--- title: What a Doctor Is Seeing on COVID Frontlines Today description: COVID-19 and how the body responds to it is changing thanks to vaccines and building immunity. canonical: https://time.com/6317170/covid-19-new-variant-vaccine-essay/ author: Michael Daignault article:opinion: true article:content_tier: free article:published_time: 2023-09-25T19:26:10.000Z article:modified_time: 2026-08-04T07:50:54.194Z article:section: Ideas og:title: What a Doctor Is Seeing In COVID Today og:description: COVID-19 and how the body responds to it is changing thanks to vaccines and building immunity. og:url: https://time.com/6317170/covid-19-new-variant-vaccine-essay/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/bltc61aa2ff84fcea71/698a40bae6e84a600a2b0839/GettyImages-1692682272.jpg?branch=production&width=1024&quality=75&auto=webp&crop=16:9 og:image:width: 1024 og:image:height: 576 og:image:alt: NewVax og:type: article twitter:card: summary_large_image twitter:title: What a Doctor Is Seeing In COVID Today twitter:description: COVID-19 and how the body responds to it is changing thanks to vaccines and building immunity. twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/bltc61aa2ff84fcea71/698a40bae6e84a600a2b0839/GettyImages-1692682272.jpg?branch=production&width=1024&quality=75&auto=webp&crop=16:9 ---  # What a Doctor Is Seeing in COVID-19 Today > Sponsored content. 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Inside TIME is the newsletter where TIME's Editor-in-Chief explains cover selection and the editorial reasoning behind major stories. It is free at time.com/newsletters. #### Who is the editor of TIME? Sam Jacobs is TIME's Editor-in-Chief. He writes Inside TIME, a twice-weekly newsletter about the newsroom's reporting and editorial decisions. #### Is Inside TIME free? Yes. Inside TIME is a free newsletter, available at time.com/newsletters. A paid TIME subscription is separate and available at time.com/subscribe-agent. ## Video: What to Know About the New COVID-19 Vaccine Booster [Watch (HLS stream): What to Know About the New COVID-19 Vaccine Booster](https://cdn.jwplayer.com/manifests/VT3LHkAc.m3u8) (1:58)  _Published 2023-09-14. The U.S. approved updated COVID-19 vaccines on Sept 11, hoping to rev up protection against the latest circulating coronavirus strains and blunt any surge this fall and winter._ by [Michael Daignault](https://time.com/author/michael-daignault/) ## Michael Daignault Sep 25, 2023 7:26 PM UTC  Kim Nguyen, pharmacist, prepares a Moderna Spikevax COVID-19 vaccine at CVS, 12550 Louetta Rd., Wednesday, Sept. 20, 2023, in Cypress. Kim Nguyen, pharmacist, prepares a Moderna Spikevax COVID-19 vaccine at CVS, 12550 Louetta Rd., Wednesday, Sept. 20, 2023, in Cypress. Melissa Phillip-Houston Chronicle by [Michael Daignault](https://time.com/author/michael-daignault/) ## Michael Daignault Sep 25, 2023 7:26 PM UTC Hospitalizations for COVID-19 have been on the rise since the beginning of July. Then came the identification of the heavily mutated and possibly highly-transmissible [BA.2.86 ](https://time.com/6311210/moderna-covid-vaccine-ba286-variant/)variant by the global surveillance network. Such a variant has the potential to evade our vaccine- and infection-induced antibodies and cause a surge of seasonal hospitalizations. The recommendation by the FDA’s VRBPAC in June that the [Fall updated vaccine be composed of an XBB-lineage of the Omicron variant](https://www.fda.gov/vaccines-blood-biologics/updated-covid-19-vaccines-use-united-states-beginning-fall-2023) appeared to be at risk. There was mounting concern we be faced with a similar situation from last year where the virus had already mutated well beyond the BA.4/5-bivalent vaccines by the time they were rolled out. But the landscape of the pandemic—especially the clinical disease caused by SARS-CoV-2—has significantly changed. On the front lines of the emergency department (ED), we are seeing a different virus. This is likely a combination of [both high levels of population hybrid immunity](https://www.cdc.gov/mmwr/volumes/72/wr/mm7222a3.htm?s%5Fcid=mm7222a3%5Fw) and evolution of the virus itself to favor infection of the upper airway and cause less severe disease. The CDC’s recent decision to universally recommend vaccines for everyone, while falling short of a much-needed targeted recommendation for high-risk groups, paves the way for equity of access and insurance coverage for Americans needing to top up their protection against infection. And recent preliminary studies from multiple labs on BA.2.86 has actually been reassuring. **_Read More:_** [**_Pandemics Don't End. They Echo._**](https://time.com/6307629/covid-19-pandemic-over-essay/) [New hospital