Omicron subvariants show resistance, putting some people at risk

Emerging omicron subvariants are resistant to leading antibody treatments for HIV patients, kidney transplant recipients and other immunocompromised individuals, making them particularly vulnerable to Covid this winter, the House has warned. White this week.

“With some of the new subvariants emerging, some of the key tools we had to protect immunocompromised people like Evusheld may not work in the future. And that’s a huge challenge,” said Dr Ashish Jha, Chief of the White House Covid. working group, told reporters on Tuesday.

President Joe Biden on Tuesday warned the roughly 7 million adults in the United States who have weakened immune systems that they are particularly at risk, but he could offer little reassurance other than to tell them to see their doctor. on the precautions to be taken.

“New variants may render some existing protections ineffective for the immunocompromised,” the president said before receiving his reminder on Tuesday. “Unfortunately this means you could be at particular risk this winter. I urge you to consult your doctors on the right steps to take to protect yourself, take extra precautions.”

The message clashes with repeated assurances from the White House that the United States has all the vaccines and treatments it needs to fight Covid this winter, as public health officials expect another surge.

While this may be true for the general population, it is not the case for people with compromised immune systems. They include people with cancer, those who have had an organ transplant, people living with HIV, and people taking medication for autoimmune conditions.

Evusheld is an antibody cocktail authorized by the Food and Drug Administration to prevent Covid in people aged 12 and over with moderately or severely weakened immune systems. The drug is given in two injections, before the infection, every six months.

Evusheld, manufactured by Astra Zeneca, has helped fill a gap in protecting people with weakened immune systems who cannot mount a strong response to vaccines. The drug, along with several rounds of vaccination, has led to a significant drop in hospitalizations among this cohort in recent months, according to Camille Kotton, an infectious disease expert who specializes in treating people with weakened immune systems.

“We’ve been in a sweet spot for maybe several months now in terms of immunocompromised patients having good protection and then good treatment options,” said Kotton, a physician at Massachusetts General Hospital and a member of the independent of the Centers for Disease Control and Prevention. vaccine advisory committee.

But the more immune-evasive omicron subvariants such as BA.4.6, BA.2.75.2, BF.7, BQ.1, and BQ.1.1 are resistant to Evusheld, according to the National Institutes of Health. Scientists at Columbia University, for example, found that Evusheld completely lost its effectiveness against BA.4.6.

And BQ.1 and BQ.1.1 are probably resistant to bebtelovimab, the monoclonal antibody developed by Eli Lily to prevent people with weakened immune systems who catch Covid from developing serious illness, according to the NIH.

This makes people with weakened immune systems increasingly vulnerable as these subvariants increase in circulation in the United States. As the omicron BA.5 declines, this swarm of new subvariants collectively accounts for about 38% of infections in the United States, according to CDC data.

Although Pfizer’s antiviral Paxlovid remains effective against omicron subvariants, people who have had organ transplants often cannot take the pill due to the way it interacts with other medications including they need,” Kotton said.

“I fear the near future will be a difficult time for immunocompromised patients,” Kotton said. “Evusheld’s monoclonal antibodies will provide less protection and bebtelovimab will provide an ineffective treatment for several of the emerging variants.”

And help isn’t on the way right now. Kotton said she is not aware of any monoclonal antibodies ready to replace those that the subvariants eliminate. Jha acknowledged at the White House on Tuesday that the United States has fewer and fewer treatment and prevention options for people with weakened immune systems as Covid evolves. He faulted Congress for failing to pass $22.5 billion in funding for the national Covid response due to Republican opposition.

“We had hoped that over time, as the pandemic progressed, as we fought this virus, we would expand our medicine cabinet,” Jha told reporters. “Because of the lack of congressional funding, that medicine cabinet has actually shrunk and that puts vulnerable people at risk.”

Andrew Pekosz, a virologist at Johns Hopkins University, said finding ways to protect people with weakened immune systems is the most critical issue in the pandemic right now and needs to be addressed quickly.

“What we really need to work on is getting new antibody treatments out of the lab and into clinics,” Pekosz said. “In the lab, scientists know what next-generation monoclonal antibodies look like.”

Kotton said people with weakened immune systems should stay up to date on their vaccines, which means getting the new booster that targets omicron BA.5. Those who have kept up to date throughout the pandemic have already received six injections.

Those starting from scratch would receive a three-dose primary series of Moderna or Pfizer along with the older generation injections, then a new booster targeting omicron, according to CDC guidelines.

People with weakened immune systems should continue to exercise caution this winter because immune-resistant omicron subvariants could be released as people gather for the holidays, Kotton said. But she noted that the group has been more diligent in wearing masks and practicing mitigation measures to avoid the virus than the rest of the population.

The bigger problem is that the general population has largely shifted away from taking basic precautions that could reduce transmissions and protect vulnerable people — like wearing masks, Kotton said.

“If we were all to mask more in public places, it would improve their safety and allow them to have a greater likelihood of a safer return to many activities,” she said.

Jha was asked by NBC News on Tuesday whether Biden telling people with weakened immune systems to see their doctors about precautions is an indication that the onus of responsibility has shifted to individuals rather than the wider community. .

“As a society — as a caring society, we care about all Americans, especially the most vulnerable Americans,” Jha said. “So there remains, I think, a collective responsibility for all of us to care about our immunocompromised fellow Americans.”

The CDC recommends that people in communities with a moderate Covid risk level test themselves and wear a high-quality mask before meeting someone indoors who is at high risk of getting sick. High-risk individuals should wear a high-quality mask when indoors in public.

When Covid levels are high, people in general should consider wearing high-quality masks and vulnerable people should consider avoiding non-essential indoor activities in public, the CDC says. You can check your county’s Covid level on the CDC’s website.

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