By Karen Kier
Pharmacist on behalf of ONU Healthwise Pharmacy

The idiom "under the radar" means the ability to go without attracting attention or to go undetected. In education circles, they may refer to a student who is under the radar as someone who follows instructions, completes their work on time, but may not fully comprehend the subject. They may not be recognized as falling behind in their understanding of the material. The education literature offers tips on how to identify these students and to improve their understanding.

One website offers tips to students who want to stay under the radar meaning they do not want to get called on in class. The advice from the website is to look pensive, engaged, and scribbling notes when the teacher looks at you. The theory is the teacher is less likely to call on someone thinking so hard and actively engaged. I find this ironic, since this is the type of student I am often looking to call upon—one engaged in class!

Another way to think about "under the radar" is stealth technology. Stealth technology was announced to the public by Secretary of Defense Harold Brown at a Pentagon news conference in 1980. However, the government and its partners were working on stealth aircraft technology in the 1940s and 1950s. A stealth prototype was first flown in 1977 and was the precursor to the F-117 Nighthawk. The government already had contracts for a stealth bomber, which became the B-2 Spirit aircraft. Stealth technology continues today with fifth-generation aircraft. 

The World Health Organization (WHO) considers the XBB.1.5 subvariant of the SARS-CoV-2 virus to be “the most transmissible” subvariant to date. The XBB.1.5 is a subvariant of the BA.2 lineage. The BA.2 lineage is called the “stealth” variant because of its ability to bypass the immune system. The XBB.1.5 has the most mutations to the viral building blocks, which allows this virus to evade the body’s natural defense within the immune system and it improves its ability to attack and attach to cells. This combination has resulted in significant spread of the infection.

A biology professor from Canada gave the XBB.1.5 subvariant the nickname “the Kraken” after a Scandinavian mythological sea creature. This sea monster is described as enormous and instills fear. Social media grabbed on to this nickname and it has caught on. 

The XBB.1.5 subvariant is taking hold in the United States. As of January 13, 2023, the CDC has reported that 43% of the infections are related to this subvariant in the U.S. The XBB.1.5 is being seen in all regions of the U.S. and is responsible for 70% of the cases in the Northeast. 

This potent mix of mutations in combination with waning immunity has COVID-19 cases increasing in the U.S. and globally. Based on this subvariant, what are the current recommendations?

On January 6, 2023, the FDA announced the lack of benefit of previous monoclonal antibodies against the XBB.1.5 subvariant as well as some others spreading in the U.S. The FDA withdrew emergency use authorization (EUA) for some of the monoclonal antibodies due to the lack of benefit in the newer strains. In addition, the FDA provided a warning that Evusheld (tixagevimab/cilgavimab) may no longer provide protection as a preventative agent against the XBB.1.5 subvariant. The agency is waiting for additional study data to confirm Evusheld activity against XBB.1.5. 

In contrast, many of the antivirals approved or given EUA by the FDA continue to provide a therapeutic benefit if given early during a COVID-19 infection. This includes continued activity against the XBB.1.5 subvariant. The antivirals should be used to treat COVID-19 infections in those who are at highest risk for hospitalization or death from the virus.  

A New England Journal of Medicine study published on January 5, 2023, provided evidence that remdesivir (Veklury), molnupiravir (Lagevrio), and nirmatrelvir had activity against XBB.1.5. Paxlovid is the brand name of the combination of nirmatrelvir with ritonavir. This information is important for providers and patients as this stealth subvariant starts to spread in the U.S.  

The COVID-19 booster vaccines, including the newer bivalent vaccines, have taken a strong hit within the media over the last few weeks. Many of the reports are spreading misinformation and disinformation related to the vaccines. The current vaccines including the bivalent can not prevent the infection due to the invasiveness of this new subvariant, but it still maintains a level of protection against severe disease. A past infection with COVID-19 including the Omicron variant is not protective against this XBB.1.5 subvariant due to evasiveness of the mutations.

I would highly recommend reading the Johns Hopkins University of Medicine’s Coronavirus Resource Center website to get the most accurate information about XBB.1.5 at https://coronavirus.jhu.edu/from-our-experts/what-you-need-to-know-about....

Fly under the radar and be stealth against the new subvariants of COVID-19. Follow the advice of experts and make sure you are up-to-date on vaccine boosters, wear a mask to reduce the risk of spread and contact your healthcare provider immediately if you have COVID-19 symptoms or test positive for COVID-19 to see if antiviral therapy is best for you. 

ONU HealthWise is offering COVID-19 vaccines as well as flu shots Monday-Friday from 10:00 a.m.-5:00 p.m. The bivalent COVID-19 vaccines are available. Clinics are Monday through Friday from 4:00 p.m.-6:00 p.m. Please call the pharmacy for more information. 

ONU HealthWise Pharmacy
419-772-3784