Many prognosticators have expressed concern that COVID-19 cases may soon begin rising due to the increasing immune-evasiveness of Omicron subvariants. Experts indicate a combination of factors, some modifiable, some not, that could produce a third consecutive COVID-19 wave this winter in the US.

They have divided the pandemic into 4 phases. Phase 1 showed only a few variants that the World Health Organization (WHO) called the SARS-CoV-2 "index virus." This was followed by a series of a variant in Phase 2 of the pandemic. Interestingly, Phase 3 witnessed no new variants, rather only highly contagious Omicron subvariants that were increasingly immune-evasive and making monoclonal antibody treatments ineffective against them. Phase 4 of the pandemic will contain Immune-evasive subvariants, fading immunity against the virus, and the inadequate uptake of COVID-19 boosters, all summed up to surge the number of cases and deaths.

Furthermore, the evidence now indicates that messenger RNA (mRNA) COVID-19 vaccines dont render lifelong, or even yearlong, protection. Thus, the health authorities have now approved updated booster shots, which combine the prototype COVID-19 vaccines with the Omicron BA.5 subvariant components, in early September of this year in the US. Experts have emphasized the critical role of these bivalent boosters in preventing severe illness and death this winter. Yet, very few of the eligible population have taken their booster shot.

A study that still needed to be peer-reviewed, posted on November 1, found that the bivalent COVID-19 boosters produced superior neutralizing activity against all the Omicron subvariants compared with the monovalent boosters. 

In a November 4 news release, Pfizer and BioNTech also announced that their bivalent booster produced four times higher neutralizing antibodies against Omicron BA.4 and BA.5 sublineages in people older than 55 years than the original COVID-19 vaccine. 

The CDC is advising people to get their bivalent booster if it′s been two months or more since the last monovalent booster dose or three months or more since a COVID-19 infection. However, there seems to be a problem with the effective government messaging, as many surveyed people still don′t know much about the importance of these new booster shots. To increase boosters uptake, states are trying to encourage more healthcare professionals to provide COVID-19 vaccination in their offices, as healthcare providers can better convince their patients about the importance of the updated booster vaccine. However, the packaging of these vaccines remains a challenge are they′re not the ideal single-serve vials, making clinicians worried about having to discard leftover doses in an open vial at the end of the day.

Bivalent boosters are also essential to curb serious COVID-19 illness this winter because nonpharmaceutical interventions (NPIs) to stop the spread of SARS-CoV-2, such as social distancing and wearing face masks, have been all but abandoned. It would be more reasonable if the individuals made themselves a choice to wear a mask, at least in a crowded place, to check the spread of infection.

Rubin R. How Immune-Evasive Omicron Offspring and a Lack of Mitigation Measures Could Shape a COVID-19 Winter Wave. JAMA. Published online November 16, 2022. doi:10.1001/jama.2022.17758