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Effective URL: https://www.cnn.com/2022/10/20/health/variants-covid-winter-surge/index.html?utm_medium=email&_hsmi=230672640&_hsenc...
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QUICK AND STEALTHY ‘SCRABBLE VARIANTS’ ARE POISED TO DRIVE A WINTER COVID-19
SURGE

By Brenda Goodman, CNN
Updated 8:43 AM EDT, Thu October 20, 2022
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CNN  — 

A flurry of new Covid-19 variants appears to be gaining traction globally,
raising fears of a winter surge.

In the United States, these are BQ.1, BQ.1.1, BF.7, BA.4.6, BA.2.75 and
BA.2.75.2. In other countries, the recombinant variant XBB has been rising
quickly and appears to be fueling a new wave of cases in Singapore. Cases are
also rising in Europe and the UK, where these variants have taken hold.

Dr. Peter Hotez, who co-directs the Center for Vaccine Development at Texas
Children’s Hospital, says he thinks of them collectively as the Scrabble
variants because they use letters that get high scores in the board game like Q,
X and B.

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FILE -- A nurse prepares a COVID-19 booster shot at a vaccination site in
Maywood, Ill., on Sept. 13, 2022. The latest shots, which target Omicron and its
subvariants, could offer protection against a winter surge in cases. But many
people are unsure if they're eligible. (Jamie Kelter Davis for The New York
Times)
Jamie Kelter Davis/The New York Times/Redux

Updated Covid-19 boosters are 'most important thing' Americans can do for their
health today, official says

As the US moves into the fall, Covid-19 cases are dropping. Normally, that would
be a reason for hope that the nation could escape the surges of the past two
pandemic winters. But virus experts fear that the downward trend may soon
reverse itself, thanks to this gaggle of new variants.

Lumped together, the variants accounted for almost 1 in 3 new Covid-19
infections nationwide last week, according to the latest estimates from the US
Centers for Disease Control and Prevention.

The updated bivalent booster vaccines and antiviral drugs like Paxlovid are
expected to continue to be protective against severe outcomes from Covid-19
infections caused by the new variants.

But the new variants are particularly devastating for millions of Americans who
have weakened immune systems. New research suggests that changes in these
variants make them impervious to the last lab-created antibodies available to
help treat and prevent severe cases of Covid-19, and the US government has run
out of money to incentivize the creation of new ones.


A CROWDED FIELD OF RISING VARIANTS

It’s not clear whether this gang of new variants will continue to run around
together, each sharing a piece of the Covid-19 infection pie, or whether one
will rise to outcompete the others, as has happened in previous surges.

Though they each descend from slightly different branches of the Omicron family
tree, these new offshoots have evolved to share many of the same mutations, a
phenomenon known as convergent evolution.

PEMBROKE PINES, FLORIDA - JULY 07: In this photo illustration, Pfizer's Paxlovid
is displayed on July 07, 2022 in Pembroke Pines, Florida. The US Food and Drug
Administration revised the emergency use authorization for Paxlovid, Pfizer's
Covid-19 antiviral treatment, to allow state-licensed pharmacists to prescribe
the treatment to people. (Photo by Joe Raedle/Getty Images)
Joe Raedle/Getty Images North America/Getty Images

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Some experts think this convergence means we’ve entered a new phase of the
evolution of the virus, one that will see circulation of several variants at the
same time.

“What is likely to happen is that we have several co-circulating, semi-dominate
lineages going into the winter season,” said Nathan Grubaugh, an associate
professor of epidemiology at the Yale School of Public Health.

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“That’s because with convergent evolution, perhaps several different lineages
can independently obtain similar transmissibility levels versus a single new
variant taking over.

“This is what predominantly happens for most pathogens, such as the flu and
RSV,” Grubaugh wrote in an email. “Now that the virus has adapted pretty well to
human transmission, most of what is circulating has high fitness.”

Maria Van Kerkhove, the Covid-19 response technical lead for the World Health
Organization, said Wednesday that the large mix of new variants was becoming
more difficult for WHO to assess because countries were dialing back on their
surveillance.

“So we need to be prepared for this. Countries need to be in a position to
conduct surveillance, to deal with increases in cases and perhaps deal with
increases and hospitalizations. We don’t see a change in severity yet. And our
vaccines remain effective, but we have to remain vigilant,” she said.


INACTION GIVES THE VIRUS AN EDGE

For now, the Omicron subvariant BA.5 still holds the top spot in the US.
According to CDC estimates, it caused about 68% of new infections in the US last
week, but it is quickly being outcompeted by several new sublineages – notably
BQ.1 and BQ.1.1.

The BQs each caused just 6% of new infections in the US last week, but in recent
weeks, the share of new Covid-19 infections caused by these viruses has doubled
every six to seven days – a rapid rate of growth against BA.5, which is already
a highly fit virus, says Dr. Anthony Fauci, who directs the National Institute
of Allergy and Infectious Diseases.

And these are just two of the new crop of Omicron descendants making a move.

FILE -- A nurse prepares a COVID-19 booster shot at a vaccination site in
Maywood, Ill., on Sept. 13, 2022. The latest shots, which target Omicron and its
subvariants, could offer protection against a winter surge in cases. But many
people are unsure if they're eligible. (Jamie Kelter Davis for The New York
Times)
Jamie Kelter Davis/The New York Times/Redux

Updated Covid-19 boosters are 'most important thing' Americans can do for their
health today, official says

“The projections vary a little, but generally, most people feel somewhere in the
middle of November that they’ll wind up being a substantial proportion and have
bumped BA.5 off as the dominant variant,” Fauci told CNN.

