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Opinion A new immunity-evading virus variant looms. Here’s how to fight it.

Stickers for patients who receive doses of the new bivalent coronavirus booster. (Hannah Beier/Reuters)

Get ready: Another covid wave is on the horizon because of a new immunity-evading subvariant, BQ.1, and its offshoots. The Centers for Disease Control and Prevention says, based in part on models, that BQ.1 and BQ.1.1 now account for nearly 17 percent of infections in the United States, up from zero a few weeks ago. The prevalent BA.5 variant is starting to fade. Especially at risk are the unvaccinated and those who have not gotten a shot of the new boosters.

Right now, the pandemic in the United States is in a lull, and overall levels remain relatively low. There are 260,808 new reported cases a week and 2,566 weekly deaths, the CDC said, partially based on modeling. Covid-19 has been one of the leading causes of death in the United States, but the numbers are far smaller than during the omicron surge last winter.

What is not yet known is whether or how well an immunity wall, built both by natural infection and vaccines, might protect against a new wave. One reason to worry is that BQ.1.1 evades immune systems on a greater scale than other variants and subvariants. Already, the new variant has the potential to make obsolete Evusheld, a key antibody used to protect immunocompromised individuals. Cases appear to be taking off in New York and could spread across the country in the months ahead. Another subvariant, known as XBB, can also easily evade immune systems. So far, it has spread far in Singapore but little in the United States.

BQ.1.1 evolved from BA.5, so there is hope the new bivalent boosters, offered by Pfizer and Moderna, will protect against it, too. The United States has ordered 171 million doses, which became available in early September, but uptake so far is a mere 19.4 million doses. “The U.S. is woefully under-vaccinated and under-boosted,” says Eric Topol, professor of molecular medicine at Scripps Research. A preliminary study of the bivalent boosters, not yet peer-reviewed, showed that they provided protection roughly similar to the previous monovalent boosters but are not as effective against BA.5 as some had predicted; more research will be needed.

Another factor is that people are desperate to return to normal, relaxing precautions as they move indoors and gather in close contact for the coming holidays. A surge in Europe is probably the result of this shift, and there are signs everywhere of an earlier influenza season as well as a wave of RSV among children, leading to overwhelmed pediatric wards.

No one will welcome a new surge, but everyone should prepare for one. The most important step is for all eligible individuals to get vaccinated and boosted. It will be necessary to return to wearing masks in some places, particularly crowded areas with close contact. Everyone should test themselves often and, if positive, stay home — for their sake and for that of others. Good ventilation — with fresh air — and air filtration are indispensable in minimizing transmission in workplaces and other areas where people gather.

The virus has not stopped, and the pandemic is not over. But there are ways to keep it at bay.

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