What to know about the new COVID subvariant, and where to get booster shots

The newest COVID-19 variant, dubbed BA.2.86, has been identified in Michigan and is likely spreading in the community at low levels, according to the Centers for Disease Control and Prevention's latest update on Sept. 15.

But a recent increase in COVID-19 infections and hospitalizations appear to be caused by XBB lineage viruses, not BA.2.86 according to the CDC.

At the same time, an updated COVID-19 booster shot that the CDC predicts will be effective at reducing severe disease and hospitalization associated with BA.2.86 became available last week. Local hospitals and health departments are ordering the most up-to-date doses which are now available.

However, the boosters are no longer free for most people. The cost will depend on an individual's health insurance.

The dominant strain of the virus in Michigan is EG.5, which made up about 28% of cases in the two-week period ending Sep. 16, followed by XBB 1.16, which made up 10.7% of cases, according to the CDC. About 22 other strains, none of which are BA.2.86, were responsible for the rest of the cases, with each one responsible for less than 10% of the total.

"There are a whole bunch of Omicron (lineage viruses) circling right now. Everything's in the category of Omicron but there's a whole bunch of different viruses," said Dennis Cunningham, medical director of infection prevention at Henry Ford Health. "I'm not too worried about (BA.)2.86. ... People who were vaccinated or infected in the past are going to have some protection against it. I think there are other variants out there that are much more likely to cause disease or cause a lot of cases."

BA.2.86 had been identified in nine states as of Sept. 8 as well as internationally, first in Israel and since in Canada, Denmark, the United Kingdom, South Africa, Sweden, Norway, and Switzerland, according to the CDC. It was first detected in July. As of Aug. 30, there had been 24 human cases worldwide.

COVID-19 continues to mutate, and the current strains that are circulating in the general public are almost "completely unrecognizable" compared to the original virus, Cunningham said.

The spike protein, which is how the virus attaches to our cells and gets inside our body, "has changed so much it looks completely different," Cunningham said.

The genetic sequence of BA.2.86 has several additional mutations, compared with previous Omicron variants. The changes represent over 30 amino acid differences from the BA.2 variant, which was dominant early in 2022, and over 35 amino acid differences compared with XBB.1.5, which has been dominant for most of this year, according to the CDC.

"This number of genetic differences is roughly of the same magnitude as seen between the initial Omicron variant (BA.1) and previous variants, such as Delta (B.1.617.2)," the CDC said in an update on Aug. 30.

Health officials continue to monitor new variants to determine if they are more infective or pathogenic, said Matthew Sims, director of infectious disease research for Corewell Health.

"We've gotten to the point where, given the general immunity in the population ... it's not the same disease it was when it started when it started," Sims said. "Now, the majority of people who get it... don't need to be in the hospital. A lot of them have very minor symptoms, if any, because there's enough antibody out there to keep it under control. But if we get a strain that the antibodies still work on at all, you know, that will become a problem again."

It is too soon to determine if the BA.2.86 is more transmissible than other variants, but the CDC estimates that around 97% of the U.S. population has antibodies to COVID from vaccination, previous infection, or both. It is likely that the cellular and antibody immune responses will provide protection against severe disease from BA.2.86, CDC officials said in an Aug. 30 update.

Where to find the new vaccine and how much it will cost

Individuals can search for locations to receive the latest COVID-19 booster shot here.

This is the first booster that will not be free of cost for everyone, local health department officials said.

"The federal government purchased all the initial COVID vaccine, so it was widely available to everyone without charge," said Susan Ringler Cerniglia, an administrator at the Washtenaw County Health Department. "This is the first update that's happening since we're shifting back to ... what would be like commercial pay."

A single Moderna COVID-19 vaccine dose in the private sector costs $128, compared to $115 for a Pfizer dose, according to the CDC.

"Vaccines do tend to be pretty expensive when they come out, so that's not an unusual price for it," Cunningham said. "I think what the big difference is, when it was under emergency use authorization, only the government can buy it and so that's why we were getting it at no extra cost because our tax dollars were used to buy it."

But most insurance providers should cover the COVID-19 vaccines at little to no out-of-pocket cost, Ringler Cerniglia said.

"For people with insurance, they should be able to go wherever they normally get their vaccines," Ringler Cerniglia said. "Some people don't have coverage, so that leaves a gap."

The Washtenaw County Health Department provides vaccines to people without health insurance, so people with private health insurance should seek out vaccines at their normal vaccine providers, Ringler Cerniglia said.

"People with insurance need to get back to those regular providers. (For) people without insurance or Medicaid coverage, health departments or other safety net providers are a good option," Ringler Cerniglia said.

The CDC's Bridge Access Program also makes COVID-19 vaccines available for free for adults 18 years and older without health insurance and adults whose health insurance does not provide zero-cost coverage.

Cunningham of Henry Ford Health said that it is not yet offering the booster because it is still in the process of updating its systems, but will soon.

"I'm really excited that we have this updated vaccine coming out. It's going to work much better for the Omicron that are currently circulating," Cunningham, of Henry Ford, said. "We are updating our electronic order systems for this new vaccine, but we hope to be giving it out shortly."

hmackay@detroitnews.com