Tag: subvariants

Rise of ‘Alarming’ Subvariants of COVID Predicted for Winter

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Dec. 16, 2022 – It’s a story perhaps more appropriate for Halloween than the festive holiday season, given its troubling implications. Four Omicron subvariants of the virus that causes COVID-19 will be the most common strains going from person to person this winter, new evidence predicts.

Not too dire so far, until you consider what else the researchers found.

The BQ.1, BQ1.1, XBB, and XBB.1 subvariants are the most resistant to neutralizing antibodies, researcher Qian Wang, PhD, and colleagues report. This means you have no or “markedly reduced” protection against infection from these four strains, even if you’ve already had COVID-19 or are vaccinated and boosted multiple times, including with a bivalent vaccine.

On top of that, all available monoclonal antibody treatments are mostly or completely ineffective against these subvariants.

What does that mean for our immediate future? The findings are definitely “worrisome,” Eric Topol, MD, founder and director of the Scripps Translational Research Institute in La Jolla, CA, and editor-in-chief of Medscape, WebMD’s sister site for health care professionals.

But evidence from other countries, specifically Singapore and France, show at least two of these variants turned out not to be as damaging as expected, likely because of high-numbers of people vaccinated, or who survived pervious infections, Topol says.

Still, there is little to celebrate in the new findings, except COVID-19 vaccinations and prior infections can still reduce the risk of serious outcomes such as hospitalization and death, the researchers say.

The “Alarming antibody evasion properties of rising SARS-CoV-2 BQ and XBB subvariants” study was published online this week in the journal Cell.

It comes at a time when BQ.1 and BQ.1.1 account for about 70% of the circulating variants, CDC data shows. In addition, hospitalizations are up 18% over the past 2 weeks and COVID-19 deaths are up 50% nationwide, The New York Times reports.

Globally, in many places, an “immunity wall” that has been built, Topol says. That may not be the case in the United States.

“The problem in the U.S., making it harder to predict, is that we have a very low rate of recent boosters, in the past 6 months, especially in seniors,” Topol says. For example, only 36% of Americans 65 and older, the group with highest risk, have received an updated bivalent booster.

An Evolving Virus

The subvariants are successfully replacing BA.5, which reigned as one of the most common Omicron variants over the past year. The latest CDC data show BA.5 now accounts for only about 10% of circulating virus. The researchers write, “This rapid replacement of virus strains is “raising the specter of yet another wave of infections in the coming months.”

The story sounds familiar to the researchers. “The rapid rise of these subvariants and their extensive array of spike mutations are reminiscent of the appearance of the first Omicron variant last year, thus raising concerns that they may further compromise the efficacy of current COVID-19 vaccines and monoclonal antibody therapeutics,” they write. “We now report findings that indicate that such concerns are, sadly, justified, especially so for the XBB and XBB.1 subvariants.”

The BQ.1 subvariant was six times more resistant to antibodies than BA.5, its parent strain, and XBB.1 was 63 times more resistant compared to its predecessor, BA.2.

This shift in the ability of vaccines to stop the subvariants “is particularly concerning,” the researchers write.

Wiping Out Treatments, Too

Wang and colleagues also tested how well a panel of 23 monoclonal antibody drugs might work against the four subvariants. The therapies all worked well against the original Omicron variant and included some approved for use through the FDA Emergency Use Authorization (EUA) program at the time of the study.

They found 19 of these 23 monoclonal antibodies lost effectiveness “greatly or completely” against XBB and XBB.1, for example.

This is not the first time that monoclonal antibody therapies have gone from effective to ineffective. Previous variants have come out that no longer responded to treatment with bamlanivimab, casirivimab, cilgavimab, etesevimab, imdevimab, sotrovimab, and tixagevimab. Bebtelovimab now joins this list and is no longer available from Lilly under EUA due to this lack of effectiveness.

The lack of an effective monoclonal antibody treatment “poses a serious problem for millions of immunocompromised individuals who do not respond robustly to COVID-19 vaccines,” the researchers write, adding “the urgent need to develop active monoclonal antibodies for clinical use is obvious.”

Going forward, the challenge remains to develop vaccines and treatments that offer broad protection as the coronavirus continues to evolve.

In a scary ending to a scary story, the researchers write: “We have collectively chased after SARS-CoV-2 variants for over 2 years, and yet, the virus continues to evolve and evade.”

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December 16, 2022
New COVID Subvariants Rising: How Concerned Should We Be?

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Oct. 18, 2022 – Move over, BA.5. There are some new kids in town and no one is sure yet if we should be worried.

But there is concern that COVID-19 virus subvariants BQ.1 and BQ1.1 will become a major threat in the U.S. and that XBB could alter the COVID picture globally.

At this point, infectious disease experts have only predictions.

A worst-case scenario would be a surge of one or more strains that evade our immune protections just as a predicted fall and winter surge hits 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 fatigue, people know the basics of protection at this point should it be necessary – gulp — to go back to masking, obsessive handwashing, and keeping a safe distance from our neighbors.

