The latest circulating COVID-19 Omicron variants – BQ.1 and BQ.1.1 – have shown greater immune escape, which is likely to lead to increasing cases over the coming months, experts have warned, emphasising the need to get vaccinated and get boosted.
MedPage Today reports that the two now make up more than half of all COVID cases in the US (30.9% and 31.9%, respectively), according to the CDC’s COVID Data Tracker, representing a rapid rise from early November when they represented about a quarter of all cases.
Dr David Weber of the UNC Medical Centre in North Carolina said the rising prevalence of these variants is probably due to ineffective immune responses from prior infections and vaccination, but healthcare providers should still rely on tried-and-true approaches, such as boosters, antivirals and masking.
“The bottom line is those variants, BQ.1 and BQ.1.1, because they escaped immunity from natural infection … we’ll expect to see increasing proportions of them over the next couple of months,” he said.
In response to the increasing prevalence of these variants, the FDA announced last week that bebtelovimab, the monoclonal antibody found to be effective against earlier variants, would no longer be authorised for emergency use.
The FDA recommends that healthcare providers consider treatment options that are effective against these new variants, including ritonavir-nirmatrelvir (Paxlovid), remdesivir (Veklury), and molnupiravir (Lagevrio). The agency also highlighted the potential efficacy of bivalent COVID-19 boosters and the use of convalescent plasma for immunosuppressed patients.
Weber said the best line of defence was the bivalent booster.
“Nothing is more important than a physician or a healthcare provider telling their patient, ‘I strongly recommend this to you’,” he said. “That’s really important because many people mistrust the medical environment, but they love their own provider, so it’s important for that medical provider to make a strong recommendation to get the bivalent vaccine."
The vaccine will be all the more important due to the uncertainty around BQ.1 and BQ.1.1,” said Dr Peter Katona of the UCLA Fielding School of Public Health in Los Angeles.
“We know that these variants are taking over,” he said. “It’s a question of what direction they take us. Are they going to take us into a more benign situation, are there going to be things that we only have to be careful about – because of long COVID and because of the people who get really sick?”
Katona said the long-term outlook on these variants was unknown at this point, so the focus should be on treating patients with the options that are currently available and effective.
Weber pointed out that COVID-19 is still the third leading cause of death in the US, so until the rates of cases and deaths can be brought down, new variants should be expected to develop.
“Everybody who gets COVID is a little incubator for developing a more efficient virus. And because millions of people continue to get COVID worldwide, and we’ve already been through the Alpha, Beta, Delta, Omicron, BA.1 [and] 2, and then BA.4 waves – so we've had five or six waves of this going over three years – there's nothing surprising about the fact that we are going to see new variants.”
Meanwhile, messages circulating on South African social media about a new COVID-19 variant of concern, warning the public to wear masks and claiming to be from the Health Ministry, have been dismissed as fake, with the authorities saying the senders’ aim is to stir up alarm.
“This is fake news by faceless sources whose sole intention is to create unnecessary panic,” said department spokesperson Foster Mohale in a News24 report.
“The fact is, the World Health Organization (WHO) had issued a notification in October on the sublineages BQ.1 and XBB, detected worldwide in ongoing work to track variants by the Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE).
“TAG-VE’s mandate is to alert WHO if a variant that can cause more severe disease, or lead to large epidemic waves causing increased burden to the healthcare system, is emerging and likely to pose a significant threat.”
But, Mohale said, there was no epidemiological evidence that these sublineages were of substantially greater risk than other variants.
The department was working with the National Institute for Communicable Diseases (NICD) and scientists to continue to monitor all lineages, he added.
“The known (COVID-19) variants are still in circulation, and we are not off the hook … people are urged to vaccinate and take booster shots they qualify for,” he said.
CSC COVID Data Tracker (Open access)
MedPage Today article – Why the Now-Dominant BQ COVID Strains Are Cause for Concern (Open access)
See more from MedicalBrief archives:
Surge of 300 COVID variants with increased immune escape properties
COVID sub-variant spreads and new symptoms emerge
Unjabbed patients face variants risk; obesity weakens vaccine protection – Recent studies