Omicron BA 4 and BA 5 Subvariants: Symptoms and Treatment?

As of the week ending July 30, 2022, BA.4 and BA.5 represent an estimated 7.7% and 85.5% respectively, of the SARS-CoV-2 variants currently circulating in the United States, according to the CDC. Data suggest that these lineages could be more transmissible than previous Omicron sublineages. However, there is no evidence currently available to suggest that BA.4 and BA.5 cause more severe disease than other variants or Omicron lineages. US CDC is continuing to assess the impact that BA.4 and BA.5 have on public health.

BA.5 became the dominant subvariant in the US earlier this month, surpassing BA.2.12.1. The BA.4 Omicron subvariant is the second most prevalent with 12.8% of cases originating from the pathogen, while the BA.2.12.1 subvariant now accounts for only 8.6%.

BA.5 is one of many Covid-19 Omicron subvariants to emerge since last winter. The subvariant is also driving up cases in parts of Europe and North America and has become the dominant U.S. Omicron strain. This version of the virus is believed to spread particularly easily, fueled in part by its ability to evade immunity built up from vaccines and prior infections.

Only a handful of scientific studies have been published on BA.4 and BA.5 so far, meaning knowledge about them remains limited. However, in one of these studies, researchers led by Alex Sigal at the Africa Health Research Institute in Durban, South Africa, investigated the extent to which antibodies from 39 people who had recovered from the original Omicron variant could prevent cells from being infected with the BA.4 and BA.5 variants.

The research found that the antibodies were several times less effective against the new sub-variants than they were against the original Omicron strain. However, antibodies produced by the 15 individuals who had been vaccinated against COVID-19 were more effective than those from people who had recovered from natural infection alone.

Sigal wrote on Twitter that BA.4/BA.5 escape, while not as dramatic as Omicron escape from the vaccine or Delta immunity, “is enough to cause trouble and lead to an infection wave. But [it is] not likely to cause much more severe disease than the previous wave, especially in vaccinated [individuals].”

COVID-19 Omicron BA4 and BA5 Variant Symptoms

The range of possible symptoms is wide but centers on the upper respiratory system. 

What are the first symptoms of omicron? "Initial symptoms appear to be related to a scratchy or sore throat, often quite mild," according to Susan Huang, M.D., the medical director of epidemiology and infection prevention at UCI Health in Orange County. "Other early symptoms are sneezing, or a runny nose — both of these often cause infected individuals to think they are suffering from allergies or a mild cold, which they hope is not COVID."

Because these symptoms can easily be mistaken for a common cold, especially during a time when travel restrictions are being lifted, many choose not to seek out a COVID-19 test initially — until other symptoms present later down the road. 

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. 

Based on a lab study (NEJM, July 2022) using the live-virus Focus Reduction Neutralization Testing (FRNT) method, bebtelovimab seems to be the most promising monoclonal antibody against the BA 5 subvariant.


Overall, the study data also suggest that the three antiviral drugs remdesivir, molnupiravir, and nirmatrelvir may still have therapeutic value against the sublineages BA.2.12.1, BA.4, and BA.5 of SARS-CoV-2 omicron variants.


Do take note of the limitation of this study as this is a non-clinical study (not in humans). There is lack of clinical data on the efficacy of these monoclonal antibodies and antiviral drugs for the treatment of patients infected with BA.4 or BA.5 subvariants. Therefore, the selection of monoclonal antibodies or anti-virals to treat patients who are infected should be carefully considered based on the potential risks as compared to its potential benefits.

To be effective, these medications must be started soon after symptoms begin (within five days and seven days, respectively). “[People who might be eligible] should call their provider right away,” says Raymund Razonable, an infectious disease specialist at the Mayo Clinic. “These treatments work best when the patients are not feeling so bad.” Side effects of Paxlovid are uncommon but include diarrhea and a metallic taste in the mouth.


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. 


McCullough et al. Reviews in Cardiovascular Medicine, 2020

Long COVID risk less from omicron variant than from delta

The omicron variant is less likely to cause long COVID than the delta variant, new research has found. Analysis by researchers from King's College London of data from the ZOE COVID Symptom study app is published in The Lancet (June 2022). The findings are from the first peer-reviewed study to report on long COVID risk and the omicron variant.

Long COVID is defined by NICE guidelines as producing new or ongoing symptoms four weeks or more after the start of disease. Symptoms include fatigue, shortness of breath, loss of concentration and joint pain. The symptoms can adversely affect day-to-day activities, and in some cases can be severely limiting. Researchers found the odds of experiencing long COVID were between 20-50% less during the omicron period versus the delta period, depending on age and time since vaccination.

The UK Office of National Statistics estimated the numbers of people with long COVID actually increased from 1.3 million in January 2022 to 2 million as of May 1, 2022.

Lead author, Dr. Claire Steves from King's College London, said, "The omicron variant appears  substantially less likely to cause long COVID than previous variants, but still 1 in 23 people who catch COVID-19 go on to have symptoms for more than four weeks.

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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