COVID Omicron BQ 1, BQ 1.1 and BA 5 Subvariants: Symptoms and Treatment?

Two new omicron subvariants have overtaken BA.5 as the prevailing versions of the coronavirus in the United States. Data from the Centers for Disease Control and Prevention (constantly updated) showed that the new subvariants — called BQ.1.1 and BQ.1 — have taken over. The two together make up around 49.7% of new Covid infections, whereas BA.5 makes up just 24%.

"BA.5 is essentially declining quickly, probably soon to be gone," said Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston.

BQ.1.1 and BQ.1 cases are also rising in the U.K. and elsewhere in Europe. The two subvariants made up around 18% of new infections in the European Union from Oct. 17-30, and the European CDC expects that share to jump to more than 50% this month or next.

Both of the subvariants are considered part of the BA.5 family — they're sublineages that evolved from BA.5. But preliminary data suggests they are better at evading immunity from Covid vaccines, including the new bivalent boosters, or a previous Covid infection than past versions of omicron. That may give these subvariants higher transmissibility, which could fuel a rise in cases this winter.


Only a handful of scientific studies have been published on BQ1, BA.4 and BA.5 so far, meaning knowledge about them remains limited. 

COVID-19 Omicron BQ1 and BA5 Variant Symptoms

As of right now, BQ.1 and BQ.1.1 do not seem to have symptoms that distinguish them from previous COVID-19 variants, says William Schaffner, M.D., infectious disease specialist and professor at the Vanderbilt University School of Medicine. “So far, they don’t seem to produce more severe disease, although it’s early,” he says. “There’s nothing distinctive about their symptoms that would tell you that you have one variant over another.” 

According to the US CDC (updated Oct 26, 2022), people with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. Anyone can have mild to severe symptoms.

Possible symptoms include:
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
Related: Flu vs COVID-19

Take a Test

Between 48 and 72 hours after potential COVID exposure or at the first sign of any symptoms, people should take either a rapid antigen or PCR test. “There should be a very low threshold for testing yourself to see whether you have COVID or whether you have something else,” says Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. COVID can look very like a cold, influenza or allergies, but the treatments for each are different.

PCR tests are more sensitive but harder to get, and taking a rapid antigen test at home usually suffices, the experts say. If the first test is negative, people should wait two days (behaving cautiously in the meantime) and take another one as Myers did. If it is COVID, the viral load will increase in that time. “Nothing in life is perfect, nor are the rapid antigen tests, but they’re pretty darn good at picking up contagious levels of virus,” says Lucy McBride, a practicing primary care doctor in Washington, D.C. (Lists of free test locations are available on the Test to Treat locator Web site provided by the U.S. Department of Health and Human Services.)

When people test positive, it is a good idea for them to call a primary care physician if they have one. Doctors can provide guidance on treatment and update medical histories. They will also report the result to public health authorities so that it is included in case counts. At a minimum, people should track the date that symptoms began and the date of a positive test.

Over-the-Counter Help

Most people who get COVID will be just fine at home. “If you’re vaccinated and boosted and generally healthy, people do very well,” McBride says. Over-the-counter medications will not treat COVID directly but can help manage symptoms. Doctors recommend acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil or Motrin) to bring down fevers and relieve achiness. Early in the pandemic, there were reports that ibuprofen made COVID worse, but those have not been substantiated. NSAIDs are only intended to be taken for short periods, however, because they have more side effects than acetaminophen, and they are not safe for everyone. People who take other medications should consult with a doctor before taking NSAIDs. Antihistamines or cold medications such as DayQuil can be used to relieve congestion and cough.

Getting enough rest is critical, as is drinking enough fluids, which prevent dehydration and reduce cough. 

Having a pulse oximeter at home would also be useful to calculate the amount of oxygen in a person’s blood without having to draw a blood sample. If oxygen levels fall below 95 per cent, that would be a sign to visit the hospital.

Thermometers, tissues and hand sanitizer are other supplies often recommended to keep at home while experiencing a COVID-19 infection. Finally, it won’t hurt to take vitamin supplements as deficiencies might be associated with the severe form of COVID-19.

Using Prescription Drugs

One of the most significant recent changes in the COVID landscape is the wider availability of authorized outpatient treatments. The antiviral drug Paxlovid reduced risk of hospitalization and death by 89 percent in a clinical trial, and it is a pill, which makes it relatively easy to take. The drug cannot be taken with many common medications such as statins or blood thinners, however.

Monoclonal antibodies also significantly reduce the risk of severe disease, but they require an injection or infusion. And not every patient is eligible to get these treatments. Both have been authorized for people who are at higher risk of severe illness because of age (65 and older) or underlying health conditions such as high blood pressure or lung disease. To date, there is no evidence that these treatments benefit people who are young or otherwise healthy. Either treatment is available by prescription or at Test to Treat sites nationwide for people who are eligible.

Older version of monoclonal antibodies, such as Regeneron’s treatment (Imdevimab + Casirivimab), could fail or partially fail because they target parts of the virus that will have mutated. 

Concerns about immunity and monoclonal antibodies

According to Assistant Professor Yunlong Richard Cao at BIOPIC, Peking University:

"...BQ.1.1 escapes Evusheld and bebtelovimab, making all clinically available antibody drugs ineffective."

Omicron variant BQ.1.1 found to be resistant to all monoclonal antibody treatments

A combined team of researchers from Leibniz Institute for Primate Research and Friedrich-Alexander University of Erlangen-N├╝rnberg, both in Germany, has found that the SARS-CoV-2 omicron variant BQ.1.1 is resistant to all known monoclonal antibody treatments. In their study, published in The Lancet—Infectious Diseases (Nov 2022), the group tested a host of omicron sublineages against all known antibody treatments.

In their work, the researchers looked at BJ.1, BA.4.6, BA.2.75.2 and BQ.1.1—all subvariants of the omicron strain of the SARS-CoV-2 virus. They tested each against all of the currently available monoclonal antibody treatments to see how well the treatments are working. They found that all of the variants were resistant to some of the treatments and that BQ.1.1 was resistant to all of them.

The finding is alarming in one respect—BQ.1.1, along with BQ.1, currently comprise nearly half of all infections in the U.S.


Other At-Home Treatments

You can find a listing of doctors who can prescribe necessary home isolation medications on Find a Provider post. 

There are many COVID-19 treatment protocols out there on the internet. We have reviewed many protocols and believe the FLCCC I-CARE protocol is the easiest and effective to follow. 

Always consult your trusted medical professional before you take any medication or supplement. 

Long COVID risk from omicron variant

As of October 17, 2022, federal data published by the US CDC found that 14.2% (National Estimate) of adults who previously had a COVID-19 infection are currently experiencing symptoms of long COVID.

Related: Treatment for Long COVID Syndrome    

Emergency warning signs

Individuals are reminded to seek immediate medical attention (go to a hospital’s emergency department) if they develop emergency warning signs of COVID-19 such as:
  • Difficulty breathing
  • Persistent pain or pressure in the chest
  • Bluish lips or face
  • New confusion or inability to arouse

Key Takeaway

As soon as you have symptoms, consult your healthcare provider and start treatment as early as possible. If treatment is delayed i.e. after 5 days of symptoms, your chances of severe COVID are higher.

Related: 

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