The most recent CDC data shows BQ.1 and BQ.1.1 subvariants have grown to about 12% of circulating virus strains in the U.S., doubling in the past week, compared to only 1% a month ago.

“I don’t think we should panic, but I am little concerned,” says Hannah Newman, MPH. “I would not be surprised to see a surge of infections as we enter respiratory season and in light of the emergence of new subvariants.”

“We are already seeing COVID on the rise in some European countries, in part due to these circulating subvariants,” adds Newman, director of infection prevention at Lenox Hill Hospital in New York City.

The emergence of BQ.1 and BQ1.1 in the U.S. and XBB globally is not completely unexpected, says Amesh Adalja, MD. “This is a virus that’s going to continue to evolve to become more able to infect us, and so these variants should not be surprising.”

Better Protection From Bivalent Boosters?

One unanswered question is how well the new bivalent mRNA vaccine boosters could work against these specific subvariants.

“The new booster is a better match to what is circulating than the old booster, but we don’t know what that means in real life,” says Adalja, senior scholar at the Johns Hopkins Center for Health Security in Baltimore. It’s difficult to answer that question because no one is planning to compare the two booster types in a clinical trial.

Newman is more optimistic. “A bit of good news is that the bivalent COVID booster will provide some protection against these strains, and we really just need people to roll up their sleeves and receive it,” she says.

The XBB subvariant, currently surging in Singapore, could be a cautionary tale for the U.S., says Eric Topol, MD, founder and director of the Scripps Research Translational Institute in La Jolla, CA, and executive editor of Medscape, WebMD’s sister site for medical professionals.

For example, prior to XBB emerging, the COVID reinfection rate in Singapore was 5%. Now it is 17%. “So that means a lot of people who had an infection are going to get hit again,” Topol says. Furthermore, Singapore reports 92% of their population is vaccinated and their uptake of boosters is twice the U.S. rate.

“And despite that, they have a very significant wave, which is going to be bigger than anything except the original Omicron,” he says.

Fewer Treatment Options

The drug Paxlovid will continue to play an important role in preventing more severe COVID outcomes, Adalja says. This is because “Paxlovid works on a whole different area of the virus, different from these mutations that get around immunity.”

In contrast, evidence so far suggests that monoclonal antibody therapies will not be effective against these new subvariants. “The ability to evade monoclonal antibody treatments is a concern for me, because it could leave our most vulnerable open to more severe outcomes,” Newman says.

“If strains are able to escape antibody immunity and monoclonal antibodies aren’t effective, we can expect to see more severe symptoms in high-risk individuals who would otherwise benefit from these treatments,” she says.

In particular, the monoclonal antibody bebtelovimab and the monoclonal combination Evusheld may be less effective against the new subvariants, Adalja says.

Does Recently Infected Mean Protected?

Most people who had COVID-19 within the past 3 to 6 months will likely have antibody levels to protect them, at least against severe disease, Adalja says. That’s one reason U.S. officials suggest people wait 3 months to get a booster after infection and Canadian officials recommend 6 months.

“You’re certainly going to be protected against severe disease,” Adalja adds. “How long you’re going to be protected, how immune-evasive these variants are, and the degree to which their immune-evasiveness reaches, that’s going to determine if you’re susceptible to infection.”

After natural immunity wanes, these immune-evasive variants could 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 gained with recent infection. However, it wanes over time. Staying up to date with vaccinations and boosters is the most proven and effective way to achieve uniform protection.”

What is known is that COVID is likely to be with us for a while, Adalja says. “I was someone who was very forthright about this, that this was never going away. I wasn’t thinking this is like a hurricane that is going to leave one day. I thought this is a new normal,” he says.

He adds we’re making progress on COVID being managed as an outpatient illness.

The Future Is Uncertain

It’s difficult to predict exactly what will happen this fall and winter based on current evidence, says Gregory Poland, MD, an internal medicine doctor at Mayo Clinic in Rochester, MN.

Throughout the pandemic, however, what happens in the U.K. and India has consistently signaled what happens in the U.S. And these other countries are experiencing “significant upticks in the subvariants,” he says.

“Unfortunately, there is no crystal ball that will predict for sure what a future wave might look like at this moment,” Newman says. “It will really depend on whether a variant will outcompete other strains and the prevention measures taken.”

She is also concerned about a convergence of COVID and flu over the winter.

“Prevention fatigue paired with upcoming holiday gatherings could be a potential for more superspreading events,” Newman says.

One concern is the relatively low uptake of the bivalent boosters among Americans, Topol says. “This is going to be really bad because a few weeks from now, we will face a very significant wave.”

The relaxation of pandemic protection measures and the waning of immunity as more and more Americans go more than 6 months from their last immunization also are concerning, Topol says. “Our immunity wall is just developing more and more holes in it.”

“We’ll see a wave even before the BQ1.1 really takes effect,” Topol predicts. “And then the two together could make for a very bad December or January.”

