Between September 2023 and October 2024, severe acute respiratory syndrome coronavirus 2 evolved through 3 variant-predominant eras: XBB, JN.1, and KP. Among 130 263 Department of Veterans Affairs patients with coronavirus disease 2019, hospitalization odds declined for JN.1 (0.81
95% CI, 0.74-0.89) and KP (0.80
95% CI, 0.72-0.88) compared with XBB, with consistently low in-hospital death rates across all eras.