New COVID variants are spreading in New Jersey. Is another surge on tap this winter?

It's been almost a year since New Jersey's last significant COVID surge, when the fast-spreading omicron variant sent thousands to the hospitals and killed more than 2,000 residents in January before quickly receding.

Since then New Jersey, like much of the U.S., has had a lull in COVID activity, with hospitalizations and severe illness remaining relatively low for the longest time period since the virus arrived in March 2020.

But public health experts and physicians are cautioning that this winter could see another surge, as new variants have begun to circulate, few residents have gotten updated booster shots and the holiday season will again see the risk of transmission rise with increased travel and indoor gatherings.

Add to that an early start for flu season and the spread of another lung disease — respiratory syncytial virus (RSV) — and emergency rooms could fill up fast.

"Having overburdened hospitals impacts much more than COVID outcomes," said Stephanie Silvera, an infectious disease expert at Montclair State University. "It delays care for non-COVID conditions and results in screening delays for cancer and other conditions."

What is the state of COVID right now?

New Jersey has been spared a significant COVID surge since the original omicron strain hammered the state in December and January.

Reports of severe illness have been stable for almost six months in the Garden State. Daily hospitalizations have bounced between 800 and 1,100, while the number of patients with COVID in intensive care have fluctuated between 90 and 130 daily, with ventilator use at 30 to 50 daily. ICU admissions and ventilator use were about 50% to 110% greater this time last year, Health Department data shows.

People are still dying every day from COVID. The daily death toll has been mostly in the single digits since early September — about half of what it was in the same time period last year.

Transmission levels have decreased across much of New Jersey in the last two to three months, according to a review of weekly Health Department reports. The latest report from last week shows medium transmission levels in almost all of the state, compared with high levels in August.

Are new variants circulating in New Jersey?

The BA.5 omicron subvariant has been the dominant strain in New Jersey since July, but newer variants are slowly pushing it out.

While CDC data shows at least eight variants in circulation in New Jersey and New York, the fastest-growing are the BQ.1 and BQ.1.1 subvariants.

Their prevalence has more than doubled in the past two weeks, according to CDC data. As of Saturday, BQ.1 accounts for 24% of all strains in New Jersey and New York, and BQ.1.1 is at 19%.

Will the latest bivalent booster work against new variants?

The bivalent booster shot is designed to target the two omicron subvariants, BA.4 and BA.5, that emerged over the summer.

The problem is that they are on their way out.

It is still unclear how effective the booster would be against BQ.1 and BQ.1.1. The strains contain the R346T mutation, which has been linked to immunization evasion. But they also evolved from the BA.5 strain.

Health experts say the new bivalent booster should provide some protection against severe illness from the newest strains.

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"Any protection is better than no protection," said Kenneth Plante, associate director of the World Reference Center for Emerging Viruses and Arboviruses at the University of Texas Medical Branch.

"It is too early to say that vaccination can protect you from more serious illness in the context of these new variants," he said. "But if history teaches us anything, it will likely do so."

And those who have already been infected with BA.5 may not necessarily be off the hook this winter, said Silvera, of Montclair State.

BQ.1 and BQ.1.1 "are very efficient at evading immune protection, so previous infection does not confer the short-term protection that we previously saw," she said.

Are many New Jerseyans getting the new booster shot?

Although New Jersey outpaces the national rate, fewer residents are getting the updated bivalent booster shot compared with last year's booster.

As of Oct. 27, about 679,000 of the 7 million New Jerseyans eligible for a bivalent booster had received one.

That amounts to 9.7% in a state that has had one of the best vaccination rates in the U.S. The national rate is 7.3%, according to federal Centers for Disease Control and Prevention data.

Last year, about 20% of New Jerseyans had gotten a booster shot by late October — about a month into the campaign.

But demand skyrocketed as Thanksgiving approached, and it then grew even greater as the highly transmissible omicron variant began to spread in early December. Walk-in vaccine clinics soon started to require appointments, with wait times quickly moving from days to weeks.

Is COVID going to surge this winter?

Many public health officials and physicians believe there will be an uptick in COVID this winter, but they don't know how bad it will be.

Since new variants emerge so quickly — as with omicron last year and BQ.1 and BQ.1.1 this year — there is often a significant lag time for science to catch up to determine their severity.

Europe has already begun to see a rise in COVID cases and hospitalizations, which is often a harbinger of things to come in the U.S.

And regardless of the new variants, some believe there will be an uptick simply because people have let their guard down by wanting to return to a normal, pre-COVID life.

"Firstly, masks are not being used," said Philip Tierno Jr. a professor of microbiology and pathology at NYU Grossman School of Medicine. "Secondly, people are not getting the new bivalent omicron boosters. Third, people are more cavalier in large gatherings. And lastly, new variants are already occurring."