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October 18, 2022
Large number of U.S. COVID deaths could be prevented if patients would take Pfizer’s Paxlovid, White House coordinator warns

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A large number of U.S. COVID deaths could be prevented if patients would take Paxlovid, the antiviral developed by Pfizer
PFE,
-1.79%
that helps reduce the risk of hospitalization and death, according to White House COVID coordinator Dr. Ashish Jha.

Jha told the New York Times that the average daily death count could be reduced to about 50 a day from 400 currently, if every American aged 50 and above that tests positive for the virus took a course of either Paxlovid or used monoclonal antibodies.

“The public doesn’t seem to understand that the evidence around hospitalization and deaths is really powerful,” Dr. Robert Wachter, chair of medicine at the University of California in San Francisco told the paper.

The issue seems to be a combination of worry about certain issues that Paxlovid can cause, including a strange metallic taste and the potential for “rebound COVID,” where patients quickly become reinfected after the five-day course of pills has been completed. That happened to both President Joe Biden and first lady Jill Biden recently.

The second reason is that many Americans — and Republicans, in particular — have refused to take COVID seriously and are not willing to take steps to reduce its impact. Trials have found Paxlovid to be effective across all age groups, but mostly among older patients. But as the COVID death rate for people under 50 is already close to zero, reducing it in a statistically significant way is difficult.

See now: CDC scraps travel health notices as countries slow testing, and study confirms Republican-leaning counties suffered more COVID deaths than Democrat-leaning ones

“I think almost everybody benefits from Paxlovid,” Jha said. “For some people, the benefit is tiny. For others, the benefit is massive.”

Yet a smaller share of 80-year-olds with COVID in the U.S. is taking it than 45-year-olds, Jha said citing data he has seen.

From the CDC: Stay Up to Date with COVID-19 Vaccines Including Boosters

The news comes as U.S. known cases of COVID are continuing to ease and now stand at their lowest level since late April, although the true tally is likely higher given how many people are testing at home, with data generally not being collected.

The daily average for new cases stood at 41,605 on Thursday, according to a New York Times tracker, down 25% from two weeks ago. Cases are declining in northeastern states including New York and New Jersey, while cases are rising in the western states Montana, Washington and Oregon.

The daily average for hospitalizations was down 11% at 27,021, while the daily average for deaths is down 8% to 391.

Coronavirus Update: MarketWatch’s daily roundup has been curating and reporting all the latest developments every weekday since the coronavirus pandemic began

Other COVID-19 news you should know about:

• Molnupiravir, the COVID pill developed by Merck
MRK,
+0.18%
and privately held Ridgeback Therapeutics, produced mixed results in two recent studies, the companies said Thursday. Early data from a trial conducted in the U.K. by the University of Oxford found no evidence of a difference when molnupiravir was added to usual care in reducing hospitalizations and death. A second study conducted in Israel found a benefit in patients who were 65 and older, but no benefit for 40- to 60-year-olds.

• Homelessness is surging in the U.S. again as pandemic programs that halted evictions are being phased out, the Associated Press reported. The overall number of homeless people in a federal report to be released in the coming months is expected to be higher than the 580,000 unhoused before the coronavirus outbreak, the National Alliance to End Homelessness said. The AP tallied results from city-by-city surveys conducted earlier this year and found the number of people without homes is up overall compared with 2020 in areas reporting results so far.

• The idea was to have China in stable and tip-top shape when thousands of delegates gather in Beijing to usher in a historic third term in power for Xi Jinping, BBC News reported. However, the coronavirus is not playing nicely. In recent weeks, tens of millions of people have again been confined to their homes in lockdowns across 60 towns and cities, and this is bringing political pressure on the man who has become the most powerful Chinese figure since the first communist-era leader, Mao Zedong.

Covid-19 lockdowns, corruption crackdowns and more have put China’s economy on a potential crash course. WSJ’s Dion Rabouin explains how China’s economic downturn could harm the U.S. and the rest of the world. Illustration: David Fang

• A new COVID-19 wave appears to be brewing in Europe as cooler weather arrives, with public health experts warning that vaccine fatigue and confusion over types of available vaccines will likely limit booster uptake, Reuters reported. The omicron subvariants BA.4 and BA.5 that dominated this summer are still behind the majority of infections, but newer omicron subvariants are gaining ground. Hundreds of new forms of omicron are being tracked by scientists, the World Health Organization said this week.

Here’s what the numbers say:

The global tally of confirmed cases of COVID-19 topped 620.5 million on Friday, while the death toll rose above 6.55 million, according to data aggregated by Johns Hopkins University.

The U.S. leads the world with 96.6 million cases and 1,062,130 fatalities.

The Centers for Disease Control and Prevention’s tracker shows that 225.8 million people living in the U.S., equal to 68% of the total population, are fully vaccinated, meaning they have had their primary shots. Just 110.5 million have had a booster, equal to 48.9% of the vaccinated population, and 24.8 million of those who are eligible for a second booster have had one, equal to 37.9% of those who received a first booster.

Some 11.5 million people have had a shot of the new bivalent booster that targets the new omicron subvariants.

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October 7, 2022