New COVID subvariants BQ.1 and BQ.1.1 Symptoms

As of December 2022, subvariants BQ.1.1 and BQ.1 combined are behind nearly 67.9% of cases (CDC). Subvariant BQ.1.1, an offspring of the BA.5, may be able to evade all defense tools we have against COVID-19, leading to more hospitalizations and more cases of long COVID and death.

What is BQ.1.1?

“We’ve dealt with this before, with influenza, for example,” Dr. Albert Ko, a physician and epidemiologist at the Yale School of Public Health, told The New York Times. “Viruses and pathogens are constantly trying to adapt and escape the immune pressure that we pose to them.”

Experts are more concerned with how many deaths a variant causes rather than the number of new mild illnesses.

“If we see that deaths are reduced and if serious illness and hospitalizations are reduced, even if people do get infected, that’s still a big success,” said Michael Osterholm, an epidemiologist and the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, per the Times.

But this also means that the immunocompromised may have fewer tools at their disposal to fight the infection as current treatments may not work well against a highly mutated virus.

How do mutations work?

Many of the omicron lineages have similar mutations and this “pattern suggests that those mutations confer an evolutionary advantage, one that would allow the virus to continue to spread among people who have different layers of protection, from vaccination and infections from earlier omicron lineages,” as Andrew Joseph wrote for health news site Stat.

Andy Pekosz, a microbiology professor at Johns Hopkins Bloomberg School of Public Health, told Global News that the BQ.1.1, which was discovered a few weeks ago, has “the most ability to escape vaccine-induced immunity, as well as some antibody treatments,” at least on paper.

“So that’s one of the reasons why we’re focusing in on this one and trying to keep track of what it’s doing and where it is.”

What are the top omicron symptoms to look out for?

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
• Loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

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.” 

How do I know I have COVID?

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.

Related: Flu vs COVID-19

How can you protect yourself?

Yes, the virus will constantly mutate, but overall, countries are better equipped to deal with COVID-19 after using various measures to prevent infections.

“I know there’s no mandates around these days, but you can lower your individual risk of getting COVID by putting on a mask in an indoor setting where we know the vast majority of COVID is transmitted,” said Dr. Isaac Bogoch, an infectious diseases specialist with the University Health Network in Toronto, per Global News.

Over-the-Counter Help

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. Paxlovid is available by prescription or at Test to Treat sites nationwide for people who are eligible.

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

One of the most concerning aspects of this surge that treatments like monoclonal antibodies may not stand up to the new variants. Early evidence indicates that due to mutations in the spike protein of BQ.1 and BQ.1.1, Evusheld and bebtelovimab each lose efficacy against the variants, according to the National Institutes of Health (NIH).

A combined team of researchers from Leibniz Institute for Primate Research and Friedrich-Alexander University of Erlangen-Nürnberg, 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.

This was confirmed by another study, published in the New England Journal of Medicine (Dec 2022).

According to the authors:

"...These results suggest that imdevimab–casirivimab, tixagevimab–cilgavimab, sotrovimab, and bebtelovimab may not be effective against BQ.1.1 or XBB in the clinical setting...These results suggest that remdesivir, molnupiravir, and nirmatrelvir are efficacious against both BQ.1.1 and XBB in vitro..."

Unlike monoclonal antibodies, the antiviral treatment Paxlovid debilitates the virus without needing to fit the virus’ spike protein. That means it should hold up against BQ,1.1, despite its mutations, the NIH said.

Related: Paxlovid vs Bebtelovimab

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. 

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: 

• Treatment Protocol for Omicron

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