The new COVID-19 substrains that are gaining ground around the world are not only more contagious than previous strains and substrains — they can also cause more severe disease.
As experts predict, it is an ominous sign if there is a new global wave of COVID in the coming months. It’s one thing to see an increase in infections that cause mostly mild illnesses. Cases are increasing, but so are hospitalizations and deaths do not. But an increase in serious illness can also lead to an increase in hospitalizations and deaths.
It could be like 2020 or 2021 again. The big difference is that we now have easy access to safe and effective vaccines. Vaccines are still effective even against new subtypes.
A new study from Ohio State University is the first red flag. A team led by Shan-Lu Liu, co-director of HSU’s Virus and Emerging Pathogens Program, modeled new SARS-CoV-2 subtypes, including BQ.1 and its close cousin, BQ.1.1.
The team confirmed what we already knew: BQ.1 and other new subtypes, many of which are descended from the BA.4 and BA.5 forms of the Omicron strain, are highly contagious. And their highly transmissible mutations make them unrecognizable by antibodies produced by monoclonal therapies, rendering those therapies futile.
That should be enough to warrant serious attention as the BQ.1 and its cousins dominate more countries and states than the BA.4 and BA.5. But then Liu and his colleagues also tested the “fusogenicity” of the subtypes. That is, how well they fuse into our own cells. “Fusion between the virus and the cell membrane is an important step in viral entry,” Liu told The Daily Beast.
In general, the higher the fusogenicity, the more severe the disease. Liu and his colleagues “observed increased cell-cell fusion in several new Omicron subtypes compared to their respective parental subtypes,” they wrote in their study, which appeared online Oct. 20 and is still under peer review. New England Journal of Medicine.
If these new subgenres are actually more transmissible and Worse, they could reverse an important trend as the COVID pandemic creeps into its fourth year. The trend, so far, is for each successive major strain or subspecies to cause more contagious but less severe disease.
That trend, combined with widespread vaccinations and new treatments, has led to what scientists call a “decoupling” of infections and deaths. Cases of COVID occasionally spike as some new, highly contagious new strain or substrain becomes dominant. But because this new type of SARS-CoV-2 causes less severe disease, deaths are not as high.
That decoupling, along with the availability of vaccines and treatments, has allowed many people around the world to return to some form of normalcy over the past year or so. If BQ.1 or another highly fusogenic subtype re-couples infections and deaths, that new normal could become a new nightmare. “More hospitalizations and deaths” is how Ali Mokdad, a professor of health metrics at the University of Washington Institute for Health who was not involved in the OSU study, summed it up.
Perhaps we have already seen the first recollection. As new subtypes began to seriously compete for dominance in recent months, epidemiologists carefully monitored the COVID statistics to detect any real-world effects.
Singapore is a false flag. The small Asian city-state saw a quick, up-and-down surge this month, and some experts initially worried a dangerous new subgenre might be involved. But the country’s health ministry sequenced numerous virus samples, sped it up, and determined that BA.5 was the culprit. Singapore’s high vaccination and immunization rates — 92 percent of residents have their primary immunizations and 80 percent are vaccinated — have reduced the rise in BA.5 without a major increase in deaths.
But there is Germany, where cases have also risen this month. German authorities have not yet determined which variant or sub-genre is to blame, but it is worth noting that the BQ.1 is spreading rapidly across Europe.
And there are signs of reunification in Germany. In October, the country registered as many as 175,000 new cases a day – matching the peak of the previous wave in July. But in the worst week of the current surge, an average of 160 Germans died a day, compared to just 125 a day during the worst week of the summer. “We can see the same patterns in other European countries and in the United States,” Mokdad said.
There is still much we do not know about the latest COVID subtypes. Their real-world impact won’t be noticed until we get good data from Germany. “It is very important to closely monitor new varieties and study their properties,” Liu said.
But one thing is clear. For all their transmissibility and fusogenicity, new subspecies No Significantly escaped the immunogenic effects of primed vaccines. And the newer “bi-recombinant” boosters developed specifically for BA.4 and BA.5 should maintain vaccine effectiveness as long as the dominant subtypes are closely related to Omicron.
Get vaccinated and stay on top of your boosters. This cannot be overemphasized. Yes, the BQ.1 and its cousins exhibit some dangerous qualities that could bend the arc of the plague toward widespread death and disruption.
But only if you are unvaccinated or behind on your booster.