SARS-CoV-2 Update 3/24/23

In 2023 our Covid-19 infection problems are being caused by XBB recombinant variants and still some BA.5 sub-variants BQ.1 and BQ.1.1. The Omicron BA.5 bivalent vaccine has had no effect on the immune evading BQ variants or XBB recombinant variants. In December the first highly infectious recombinant variant, XBB, began spreading around the world. Since then the XBB variant XBB.1.5, has rapidly spread across the country and the world. Another variant, CH.1.1 (BA. caused 5.9% of infections in the world from December 25 to January 14, 2023 and, from December 26 to January 1, 19.5% of infections in the United Kingdom.  CH.1.1 has not become a predominant isolate in the USA. We follow all UK Technical bulletins and the 51st was released March 10, 2023.

In UK testing XBB.1.5 has a significant growth advantage over BQ and CH.1.1 isolates and has dominated infections in the USA. The new variant XBB.1.9.1 has a 15% growth advantage over XBB.1.5         (see Table 8 from UK Technical Bulletin 51 below). Whether an XBB.1.5 infection will provide any protection against other variants like XBB.1.9.1 is currently unknown. On January 13, the World Health Organization (WHO) updated its recommendations on mask wearing to specify that, given the global spread of COVID-19, masks should be worn “irrespective of the local epidemiological situation,” meaning that masks are now recommended for everyone, not just people in areas with high levels of transmission.

XBB.1.5 Variant Continues to Dominate in the United States

During the week ending in 3/25/23, the CDC estimates that based on genomic surveillance, XBB.1.5 accounted for 90.2% of infections, XBB.1.9.1 2.5% 0f infections, BQ.1.1 2.5% of infections, XBB.1.5.1 2.4% of infections, XBB at 1.2% of infections, followed by BQ.1 at 0.4%,, CH.1.1 at 0.4%, BA.2 at 0.2% and BN.1 at 0.1%. .  

BQ.1.1 has five spike mutations that are different from BA.5. Four of these mutations allow escape from immunity from monoclonal antibodies, any prior infection (including Omicron BA.5), or any vaccine to include the bivalent Omicron BA.5 vaccine. Infections are still occurring in our clinic in patients that received the Omicron BA.5 bivalent vaccine. The XBB recombinant isolate XBB.1.5  has rapidly become the dominant infection in the USA. It took 28 days to become the cause of 40% of infections in the USA. As of 3/25/23, XBB.1.5 has a growth advantage over all other variants except XBB.1.9.1.  XBB.1.5 now causes over 90.2% of infections in the United States. Variant XBB.1.9.1, unlike all other variants tested (UK Technical Bulletin 51), has a 15% growth advantage over XBB.1.5.

What happens next? History shows us that the variant with the most significant growth rate advantage will be the next dominant variant. Our bet is on XBB.1.9.1. 

We are setting ourselves up for what has been described by Nassim Nicholas Talib as a gray swan event. The uncontrolled spread of SARS-CoV-2 in human populations could result in isolates that have enhanced lethality, just like acquisition of ITAM sequences did in the outbreak of Andes virus (ANDV) hantavirus pulmonary syndrome in Argentina in 2018-2019, which resulted in a 32% fatality rate. Our current death rates for SARS-CoV-2 are already catastrophic; a 32% death rate would be apocalyptic. 

The following is a quote from a recent paper by Madison Stoddard et al.: “At its heart, the problem is one of risk management-plausible risks do not need to be inevitable in order to warrant mitigation. In his book “The Black Swan”, a classic in the risk-management community, author Nassim Nicholas Talib describes a type of event known as a Grey Swan – a rare and highly consequential event that, unlike absolutely unforeseen Black Swan events, can be expected. Our work here shows that ahistorical and potentially destabilizing mortality events as a result of the COVID-19 pandemic are Grey Swans, very much within the realm of the possible. In this paper, we describe one mechanism by which this can occur-antigenic shift (a sudden jump in immune evasion) leading to a reversion to a higher death rate. Such an event, if it were to happen, would not only have been predictable, but can occur repeatedly in the absence of further corrective measures.”

