The new COVID-19 sub-variants that are becoming dominant around the world are not only more contagious than previous variants and sub-variants, they can also cause more serious diseases.
That’s an ominous sign if, as experts predict, there’s another global wave of COVID in the coming months. It’s one thing to endure a spate of infections that usually result in mild illness. Cases are rising, but hospitalizations and deaths do not. But an increase in serious illnesses can also lead to an increase in hospitalizations and deaths.
It could be like 2020 or 2021, all over again. The big difference is that we now have easy access to safe and effective vaccines. And the vaccines still work, even against the new subvariants.
A new study from Ohio State University is the first red flag. A team led by Shan-Lu Liu, co-director of HSU’s Viruses and Emerging Pathogens Program, has modeled new SARS-CoV-2 subvariants, including BQ.1 and its close cousin, BQ.1.1.
The team confirmed what we already knew: BQ.1 and other new subvariants, most of which are the offspring of the BA.4 and BA.5 forms of the Omicron variant, are highly contagious. And the same mutations that make them so transferable also make them unrecognizable to the antibodies produced by monoclonal therapies, rendering those therapies useless.
That should be reason enough to pay close attention, as BQ.1 and its cousins surpass BA.4 and BA.5 and become dominant in more countries and states. But then Liu and his teammates also checked the ‘fusogenicity’ of the subvariants. That is, how well they fuse with our own cells. “The fusion between the viral and the cell membrane is an important step in virus entry,” Liu told The Daily Beast.
In general, the greater the fusogenicity, the more severe the disease. Liu and his colleagues “saw increased cell-cell fusion in several new Omicron subvariants compared to their respective parental subvariants,” they wrote in their study, published online Oct. 20 and still under peer review. New England Journal of Medicine.
If these new sub-variants are indeed more transferable and more severe, they could reverse an important trend as the COVID pandemic approaches its fourth year. The trend to date has been that each successive main variant or subvariant is more contagious but causes less severe disease.
That trend, combined with widespread vaccination and new therapies, led to what scientists call a “decoupling” of infections and deaths. COVID cases decrease and increase as a new highly contagious new variant or subvariant becomes dominant. But because these new forms of SARS-CoV-2 cause less serious diseases, the number of deaths is not increasing nearly as much.
That disconnect, along with the availability of vaccines and therapies, has allowed most people around the world to return to some sort of normalcy over the past year. If BQ.1 or another highly fusogenic subvariant re-links infections and deaths, that new normal could become another nightmare. “More hospitalizations and deaths,” summed up Ali Mokdad, a professor of health metrics at the University of Washington Institute for Health who was not involved in the OSU study.
We may have already seen the first reconnection. Ever since the new subvariants began to seriously compete for dominance in recent months, epidemiologists have looked carefully at COVID statistics to uncover any real-world implications.
Singapore was a false flag. The tiny Asian city-state had a rapid, up-and-down surge this month in cases that some experts initially feared could contain a dangerous new sub-variant. But the country’s health ministry quickly sequenced many viral samples and determined that BA.5 was the culprit. Singapore’s high rates of vaccination and boosting – 92 percent of residents have their first injections and 80 percent get a boost – suppressed the BA.5 surge without a major spike in deaths.
But then there is Germany, where the number of cases also rose this month. The German authorities have not yet determined which variant or sub-variant is to blame, but it is worth noting that BQ.1 is quickly spreading across Europe.
And there are signs of reconnection in Germany. In October, the country registered a whopping 175,000 new cases per day, which corresponds to the peak of the previous wave in July. But an average of 160 Germans died every day in the worst week of the current wave, while only 125 died a day in the worst week of the summer wave. “We could see the same patterns in other European countries … and in the US,” Mokdad said.
There’s still a lot we don’t know about the latest COVID subvariants. And their impact in the real world won’t come into play until we get good data from Germany. “Precise monitoring of new variants and studying their properties are critical,” Liu said.
But one thing is clear. Despite all their transferability and fusogenicity, the new subvariants have not significantly escapes the immune effects of the leading vaccines. And the latest “bivalent” boosters, specially formulated for BA.4 and BA.5, should maintain the effectiveness of the vaccines as long as the dominant subvariants are closely related to Omicron.
Get vaccinated and keep up to date with your boosters. It is impossible to emphasize this too much. Yes, BQ.1 and its cousins exhibit some alarming traits that could bend the arc of the pandemic back to widespread death and disruption.
But only if you are not vaccinated or are way behind on your boosters.