Oct 18 2022 – Moving, BA 5. There are some new kids in town and no one is yet sure if we should worry.
But there is concern that the COVID-19 virus sub-variants BQ.1 and BQ1.1 will become a significant threat in the United States and that the XBB could change the picture of COVID globally.
At this point, infectious disease experts have only predictions.
The worst-case scenario could be a rush of one or more strains evading immune protection just as the forecast fall and winter hit the United States.
At the same time, we know a lot more about SARS-CoV-2 than we did when COVID first became a household name. And despite some widespread pandemic exhaustion, people know the basics of protection at this point if it is necessary – to swallow – to return to masking, obsessive hand-washing and keeping a safe distance from our neighbors.
The latest CDC data shows that the BQ.1 and BQ.1.1 subvariants have grown to about 12% of circulating viruses Strains in the US, have doubled in the past week, compared to just 1% a month ago.
“I don’t think we should panic, but I’m a little concerned,” says Hannah Newman, MPH. “I wouldn’t be surprised to see a wave of infections as we enter respiratory season and in light of the emergence of new sub-variables.”
“We’re already seeing a rise in COVID in some European countries, in part because of these pervasive subvariables,” adds Newman, director of infection prevention at Lenox Hill Hospital in New York City.
Amesh Adalja, MD, says the emergence of BQ.1 and BQ1.1 in the US and XBB globally is not entirely expected. “This is a virus that will continue to evolve to become more capable of infecting us, so these variables should not be surprising.”
Better protection than bivalent boosters?
One of the unanswered questions is to what extent the novel bivalent mRNA vaccine boosters can work against these specific subvariants.
“The new booster is a better match with what’s circulating than the old booster, but we don’t know what that means in real life,” says Adalja,Principal Investigator at the Johns Hopkins Center for Health Security in Baltimore. This question is difficult to answer because no one plans to compare the two boosters in a clinical trial.
Newman is more optimistic. “There’s a little bit of good news that a bivalent COVID booster will provide some protection against these strains, and we really need people to roll up their sleeves and take it,” she says.
Alternative XBB, which is currently on the rise in Singapore, may be a cautionary tale for the United States, says Eric Topol, MD, founder and director of the Scripps Research Translational Institute in La Jolla, Calif., and executive editor of Medscape, WebMD’s sister site for medicine. professionals.
For example, before the emergence of XBB, the re-infection rate for COVID in Singapore was 5%. Now it is 17%. “This means that a lot of people who get an infection will get it again,” Topol says. Furthermore, Singapore reports that 92% of its population has been vaccinated and their booster uptake is twice the rate in the United States.
“And despite that, they have a pretty big wave, which would be bigger than anything else except the original Omicron,” he says.
Fewer treatment options
Adalja says Paxlovid will continue to play an important role in preventing more severe COVID outcomes. That’s because “Paxlovid acts on a completely different region of the virus, different from these mutations that revolve around immunity.”
In contrast, evidence to date suggests that monoclonal antibody treatments will not be effective against these new subvariants. “The ability to evade monoclonal antibody treatments is a concern for me, as it may leave the most vulnerable people vulnerable to more serious outcomes,” Newman says.
“If the strains are able to escape antibody immunity and the monoclonal antibodies are not effective, we can expect to see more severe symptoms in high-risk individuals who may benefit from these treatments,” she says.
In particular, the bebtelovimab monoclonal antibody and the monoclonal formulation Evusheld may be less effective against the new sub-variants, Adalja says.
Does newly infected mean protection?
Adalja says most people who have contracted COVID-19 in the past three to six months are likely to have levels of antibodies to protect them, at least from severe illness. This is one reason why US officials are suggesting that people wait 3 months for a booster dose after infection and Canadian officials recommend 6 months.
“You will definitely be protected from severe disease,” Adalja adds. “How long you will be protected, how evasive these immune variants are, and the degree to which your immune evasion is, that will determine whether you are susceptible.”
After the natural immunity wanes, these immune-evading variants can infect someone again, but they are more likely to experience a mild case, Adalja says.
Newman agrees. There is a level of natural immunity that is acquired with a recent infection. However, it diminishes over time. Staying up to date with vaccinations and boosters is the most effective and efficient way to achieve uniform protection.”
What is known is that COVID will likely be with us for a while, Adalja says. “I was a very open person about this, and that this is never going to go away. I never thought this was like a hurricane would leave one day. I thought this was the new normal,” he says.
He adds that we are making progress in managing COVID as an external disease.
The future is uncertain
It’s hard to predict exactly what will happen in the fall and winter based on current evidence, says Gregory Poland, MD, an internal medicine physician at the Mayo Clinic in Rochester, Minnesota.
Throughout the pandemic, however, what’s happening in the UK and India is consistently indicative of what’s happening in the US and these other countries are seeing “significant spikes in sub-variables,” he says.
“Unfortunately, there is no crystal ball that predicts with certainty what a future wave might look like at this moment,” Neumann says. “It will really depend on whether the alternative will outperform the other strains and the prevention measures taken.”
She is also concerned about the convergence of the coronavirus and influenza during the winter.
“Preventive fatigue combined with upcoming holiday gatherings could be a potential for more widespread events,” Neumann says.
One concern, Topol says, is the relatively low uptake of bivalent reinforcers among Americans. “It’s going to be really bad because a few weeks from now we’re going to have a very big wave.”
The easing of pandemic protection measures and waning immunity as more Americans go more than 6 months from their last immunization is worrying, Topol says. “Our immune wall develops more and more holes in it.”
Topol predicts, “We’ll see a wave even before BQ1.1 actually takes effect.” “And then the two together can make for a really bad December or January.”