We’re asking people to take those corrective measures; be respiratorily safe by wearing an N95 mask, avoiding in-person gatherings, and improving ventilation. This is the only way to prevent a possible Gray Swan event. 

This paper is also notable because it challenges the widely-held belief that “hybrid immunity” to SARS-CoV-2 is advantageous. 


Here are our 14-day moving average determinations for SARS-CoV-2 for the United States. We use the  WORLDOMETERS aggregators data set to make any projections since it includes data from the Department of Veterans Affairs, the U.S. Military, federal prisons and the Navajo Nation.

On 3/24/23, the United States had 5,076 documented new infections. There were also 54 deaths. Forty-one states and the District of Columbia did not report their infections, and 44 states and the District of Columbia didn’t report their deaths. In the United States on 3/23/23 the number of hospitalized patients (22,522)  has decreased  (-4.95% compared to the previous 14 days) and was 23,697 on March 13th. On 2/23/23 there were 3,013 patients who were seriously or critically ill (a 4.28% decrease); that number was 3,148 two weeks ago. The number of critically ill patients has decreased by 135 in the last 14 days, while at least 4,815 new deaths occurred. Patients are still dying each day (average 344/day, the last 14 days). 

As of 3/24/23, we have had 1,153,580 deaths and 106,087,835 SARS-CoV-2 infections in the United States. We have had 528,770 new infections in the last 14 days. We are adding an average of 264,385 new infections every seven days. For the pandemic in the United States we are averaging one death for every 91.96 infections or over 10,874 deaths for each one million infections. As of 3/10/23, thirty-nine states have had greater than 500,000 total infections, and 38 states and Puerto Rico have had greater than 5,000 total deaths. Forty-seven states and Puerto Rico have had greater than 2,000 deaths. Only Vermont has had less than a thousand deaths (910 deaths). As of 3/24/23, 14 states have over 4,000 deaths per million population: Arizona (4,560, Mississippi (4,503),  West Virginia (4,470), New Mexico (4,336), Arkansas (4,328), Alabama (4,306), Tennessee (4,290), Michigan (4,233),  Kentucky (4,083), New Jersey (4,060), Florida (4,057) Louisiana (4,052), Georgia (4,010) and Oklahoma (4,004). Eighteen states (Alabama, Virginia, Missouri, North Carolina, Indiana, Tennessee, Massachusetts, Ohio, Michigan, Georgia, Illinois, New Jersey, Pennsylvania, Florida, Texas, New York, Arizona and California) have had greater than 20,000 deaths. Nine states have had greater than 40,000 deaths: Florida (87,141 deaths), Texas (93,964 deaths), New York (77,331 deaths), Pennsylvania (50,623 deaths), Georgia (42,571 deaths), Ohio (41,924 deaths), Illinois (41,618 deaths), Michigan (42,278), and California (101,798 deaths, 18th most deaths in the world). 

On 11/20/20, there were 260,331 (cumulative) deaths in the US from SARS-CoV-2. Since 11/20/20 (28 months), there were 886,479 new deaths from SARS-CoV-2. For twenty-four of those months, vaccines have been available to all adults. During these twenty-four months, 581,381 people have died of SARS-CoV-2 infections. Clearly, a vaccine-only approach is not working anywhere, especially not in the United States. In addition to getting more people vaccinated, most of the hospitalizations and deaths could have been prevented by proper masking (N95 or better), social distancing, and treatment with oral antiviral agents like Paxlovid. We recommend all of these precautions and treatments to every patient in our clinic, and we have only lost one patient to COVID-19 in 3 years. 

As of 3/24/23, California was ranked 30th in the USA in infection percentage at 30.76%. In California, 26.79% of the people were infected in the last 23 months. As of 3/24/23, 33 states have had greater than 30% of their population infected. Fifty states, the District of Columbia and Puerto Rico have greater than 25% of their population infected.    

