments should you get sick. Here are five questions to ask your doctor for a COVID-19 treatment strategy before infection.
“The recommendations are going to vary based on what specific medication and condition you may have, but in general, we’re in a much better place now than we were two or three years ago in terms of the treatments we have available,” says Dr. Wallace. “And while for many of our patients the vaccines may be less effective based on certain medications they may be on, they still provide some level of protection for most.”
That said, there are certain settings in which you may still want to be cautious if you’re immunocompromised, like a very densely crowded space that’s not well ventilated. Or, for instance, you may want to wear a high-quality mask if you’re traveling on a plane, adds Dr. Wallace.
“Talk to your provider and get specific recommendations based on your treatment, condition, and comorbidities,” says Dr. Wallace. “Hopefully, we’ll continue to see new treatments and preventive strategies emerge for immunosuppressed patients who remain at risk for these things.”
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Corey L, et al. SARS-CoV-2 Variants in Patients with Immunosuppression. The New England Journal of Medicine. August 5, 2021. doi: https://doi.org/10.1056/NEJMsb2104756.
COVID-19 Reported Patient Impact and Hospital Capacity by State Timeseries (RAW). U.S. Department of Health and Human Services. May 16, 2023. https://beta.healthdata.gov/Hospital/COVID-19-Reported-Patient-Impact-and-Hospital-Capa/g62h-syeh.
COVID Variants: What You Should Know. Johns Hopkins Medicine. April 8, 2022. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/a-new-strain-of-coronavirus-what-you-should-know.
Interview with Sydney Ramirez, MD, PhD, an infectious disease doctor and researcher at the University of California San Diego and La Jolla Institute for Immunology
Interview with Zachary Wallace, MD, a rheumatologist at Massachusetts General Hospital.
Summary of Variant Surveillance. COVID Data Tracker. U.S. Centers for Disease Control and Prevention. Accessed May 16, 2023. https://covid.cdc.gov/covid-data-tracker/#variant-summary.
XBB.1.16 Initial Risk Assessment. World Health Organization. April 17, 2023. https://www.who.int/docs/default-source/coronaviruse/21042023xbb.1.16ra-v2.pdf?sfvrsn=84577350_1.