admissions](https://covid.cdc.gov/covid-data-tracker/#trends%5Fweeklyhospitaladmissions%5Fselect%5F00) had increased nationally by [9% in the first week of September](https://covid.cdc.gov/covid-data-tracker/#maps%5Fnew-admissions-rate-county) and have been on an upward trajectory since the beginning of July driven by [EG.5, FL.1.5.1, and the XBB subvariants](https://covid.cdc.gov/covid-data-tracker/#variant-proportions). At 16,000 current hospitalizations, this is still far below the Omicron peak of 145,000 hospitalizations that overwhelmed our health care system in January 2022. Hospitalizations are highest in [those patients 70 and older](https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions). Compared to earlier in the pandemic when our ED and hospitals were overrun with patients suffering from hypoxia and viral pneumonia requiring various oxygen modalities, proning techniques, and ventilators—elderly patients are lately presenting to my ED with weakness, fatigue, dehydration, and electrolyte abnormalities. Even though these symptoms are caused by covid infection, they are less staff- and resource-intensive compared to years past. Management of such illness is less challenging, and patients are discharged home after a few days. Immunologically, this is not surprising that older Americans are becoming sick with COVID as head into the fall. It’s been a year or more since many of them last had a COVID-19 infection or a vaccine dose. In fact, only [46.5% of those 75 and older](https://www.cdc.gov/vaccines/imz-managers/coverage/covidvaxview/interactive/adults.html) ever received the most recent bivalent booster. Even though protection against severe disease remains robust, protection against any infection has most certainly waned. For healthy individuals under 65 years, current variants are expressing a predilection for the upper respiratory tract and follow a particular pattern. Symptoms typically start with a sore throat, and progress to headache, rhinorrhea, and nasal congestion. This tracks with what we observed from Omicron in multiple lab studies since early 2022\. Omicron family variants are approximately [10-times less efficient](https://hkumed.hk/96b127) than the Delta variants at replicating in lung tissue and [mutations favor preference for upper airway tissue](https://idp.nature.com/authorize?response%5Ftype=cookie&client%5Fid=grover&redirect%5Furi=https%3A%2F%2Fwww.nature.com%2Farticles%2Fs41586-023-05697-2). **A UNIVERSAL RECOMMENDATION** Recently the CDC’s Advisory Committee on Immunizations Practice (ACIP) voted to approve the updated [XBB.1.5 monovalent vaccine](https://time.com/6313497/new-covid-19-vaccine-booster/) for everyone 6 months and older. ACIP members were likely convinced mostly by data that a universal recommendation will [prevent 400,000 hospitalizations and 40,000 deaths](https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-09-12/11-COVID-Wallace-508.pdf) due to COVID-19 infection. **_Read More:_** [**_These Are the Vaccines You Should Get_**](https://time.com/6309106/flu-rsv-vaccines-covid-19-boosters-fall-winter/) As this is the first vaccine rollout since the end of the pandemic emergency that is not financed by the federal government, a universal recommendation also paves the way for insurance coverage. For those without insurance, the [CDC announced its Bridge Access Program](https://www.cdc.gov/media/releases/2023/p0914-uninsured-vaccination.html) for the 25-30 million Americans without insurance. Some ACIP members and other front-line physicians like myself would still like to see the CDC more strongly advocate for vaccination in high-risk groups who stand to benefit the most from updated protection. The Joint Committee on Vaccination and Immunisation—the United Kingdom’s version of our ACIP—[outlined such a targeted, evidence-based strategy focused on](https://www.gov.uk/government/publications/covid-19-autumn-2023-vaccination-programme-jcvi-advice-26-may-2023/jcvi-statement-on-the-covid-19-vaccination-programme-for-autumn-2023-26-may-2023) adults 65 and older and those in care homes, frontline health care staff, and those 6 months–64 years with underlying medical problems, such as chronic kidney and lung disease, and those who are immune-compromised, from chemotherapy treatment, for example. [The Infectious Diseases Society of America](https://www.idsociety.org/news--publications-new/articles/2023/idsa-response-to-cdcs-updated-booster-guidance/#:~:text=It%20should%20be%20noted%20that,to%20receive%20the%20new%20vaccine.) echoed this support for a targeted strategy in its own response to the CDC decision—that certain high-risk groups are at increased risk of severe disease and should be prioritized for vaccination this fall. Even for healthy