Some of the most concerning, new COVID-19 variants that epidemiologists have been keeping an eye on have reached Hawaii’s shores.

The pair that many are concerned about — BQ.1 and BQ.1.1 — are growing quickly in proportion across the U.S., following trends of growth in Europe. Health experts are concerned not only because of their increased ability to get around immunity from vaccination and previous infections, but their ability to evade existing treatments.

The Hawaii Department of Health’s variant report Tuesday showed that BQ.1.1, a descendant of BQ.1, has been detected via genome sequencing of test specimens. This comes two weeks after the previous report, which noted that BQ.1 had been detected.

In addition, the report also confirmed the detection of XBB.1, an offshoot of another immune-evasive variant called XBB, which has driven cases up in Singapore.

All three belong to the omicron family and represent a very small percentage, at just over 2%, of viruses circulating in the state, according to the report. They are among several hundred viruses evolving with a jumble of alpha-numeric names that experts are referring to as an “alphabet soup,” “variant soup” or “variant stew.”

How concerned should Hawaii residents be about these new variants?

The pandemic is clearly not yet over, according to epidemiologists tracking the evolution of variants.

It means we can expect another wave in the U.S. and in Hawaii, according to Tim Brown, an infectious disease expert at the East-West Center, though exactly when or to what extent remains unknown.

What’s most concerning about BQ.1 and BQ.1.1 is they have significantly higher rates of getting around the human immune response, or “immune escape,” than previous variants, he said. They are also resistant to treatment with Evusheld and bebtelovimab, monoclonal antibody therapies.

BQ.1 and BQ.1.1 make up about 17% of U.S. COVID-19 cases and are listed separately on the Centers for Disease Control and Prevention Nowcast forecasting chart. The presence of XBB.1 in the U.S. is low, and it is not listed yet.

The European Centre for Disease Prevention and Control projects that BQ.1 and BQ.1.1 will likely fuel rises in COVID-19 cases there in weeks and months ahead, and become dominant by mid-November to early December. There is no evidence so far, however, indicating the two variants cause more severe illness.

For XBB, the concern is with reinfections, said Brown. The rate of reinfections in Singapore has grown significantly since XBB became dominant there. This is despite Singapore having a population with a high rate of primary vaccinations and first boosters.

This is why getting the new bivalent booster is important ahead of the holidays, he said.

The hope is that with its new formula targeting both the original strain and BA.5, it will offer better protection against these newest variants, most of which are descendants of either BA.2 or BA.5.

BQ.1 and BQ.1.1 are descendants of BA.5, while subvariant XBB is a “recombinant” of two BA.2 sublineages with a significant growth advantage, according to the World Health Organization. There has been no change in severity detected from these three so far, WHO said.

Officials say they only have preliminary data, but believe the new COVID-19 boosters should still be effective at preventing serious illness and deaths from newer variants.

As of Wednesday, a total of 146,405 bivalent boosters had been administered in the state, according to DOH, representing about 11% of Hawaii’s eligible population ages 5 and older.

All residents ages 5 and older are eligible for the bivalent booster if it has been at least two months since the final dose of their primary series or a previous booster.

Those who were recently infected with COVID-19 can get the booster three months after a positive test, CDC said.

DOH is urging kupuna, ages 65 and older in particular, to get the boosters because they are at higher risk.

Brown said these new variants mean also stepping up other precautions, such as the use of high-quality N95 masks, and testing before gathering. Vaccines alone will not prevent a breakthrough infection, he said.

On Wednesday, DOH reported the seven-day average of new COVID-19 cases increased to 177 compared with 151 reported on Oct. 19. The state’s average positivity rate also increased to 6.2% compared with 5.8% reported the previous week.

Hospitalizations of COVID-19 patients remained steady, with a weekly average of 67 in Hawaii hospitals over the week compared with 66 the previous week, according to the Healthcare Association of Hawaii. On Wednesday, only one COVID-19 patient was in intensive care.

Hawaii hospitals, however, are at full capacity with non-COVID-19 patients, said HAH President and CEO Hilton Raethel, with more than 2,400 patients filling beds per day.

“Unfortunately hospitals continue to be very, very full,” said Raethel. “Our average daily census was over 2,400, and has been that way for a long time. We keep hoping the numbers will go down and we’re very concerned because we’re now entering into the flu season.”

This is due, in part, to patients that are waiting to be discharged to a skilled nursing facility, as well as non-COVID-19 patients who are sicker and staying longer in hospitals.

There also has been a rise in respiratory syncytial virus infections, or RSV, among very young children, who are showing up in emergency departments. But fortunately few require hospitalization.

At the same time, Hawaii hospitals continue to experience staffing shortages and have 400 to 600 traveling health care workers helping out on any given day.

Another potential COVID-19 outbreak driven by new variants would be very concerning for hospitals at full capacity.

“We are concerned about what could happen in the next couple of months,” Raethel said.

DOH also reported two more deaths, bringing the state’s coronavirus-related death toll since the start of the pandemic to 1,704.