As we head towards Fall, a new COVID-19 subvariant EG.5 (nicknamed Eris) (https://www.today.com/health/coronavirus/eris-eg5-covid-subvariant-symptoms-rcna98833) is rapidly becoming the dominant strain across the United States, based on the latest data from the U.S. Centers for Disease Control and Prevention (CDC). (https://covid.cdc.gov/covid-data-tracker/#variant-proportions) 
 
The EG.5/Eris subvariant has been classified as a “variant of interest” by the World Health Organization (WHO) and has also been reported to be circulating in 51 countries (including China, Japan, South Korea, and Canada). 
 
EG.5/Eris is a subvariant of prior omicron variants, including XBB.1.16 (Arcturus) ; XBB.2.3 (Acrux) and XBB.1.5 (Kraken) which have dropped into second, third and fourth places respectively, according to current test results (with EG.5 Eris at 17.3 percent; XBB.1.16/Arcturus at 15.6 percent; XBB.2.3/Acrux at 11.2 percent; and XBB.1.5/Kraken at 10 percent).
 
It is important to note that although the total number of cases increased to 27 percent in late July, level of infection is still very low compared to prior surge peaks.

However, with reduced COVID-19 testing in recent months, best estimates of community infections were based on wastewater analyses. While an increase on the EG.5/Eris subvariant was confirmed, overall infections are still at a much lower level compared to past results.
 

Transmissibility

EG.5/Eris has two mutations in the spike protein which contribute to increased transmissibility. As experts say, “it must be more infectious or transmissible” to outcompete prior highly infectious variants.
 
According to WHO’s Risk Evaluation report (https://www.who.int/docs/default-source/coronaviruse/09082023eg.5_ire_final.pdf?sfvrsn=2aa2daee_3), “EG.5 carries an additional F456L amino acid mutation in the spike protein compared to the parent XBB.1.9.2 subvariant and XBB.1.5 Within the EG.5 lineage, the subvariant EG.5.1 has an additional spike mutation Q52H and represents 88 percent of the available sequences for EG.5 and its descendent lineages.” 

However, the situation is complicated because other variants are also “co-circulating” with EG.5/Eris.
 
“Based on the available evidence, the public health risk posed by EG.5 is evaluated as low at the global level, aligning with the risk associated with XBB.1.16 and the other currently circulating variants of interest (VOI).”
 
“While EG.5 has shown increased prevalence, growth advantage, and immune escape properties, there have been no reported changes in disease severity to date. However, due to its growth advantage and immune escape characteristics, EG. 5 may cause a rise in case incidence and become dominant in some countries or even globally,” notes WHO.
 
EG.5/Eris possessing “increased immune escape properties” may be an important factor in outcompeting the other co-circulating omicron subvariants.

Severity of Disease

On a cautious note, WHO has stated that “there have been no reported changes in disease severity to date” from the EG.5/Eris subvariant.
 
It is noteworthy that the U.S. recently saw its first increase in hospitalizations for the year. This information is of importance to myeloma patients, as these cases are individuals with risk factors and more likely to develop severe complications.



More importantly, population immunity from vaccination and prior infection definitely provide protection from severe disease.



Symptoms



Symptoms of EG.5 infections are similar to prior omicron subvariants and may include:

• Cough
• Sore throat
• Runny nose
• Sneezing
• Fatigue
• Headache
• Muscle aches
• Altered sense of smell


However, if the disease progresses to a severe infection, difficulty in breathing due to lung infection may occur.
 

Testing is Strongly Advised for Myeloma Patients

The good news is all current COVID-19 tests (including PCR tests and rapid at-home antigen tests) are capable of detecting EG.5/Eris. Myeloma patients should not hesitate to get tested if symptoms develop.
 
However, since COVID-19 tests are no longer free, it is important to double check your insurance coverage. For in-home testing, make sure to check the expiration date. 
 
The COVID-19 antiviral Paxlovid is also effective against EG.5/Eris but should be taken at the earliest time possible to gain its maximum benefit.
 

Updated Vaccines Coming this Fall


In June 2023, the U.S. Food and Drug Administration (FDA) advised vaccine manufacturers to update COVID-19 boosters to target the XBB.1.5 strain—the dominant strain at the time.
 
To date, the FDA needs to authorize the updated vaccine for use, while the CDC needs to make its recommendations.
 
According to CDC Director Dr. Mandy Cohen, the updated vaccines are anticipated “to become available by the third or fourth week of September.”
 
Experts indicate that the updated vaccines should work well against the EG.5/Eris subvariant and other variants with the XBB lineage. However, there is still no definite guidance at the moment.



Additionally, a recent study published in eBioMedicine (https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(23)00308-0/fulltext#%20) (a peer-reviewed journal from The Lancet Discovery Science) revealed that people who received vaccination shots on the same arm "had a stronger immune response than those who distributed shots between both arms," as reported by USA Today. (https://www.usatoday.com/story/news/health/2023/08/17/arm-for-vaccine-shots-matter/70604228007/)

"In the observational study, authors analyzed immune responses from about 300 people who never had COVID-19 and received two doses of Pfizer-BioNTech’s COVID-19 vaccine between March and September 2021."

"Study participants were randomized to receive both doses in one arm or the second dose in the opposite arm. Two weeks after receiving the shots, researchers discovered certain immune cells – commonly known as 'killer T cells' – were detected in 67% of people who received both injections in the same arm versus only 43% of those who got them in different arms," USA Today reported further.

Therefore, I would highly recommend that you get an updated booster/vaccine shot on the same arm where you received your previous vaccinations to get the maximum benefit from these "killer T cells."

If there is particular concern about the dangers of possible COVID-19 infection, consideration can be given to vaccinate using the 2022 booster right now. Experts agree this can potentially be helpful, although not targeting the new variants directly. This is something that you should discuss with your doctor.
 

Masks May Need a Comeback



It has been wonderful to be free of masks in recent months! However, as community levels of infection rise, it is important to pay attention to local circumstances and consider wearing a mask in situations of risk—especially indoors and with large groups, such as meetings, weddings, or crowded restaurants.
 
Various details about mask-wearing (https://www.myeloma.org/blog/covid-19-surges-waves-keep-coming-should-myeloma-patients-do) (including wearing high-quality ones such as N95 masks) which were discussed extensively in my past blogs still apply, if there is concern. 
 

The Bottom Line



The emergence of yet another COVID-19 omicron subvariant in EG.5/Eris should be a top-of-mind concern, especially for myeloma patients. It’s important to practice caution on day-to-day activities, particularly when in contact with large groups or when traveling. 
 
Hopefully, no Fall-Winter surge will occur but keep vigilant and stay updated on COVID-19 community levels (https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html) in your area. 

Please do not hesitate to get tested, if symptoms emerge.

While we wait for the FDA and the CDC to sign off on the updated boosters, I strongly advise staying safe at all times.