Watching World Data

Over the next few months, we’ll be paying close attention to correlations between the SARS-CoV-2 data, the number of isolates identified in various countries and states, and the non-pharmaceutical interventions (like mask mandates and lockdowns) put in place by state and national governments. Data on infections, deaths, and percent of population infected was compiled from Worldometers. Data for this table for SARS-CoV-2 Isolates Currently Known in Location was compiled from GISAID and the CDC. It’s worth noting that GISAID provided more data than the CDC.

LocationTotal Infections as of 3/24/23New Infections on 3/24/23Total DeathsNew Deaths on 3/24/23% of Pop.InfectedSARS-CoV-2 Isolates Currently Known in LocationNational/ State Mask MandateCurrently in Lockdown
World683,196,970(1,785,969 new infections in the last 14 days with an average of 127,569 infections per day).71,2606,826,301(15,937 new deaths in the last 14 days with an average of 1,138 deaths per day.)4358.76%B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)A lineage isolateV01.V2 (Tanzania)APTK India VOC 32421Delta/B.1.617.2 (India)BV-1 (Texas, USA)Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Theta/P.3 (Philippines) Mu/B.1.621 (Colombia)C.1.2 (South Africa 2% of isolates in July 2021)R1 (Japan)Omicron/B.1.1.529 + BA.1 + BA.2 + BA.3 (South Africa November 2021)B.1.640.1 (Congo/France)B.1.640.2 (Cameroon/France)Four new recombinants 12/31 to 3/22)BA.2.12.1 (USA)BA.4 (South Africa)BA.5 (South Africa)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBB (new recombinant India)BQ.1BQ.1.1BS.1BN.1XBB.1XBB.1.5CH.1.1XBB.1.9.1XBB.1.5.1  NoNo
USA106,087,835(ranked #1) 528,770 new infections in the last 14 days with an average of 37,769  infections/day
5,076(ranked #5)
41 states and D.C. failed to report infections on 3/24/23.
1,153,580(ranked #1) 4,815 new deaths reported in the last 14 days or an average of 344 deaths/ day. 54
44 states and D.C. failed to report deaths on 3/24/23.
B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Iota/B.1.526 (USA-NYC)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)BV-1 (Texas, USA)Theta/P.3 (Philippines) Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)R1(Japan)         Omicron/B.1.1.529 + BA.1 + BA.2 (South Africa November 2021)B.1.640.1 (Congo/France)Recombinant Delta AY.119.2- Omicron BA.1.1 (Tennessee, USA 12/31/21)\BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BA.4.6 (USA 7/22)BA.4.6 (USA 7/22)BF.7BJ.1XBB (new recombinant India)BQ.1BQ.1.1BN.1XBB.1XBB.1.5XBB.1.5.1CH.1.1XBB.1.9.1NoNo
Brazil37,204,677(ranked #5) 119,157 new infections in the last 14 days. 699,917(ranked #2; 607 new deaths in the last 14 days)17.27%
India 44,702,257(ranked #2)12,289 new infections in the last 14 days..
530,824(ranked #3) 44 new deaths in the last 14 days)63.17%
Unchanged in 14 weeks
United Kingdom
24,448,729(ranked #9) 52,195 new infections in the last 2 weeks.209,396 (ranked #7) 1,701 new deaths in the last 2 weeks35.69%B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Epsilon/B.1.427 + B.1.429 (USA)*Gamma/P.1 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru)Mu/B.1.621 (Colombia)C.1.2 (South Africa)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)XD (AY.4/BA.1) recombinantXF (Delta/BA.1) recombinantXE (BA.1/BA.2) recombinantBA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)XBBXBB.1XBB.1.5XBB.1.5.1CH.1.1XBB.1.9.1NoNo
California, USA12,155,825(ranked #13 in the world; 59,316 new infections in the last 14 days).908101,798 (ranked #18 in world; 516  new deaths in the last 14 days1030.76%B2 lineageAlpha/B.1.1.7 (UK)Eta/B.1.525 (Nigeria/UK)Beta/B.1.351 (SA)Gamma/P.1 (Brazil)Epsilon/B.1.427 + B.1.429 (USA)*Zeta/P.2 (Brazil)Delta/B.1.617.2 (India)Theta/P.3 (Philippines) Kappa/B.1.617.1 (India)Lambda/C.37 (Peru) Mu/B.1.621 (Colombia) Omicron/  B.1.1.529 + BA.1 (South Africa November 2021)BA.2BA.2.12.1 (United States)BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)BA.2.75 (India 7/22)BQ.1BQ.1.1BN.1XBBXBB.1XBB.1.5CH.1.1XBB.1. 5.1XBB.1.9.1NoNo
Mexico7,516,046(ranked #19) 32,602 new infections in 14 days).(333,362(ranked #5) 174 new deaths in the last 14 days)5.71%NoNo
South Africa4,071,998(ranked #38; 4,545 new infections in the last 14 days).359102,595 (ranked #18) no new deaths reported  in the last 56 days).6.70%

