A COVID summer uptick is underway as FLiRT and LB.1 variants ascend

Three years after President Biden hoped July 4, 2021, would mark the country’s independence from COVID, the coronavirus is still here as new variants drive yet another summer uptick.

The country is indeed free from the waves of mass death that once overwhelmed hospitals and morgues, as well as policies restricting how Americans had fun and went to school and work.

But just as the American Revolution didn’t fully eradicate the British threat (see: the War of 1812), the coronavirus remains a public health issue, inflicting milder but disruptive illness on most people and posing a greater danger to the medically vulnerable.

If you’re hearing about more people testing positive or getting sick, it’s no surprise, as data shows another wave forming, especially in the West. Here’s what to know about the latest with the coronavirus:

- - -

What’s the latest COVID data this summer?

Coronavirus infections are likely growing in 44 states and territories as of June 25, according to the Centers for Disease Control and Prevention.

Nationally, coronavirus activity in wastewater remains low but is increasing; it is highest and rising most sharply in the West, according to the CDC. June data may be incomplete because of reporting delays.

Jasmine Reed, a CDC spokesperson, said the recent increases are happening after a spring where the United States experienced the lowest coronavirus activity since the first pandemic wave.

“Covid-19 is expected to continue to have periodic surges as new variants emerge; immunity from previous infections and vaccinations also decreases over time,” Reed said in an email.

Experts say wastewater data is best interpreted as a way of understanding which way the virus is trending.

“We have consistently seen over the past three years that there is a winter surge and there is also a summer surge,” Marlene Wolfe, program director for WastewaterSCAN, a private initiative that tracks municipal wastewater data, and an assistant professor of environmental health at Emory University’s Rollins School of Public Health. “Right now we are waiting to see whether we actually will see a downturn over the next couple of weeks and we’ve hit the peak here, or whether those levels will actually go up.”

The CDC no longer tracks comprehensive COVID hospitalization data, which served as a good barometer for the virus’s severity. Agency officials said the data it does have shows recent increases in COVID hospitalization rates among seniors in some parts of the West.

The death toll of the ongoing summer uptick is not clear because fatality data takes several weeks to become accurate. In May, weekly deaths involving the coronavirus hovered in the low 300s, according to the CDC.

- - -

Which variants are now circulating?

The coronavirus is constantly evolving to overcome the immune defenses of a population in which nearly everyone has antibodies from vaccinations or previous infections.

Nearly two-thirds of infections are caused by KP variants dubbed FLiRT (named after the locations of their mutations, not anything romantic), according to CDC data as of June 22. A similar variant called LB.1, which has an additional mutation than the FLiRT variants, is on the rise and accounted for 17.5 percent of cases.

They are all descendants of the JN.1 variant, which drove the winter wave and was significantly different from the dominant variant that preceded it.

- - -

What do we know about the FLiRT and LB.1 variants?

These new variants don’t mark a significant evolutionary leap or seem to cause more severe disease and death.

“So much of this is at the molecular level. The clinical difference is minor, if any,” said Preethi Malani, an infectious diseases physician at the University of Michigan. “It’s important to track these from a public health standpoint, but to me, this is normal expected evolution.”

The Infectious Diseases Society of America offers a detailed examination of the preliminary research findings on each of these new variants, cautioning much of the data has not been peer-reviewed or corroborated by real-world studies of how the virus operates outside labs where they are researched. Here are the key takeaways:

-- The most common FLiRT variants have mutations that can more efficiently infect people who have been vaccinated and spread more easily than JN.1.

-- LB.1 appears to be even more infectious than FLiRT variants and more adept at overcoming immunity conferred by vaccines.

-- Vaccination still produces antibodies that can recognize the latest variants and effectively defends against severe disease.

-- Paxlovid, the antiviral treatment, is still effective against the new variants and tests can still detect it.

- - -

What’s happening with vaccines?

The coronavirus vaccine currently on the market is designed to target defunct XBB variants, but it still confers some protection against the latest variants. An updated vaccine is expected to hit the market in late summer or fall and will be promoted as part of a broader respiratory virus vaccination campaign.

CDC Director Mandy Cohen last week recommended everyone six months and older to receive that new vaccine. The Food and Drug Administration urged manufacturers to target the KP.2 variant.

Reed of the CDC said the new vaccine should be effective against the other common variants, citing early lab studies, because they are closely related.

People who are 65 and older or are immunocompromised qualify for a second dose of the existing vaccine. If they haven’t already received an additional dose, it’s worth consulting a doctor whether to get one now while COVID is on the rise or wait until the updated vaccine hits the market.

Health insurers are supposed to cover coronavirus vaccines at no costs, and the hiccups that led to denials last fall should have been resolved. But people without health insurance will no longer be able to get free shots through the CDC’s Bridge Access Program, which ends in August because of a lack of funding.

- - -

What are the latest isolation guidelines?

If you contract COVID-19, the CDC now advises people isolate until their overall symptoms have improved and they have been fever-free for 24 hours without the use of fever-reducing medication. The agency also advises precautions such as wearing masks and improving air circulation for an additional five days. This guidance applies to all respiratory illness regardless of whether you test positive for COVID.

This change in guidelines has been widely cited by institutions who have dropped special isolation requirements for people who have COVID.

Noelle Ellerson Ng, associate executive director for advocacy and governance at the School Superintendents Association, said isolation policies have largely shifted to pre-pandemic protocols that emphasized improving symptoms.

“Districts are trying to balance the appropriate focus on containing or limiting contagious germs with minimizing chronic absenteeism,” Ellerson Ng said.

- - -

What’s happening with long COVID?

With hospitalizations and deaths sharply declining and largely concentrated in elderly and severely immunocompromised people, long COVID has become the largest threat to the general public. Long COVID encompasses symptoms lasting weeks to years, including debilitating fatigue or brain fog and persistent coughing and chest pain.

Anyone who gets COVID can develop long COVID, even otherwise healthy people who had mild cases. But the risk increases for people who experienced severe illness, have never been vaccinated, have underlying conditions or are 65 and older. Long COVID has become less common than earlier in the pandemic.

Long COVID activists have criticized public health officials for treating COVID like the flu, arguing the lasting damage of the virus merits a more aggressive response to minimize transmission.