A new COVID-19 variant may trigger a never-before-seen symptom, especially in kids

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• A new COVID-19 subvariant, known as XBB.1.16 but often called “Arcturus,” has progressively become more viral here in the United States, accounting for 10% of infections through late April.
• Healthcare professionals have indicated that itchy conjunctivitis may be associated with this particular subvariant, though COVID-19 has previously been linked to eye infections.
• Doctors are independently reporting a rise in red, itchy eyes in children affected by XBB.1.16, a trait that has not been associated with previous Omicron subvariants.
• Federal health agents have not confirmed eye infections as a common COVID-19 symptom.

Just as federal health regulators have released additional booster vaccines to at-risk Americans, doctors across the globe are raising concerns about a new SARS-CoV-2 variant that has the potential to trigger elevated COVID-19 spread this spring. Known officially as subvariant XBB.1.16 — but quickly picking up a moniker of “Arcturus” among media and healthcare professionals alike — this Omicron subvariant is increasingly being traced back to new COVID-19 cases here in the United States, according to the latest Centers for Disease Control and Prevention data.

First detected back in January, this subvariant has generated headlines in India, where it has triggered a majority of new COVID-19 cases (including potent breakthrough illnesses) and has particularly impacted the nation’s youth.

The World Health Organization designated XBB.1.16 as a “variant under monitoring” in late March, indicating Arcturus may demonstrate a “growth advantage relative to other circulating variants.” Since then, the variant has been uncovered in more than 30 nations across the world — with CDC agents including it in its variant tracking in mid-April, illustrating that Arcturus is responsible for nearly 10% of new COVID-19 infections in the U.S. That number is likely underreported, as a majority of COVID-19 patients don’t ever find out which SARS strain they’ve been infected with.

Many U.S. hospitals were able to avoid a catastrophic surge in COVID-19 cases this winter thanks to updated bivalent vaccines, and as of late April, there isn’t concern about a rise in COVID-19 infection rates anytime soon. But healthcare authorities are still worried about XBB.1.16 for a few reasons — including a potential new symptom that is a major departure from the upper respiratory symptoms that recent strains have presented.

What to know about the “Arcturus” COVID-19 variant

Previous sub-variants linked to Omicron have been noted to be viral and severe, but XBB.1.16 cases thus far haven’t caused healthcare providers to be concerned about an uptick in severe illnesses, hospitalizations or deaths in the weeks to come. And unlike earlier variants, most healthcare agencies are projecting that Arcturus isn’t expected to spark a major uptick in new cases. In fact, most of the characteristics of this variant are similar to XBB.1.5, which is still responsible for the bulk of the current cases here in the U.S.

“COVID cases are declining nationwide, with 98% of counties now listed in the Low Community Level [of risk] as of last week,” explains Charles C.J. Bailey, M.D., the medical director for infection prevention at Providence St. Joseph Hospital and Providence Mission Hospital in Southern California. “Although XBB sub-variants are currently predominant, they represent the largest slice of a markedly smaller pie, compared to earlier periods of the pandemic… The risk of getting COVID of any type is currently low.”

Rather, evidence of the spread of the Arcturus variant (particularly overseas in India, where WHO officials say it’s the prominent strain) indicates that this particular subvariant may spread more easily compared to its predecessors — which has some experts concerned about the potential for an increase in U.S. spread later this spring and summer, even if overall infection rates are down.

What’s most concerning about Arcturus is largely the discussion around a noticeable trend being documented in India surrounding a potential new eye health symptom that some attribute to SARS-CoV-2 infections. Many reports highlight insight shared by a local pediatrician and WHO interest group member that suggests “itchy conjunctivitis” or pink eye could correspond to the subvariant, especially in children.

Eye-related symptoms, including itchiness, discharge or pink eye have yet to be directly associated with COVID-19 spread thus far — and healthcare professionals including Shira Doron, M.D., epidemiologist and chief infection control officer for Tufts Medicine health system, say this potential XBB.1.16 symptom hasn’t been confirmed with peer-reviewed research or by any federal health group.

“It is unlikely that this is true,” Doron told Good Housekeeping.

But the possibility isn’t entirely out of the question, adds Dr. Bailey: “[A change in symptoms] would not be unusual and has been seen already with COVID, as later variants seem less likely to be associated with loss of taste and smell than initial COVID cases — and the overall severity of Omicron sub-variants is noticeably less than with the Delta variant.”

Is there a link between COVID-19 and pink eye?

