Booster options grow as subvariants keep evolving

Health officials are keeping a wary eye on newly emerging omicron subvariants as Hawaii’s COVID-19 death toll surpassed 1,700 this week.

The Hawaii Department of Health reported three more deaths Wednesday, bringing the state’s COVID-19 death toll to 1,702. The majority of deaths have occurred among kupuna ages 60 and older with one or more underlying conditions, and more men than women, according to DOH’s mortality data.

The state’s seven-day average of new cases, meanwhile, appears steady, with 151 per day reported Wednesday, up slightly from 145 reported on Oct. 12. The state’s average positivity rate also remained about the same — 5.8% compared with 5.6% reported the previous week.

Hospitalizations of patients with COVID-19 ticked up, with a seven-day average of 66 over the week, up from 53 reported the previous week, according to the Healthcare Association of Hawaii.

As winter approaches, health officials are watching troublesome new subvariants — all of them evolving simultaneously from omicron. Among them are BQ.1 and its descendant, BQ.1.1, which are both offshoots of BA.5 and rising quickly in the United States and Europe.

The new subvariants are more adept at dodging immunity from vaccination and previous infections.

DOH in its latest variant report confirmed BQ.1 is now present in Hawaii, based on genome sequencing of tests collected statewide, along with BA.2.75.2.

Subvariants BA.4.6, BA.2.75.2 and BQ.1.1 all evade Evusheld, the monoclonal antibody used to prevent COVID-19 in the immunocompromised, according to Kaiser Health News.

Another troubling variant, XBB, a hybrid of two strains of BA.2 — which has not been detected in Hawaii — has driven cases up in Southeast Asia, particularly Singapore.

Tim Brown, an infectious disease expert at the East-West Center in Manoa, described the evolving viruses a “variant stew,” which he says is one of the consequences of the “let ‘er rip” approach to lifting public health restrictions. “There are so many infections developing every day as we allow huge numbers of people to contract and spread omicron and its kids,” he said in a report.

The concern, Brown said, is these newer variants are not only becoming more transmissible but are resistant to monocolonal antibody treatments such as bebtelovimab and Evusheld. The hope is that the new bivalent booster will be more effective against the new variants evolving from BA.5.

Officials continue to urge all eligible residents to get the bivalent booster by Pfizer or Moderna, which targets omicron subvariant BA.5.

As of Wednesday, the DOH reported 77.8% of the state’s population had completed their primary series of COVID-19 vaccinations. All residents ages 5 and older are now eligible for the new bivalent booster if at least two months have passed since the final primary dose, or the latest booster dose. A total of 125,355 bivalent boosters have been administered statewide since Labor Day weekend, when they became available.

Additionally, the DOH announced Wednesday that upon federal approvals, Novavax is now available as a first COVID-19 booster for adults. Novavax is a protein-­based option for individuals who cannot get an mRNA vaccine or who would otherwise not get a booster.

The Novavax booster is available as a first booster to adults who completed their primary COVID-19 series — whether it was Novavax, Pfizer, Moderna or Johnson &Johnson — as long as it was at least six months ago.

While it was formulated to work against the original COVID-19 strain, Novavax recently presented data showing a significant antibody boost against omicron subvariants BA.1, BA.2, and BA.5.

“According to Centers for Disease Control and Prevention data, almost 50% of adults who received their primary series have yet to receive their first booster dose,” Stanley C. Erck, Novavax president and chief executive officer, said in a statement. “Offering another vaccine choice may help increase COVID-19 booster vaccination rates for these adults.”

In the U.S., BA.5 is still dominant, making up about 68% of new COVID-19 cases, while BA.4.6 makes up 12.2%. But omicron subvariants BQ.1 and its offshoot BQ.1.1, which CDC previously lumped in with BA.5, are now listed separately with each variant making up 5.7% of the share of variants, or 11.4% combined.

While overall cases in the U.S. appear to be on the decline, there has been a rise of COVID-19 cases in the Northeast, which has the highest proportion of BQ.1.1, CDC data shows. Daily hospitalizations in New York state are also on the rise.