These variants are different from BA.4 and BA.5, but they’re descended from
those viruses, the result of genetic drift. So they share many parts of their
genomes with that virus.

Their changes aren’t on the scale of what happened when the original Omicron
arrived on the scene in November 2021. That strain of the virus, which is now
long gone, came out of genetic left field, leaving researchers and public health
officials scrambling to catch up.

Fauci says that this time, we are as ready as we could be for the latest batch
of variants.

“It isn’t that different from BA.5 that it would completely escape the
protection that you would get from vaccine” – if people would just get the shot,
Fauci said.

The bivalent booster vaccine, authorized in September, protects against the
original strain of the coronavirus as well as the BA.4 and BA.5 subvariants.

“We have a BA.5 bivalent updated vaccine as a booster that we’re pushing people
to do. It’s matched against the still-dominant variant, which is BA.5, and
almost certainly will have a reasonably good degree of cross-protection against
the BQ.1.1 and the others, and yet the uptake of these vaccines, as we are
already in the middle of October, is disappointing,” he said.

Chimére Smith, 39, has been struggling with long Covid since she was sick in
March 2020. She underwent numerous neurologic tests, including
electroencephalogram, to evaluate her problems with short-term memory, mobility
and vision.
Courtesy Chimére Smith

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According to the latest data from the CDC, 14.8 million people have gotten an
updated bivalent booster six weeks into the campaign promoting it. That’s less
than 10% of the population that’s eligible to get one.

The poor uptake of the new boosters, combined with the immune evasiveness of the
new variants and the waning of population immunity, is almost surely a recipe
for rising cases and hospitalizations in the weeks ahead.

“It’s probably going to be significantly bigger than the BA.5 wave, at least
that’s what I expect,” said Mark Zeller, a project scientist who monitors
variants at the Scripps Research Institute. But Zeller says he doesn’t expect
this winter’s surge to reach heights of January’s Omicron wave.

Hotez says people shouldn’t panic about this news but should pay attention.

“We’re underperforming as a nation with people getting their bivalent boosters,”
Hotez said.

The genetic changes these variants share appear to help them escape the immunity
created by vaccines and past infections – a recipe for reinfections and
breakthrough infections, particularly for people who haven’t had an updated
booster.


CRITICAL THERAPIES COULD SOON STOP WORKING

Crucially, some of the variants also appear to be impervious to the last
lab-created antibodies available to ward off severe Covid-19 infections: an
antibody treatment called bebtelovimab, which is made by Eli Lilly, and the
combination of two long-acting antibodies in Evusheld, a shot made by
AstraZeneca that helps keep people who are immunocompromised from getting sick
in the first place.

If these antibodies stop working against the virus, the United States will still
have Covid-19 antiviral drugs like Paxlovid, molnupiravir and remedsivir to help
those at risk of severe complications.

Passenger walk through the arrival lobby of Haneda Airport in Tokyo, Japan, on
Tuesday, Oct. 11, 2022. Japan began accepting vaccinated visitors from 68
countries without visas Tuesday, ending almost three years of tighter border
controls that kept tourists out of the island nation. Photographer: Toru
Hanai/Bloomberg via Getty Images
Toru Hanai/Bloomberg/Getty Images

What Covid-19 precautions should people take for international travel?

But antibody therapies are particularly important for people with immune
function that has been blunted by drugs, disease or age. These are the same
people whose bodies don’t respond robustly to vaccines.

The antibodies are also needed to help people who can’t take antiviral therapies
because of possible reactions with other medications.

White House Covid-19 Response Coordinator Dr. Ashish Jha says the federal
government has been spurring the development of new monoclonal antibodies during
the pandemic by promising to purchase new therapies after they’re made.

The government can’t do that anymore, he said, because Congress has declined to
pass additional funding for the Covid-19 response.

As a result, development of new antibodies – and other new therapeutics – is
lagging.

“So even if we got money today, it would take us many months to bring a
monoclonal into the marketplace, and we don’t have the money today anyway,” Jha
told CNN.

White House COVID-19 Response Coordinator Dr. Ashish Jha.
Kevin Dietsch/Getty Images

US without 'adequate' Covid-19 tests this winter due to congressional inaction,
White House says

Jha said that means the nation is facing fall and winter with a smaller arsenal
against the virus, just when it needs to expand its options.

“There is not a monoclonal sitting ready to go tomorrow that we could just buy
off the shelf,” he said.

Antibodies are a losing proposition for companies because it takes millions of
dollars of investment to make them and because the virus is evolving so fast,
they might be effective for only a few months.

“That is a terrible business model,” Jha said.

The administration has been thinking about ways to commercialize some parts of
the Covid-19 response – to get out of the business of buying vaccines and
therapies – ultimately passing the costs on to consumers and insurers. But Jha
says the process has to be guided by “the needs on the ground and the realities
of the virus.”


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He says current realities require that the government continue to incentivize
the production of new therapies, and he expects that the Biden administration
will again try to ask Congress to pass more funding to do that.

“And the truth is that if we want monoclonals to protect high-risk people –
which we do – then at this point, given the speed of viral evolution, the US
government has to be a major player in that role,” Jha said. “The market cannot
take care of it by itself.”

CNN’s Carma Hassan contributed to this report.


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