B2 lineageAlpha/B.1.1.7 (UK)Beta/B.1.351 (SA)Delta/B.1.617.2 (India)Kappa/B.1.617.1 (India)       C.1.2 (South Africa, July 2021)Omicron/B.1.1.529 + BA.1 (South Africa November 2021)B.1.640.1 (Congo/France)BA.2BA.4 (South Africa 11/21)BA.5 (South Africa 11/21)NoNo
Canada4,618,059(ranked #34) 17.444 new infections in 14 days).51,800(ranked #24) 353 new deaths in the last 14 days.12.03% NoNo
Russia22,562,888(ranked #10), 164,021 new infections in 14 days).12,493 (ranked #1)397,009(ranked #4)502 new deaths in 14 days-515.47%0.11% increase in 14 days.NoNo
Peru4,490,491(ranked #35, 2,721 new infections in 14 days).. 219,694(ranked #6) 146 new deaths in the last 14 days.13.33%NoNo
Spain13,790,580(ranked #12; 12,113 new infections in 14 days).1,057 (ranked #12)120,170 (ranked #15) 552 new deaths in 14 days.4029.51%
France39,744,118 (ranked #3) 78,188 new infections in 14 days).8,839 (ranked #3)165,469 (ranked #10) 306 new deaths in 14 days.1560.60%  a 0.14% increase in 14 days.NoNo
Germany38,330,941(ranked #4; 74,938 new infections in 14 days.)4,325 (ranked #6)170,331 (ranked #9)1,274 new deaths in 14 days. 10045.70%0.10% increase in 14 daysNoNo
South Korea30,749,740 (ranked #7; 134,218 new infections in 14 days).10,283(ranked #2)34,211 (ranked #32) 118 new deaths in 14 days.1059.91%0.27% increase in 14 daysNoNo
Netherlands8,608,123(ranked #17; 5,857 new infections in 14 days).318    (ranked #20)22,992 (ranked #42)
Unchanged in 8 weeks
Taiwan10,239,980(ranked #15); 87,102  new infections in 14 days25)18,931 (ranked #50; 506 new deaths in the last 14 days)
0.37% of population has been infected in the last 14 days
Japan33,407,175(ranked #6)99,766 new infections in the last 14 days8,639(ranked #4)73,681(ranked #20)643 new deaths in the last 14 days for an average of 46  deaths per day.4926.60%0.08% of the population infected in the last 14 days.NoNo
Hong Kong2,884,447(ranked# 41) 560 new infections in the last 14 days.2513,474 (ranked#60)7 new deaths in the last 14 days.37.93%0.01% increse in the last 14 days.NoNo

What Our Team Is Reading This Week