COVID-19 Variants and Vaccine Decisions Heading Into Fall

As new COVID-19 variants circulate and the respiratory virus season approaches, families are once again facing decisions about prevention, especially with schools reopening. Sharon Nachman, MD, division chief of pediatric infectious diseases at Stony Brook Children’s Hospital, shared her perspective on what the latest variants mean for both children and adults and how families can prepare.

Currently, 2 dominant variants are being tracked: Stratus and Nimbus. According to Nachman, both are highly transmissible but not linked to more severe illness compared with earlier strains. “The Stratus variant and the Nimbus variant—those are two of the ones that we're seeing right now—actually are both equally good at infecting a host. They are not, however, associated with more severe illness like we've seen with other strains in the past. So you can easily catch it and you can easily spread it.”

She noted that tracking data shows an upward trend in these variants over the summer: “From May to June to now, in August, we are seeing climbing percentages of both Nimbus and Stratus.” Although hospitalizations have not risen at the same pace, symptoms are shifting. “As part of all the COVID-19 variants that we see, we have seen more sore throat, more hoarseness of throat—that kind of horrible complaint that ‘I can’t talk, I can’t swallow’—happening.”

Though the severity remains relatively mild for most, Nachman cautioned that this could change. “Can this change over the fall and winter? Absolutely it can,” she said. “These variants have many sites of mutation from the original strains that we had back in 2020 as well as in 2022 and 2023.” As she explained, widespread transmission fuels further mutation: “The more people that get it, the more they pass it, the more mutations that happen. So that means the fall and winter are going to be primed for us to see more infections and probably with different variants.”

One practical piece of advice remains consistent. “If you or your child has COVID-19, it would not be a bad idea to stay home until you're not coughing and [you do not] have fever,” she said. This minimizes the risk of passing the virus to others: “They're probably going to pass that variant to the next kid or the next adult—and on and on.”

On the topic of vaccination, Nachman emphasized education as the first step in addressing hesitancy. “Yes, there are several mRNA vaccines out there. mRNA vaccines do not have any mercury in them or thimerosal in them,” she explained. “If it's one vial, one person, there's no thimerosal, there's no preservative.”

She also reassured parents concerned about the safety of mRNA vaccines. “There's nothing live about this vaccine. The vaccine is not going to cause an infection in anyone,” she said. “By giving a COVID-19 vaccine, you turn on the machinery. Unfortunately, when you turn on the machinery, you feel under the weather. You may have some fever and some body aches, but that's because your body is a good immune machine and it's making antibodies.”

Vaccination decisions should take into account both individual and household risk. “We are especially concerned for the fall and winter for older populations as well as populations with underlying lung issues,” she said, noting these groups continue to face higher risks for severe illness and hospitalization.

Although children may typically experience milder symptoms, Nachman urged parents to think about the bigger picture. “In the past, people have said, ‘Oh, kids don't get so sick with COVID-19, they don't need a vaccine.’ As someone who worries about even one child getting sick, I tell families, ‘Think about who your kid is and who else is at home with you.’” For multigenerational households, she recommends considering how one child’s infection could affect more vulnerable relatives. “You may need to circle around that person and have everyone protected so that they're not going to bring it home to that individual.”