Federal health officials at the CDC have not yet formally linked pink eye or any eye-related health condition to COVID-19 in listing it as an official symptom. But more doctors are acknowledging the prevalence of pink eye and eye-related discharge, itch in the form of anecdotal evidence, including testimony from Matthew Binnicker, M.D., the director of the Mayo Clinic’s Clinical Virology Laboratory; Dr. Binnicker shared this week that care providers are seeing a rise in red, itchy eyes in children affected by SARS infections.

The idea that COVID-19 can trigger an eye infection, namely conjunctivitis, isn’t entirely new — there has been published research that indicates that the development of COVID-19 may trigger pink eye in some individuals. A 2021 case presentation published in the Qatar Medical Journal indicated that in extremely rare cases, pink eye may be the “only sign and symptom of COVID-19” for otherwise sick individuals.

Furthermore, diagnosis materials published by the American Academy of Ophthalmology for its professionals indicate that pink eye may manifest in patients after an initial SARS infection.

But red, itchy eyes are common this time of year due to seasonal allergies, making it crucial to be able to spot early signs of pink eye — and monitor yourself for other well-documented COVID-19 symptoms to better determine if you’re really sick.

“Setting aside the possibility that COVID is a common cause of conjunctivitis, an infected eye can be hard to distinguish from an allergic one,” Dr. Doron adds, with one distinction. “Crusty and goopy eyes are usually more likely to be infected, and very itchy ones are usually allergy-related.”

It’s highly unlikely that pink eye will be an issue for a majority of those who are unlucky enough to develop a breakthrough COVID-19 infection this spring. If anything, monitoring eye health may be more important for children and other youth and their parents, based on the bulk of case data generated overseas.

“Exposed adults may or may not manifest this symptom in the end, just as the same common cold virus moving through a family may have different symptoms in each member of the household,” Dr. Bailey said.

While most can’t say with certainty whether or not Arcturus leads to pink eye directly just yet, Dr. Doron clarifies that many respiratory viruses can trigger eye issues during infection; according to materials published by Johns Hopkins Medicine, a majority of conjunctivitis cases are actually caused by adenovirus, as well as more common viruses like herpes simplex.

“There are a lot of viruses going around, some with a tendency to cause pink eye/conjunctivitis, so it’s quite possible that’s what is causing the uptick of pink eye that pediatricians are reporting.”

Potential XBB.1.16 symptoms

Experiencing pink eye as the only symptom associated with a COVID-19 infection, including one prompted by Arcturus, would be very rare — you are more likely to experience any of the other well-documented signs of illness that are associated with COVID.

Because it has yet to become the predominant strain here in the U.S., CDC officials have yet to name any particular subset of symptoms as directly correlated with the XBB.1.16 variant. Just like its predecessor, XBB.1.5, any combination or severity of commonly reported COVID symptoms are possible in the early days of an illness.

According to CDC officials, these are potential symptoms to monitor if you believe you are sick:

• Fever
• Body chills
• Chronic cough
• Headache
• Sore throat
• Nasal congestion or runny nose
• Fatigue
• Nausea and vomiting
• Diarrhea
• Shortness of breath, or difficulty breathing
• New loss of taste or smell

Most of these symptoms may be mistaken for seasonal illness or the flu — but the quickest way to determine whether or not you have been impacted is to seek out a rapid COVID-19 test.

The bottom line

It’s unclear if pink eye or itchy conjunctivitis is truly more commonly associated with infections caused by the XBB.1.16 variant — though itchy, infected eyes can indeed be triggered by COVID-19.

“We can’t use anecdotes to determine whether there is, in fact, a predilection for certain variants to cause certain symptoms,” Dr. Doron explains. “In general, that is not the case, except that Omicron — and all subvariants — is less likely than previous mutations to be associated with lung involvement, and thus is less severe.”

Experiencing one, two or a combination of any of the well-documented respiratory symptoms associated with COVID-19 should prompt you to seek out a rapid antigen test. If itchy, irritated eyes are your only symptom, you may be experiencing seasonal allergies — discharge of any kind may indicate that it may be an eye infection instead, which should prompt you to seek medical attention immediately (even if you aren’t experiencing other COVID-19 symptoms).

Trends associated with XBB.1.16 are a good reminder to monitor your child’s health closely as the summer season approaches, given that doctors have shared that Arcturus may impact children more significantly than adults. In any case, the best way to avoid a COVID-19 breakthrough infection or reinfection is to stay up to date on your vaccinations. Receiving a bivalent booster vaccine is crucial to protect yourself from severe COVID-19 symptoms and complications, including any likelihood of future infection caused by XBB.1.16.