XBB.1.5 and How This Variant Changes the Situation

Young Adults May Have Long COVID and Not Know it

If you are under 35 years old, stay in average shape, eat a mostly healthy diet, and have a strong immune system, you aren't likely to have symptoms from low-level exposure. That doesn't mean you avoided all of the potential long-term issues.

Anywhere from 30% to 50% of children under 17 are asymptomatic. Around 20% to 30% of 18- to 29-year-olds are asymptomatic, and those that aren't asymptomatic are more likely to have mild cold or allergy-like symptoms. Parents of younger children have also had this experience, so they often assume the same and won't test themselves or their kids. For these reasons, people under 35 may not realize they have COVID.

Many have had long-term COVID symptoms like brain fog, more severe headaches, extreme fatigue, or stomach pain. They may experience an increased level of anxiety than they had before COVID or maybe never had before, or they may experience depression and not understand why when they have always been positive and happy. They assume it comes with age or something else must be going on. They may not talk about it because it isn't as if they can't function. They may be unaware of what long-term issues COVID can cause or that they were ever infected.

Many people in this age group may have been around lower numbers of viral particles in the air when infected because they were in a classroom, lecture hall, playing sports, at a party, or somewhere else. In theory, the repeated low-dose exposures could have built and maintained a level of antibodies that would have kept them from getting re-infected for the first year or two of the pandemic or helped them avoid moderate to severe symptoms. The implementation of universal mask use in schools, colleges, and work places, during the first year or two would have helped ensure lower dose exposures.

Many went for two years or more without showing any signs of infection before they got mildly or moderately sick. Some people saw the stretch of immunity come to an end with the Delta variant, and others with the many sub-variants of Omicron.

There are two reasons for this. Around the time of the Delta variant, the virus changed to avoid being stopped by antibodies from previous infections or vaccines. The second reason is that, at some point, people get exposed to large amounts of virus particles all at once.  For example, imagine driving in the same vehicle, working out at the gym, or going to see a movie, and you end up sitting in front of a very contagious person. How many times have you heard that healthy people have nothing to worry about?  Many would say that they are out all the time and definitely immune. That was true until it wasn't. This has been the experience of many people. Even if the symptoms of this virus are mild, it can still cause problems with the brain, muscles, blood vessels, and nerves. This can lead to any of over 200 symptoms that affect ten organ systems and can last for weeks, months, or even years.

No matter how healthy or young you think you are, if you are exposed to enough virus particles at once, your body could be overrun before T cells can respond. During that time, COVID will try to get into the organs. The more viral particles a person is exposed to, the more likely it is that viral particles will get past the body's defenses and enter organs where the immune response can't reach them. This can lead to the many symptoms of Long COVID including an increased risk of cancers and autoimmune disorders.

Becoming aware of the symptoms can help find solutions to some of these issues but it is much more difficult to know if you haven’t taken the time to test for COVID and other respiratory viruses. Testing to determine the culprit of just mild symptoms can go a long way to helping you help yourself later, if unexplained symptoms arise. It is also important to be able to verify COVID if things take a turn for the worse and find that you are unable to maintain a job, requiring disability. This is happening to millions of people and will likely continue to happen more often as these variants evolve and people are exposed to larger amounts of virus at one time.

Requesting a “respiratory viral panel” (RVP) can help eliminate quite a few viruses with one test. One more swab can eliminate COVID as the cause. If one or more of these come up positive, then your doctor will have much more information to go off to treat existing conditions and any symptoms that develop in the future. You will have also proof of it occurring should things get worse.

What Viruses do PCR-based Panels Detect?

“While there is some variation among panels, most multiplex PCR-based respiratory viral panels test for influenza, respiratory syncytial virus (RSV), adenovirus, parainfluenza virus, adenovirus, coronavirus (not that coronavirus–see below), rhinovirus, enterovirus, and human metapneumovirus; some also include bocavirus and offer subtyping of influenza, parainfluenza, RSV, and coronavirus. (Of note, most panels cannot distinguish between rhinovirus and enterovirus.)” (3)

COVID can get around antibodies from prior infections or vaccines, but what about the killer T-cells?

During an infection or after vaccination, the body builds an army of CD8 T-cells, also called killer T-cells because they kill the virus inside our infected cells. After 6 months from the last booster shot or infection, the army of killer T-cells starts to weaken and is undetectable after 10 to 12 months. This means that more people will be at risk of mild to severe symptoms, the more time that passes beyond the 6 months.

Because the virus can dodge antibodies, that means we are relying on the killer T-cells. This allows the virus to move into other parts of your body, infecting cells along the way, because the killer T-cells don't respond until after the virus infects our cells. If 100 viral particles enter your body and infect 100 cells, the killer T-cells will only have to kill 100 of our own cells to eliminate the virus. If exposed to a million viral particles, then a million of your cells will have to die to eliminate the virus. Obviously, the more viral particles that someone is infected with, the harder it will be and the longer it will take to clear the virus from circulation and if necessary, confine it the places that the killer T-cells can’t reach.

XBB.1.5 is extremely contagious and spreading faster than any prior variant, so what changed to give it this advantage? 

ACE2 receptors exist in the cells of the eyes, ears, nose, throat, tonsils, lungs, blood vessels, GI tract, testis, heart, brain, and other parts of the body. ACE2 receptors serve as the entrance for coronaviruses like HoV-NL63, SARS-CoV, and SARS-CoV-2 into human cells.  XBB.1.5 has a stronger ability to bind to these receptors. This new gripping strength provided by a new mutation, is aiding its ability to infect people. Once it gets a hold of someone, it replicates and spreads. XBB.1.5 can not only dodge antibodies and immune system cells but also attack them and, in some cases, use them to make more copies of itself.