The new subvariants of COVID-19 that are becoming dominant around the world are not only more contagious than previous variants and subvariants, they can also cause more severe disease.
It is a worrying sign if, as experts predict, there is a new global wave of COVID in the coming months. It’s one thing to withstand a spike in infections that mostly results in mild illness. Cases are rising but hospitalizations and deaths don’t. But an increase in serious illnesses could 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. 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 Virus and Emerging Pathogens program, modeled new subvariants of SARS-CoV-2, 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 them from the BA.4 and BA.5 forms of the Omicron variant, are highly contagious. And the same mutations that make them so transmissible also make them unrecognizable to 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 sub-variants. That is, to what extent they fuse with our own cells. “Fusion between the viral and cell membrane is an important step in viral entry,” Liu told The Daily Beast.
In general, the greater the fusogenicity, the more severe the disease. Liu and colleagues “observed increased cell-cell fusion in several novel Omicron subvariants compared to their respective parental subvariants,” they wrote in their study, published online October 20 and still under peer review. New England Journal of Medicine.
If these new subvariants are indeed more transmissible and more serious, they could reverse an important trend as the COVID pandemic approaches its fourth year. The trend so far is for each successive major variant or subvariant to be more contagious but cause less severe disease.
This trend, combined with widespread vaccination and new therapies, has led to what scientists call a “decoupling” of infections and deaths. COVID cases sometimes increase as a new, highly contagious variant or subvariant becomes dominant. But because these newer forms of SARS-CoV-2 cause less severe disease, deaths don’t increase as much.
This decoupling, along with the availability of vaccines and therapies, has allowed most people around the world to return to some sort of normality over the past year. If BQ.1 or another highly fusogenic subvariant recouples infections and deaths, this new normal could become a new nightmare. “More hospitalizations and deaths,” summed up Ali Mokdad, professor of health sciences at the University of Washington Institute of Health, who was not involved in the OSU study.
It is possible that we have already seen the first recoupling. Since the new subvariants began to seriously compete for dominance in recent months, epidemiologists have been carefully monitoring COVID statistics to spot any real impact.
Singapore was a false flag. The tiny Asian city-state has seen a rapid rise in cases this month that some experts say may involve a dangerous new sub-variant. But the country’s health ministry sequenced numerous viral samples, quickly, and determined that BA.5 was the culprit. Singapore’s high vaccination and booster rate – 92% of residents have their first shots and 80% are boosted – has curbed the BA.5 surge without a major spike in deaths.
But there is also Germany, where cases have also increased this month. German authorities have not yet determined which variant or sub-variant is to blame, but it should be noted that BQ.1 is spreading rapidly throughout Europe.
And there are signs of recoupling in Germany. In October, the country recorded up to 175,000 new cases per day, matching the peak of the previous wave in July. But 160 Germans died each day on average in the worst week of the current surge, while just 125 died per day in the worst week of the summer surge. “We could see the same patterns in other European countries…and in the United States,” Mokdad said.
There’s still a lot we don’t know about the latest COVID subvariants. And their real-world impact won’t be highlighted until we get good data from Germany. “Close monitoring of new variants and the study of their properties are essential,” Liu said.
But one thing is clear. Despite their transmissibility and fusogenicity, the new subvariants do not have significantly escaped the immune effects of major vaccines. And the latest “bivalent” boosters, formulated specifically for BA.4 and BA.5, should maintain vaccine efficacy as long as the dominant subvariants are closely related to Omicron.
Get vaccinated and stay up to date on your reminders. It is impossible to overemphasize this. Yes, BQ.1 and its cousins exhibit alarming qualities that could lead the pandemic arc back to widespread death and disruption.
But only if you are not vaccinated or behind on your reminders.