When the wave of COVID infections from the highly contagious BA.5 subvariant finally subsided in late July, new subvariants were already vying for dominance — and the ability to trigger the next wave of infections.
Just over two months later, epidemiologists are close to naming a winner. In the UK, infections of a highly mutated subvariant called BQ.1.1 doubling every week– a growth rate that far exceeds other leading sub-varieties. In the US, BQ.1.1 is spreading twice as fast as its cousin sub-variant BA.2.75.2.
That means BQ.1.1 is terribly contageous. But that’s not the most alarming feature of the subvariant. Most disturbingly, it also evades certain antibodies. In fact, BQ.1.1 appears to be the first form of COVID against which antibody therapies – for example, evusheld and bebtelovimab – do not work at all.
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Fortunately, the best vaccines still work against BQ.1.1, especially the latest “bivalent” messenger RNA boosters. However, the uptake of the new booster has been alarmingly slow, which means that the new lampreys do not yet offer much protection at a population level.
We have the tools to beat COVID. But “the reality is that no one is using the tools,” James Lawler, an infectious disease expert at the University of Nebraska Medical Center, told The Daily Beast.
Highly contagious and immune-evasive, BQ.1.1 is poised to take advantage of an increasingly vulnerable global population as antibodies from vaccinations and past infections gradually decline over the coming months. The question is not whether a new wave of infections is on the way. It’s exactly when.
“We are currently in a very fluid phase of the pandemic,” Edwin Michael, an epidemiologist with the Center for Global Health Infectious Disease Research at the University of South Florida, told The Daily Beast. Michael has built advanced computer models to simulate the COVID pandemic.
BQ.1.1 was not the inevitable winner of the viral competition that raged, mostly unseen, in the months following the peak of the BA.5 wave. There were other highly contagious and somewhat evasive sub-variants, including BA.2.75.2 and BA.4.6.1.
But BQ.1.1 had an advantage, thanks in part to raising three key mutations to its spike protein, the part of the SARS-CoV-2 virus that helps it grab hold of and infect our cells. These mutations—N460K, K444T and R346T—make BQ.1.1 more contagious than its cousins.
These and other mutations also give BQ.1.1 the ability to evade antibody therapies. Of course, these therapies aren’t the only way to treat COVID — there are antiviral drugs and treatments that don’t contain doses of antibodies.
But antibody therapies have been shown to be popular and effective against other variants and subvariants of SARS-CoV-2. BQ.1.1 could render them obsolete, reducing our options for preventing COVID infections from becoming COVID deaths.
One of the key trends, as the COVID pandemic approaches its fourth year, is the “decoupling” of infection rate from death rate. The worst day for COVID cases was January 18, when 3.8 million people contracted the virus.
But by then, tens of millions of people had been vaccinated — and hundreds of millions more had natural antibodies from a previous infection. At the same time, our arsenal of therapies expanded. That explains why the worst day for COVID deaths didn’t coincide with the worst day for infections. Instead, it happened almost exactly a year earlier: January 20, 2021, when nearly 18,000 people died.
The disconnection trend has persisted. The number of cases fluctuates wildly, but the death rate – despite a few bumps here and there – usually continues to creep down. But if BQ.1.1 drives the next wave of COVID, as seems increasingly likely, it’s possible the disconnect could reverse somewhat as treatment options dwindle.
Fortunately, the latest mRNA boosters from Moderna and Pfizer are still very effective against BQ.1.1. There’s a good reason for this. Moderna and Pfizer have specifically formulated the new bivalent boosters to provide immunity against BA.5. BQ.1.1 is a form of BA.5, albeit with additional mutations.
Of course, the bivalent boosters only help if you get them. And a growing sense of complacency in many countries has translated into ever lower vaccination rates. “Vaccine uptake has collapsed and will continue to fall,” Ali Mokdad, a professor of health metrics at the University of Washington Institute for Health, told The Daily Beast.
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In the US, 80 percent of people have received at least one COVID shot; 67 percent completed a full course of vaccines — either two doses of mRNA or a single dose of certain other vaccines. Only 33 percent received the first round of boosters, which became available last fall. And only 10 percent got the bivalent boosters that regulators began rolling out in August.
The numbers aren’t much better in other developed countries – and much worse in developing countries. And that means the world is largely dependent on antibodies from past infections to prevent a catastrophic wave of new cases and deaths.
But natural antibodies eventually fade. “In terms of variables, the most important is the rate at which natural immunity will decline,” Michael said. It is possible for a useful degree of immunity to previous infections to last for a year or more. It is also possible that it will disappear after six months or so.
However, epidemiologists agree that natural immunity is doing eventually fade – and vaccine uptake is too low to compensate for this population-wide loss of antibodies. BQ.1.1 or some other highly contagious new sub-variant is just waiting for our defenses to slip. A new wave of infections could come as early as this winter. Or persistent antibodies can slow it down. Michael said his computer models predict an increase in cases starting in April.
Earlier would actually be better for humanity. Bad as BQ.1.1 is, it is not the last word on the evolution of SARS-CoV-2. “It still has a lot of potential mutations,” Mokdad said of the virus. “The flu virus continues to mutate and this is no different.”
A positive test was observed after using the COVID-19 Rapid Antigen Test Kit, which demonstrates infection with the coronavirus, on October 10, 2022 in Weymouth, England.
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On October 10, 2022 in Weymouth, England, a positive test is seen after using the COVID-19 rapid antigen test kit, which shows infection with coronavirus.
Finnbarr Webster/Getty Images
New and possibly worse sub-variants will follow BQ.1.1. Even if these new subvariants continue to evade antibody therapies, a steady rollout of new boosters would likely protect us. But we as a species just can’t be bothered to get pricked.
So we’re counting on catching and surviving COVID, and building natural antibodies, to prevent potentially worse COVID in the future. We collectively walk on a tightrope of immunity.
It is easy to slip and fall. If you’re not up to date on your boosters and your antibodies from a previous infection wear off before getting COVID again, you could be in big trouble. Especially if you catch BQ.1.1 or an even more evasive sub-variant. One that shakes off some of our best drugs.
That is the individual prognosis. The prospects for humanity as a whole are equally worrying. For example, Lawler said he thinks COVID will be with us, well, pretty much forever. Like the flu. But a lot worse then the flu.
The best-case scenario, as Lawler described it, is still pretty grim. “I think over the next few years a gradual increase in vaccination and repeated COVID infections – over and over – will eventually give us enough population immunity so that we will see less explosive outbreaks and hospitalizations and deaths that are slightly lower,” he said. said. “But I doubt they will reach the level of seasonal flu.”
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