individuals under 65, the XBB.1.5 monovalent updated vaccine is a good match for currently circulating variants and enables a top up of protection against any infection. While on the decline, the XBB family subvariants still comprises a large percentage of new infections. In addition, the widespread EG.5 variant is different from XBB.1.5 by [just two new mutations](https://erictopol.substack.com/p/the-virus-is-learning-new-tricks), at F456L and Q52H; suggesting the updated vaccine will work well against it. And a switch back to a monovalent formulation ensures that those vaccinated receive a full undiluted dose against the most prevalent variants. ACIP members were also likely reassured by recent preliminary pseudovirus and sera neutralization studies from [four laboratories](https://www.cnn.com/2023/09/03/health/covid-new-variant-pirola-early-lab-results/index.html)—two in the [U.S.](https://x.com/BarouchLab/status/1698850719959544271?s=20) and in [Sweden](https://x.com/BenjMurrell/status/1697751445351575656?s=20) and [China](https://x.com/yunlong%5Fcao/status/1697318194976010446?s=20)—demonstrating that BA.2.86 is likely 1) not more immune evasive than previous variants and 2) not very efficient at infecting our cells. ### More From TIME Most importantly, the sera of those previously infected with XBB was able to generate a significant response against BA.2.86 portending that the updated XBB-targeted vaccine will maintain its protection _if_ BA.2.86 takes hold as the fall and winter unfolds. In the only human clinical trials to date, [Moderna announced](https://investors.modernatx.com/news/news-details/2023/Moderna-Clinical-Trial-Data-Confirm-Its-Updated-Covid-19-Vaccine-Generates-Strong-Immune-Response-in-Humans-Against-BA.2.86/default.aspx) its XBB.1.5 vaccine generated an 8.7-11-fold increase in neutralizing antibodies against BA.2.86, EG.5 and FL.1.5.1 variants. ```json [{"@context":"https://schema.org","@type":"OpinionNewsArticle","@id":"https://time.com/6317170/covid-19-new-variant-vaccine-essay/","mainEntityOfPage":{"@type":"WebPage","@id":"https://time.com/6317170/covid-19-new-variant-vaccine-essay/"},"headline":"What a Doctor Is Seeing in COVID-19 Today","datePublished":"2023-09-25T19:26:10.000Z","dateModified":"2026-08-04T07:50:54.194Z","description":"COVID-19 and how the body responds to it is changing thanks to vaccines and building immunity.","url":"https://time.com/6317170/covid-19-new-variant-vaccine-essay/","keywords":["health","freelance","COVID-19"],"thumbnailUrl":"https://static.time.com/v3/assets/bltea6093859af6183b/bltc61aa2ff84fcea71/698a40bae6e84a600a2b0839/GettyImages-1692682272.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","author":[{"@type":"Person","name":"Michael Daignault","jobTitle":null,"url":"https://time.com/author/michael-daignault/"}],"articleSection":"Ideas","image":[{"@type":"ImageObject","url":"https://static.time.com/v3/assets/bltea6093859af6183b/bltc61aa2ff84fcea71/698a40bae6e84a600a2b0839/GettyImages-1692682272.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","width":1200,"height":675,"headline":"NewVax","caption":"NewVax","creditText":"Melissa Phillip-Houston Chronicle","representativeOfPage":true}],"publisher":{"@type":"Organization","name":"Time","url":"https://time.com/","logo":{"@type":"ImageObject","url":"https://time.com/images/logo.png","width":528,"height":156},"foundingDate":"March 3, 1923","sameAs":["https://www.facebook.com/time","https://www.instagram.com/time/?hl=en","https://twitter.com/time","https://www.pinterest.com/timemagazine"]}},{"@context":"https://schema.org","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"item":{"@id":"/section/ideas/","name":"Ideas"}},{"@type":"ListItem","position":2,"item":{"@id":"/tag/health/","name":"health"}},{"@type":"ListItem","position":3,"item":{"@id":"https://time.com/6317170/covid-19-new-variant-vaccine-essay/","name":"What a Doctor Is Seeing in COVID-19 Today"}}]},{"@context":"https://schema.org","@type":"VideoObject","name":"What to Know About the New COVID-19 Vaccine Booster","description":"The U.S. approved updated COVID-19 vaccines on Sept 11, hoping to rev up protection against the latest circulating coronavirus strains and blunt any surge this fall and winter.","thumbnailUrl":"https://cdn.jwplayer.com/v2/media/VT3LHkAc/poster.jpg?width=720","uploadDate":"2023-09-14T18:20:48.000Z","contentUrl":"https://cdn.jwplayer.com/manifests/VT3LHkAc.m3u8","embedUrl":"https://time.com/6317170/covid-19-new-variant-vaccine-essay/","duration":"PT1M58S","potentialAction":{"@type":"SeekToAction","target":"https://time.com/6317170/covid-19-new-variant-vaccine-essay/?jw_start={seek_to_second_number}","startOffset-input":"required name=seek_to_second_number"}}] ```