As the United States anticipates the onset of cold and flu season, the landscape ofCOVID-19 continues to evolve with new variants and updated vaccine recommendations. Despite a summer lull in cases, rising infections and hospitalizations, coupled with new strains, have brought the virus back to the forefront of public health concerns.

Several new COVID-19 variants are currently circulating, contributing to the ongoing spread of the virus. XEC, an Omicron variant with multiple spike mutations, has become the second-most prevalent strain in the U.S., accounting for over 1 in 10 cases and detected in at least 25 states. This recombinant strain, a hybrid of two pre-existing Omicron subvariants, might be more infectious than previous strains. The dominant strain remains KP.3.1.1, representing nearly 60 percent of cases.

Other notable variants include EG.5, also known as “Eris,” which was the most common variant during the summer and accounts for almost 25 percent of infections, and BA.2.86, dubbed “Pirola,” which has been spotted globally and is under monitoring by the World Health Organization (WHO). Additionally, a new variant named Stratus is also contributing to increasing cases. Experts likeDr. Amy Edwardsnote that with so many contagious variants, the days of having one singular dominant variant may be over.

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While new variants like XEC are emerging, early reports suggest that they do not cause dramatically different symptoms from other COVID-19 strains. According to the Centers for Disease Control and Prevention (CDC), common symptoms to watch for include fever or chills, cough, shortness of breath or difficulty breathing, sore throat, congestion or runny nose, new loss of taste or smell, fatigue, muscle or body aches, headache, nausea or vomiting, and diarrhea. For many otherwise healthy individuals, COVID-19 may present with cold-like symptoms, but for those in high-risk categories, symptoms can be more severe.

In response to these evolving strains, theFood and Drug Administration (FDA) has approved new, updated COVID-19 vaccines from Pfizer (Comirnaty) and Moderna (Spikevax). These mRNA vaccines, which mark the third update, are monovalent, meaning they specifically target one strain: the KP.2 strain of SARS-CoV-2, or the XBB.1.5 Omicron subvariant.

While the Novavax vaccine is not yet ready, the updated Pfizer and Moderna shots are designed to provide better protection against currently circulating variants, including XEC, EG.5, and BA.2.86. Dr. Thomas Russo, professor and chief of infectious disease at the University at Buffalo, highlights that these updated shots are better matched to circulating variants and offer strong protection against severe COVID-19 and death, and modest protection against infection.

The CDC recommends that everyone aged six months and up get the updated COVID-19 vaccine. For optimal timing, Dr. Russo suggests high-risk individuals get vaccinated as soon as possible, while those considered low-risk should aim to get their shot by Halloween. If an individual has been infected during a recent COVID wave, it's advised to wait three months from the time of infection to get vaccinated.

Similarly, if a vaccine has been received in the past few weeks, waiting until the two-month mark is recommended. Side effects are similar to previous vaccines, including pain, swelling, and redness at the injection site, fatigue, headache, chills, muscle pain, joint pain, and fever. It is also possible to receive the COVID booster at the same time as a flu shot, though some experts suggest spacing them out by a week or two to potentially mitigate side effects.

However, the availability and eligibility for these updated vaccines have been marked by significant confusion. The FDA initially updated its guidance to recommend the vaccine only for people aged 65 and older or those at high risk (of any age). While the CDC still needs to vote on these recommendations, actions by U.S. Secretary of Health and Human Services (HHS) Robert F. Kennedy Jr., including the firing of the CDC head and unseating of Advisory Committee on Immunization Practices (ACIP) members, have created uncertainty regarding the final guidance.

Currently, the FDA has authorized Moderna for high-risk individuals aged 6 months and up, Pfizer for high-risk individuals aged 5 years and up, and Novavax for high-risk individuals aged 12 years and up. High-risk includes those 65 and above, and anyone with an underlying health condition. This confusion is compounded by the fact that 16 states require CDC recommendations for pharmacists to administer vaccines, potentially necessitating a physician's prescription in those areas. Commercial availability is rolling out, but not yet uniform across all pharmacies.

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The cost of the new vaccines also presents a barrier for some. While most health insurance companies are expected to cover the vaccine for eligible groups, uninsured adults may face out-of-pocket costs ranging from $140 to $160, as public health programs that previously covered adult vaccinations are no longer available. Children are typically covered through pediatric vaccination programs. For uninsured individuals, the CDC recommends seeking a free vaccine through local health centers or pharmacies participating in the CDC’s Bridge Access Program.

To protect oneself, experts emphasize the importance of getting the updated COVID-19 vaccine. Additionally, wearing a mask in crowded indoor areas, especially when local COVID-19 levels are high or if one is considered high-risk for complications, remains a good protective measure. If symptoms develop, testing for the virus is crucial to prevent further spread. For high-risk individuals who contract COVID-19, contacting a primary care physician about antiviral medications like Paxlovid is recommended to mitigate serious complications.