COVID-19 isn’t done with us yet. Waste water surveillance is showing signs that COVID infections are creeping up again. And recent analysis suggests that rise may be driven in part by a new type of variant called “FLiRT.” We asked several infectious disease experts to weigh in on the relative danger and offer advice on how to stay safe.
How much are the waste water numbers climbing?
The amount of detectable virus per millimeter of waste water has risen significantly since late April in Eastern Massachusetts, said Dr. Shira Doron, chief infection control officer for the Tufts Medicine health system and hospital epidemiologist at Tufts Medical Center. But, prior to the current spike, the virus was present in such small quantities that levels remain modest.
Doron called the increase “very, very, very gradual.”
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“What goes down, must go up,” she said. “Certainly it’s nothing like when Omicron was emerging and overtook the landscape within days.”
Overall, the new variants now account for about 40 percent of the viruses now circulating in the United States, according to data from the Centers for Disease Control and Prevention.
What are the FliRT variants?
“FLiRT” is the nickname for a family of variants, including KP.2 and KP.3. They are all descended from the now dominant JN.1 variant, which itself descended from BA.2.86, a variant that gained widespread notice when it first emerged last fall because it carried about 30 new mutations, more than any other variant circulating at the time. The FLiRT variants are characterized by changes at three specific positions in the grappling-hook-like spike protein, which the virus uses to bind to human cells prior to infecting them. The name itself is an acronym derived from the technical names of the location where the mutations are located on the spike protein.
Are hospitalizations up? How big do people think this uptick is going to get?
So far there’s no indication that hospitalizations are rising locally, several infectious disease doctors said. Emergency department visits and hospital admissions for COVID-19 held steady at low levels through the week ending May 18, according to Massachusetts’ respiratory illness dashboard.
But government websites in both the United Kingdom and Singapore, two countries where the latest variants make up a larger share of total cases, recently issued alerts noting that they had seen an increase in the number of hospitalizations. This suggests that in the weeks ahead, we may get a bump in people presenting to emergency departments with COVID. And some of them may require hospitalization, says Dr. Leonard Mermel, medical director of epidemiology and infection control at Rhode Island’s Lifespan, which operates hospitals across the state.
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Overall, however, the number of patients in the United Kingdom and Singapore sick enough to require ICU treatment hasn’t risen significantly, which means it’s unlikely we will see a major uptick in the number of patients who require critical care.
“Maybe I’m being a little overly optimistic, but I think it’s unlikely we’d see massive spikes in severe cases because we do have some [immune] protection,” Mermel said. “The new variants are different enough that they are not recognized by our immune response, so it’s easier if exposed to become infected. But based on what’s happening overseas, the antibodies we have from previous versions would protect against severe disease in most people.”
Do younger healthy people need to take any sort of precautions?
The guidance for young, healthy individuals remains the same: They may want to wear a mask in close settings, such as when taking public transportation. Washing hands is a good idea. People who are sick should stay home and avoid infecting others.
“People kind of know what to do by now,” said Dr. Louise Ivers, an infectious disease expert and chief of global health at Mass. General Hospital. “I think it’s important to be vigilant and follow any precautions recommended by the Massachusetts or Rhode Island health departments. I don’t think at this moment there’s any changes that are needed. Personally, I keep my eye on it. I still respect it. I still wear a mask on public transportation.”
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Should seniors get a booster now or wait?
Infectious disease experts advise those who are older, have multiple medical conditions, or are immunocompromised to make sure they are up to date on their vaccines. With COVID fatigue now endemic, Ivers said, many Americans no longer seem to be testing themselves for COVID, which makes it more important than ever for the most vulnerable to protect themselves.
Newly updated mRNA COVID vaccines became available last fall. In February, the CDC recommended an additional dose for adults ages 65 and older. Though the vaccines were designed to target XBB.1.5, a subvariant of Omicron that dominated the United States last year, the CDC says the updated vaccines still provide protection against currently circulating variants. Paxlovid, as a treatment, should still be effective.
When will everyone else be eligible for another COVID vaccine dose?
Infectious disease experts are watching the progression of the new strains closely, Doron said. They are likely to choose a new vaccine makeup that may incorporate some of the new variants sometime next month. It should be available in the fall, she said.
She emphasized there is no cause for alarm.
“It’s just a gradual increase,” Doron said. “And that’s probably how it’s always going to be forever until the end of time. A subvariant of Omicron or a new variant will predominate, and then something else will come along and replace it. That’s just the nature of the mutation of viruses.”
Adam Piore can be reached at [email protected].